2010 ASA Deming Lecture – “Dr. Deming Consults on Quality for Sir William Osler” by Brent James, Institute for Health Care Delivery Research. Brent James has worked at Intermountain Healthcare for several decades. I wrote a previous post on this blog about a paper he wrote about using Deming’s ideas at Intermountain Healthcare.
The beginning of the talk provides an overview of the huge macroeconomic risks of the health care system in the USA. As those familiar with Deming’s ideas know, Dr. Deming added excessive health care costs to his 7 deadly diseases of Western management. The last 2 deadly diseases he added specifically about problems in the USA: excessive health care costs and excessive legal damage awards swelled by lawyers working on contingency fees.
Next, Brent James looks at the long term history of health care in the USA and the great gains achieved during the 1900s. On this success Brent says
As he explained earlier that vision was to learn what was working and what wasn’t by collecting and studying data on patients and experimenting using the scientific method to improve health care results.
The presentation then explores the enormous opportunities for improvement in the current health care system. One of the many very interesting ideas Brent presents is the problem of spreading new medical knowledge to the people working in the healthcare system.
[People] couldn’t keep up. He [researcher] found that 3 to 4 years 14 to 15 years after initial board certification 2/3 of internists couldn’t pass the qualifying exam. Even better work came from John Williamson at Hopkins, Williamson demonstrated that for a major new research finding to make it into widespread practice across the United State takes about 17 to 20 years.
I hear a lot of talk about companies wanting to hire the best and the brightest (I’m going to abbreviate this as BaB for this article). But I wonder if that’s a great long-term strategy? Is there something better?
When building a business, we’re often so focused on the parts that make up the system of our business that we forget that our business is itself a part of a bigger system. Is it selfish for a business to hire only BaBs? Would it be better for that business, in the long haul, to hire average people and help them become great? Would that be a short term sacrifice that would benefit the bigger system and thus ultimately the business itself?
It’s interesting that there’s a book designed to teach managers how to keep the BaBs that they hired. That’s a fear isn’t it, with hiring a BaB – the fear of their mobility. Compare the loyalty of the BaB you just hired from another company versus someone who your company helped develop into a BaB.
“For all the hype that surrounds stars, human resources experts have rarely studied their performance over time. Six years ago, we started tracking high-flying CEOs, researchers, and software developers, as well as leading professionals in investment banking, advertising, public relations, management consulting, and the law. We observed that top performers in all those groups were more like comets than stars. They were blazing successes for a while but quickly faded out when they left one company for another.”
Why might this be? One of the key reasons cited has to do with systems. The performance of any individual is a combination of her own individual performance plus her interaction with the system in which she works. The equation looks like this, where P is performance, I is the individual’s contribution, and SI is the contribution due to the individual’s interaction within the system: P = I + SI
Even if you knew P, you’ve still got a single equation with two variables. And the SI term is constantly changing over time, so it’s ultimately impossible to measure. When you remove the BaB from their system and bring them into yours, you’ve really no idea what P will become.
A business that takes the long term view need not be in a rush to hire BaBs. Because it believes in strengthening the system in which it is a part, a business with long term vision will develop its employees. It will help its employees continue their education (and here I don’t necessarily mean a traditional college education). It will constantly bring in new knowledge from the outside and share that knowledge with any employee interested in learning.
When I look back on my life, the happiest, most energetic and productive times were when I was in a development spurt. I was eager to challenge myself, venturing outside my comfort zone little by little, and getting better every day. And it’s not just my experience. Listen to Liz Wiseman talk about the power of rookies. But people won’t take themselves out of their comfort zone, learn, and develop, unless they feel safe.
Many business environments are not suitable for inspiring learning. We only learn by making mistakes, and when mistakes are not tolerated, or there’s an environment of fear, or short term thinking, forget it – you’re not going to have much luck growing BaBs from within.
If, however, you build an environment free from these things, safe and conducive to exploration and learning, this is a very sustainable model. This leads me to one last great reason to build your own BaBs instead of hiring them from the outside: those BaBs know how important it is to preserve the environment in which they flourished. A rock star from the outside won’t have this important understanding, and what’s worse, they may bring along baggage from their previous company which tends to threaten that safe environment you’ve worked so hard to build.
Guest post by David Kachoui (previously published in Quality Progress, August 2014): Director of Business Development at Natech Plastics
To celebrate “Restaurant Week,” my daughter’s first-grade class recently turned its classroom into a restaurant for a day. Parents were patrons. Students ran operations. Upon arrival, we were greeted by a polite, 6-year-old host with a white shirt and bowtie. He checked our names on the reservation list, walked us to our table and handed us our menu. A shy girl served drinks. The waitress, who happened to be our daughter, took orders. Later, she picked up the orders from the first-grade chefs and served our table.
