Yesterday, I shared some more notes from Part 3 of the 1980 NBC documentary “If Japan Can, Why Can't We?” that featured W. Edwards Deming.

Next week, I'll release Episode 238 of my podcast series, which is a discussion with Kevin Cahill, one of Dr. Deming's grandsons. I think you'll really enjoy his memories and reflections on Deming's work.

One of the first people in healthcare to be influenced by Deming's work is Dr. Don Berwick, founder of the Institute for Healthcare Improvement (at right in that picture).

Berwick wrote about Deming's ideas back in 1989, in the New England Journal of Medicine, as I blogged about here: “Dr. Donald Berwick – Ahead of his Time on Kaizen in 1989.”

Hear Mark read this post (as part of the “Lean Blog Audio” podcast):

This article, from December, was floating around social media the other day (hat tip to Paul Levy):

Don Berwick Offers Health Care 9 Steps to End Era of ‘Complex Incentives' and ‘Excessive Measurement'

Among the points that Berwick makes, here is the one most directly related to Deming, Lean, and continuous improvement:

5. Recommit to improvement science: For improvement methods to work, you have to use them, and most of us are not. I'm trying to be polite, but I am stunned by the number of organizations I visit today in which no one has studied [W. Edwards] Deming's work, no one recognizes a process control chart, no one has mastered the power of testing PDSA (plan-do-study-act), Nathaniel's Method or the route to the top. You can see the proof of concept. This is beyond theory now.

I share Berwick's view that most healthcare organizations today don't really practice any of Deming's methods or teachings. And this is too often true in organizations that would say they are “implementing Lean.” People remember Dr. Deming and they know of PDSA, but very few really get an opportunity to practice PDSA — being encouraged to do it or being coached well by leaders who understand it. There's lip service.

I see lots of charts posted on the walls of Lean organizations, but there's very little understanding of SPC or control chart thinking. I've blogged about this many times before. Instead of Deming's approach, we see arbitrary targets, slogans and admonishments to do better, and a lack of distinction between special cause and common cause variation in organizations.

Back to Berwick's paragraph, I'll have to claim ignorance about “Nathaniel's Method” and I haven't been able to figure that out via Google searches. Can somebody help with that by posting a comment?

Whether we call it Deming, PDSA, Lean, or “improvement science,” Dr. Berwick is right that we have many “proofs of concept.” It's beyond theory that Lean can make a big difference in healthcare.

It frustrates me that we have such powerful proofs of concept that aren't leading to everybody fully embracing Lean. Part of the problem is that organizations THINK they are embracing Lean, but they won't get the results of ThedaCare or Virginia Mason or others if they don't follow the process of those organizations. Training a few green belts or using a few Lean tools here or there won't bring the same results as the widespread culture change and management systems do at the best Lean health systems.

I recently talked to somebody at a health system who lamented that they had a “lack of energy around Lean.” They had originally trained about a dozen green belts who were supposed to then get 20% of their time dedicated to improvement work.

This didn't happen. There was “no real effort” to give them time to do improvement work. Lean became “the lowest priority” within the organization. That's not the fault of green belts. That's a leadership problem. If your executives don't have enthusiasm for Lean, nobody else in the organization will either.

One of my resolutions for 2016 is to fret and complain less about organizations who aren't making progress or who seem to “not get it.”

If people don't “get it,” whose fault is that? In the Training Within Industry method, they say, “If the student hasn't learned, the teacher hasn't taught.”

Of course, if people aren't even trying to be students, maybe that's not the teacher's fault. How many executives would claim to be “leading a Lean transformation” without studying Lean or reading a book themselves?

Paul Levy wrote a few interesting tweets about this, as somebody who is trying to teach and influence others too:

Coach John Wooden used to say, "You haven't taught if they haven't learned." https://t.co/fnRxDeOrx4 — Paul Levy (@Paulflevy) January 5, 2016

Yes, so true. But what does it say about effectiveness of those of us who advocate for this? https://t.co/fnRxDeOrx4 — Paul Levy (@Paulflevy) January 5, 2016

So maybe our own pedagogical approach is deficient. https://t.co/fnRxDeOrx4 — Paul Levy (@Paulflevy) January 5, 2016

Sorry, but I see a lot of lecturing at people versus motivating them. Doesn't work in any environment, esp not hc. https://t.co/bgtUmF4l9l — Paul Levy (@Paulflevy) January 5, 2016

Why don't more organizations embrace Deming, Lean, and improvement science? Why do many who say they embrace it do so half-heartedly?

What do you think?

Photo by Flickr user Tim Pierce, used under Creative Commons license

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