Management guru’s wisdom more important than ever as healthcare strives to reward value
To many observers, the enduring wisdom of W. Edwards Deming, one of the world’s best-known management experts, has been applied in some degree to almost every business sector—including healthcare.
In an industry made more complicated than it inherently is through regulation, political maneuvering and perpetual change, healthcare should embrace these principles as a mantra for the future, incorporating all of Demings’ 14 principles into a daily regimen.
In fact, we should depend more than ever before on two of the key tenets that underlie his philosophy and apply most directly to our work: understanding variation and breaking down barriers.
While we preach adherence to these principles, we often don’t practice them effectively, at least not in a consistent way that would move the industry closer to its elusive holy grail: the Triple Aim.
One formidable obstacle to dramatic improvements in the delivery of superlative care has always been the existence of silos—barriers that impede efficiency and help foster an “us-against-them” mentality when teamwork and collective responsibility hold the key to success.
In healthcare, groups such as management, operations, finance and clinical staff tend to form distinct, independent domains, focusing more on their own work rather than on how they can support organizational success.
This has been an historic obstacle for an industry well-known for a bifurcation between hospital leadership and the medical staff. As physicians, we are well-aware of this division, which is narrowing as we accept an integrated, teambased approach to patient care, based on value versus volume. Yet, it remains more an exception than the rule where physicians, nurses and administrators are forming functional, cross-purpose teams to improve care and lower costs.
Management processes such as Six Sigma and Lean have been an integral part of healthcare for years. But they represent just one step in a journey toward quantifiable and meaningful improvements in patient outcomes. Imagine the enhancement across the board in a system clearly dedicated to and reliant on the principles Deming espoused. We believe the result would be better outcomes, better quality and better operations in a safer environment.
His principles were first embraced in Japan, and then replicated in the U.S. by an auto industry seeking greater reliability through standardization. One need not go to Japan to figure out that instead of having a dozen different but essentially interchangeable knee replacements available to our orthopedic surgeons, we probably need to get to one or two.
We in healthcare must do the same across the system, stripping needless or harmful variation from our processes to create a system that guarantees high re- liability and high quality.
In recent years, many tens of millions of dollars, along with countless other resources, have been invested in processes to reduce variation. The hard truth is: We are not getting there, and we are not getting there quickly enough.
For our organization—Catholic Health Initiatives, with 100 hospitals and other operations in 17 states— scale and scope have provided a tremendous advantage in promoting many of Deming’s principles.
Size also has helped the organization sustain the momentum for change and implement a comprehensive, systemwide analytics platform that uses data to decrease variation and reduce hospital-acquired infections, mortality and safety issues. What’s more, big data is used to identify any weak areas in clinical care, allowing leaders to create effective plans to address deficiencies.
The goal: Mistake-free outcomes. It’s an objective shared by everyone in healthcare.
While we’ve highlighted just two of the 14 “points for management” from Deming, each of the other 12 are just as applicable in an industry constantly striving to improve its performance.
Adopting a devil’s advocate approach to the healthcare landscape, there are still too many executives who pay lip service to these management tenets, not giving them the support they need to take hold and thrive in their organizations. Instead, let’s wholeheartedly welcome Deming’s wisdom, put his principles into practice, and guarantee the highest-quality care to every patient, every time, everywhere.
Dr. Robert Weil, left, is senior vice president and chief medical officer for Catholic Health Initiatives. Dr. James Reichert is the organization’s vice president for clinical analytics.