As I sat eating my taco, I noticed every parent had wide smiles. I did, too. The sight was cute: We were all proud of our children and the experience of getting served by them was fun. When we finished, we gave our bill to the little cashier and paid him $5, which he tucked into the proper compartment of the cash register. My wife was so impressed that no one spilled anything. This got me thinking that this was actually impressive on a much deeper level.
Edwards Deming, the father of the quality movement, defined quality as “pride in workmanship.”1He proposed that the root cause of the lack of quality lies, in part, with our educational system.2The necessary behaviors for quality are innate in children, but generally are crushed over time.3
In other words, something we are doing is sabotaging a national culture of quality. I cannot disagree. I have gone through the recruiting process with hundreds of college graduates and have been struck by the general lack of some key fundamentals that are necessary regardless of industry. Basics like self-education, self-initiative and self-discipline are too rare. As a result, organizations must devote considerable resources to teach these fundamentals.
But what I saw in the first-grade restaurant was something different. Fujio Cho, the former Toyota president, identified respect for people and continuous improvement as the automaker’s two core pillars.4 On this day, I saw both of these pillars to the point that these did not feel like 6 and 7-year-olds. In a surreal way, this seemed more like an actual restaurant—which happened to be run by miniature adults.
I noticed that unlike the parents, the children were not smiling. This was serious business for them. They had a sense of self-respect, respect for one another and ownership over performing their jobs well. Nobody was teaching them what they were supposed to learn. They were figuring things out and making improvements on their own while they went along. At first, the busboy picked up dishes by hand and carried them to his tray. By the end, he was carrying the tray to tables so he did not have to keep walking back and forth.
I cannot help but wonder how many of these children will maintain this level of pride in their work during the next five to 10 years, and how many will have it crushed somewhere along the way. We must move beyond quality in the product, the individual and the organization, and toward a broader cultural movement as a society, and that starts with our children.
Much has been learned in the professional world about quality, which could be useful to our educational system. At some point, should industry take responsibility and make a commitment for progress toward a societal quality culture? If our schools were to output children with this level of pride in their work as the norm rather than the exception, all industries would benefit. Looking through the lens of a business professional with a passion for quality, the deeper reasons for the success of restaurant day provide useful insight toward what a quality culture really means and how to get closer to achieving it.
Motivation and age integration
One thing that restaurant day got right was age mixing: Children were not segregated with only children of their own age. Teachers were in the mix working with the children. One oversaw the cash register, and another watched the kitchen. Both were engaged in activities and available to guide as needed. Parents played the roles of diners. So here we had children working with adults to serve adults. As a result, the children were motivated to perform their important tasks to the best of their abilities.
Deming said that competition squeezes out intrinsic motivation while collaboration nurtures intrinsic motivation, curiosity and joy in learning.5 According to Peter Gray, age segregation of children contributes to competition, while age mixing contributes to self-education, learning and supportive teaching.6 This means that if learning activities were to expand to children of multiple ages, the collaboration and intrinsic motivation would increase.
The pursuit of gratification
The children had a greater sense of importance than they normally would in a typical classroom lecture. These children were not having fun, goofing off, getting bored, whining or doing the things we would normally expect from kids. They felt a sense of importance through meaningful work. They were attentive. I saw pride in the work of every student. The busboy hovered over my wife like a hawk until she finished her drink so he could clear her cup right away. Nothing was getting in between him and his job. The children might have been happier watching TV, but they would have felt no sense of accomplishment.
Rather than just wanting to have fun all the time, children actually get intrinsically motivated by mastering new activities.7 Intrinsic motivation to achieve a sense of accomplishment is more closely associated with the emotion of gratification than happiness. This warrants a closer look at the difference between the two emotions.
Andrew Ortony defines happiness as a simple emotional reaction where one is “pleased about a desirable event.” The more desirable the event, the greater the intensity of happiness.8 Gratification, on the other hand, is a more complex emotion where one “approves of one’s own praiseworthy action and is pleased about the related desirable event.” The intensity of gratification experienced depends on the levels of praiseworthiness, unexpectedness and desirability.9
In other words, the harder you work at something and the less likely you are to achieve it, the greater the feeling of gratification after you actually succeed. Eating a tasty meal brings happiness, but not gratification. Climbing Mount Everest yields high gratification accompanied by intense misery along the way.
