Anticlue

Deming's Adaption of the 14 Points for Medical Service

Just came across this one today, and I wanted to share and keep it in a place I'll remember.

1. Establish constancy of purpose toward service.
   1. Define in operational terms what you mean by "service to the patient"
   2. Define standards of service for a year and hence 5 years
   3. Define patients whom you are seeking to serve
   4. Constancy of purpose brings innovation
   5. Innovate for better service
   6. Put resources into maintenance and new aids into production
   7. Decide whom the administrators are responsible to and the means by which they can be help responsible
   8. Translate this consistency of purpose to service to patients and the community
   9. The board of directors must hold on to the purpose
2. Adopt the new philosophy. We are in a new economic age. We can no longer live with commonly accepted levels of mistakes, materials not suited to the job, people of the job who do not know what the job is and are afraid to ask, failure of management to understand their job, and antiquated methods of training on the job, and inadequate and ineffective supervision. The board must put resources into this new philosophy, with commitment to in-service training
3. 1. Require statistical evidence of quality of incoming materials, such as pharmaceuticals, inspection is not hte answer. Inspection is too late and is unreliable. Inspection does not produce quality. The quality is already built in and paid for. Require corrective action, where needed, for all taks that are performed in the hospital
   2. insititute a rigid program of feedback from patients in regard to their satisfaction with services
   3. Look for evidence of rework or defects and the costs that may accrue.
4. Deak with vendors that can furnish statistical evidence of control. We must take a clear stand that price of services has no meaning without adequate measure of quality. Without such a stand for rigorous measures of quality business drifts to the lowest bidder, low quality and high cost being the inevitable result. Requirement of suitable measures of quality will, in all likelihood, require us to reduce the number of vendors. We must work with vendors so that we understand the producures that they use to achieve reduced number of defects
5. Improve constantly and forever the system of production and service
6. Restructure training
   1. Develop the concept of tutors.
   2. Develop increased in-service education
   3. Teach employees methods of statistical control on the job
   4. Provide operational definitions of all jobs
   5. Provide training until the learner's work reaches the state of statistical control.
7. Improve supervision. Supervision is the responsibility of the management.
   1. Supervisors need time to help people on the job
   2. Supervisors need to find ways to translate the constancy of purpose to the individual employee
   3. Supervisors must be trained in simple statistical methods with the aim to detect and eliminate special causes of mistakes and rework.
   4. Focus supervisory time on people who are out of statistical control and not those who are low performers. If the memebers of the group are in fact in statistical control, there will be some low performers and some high performers.
   5. Teach supervisors how to use the results of surveys of patients.
8. Drive out fear. We must break down the class distinctions between types of workers within the organization - physicians, nonphysicians, clcinical providers versus nonclinical providers, physician to physician. Discontinue gossip. Cease to blame employees for problems of the system. Management should be help responsible for faults of the system. People need to feel secure to make suggestions. Management must follow through on suggestions. People on the job cannot work effectively if they dare not offer suggestions for simplification and improvement of the system.
9. Break down barriers between departments. One way would be to encourage switches of personnel in related departments.
10. Eliminate numerical goals, slogans, and posters imploring people to do better. Instead display accomplishments of the management in respect to helping employees improve their performance.
11. Eliminate work standards that set quotas. Work standards must produce quality, not mere quantity. It is better to take aim at rework, error, and defects.
12. Institute a massive training program in statistical techniques. Bring statistical techniques down to the level of the individual employee's job, and help him to gather informiaton about the nature of his job in a systematic way.
13. Institute a vigorous program for retraining people in new skills. People mus tbe secure about their jobs in the future and must know that acquiring new skills will facilitate security.
14. Create a structure in top management which will push every day on the previous 13 points. Top management may organizae a task force with the authority and obligation to act. This task force will require guidance from an experienced consultant, but the consultant cannot take on obligations that only management can carry out.