Skip Steward, Chief Improvement Office (CIO) for Baptist Memorial Health Care Corporation in Memphis, Tennessee is the latest guest on the Deming Podcast (download the podcast).

Dr. Deming’s thinking continues to influence me, not only in things like PDSA thinking, but also in some of those other fundamental principles around constancy of purpose, around how we think about systems, how we think about the worker and the work that they are doing. A friend of mine the other day told me that “improving the work is the work.” I reflect on Dr. Deming quite often.

Skip discusses that it unfortunate that at Baptist Memorial Health Care the knowledge of Deming is largely limited to the folks working in quality specific positions. He says this is something he has seen throughout his career – with Deming’s ideas not being appreciated as widely as they should be.

He also discusses the success they have achieved in involving senior executives in the organizational hierarchy (CEO of the individual hospitals etc.) as active participants in practicing the principles of Baptist Management System in their daily work. One thing that has worked very well is using Toyota Kata principles. The executives have taken to that practice quite well (more effectively than other attempts to engage senior executives in changing their behaviors).

Skip talks about building relationships to earn the right to work together with staff to improve the organization. He did not just rely on the authority of his position, he understood the importance of earning respect and trust in order to help facilitate the adoption of new management system practices.

He also talks about the de-emphasis on tools several times in the podcast. At the same time if you listen to what he says they have done, and are doing, he lists a great deal of tool and concept use.

As I have said before I understand the criticism of using tools without understanding how they fit into a management system. That use of tools without the vision of how those tools play a role in a view of the organization as a system greatly limits the possible benefits.

At the same time those tools and concepts are very powerful and ignoring them also creates a system that is much less effective than it could be. It seems to me he really is using tools and concept a great deal but in a way that is integrated with the management system. The emphasis is on thinking systemically and understanding the role those tools are meant to fulfill. The tools serve a purpose they are a means to an end, not an end themselves. This is exactly the right way to do things, in my opinion.



My opinion that he uses tools and concepts a great deal my be faulty. Listen to the podcast yourself and decide. But it seems to me when he says they are not tool focused he really means they focus on the overall management system and then take great advantage of the many useful tools and concepts to be as effective as they can be. A list of the tools and concepts he mentions being used at Baptist Memorial during the 20 minute podcast: Plan-Do-Study-Act, strategic deployment (Hoshin planning), A3 reports, Toyota Kata, constancy of purpose, respect of every individual, Training Within Industry (TWI), job work instructions, thinking systemically, creating habits, huddle board, cadence, pilot on a small scale.*

There is a widespread frustration with seeing tools applied without understanding how those tools are meant to be used to create value for the organization. But the problem is not in using good tools. The problem is in not having a management system that guides the tool use in the proper ways. We don’t need to drop the use of so many tools we need to use tools and concepts more effectively by creating a management system (as Deming suggested) that provides a structure for the use of those tools and concepts. The management system should guide the use to tools and concepts.

In my experience the misuse of tools is not due to overuse of tools. It is due to the poor use of tools (largely due to a failure to take a systemic view and understand the role the tools should play in the management system overall). But I often hear (and hear even more among Deming folks than others) a characterization of the problem as an overuse of tools. I think this is a mistake and causes us to avoid the solutions we should seek; we should strive to have tools used more effectively. Avoiding the use of tools is not the correct aim in my opinion. But I think this anti-tool view has become common and therefore even those using tools effectively seek to downplay the importance they play in managing more effectively.

Related: Healthcare, Paradigm Shifts and the Influence of W.E. Deming – Process Behavior Charts are the Secret to Understanding the Organization as a System – Quality Improvement in Maternity Services, How Deming Can Help

* I understand, some of the tools and concepts don’t seem to fit the “anti-tool” complaint. But the line between tool and concept is fuzzy. Control charts (process behavior charts) can be seen clearly as a tool by many people. But even that in a Deming context requires many concepts as part of using the tool. Doing the calculations isn’t the extent of “using the tool,” not even remotely close to it.

Then you can go to things like mistake-proofing which seems like a tool but really isn’t. It is concept that is then used to create a specific solution which can easily be identified as a mistake-proofing result.

I tried to explain my reason for including concepts and tools but it just isn’t working well (my attempts to do so are far too long). So if you would like to, just eliminate the items you don’t consider tools from the list.