Lessons from history show us that children derive great gratification by impressing adults. As an 11-year-old locksmith apprentice, Harry Houdini impressed his boss and a large prisoner by unlocking a set of handcuffs without a key.10 Albert Einstein impressed his uncle who would give him math challenges he playfully doubted he could solve.11 The rest is history.
Back to the classroom: The scene was just as chaotic as a real restaurant yet just as productive on more than one level. For the most part, the children had to figure out how to solve problems on their own or together. The teachers were not authoritarians in complete control of obedient children. They were available—not to control, but to guide when necessary. Rather than compete with one another, everyone had to support one another to keep figuring out how to deal with the new challenges. They were continually improving as a team.
Continual improvement requires continual learning. In the pre-mass production era, craft production was the method of teaching. The master craftsperson would continually improve while teaching the apprentice in a plan, do, teach and improve cycle.12 Toyota has achieved impressive continual improvement with this model,13 which is the envy of many organizations across many industries. Incorporating this craftsperson-apprentice model into education would alter the typical teacher-student relationship to a model that is more conducive to continual improvement.
Spread the learning
A restaurant run by first graders could go horribly wrong. The children, teachers and administrative staff deserve credit for succeeding. This should be treated as a beginning to a successful pilot worth expanding. The spreading of best practices entails spreading learning and understanding, not just replicating the solution as a tool.14
In other words, making every day restaurant day would not guarantee that every child graduates with pride in workmanship. This could be expanded in either time (regular restaurant days) or content (other variations of the classic lemonade stand). Running different “businesses” would impart different skills and knowledge.
In whatever form an expanded pilot takes, the educational leaders must have a full understanding of the deeper purpose. The results should be observed specifically from the perspective of learning the essentials of quality. In such a scenario, children would figure out so much more than they could ever be taught in the traditionally structured classroom.
These suggestions actually apply to professionals of any age. Starting at first grade gets us closer toward finding the root cause of the problem. Industry can help provide the solution for our educational problems. But ultimately, education will provide the solution for our industry problems.
Rafael Aguayo, Deming: The American Who Taught the Japanese About Quality,Simon & Schuster, 1990, p. xi.
Edwards Deming, The New Economics,Massachusetts Institute of Technology Center for Advanced Engineering Study, 1994, p. 6.
Ibid, p. 122.
Warren R. Plunkett, Raymond Attner and Gemmy Allen, Management: Meeting and Exceeding Customer Expectations,Thomson South-Western, 2008, p. 95.
Deming, The New Economics,see reference 2, p. 121.
Peter Gray, “Why We Should Stop Segregating Children by Age: Part II—The Unique Educative Qualities of Age-Mixed Play,” Freedom to Learn, 17, 2008.
Deming, The New Economics,see reference 2, p. 111.
Andrew Ortony, Gerald L. Clore and Allan Collins, The Cognitive Structure of Emotions,Cambridge University Press, 1990, p. 86.
Ibid, p. 148.
William Kalush and Larry Sloman, The Secret Life of Houdini: The Making of America’s First Superhero,Atria Books, 2006.
Walter Isaacson, Einstein: His Life and Universe,Simon & Schuster, 2007, p. 45.
Jeffrey K. Liker and James K. Franz, The Toyota Way to Continuous Improvement,McGraw-Hill, 2011, pp. 21-22.
In the new way, management introduces, through consumer research, a 4th step, and runs through the 4 steps is a cycle, over and over
Design the product (with appropriate tests).
Make it; test it in the production line and in the laboratory.
Put it on the market.
Test it in service; through market research, find out what the user thinks of it, and why the non-user has not bought it.
Re-design the product, in the light of consumer reactions to quality and price.
Continue around and around the cycle.
This iterative idea that puts the customer at the center of focus is often stated today. Even today though the practices of many companies don’t demonstrate a priority for iterative learning based on customer experiences and a concern for why non-users have not become users.
Like many of Deming’s ideas the idea of iterative customer focus can seem too simple to be very powerful. But in fact that idea is extremely powerful. Those familiar with agile software development can see the idea of delivering working software quickly and iterating based on actual customer use illustrated in Dr. Deming’s “new way” iterative cycle shown in his paper published in 1952.
The importance of learning about non-users is something that still today is often overlooked.
Another quote from the article:
The W. Edwards Deming Institute makes this paper, and many more, available on our website. As you would expect from a non-profit focused on promoting the application of his ideas, these articles are freely available with no barriers to downloading them.
Kat Vanden Heuvel, Executive Director at Sawtooth Botanical Garden, shares how Deming principles have changed the way people think and work at her organization in this video with Nicole Luisi of Aileron.
