Adaptation of the 14 Points to Medical Service

By John Hunter, author of the Curious Cat Management Improvement Blog (since 2004).

Dr. Deming’s 14 points for management have been put into various specific contexts by people over the years. Dr. Paul Batalden and Dr. Loren Vorlicky of the Health Services Research Center translated them into a health care context. Dr. Deming included their work in Out of Crisis, pages 201-202:

6. Restructure training.
a. Develop the concept of tutors.
b. Develop increased in-service education.
c. Teach employees methods of statistical control on the job.
d. Provide operational definitions of all jobs.
e. Provide training until the learner’s work reaches the state of statistical control, and focus the training to assist the learner to achieve the state of statistical control.

7. Improve supervision. Supervision belongs to the system and is the responsibility of the management.
a. Supervisors need time to help people on the job.
b. Supervisors need to find ways to translate the constancy of purpose to the individual employee.
c. Supervisors must be trained in simple statistical methods for aid to employees, with the aim to detect and eliminate special causes of mistakes and rework. Supervisors should find causes of trouble and not just chase anecdotes. They need information that shows when to take action, not just figures that describe the level of production and the level of mistakes in the past.
d. Focus supervisory time on people that are out of statistical control and not those that are low performers. If the members of a group are in fact in statistical control, there will be some that are low performers and some that are high performers.
e. Teach supervisors how to use the results of surveys of patients.

As Deming said in Out of the Crisis, “The 14 points…apply to a service organization with little modification.” The truth is applying any of Deming’s ideas require thinking about them and your context and adapting the ideas to the local context (no matter what industry you are in). It isn’t a cookbook with a recipe it is a management system that must be thoughtfully adapted for your organization.

One of the things I find a little annoying is people that think Deming thought his ideas were just about the factory floor. That obviously was not the case. But since several of the largest clients were manufacturers it is understandable that people linked the ideas to manufacturing.

Also those teaching others often ignore most of what Deming taught and only mention control charts and maybe one or two other tools in relation to his work. This is an illustration of why relying on second, third and fourth hand information often leads you astray.

When you find something worthwhile don’t just rely on what one person tells you, go look at the original source and what other experts say about either the original source or working with applying the ideas directly.

That many don’t look more closely to see that from the beginning Dr. Deming was addressing how to manage organization better (no matter what the line of business what the business focus was) I find a bit frustrating. But I should probably learn to accept this is just how things are, as it is still going on decades later.

Hopefully resources such as this blog, our podcasts, streaming video of conference presentations will help people learn about how broadly Deming’s ideas have been applied.

Related: The Principles and Methods for Improvement are the Same in Manufacturing and Service CompaniesDr. Deming on InnovationThe Public Sector and Deming (2006)Application of Deming’s System of Profound Knowledge in HealthcareDeming’s Ideas at Markey’s Audio Visual (2005)Using Deming’s Ideas in Software Development

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