Nearly everyone who has studied leadership and upper management in the past 75 years has heard of, studied, and perhaps learned to revere Dr. W. Edwards Deming.  Dr. Deming is noted for his work in improving production and quality in the automotive industry in Japan. His efforts to help Japan are often credited with that country becoming a world economic power. After that, turning the techniques he learned to other industries, Dr. Deming became a consultant in helping many businesses and industries learn how to improve their production and their products. But what does this have to do with principles of quality management in healthcare?

Principles of Quality Management in Healthcare


1.  Quality Improvement Starts with Managers Evaluating and Changing Process

Understanding how Deming and his philosophy can apply to healthcare to improve the outcomes of this service-based industry opens your eyes to great possibilities with great healthcare outcomes.  The theory from Deming that allows his theories of quality improvement to be applied not only in automobile manufacturing, but across a wide variety of industry is that all improvement is about managing the process involved in change and improvement.

When healthcare is evaluated to determine what processes need to be changed, the number of processes involved is nearly overwhelming.  However, there is a philosophy that when all processes in an industry are evaluated, 20% of them cause 80% of the impact.  The initial difficult step is to identify those most important 20% of the processes.


2.  You Must Be Able to Measure Something to Improve It

Data based decision making allows managers and leaders to take the guesswork out of change.  Good data is the lifeblood of making improvements in any organization.  Without data, more importantly without good data, change is just change and improvements or regression can be merely coincidences.  Either improvements or regressions can be caused by flukes without data to show what the change is caused by.  This is especially important if you are going to improve some aspect of the healthcare cycle.



3.  The Point of Managed Care Should Focus on Managing Process, Not People

A mistake made two decades ago when managed care was all the rage, is managers tried to tell doctors and nurses what they should do.  To have managed care work successfully, it is important to have doctors and nurses involved in the process.  These are the practitioners who understand what is happening and what should be happening.  These are also the people who will understand how to make improvements in the process.  When doctors and nurses are involved in making changes, rather than simply being managed, they feel empowered, and changes are much more likely to be successful.

4.  Not Just Any Data

When collecting data to determine how to determine to make improvements, not just any data will do.  It is important to find data on specific areas of improvement, find the appropriate data connected with that area, and then get the data in the right hands.  The most important hands to get that data to are the people who are in the trenches.  The people most responsible for creating the data need to have an understanding of “where they are now” so they can understand what and how things need to be improved.

5.  Use the Right People: Smart Cogs


Deming used the term “smart cogs” to describe the people who were most responsible for outcomes.  These are the doctors and nurses who can make a difference by performing duties in different ways to improve data.  What every manager and leader needs to best understand is that physicians will make changes that are needed; but if they do not understand the data they will be more reluctant to implement change. 

Not only is it necessary to help those physicians and nurses on the front line see and understand what is wrong with old data, but to help them understand how making changes will improve subsequent data.  Seeing a future and seeing how change will improve that future makes change easier for these front line workers, and probably most of us, to follow-through with change.

Change is not easy to achieve in any vocation or industry.  The important thing is to find good data and share it with those who will be responsible for change.  It is also important to get input from those people about how to make that change take place.  With those steps in place, positive change will rapidly be forthcoming.