Kat discusses how the 2 1/2 day Deming seminar she attended helped her to appreciate the importance of making things visible and interactions between components of a system. She came to the seminar already practicing these ideas in her work but the seminar helped her refine and enhance how she made those ideas effective in her organization.
She mentioned how while she appreciated the importance of interactions within a system she also believed in giving people independence in how they did their work. And while that freedom to act as they believe is best is good, without the proper appreciation by everyone for the systemic impacts of their decisions such independence can lead to systemic problems.
Leaders should create a management system that lets people take pride in their work (which includes giving them the tools, education and management system that let them be successful). The balance between trusting people and setting the stage properly to help them succeed that isn’t given enough focus in my opinion. Letting decisions be made by those closest to the work is great but you need to prepare those people with the tools and understanding of the organization as a system. Doing so puts in place a strong and effective management system that reliably produces great results.
It wasn’t until I gained a better understanding of his [Deming’s] concept of profound knowledge by reading his works, combined with what I learned during consulting engagements with Peter Drucker and Russ Ackoff that I came to more fully understand and appreciate the value of his thinking.
What I appreciated most was the fact that he railed against decision-makers and those providing them information who blindly asserted opinion as fact out of convenience or ignorance. Instead, he challenged all involved to test their opinions, theories, hypotheses, hunches, beliefs against reality to truly understand what is going on and learn what is necessary to improve the situation.
The idea of testing opinions and beliefs is key to Deming’s management system (as it is to the scientific method).
Vincent’s talk drives home the importance of focusing on what you learn and how to apply what you learn. In my experience people don’t spend nearly enough time thinking. And directing that thought at experiments, what the experiment results mean and how we can apply what we have learned to our organization are great areas in which to focus our thinking on.
This webcast shows JW Wilson’s presentation, The Neuroscience of Deming, at the 2012 Annual Deming Conference. In a previous post I wrote about this presentation which included a couple clips from the presentation. Now we have the full presentation on our YouTube channel:
Long-term commitment to new learning and new philosophy is required of any management that seeks transformation. The timid and the fainthearted, and people that expect quick results, are doomed to disappointment.
W. Edwards Deming, in Out of the Crisis.
In the talk JW Wilson says:
Learning is all about accelerating your ability to adapt.
Our education system has fallen into a trap of being guided by what is easy to measure – scores on a test instead of what is important (increasing your understanding of the world that will allow you to adapt – which isn’t so easy to measure).
Experiential learning engages our brain in a way that makes transformation far more possible. Experiential learning is much more engaging with students at the time, but it is much more important that such learning has far more staying power. That learning resonates with how our brain works to help us retain it for the long term and lets us apply the ideas in the future.
The higher the meaning the higher the memory.
This is so important. Memorization for a test has very little meaning and so even those that do memorize well forget it soon after the memory exercise is over. Tie the learning to meaning that matters and people retain the ideas to help them use those ideas in the future. People see how the ideas have meaning that relate to things that matter in their life and are worth remembering, thinking about and using in the future.
Guest post by Michael Godfried: planner and policy analyst in Washington State.
Mike Rose is a wonderful writer with a host of books to his name. The Mind at Work: Valuing the intelligence of the American Worker (2004) looks at the mental dimension of work that is often dismissed as mindless. Rose provides vignettes of waitresses, hair stylists, plumbers, construction workers, welders and auto industry assembly line workers. This nuanced and scholarly book reads like a fascinating novel. To read his vignettes is to follow the wisdom of Marcel Proust in looking at world of work around us with fresh eyes.
Mike Rose is a faculty member at the UCLA Graduate School of Education. Although he has a doctorate, he knows what its like to come from the other side of the tracks. He is the son of Italian immigrants born in Altoona, Pennsylvania, in the shadow of the once great Pennsylvania Railroad manufacturing yards. His mother, a waitress, worked double shifts to put food on the table. Due to mixed-up test results, Rose was put on the vocational track in High School. When the mistake was finally discovered, Rose was far behind and struggling to catch up.
As a man on the boundary, Rose has kept one foot inside of academia and one foot in the world outside of the ivory towers. No stranger to community service, he has run job training and literacy programs for low-income communities and returning Vietnam Vets. Rose has traveled the country and conducted countless interviews that he has then brought to life in a series of compelling books. Like Dr. Deming, Professor Rose is not afraid to move between academia and the world outside and seek a broader systems view.
Rose notes a historic distain for those who make a living by doing physical work. We find this legacy in the Ancient Greek philosophers, who despite their many merits, looked at artisans as mentally warped. The French philosopher Rene Descartes (1596-1650) cut a tragic split between active mind and machine-like, bodily matter. Frederick Taylor’s (1856-1915) Scientific Managementdepicted factory workers as uncouth lumps of clay to be shaped to fit industrial ends. Today, Rose says, we talk about work ‘above the neck’ and ‘below the neck.’
Rose’s portrait of his Uncle Joe Meraglio may be most interesting for those who followed Dr. Deming’s work in the auto industry. As a boy, Joe toiled in the dirty, loud and dangerous railroad yards. After WWII, he worked for General Motors (GM) in the Youngstown and Lordstown factories. He rose from a wet sander on the assembly line to a foreman and then to a superintendent, retiring in 1987.
Rose describes his Uncle’s work on the assembly line starting out: “It was hard, low tech labor – basically a piece of sandpaper and a water hose – and, like all assembly line work, called for an economy of movement, working smart to hold exhaustion at bay. Though it was classified as unskilled, there was definitely a technique to wet sanding.” (p. 128)
Although lacking formal education, Joe was bright and availed himself of whatever training opportunities came his way. He took the initiative to improve several assembly line processes despite a GM company culture that could hardly be called ‘empowering.’ As a foreman, Joe rotated his staff through a variety of positions to vary the otherwise repetitive routines of assembly line work.
Knowing of Dr. Deming’s high regard for “willing workers”, he would likely have enjoyed The Mind at Work, not to mention a conversation with Joe Meraglio. Unlike Taylor, Dr. Deming did not see workers as lumps of clay. Dr. Deming saw employees, with rare exception, as wanting to take pride in their work and make a contribution. He strongly supported training, learning and involving employees in improvement efforts like those implemented by Joe Meraglio at GM.
Dr. Deming writes in Out of the Crisis:
“The greatest waste in America is failure to use the abilities of people. One need only listen to a tape of a meeting with production workers to learn about their frustrations and about the contribution that they are eager to make.” (p. 53)
Many popular writers on business management tend to idolize top leadership and put down the work force. Deming’s views were quite different. He saw most problems as being systemic. Top leadership is responsible for system design. In the 1980s, he excoriated top management for their failures and their scape-goating of employees. He recounted stories of employees who saw problems on the factory floor but were either ignored or faced with dismissal for pointing them out.
Deming’s distain leaps from the pages of Out of the Crisis:
“ ”Our troubles lie entirely in the work force.” The supposition is prevalent the world over that there would be no problems in production or in service if only our production workers would do their jobs in the way they were taught. Pleasant dreams. The workers are handicapped by the system, and the system belongs to management.” (p. 134)
Although Dr. Deming did not talk explicitly about the cognitive dimension of manual work, that notion seems to be implicit in his writings. Like Professor Rose, Dr. Deming affirms the agency and contribution of workers and their ability to learn and improve. In his closing paragraph, Rose recalls a term of key importance within the Deming philosophy:
“To affirm our capacity as a people is not to deny the obvious variability among us…To affirm this conception of mind and work is to be vigilant for the intelligence not only in the boardroom but on the shop floor…in the classroom, the garage, the busy restaurant, vibrant with desire and strategic movement. This is a model of mind that befits the democratic imagination.” (p. 216)
Please checkout Mike Rose’s website that has interviews, blog posts and links to his books.
Read an interview with Mike Rose on the 10th anniversary of the release of The Mind at Work.
Listen to an interview with Mike Rose on the topic of The Mind at Work.
You can’t know how much a dissatisfied customer will cost your business in the long run. You can make statistical judgements about how costly dissatisfied customers are to a business but those are loaded with many guesses. They can give a general indication of the magnitude of the costs but they are largely guesses, not something you can measure.
Sometimes a business largely gets away poor quality for a long time. The customer doesn’t change behavior, doesn’t complain to others and doesn’t punish the company in the long term. But you never know when one small failure will cause the luck to run out and turn a customer against the business and costing it dearly.
I may finally escape the incumbent monopolistic internet service providers that most of us in the USA must put up with (because we often have no real options). I recently moved into a house that can get Google Fiber. For a long time I just had to accept the poor treatment at the hands of whoever I had to rely on for internet service. Now I have a choice and I am very happy to get a chance to escape companies that have mistreated me for decades. When your customers are wishing they could flee they may still have to wait until they know of an alternative.
Very dissatisfied customers may be actively seeking alternatives. But there is no way to know when a competitor like Google Fiber (or Ting Fiber or other companies that are seeking to lure away long mistreated customers) will enter the market. And even when they do you might get lucky and they will cut back on plans to expand (as Google Fiber has done). The loss a business will suffer from dissatisfied customers can’t be known. A large inventory of dissatisfied customers is certainly a big risk to the businesses future, but how big a risk is unknown.