What Could we do Better?
Instituting a Management Improvement Culture in Your Organization
Find the Root Cause Instead of the Person to Blame
Good Process Improvement Practices
Management is Prediction
The Purpose of an Organization
Performance Without Appraisal
Manufacturing and the Economy
Practical Ways to Respect People
10 stocks for 10 years
Deming and Toyota
Curious Cat Management Improvement Articles
Institute for Healthcare Improvement
Management Improvement Jobs
Deming on Management
Management and Leadership Quotes
I am now using this blog to re-post some comments I make other blogs. For my full management blog see the
Curious Cat Management Blog
Deming Wanted Managers to Understand the Systems They Managed and to Visit Where the Work was Done
Comments on Deming wasn’t a fan of Management by Walking Around
Deming’s view is entrenched in Lean management practice in the form of “Genchi Genbutsu”, literally “go and see” at the “real place”. Where practitioners of Management by Walking Around merely visit the workers for a chat, practitioners of Genchi Genbutsu stay with the workers to understanding what is going on.
True, and the details you provide are important. It wasn't managers going to the gemba Deming was against. What mattered is the system. Some people did Management by Walking Around (MBWA), even decades ago, in a useful way - with understanding
. But most did not.
are much more likely to be useful (because the expectations are for a more engaged leader) but there are plenty of times those are not done well, and are no better than bad MBWA. Jim Womack has a book out on Gemba Walks
which provides good details to managers on what they should do (and what Deming wanted them to do).
Related: Out of Touch Executives Damage Companies, Go to the Gemba
- Leadership and Management
- Jeff Bezos Spends a Week Working in Amazon’s Kentucky Distribution Center (2009)
- Customer Gemba
Labels: coaching, Deming, employees, evidence based management, gemba, lean thinking, management, managing people, process thinking, quality tools, trust
What is a Lean Program, Deming Program?
Building a System to Reduce Interruptions for Software Developers
I feel strongly about the damage done by interruption to makers focus
. My appreciation for this damage to system performance was greatly enhanced as I became a software developer.
In my work prior to software development I could see that interruptions were not ideal but they were not so damaging to my work and they do also have value. But work that requires extra focus, and software development sure did for me, the damage increasing greatly.
Over 20 years ago at the Madison Area Quality Improvement Network they had a simple visual management sign at everyones office and cube. You could dial between various settings - GREEN available (free to interrupt)... RED busy, don't interrupt... There were 3 to 5 settings. It worked very well for them.
Of course such a system is highly dependent on the overall management system. Just putting that up in most offices would likely fail. MAQIN was an organization that embodied modern management practices (Deming, lean, respect for people, organization as system, etc.). It worked very well for them.
When building a software development team
I tried to protect developers from interruption while having very open communication between developers and program managers (product owners). As is often the case, the real roles didn't line up exactly. In our organization, the people that needed us to develop software (to varying levels) didn't want to take on the responsibilities that agile would suggest (setting priorities etc.). Nor did the that organization want to deal with the conflicting priorities of the various people in their organization had for software development. As part of making things work, I took on a bit of the priority setting roles.
One of the things I did was explain to those that had us do software development was why it was critical to allow software developers to have uninterrupted time to focus. I shared various articles and reports over time and would talk about this as I interacted with them. I encouraged people to talk to me first (at that time I had transitioned from developer/software-development-program-manager to nearly entirely a program manager role).
We also had weekly meetings (when it made sense) with the "product owners", me and the developers working on the software. We scheduled additional meetings when necessary.
I also encouraged people to use email when possible to just check on things, ask simple questions, ask to meet. Again I explained how just going up to talk to the developer could impose significantly higher costs to them being able to focus of their work than there were for interrupting my work or others that had work that could more easily be interrupted with lower consequences.
When there were very important deadlines I would increase these instructions not to interrupt the software developers. And I would talk to the developers about how things were going and if the developers wanted help pushing back a bit I would then do so - mainly by trying to work on the system (provide a set time to allow needed discussions, coach the "product owners" on the difficulty caused by interruptions etc.).
As you might expect this worked better with some people than others. It made a significant difference though. And in our organization it was actually a bit less effective because the software developers were all so nice. They could say how interruptions damaged what they could do systemically but were always super friendly whenever they were interrupted. I was by far the most willing to actually disappoint people face to face in the name of improving overall performance.
It is very hard to overestimate the systemic nature of all of this. By delivering great results we were able to reinforce that if we followed the modified Deming/agile methods we were using were important. Those needing work from us ranged from very skeptical to accepting of those ideas but our performance (both in meeting their desires for software and for interpersonal interactions) made them willing to go along with the methods we said were important.
Related: Deming and Software Development
- Mistake Proofing Deployment of Software Code
- Creating a Culture that Values Continual Improvement
Labels: coaching, evidence based management, information technology, management, managing people, organization as a system, process improvement, process thinking, respect for people, systems thinking
A College Degree Isn't an Acceptable Hiring Screen
Comment on: Do You Need a Degree to be Hired to Develop Software?
In all the time I hired developers (about 10 years), I never made a college degree a requirement.
The best developer (who was also much more - designer, coach, architect, program manager...) I ever helped hire didn't have a college degree.
Our company had just hired a new HR person that started "showing their worth" with new rules such as the dictate that all hires must have a college degree. Thankfully out team agreed higher him was wise and the CIO decided that dictate was nonsense and we hired the applicant.
I have written about what a great software development team we created
In addition to a college degree being a lousy hiring screen, so are most of the automated screen poorly designed HR departments use. Years of experience, experience with a list of specific software, keywords listed, etc. are just lazy and poor criteria to use to reject applicants.
Related: Dee Hock on Hiring (2010)
- Hiring – Does College Matter? (2007)
- Google’s Answer to Filling Jobs Is an Algorithm (but yours shouldn't be)
- The Illusion of Knowledge
- Working as a Software Developer
Labels: business, career, employees, managing people, organization as a system, programming, respect for people
Did Deming and Drucker Agree on Important Management Practices?
Response to, Help needed fleshing out differences between Drucker & Deming? on The W. Edwards Deming Institute LinkedIn
Here are some links about the topic
There were cases where Deming and Drucker disagreed but in many ways the ideas they proposed were compatible.
Drucker did propose MBO, his version was not the same thing we criticize. Drucker did criticize how it was being implemented. I think you can argue even with the way Drucker wanted it done, but that way isn't nearly as bad as the way it was done in practice (so don't think Drucker was promoting managing in the way MBO has often been practiced).
And also don't tie Drucker to just MBO, he had lots of ideas over a very long career and many work fine with a Deming management system. I think in many ways Drucker's stuff can be more easily molded to whatever someone wants it to be - this is one reason I think you see Drucker taught in business school. They can claim Drucker wouldn't object to many things, even though, really I think he would - I am not sure Drucker spoke out so directly (especially compared to Deming).
But Drucker was direct on some things, like how bad excessive taking of company's money by executives was
. And MBA programs seem perfectly fine ignore this, even though what Drucker found horrible has become mathematically 10 times worse than it was.
I think Drucker was ahead of Deming on this. I don't know that Deming ever was clear on how bad this practice was, but I think he would be clear about it today (though that is just my guess, I could be wrong). I think Dr. Deming would add that to the list of deadly diseases. Remember the original list was 5 before he added 2, to make it 7.
Related: Deming's Point 11.b of 14 - Deming versus Drucker
- Why There's No Right Way to Do MBO
- 3 Deming-Based Alternatives to Management by Objective
Labels: Deming, management, management consulting, overpaid executives
The Value of Putting Pen to Paper
Comments on Learning by Writing… by Hand
The psychology behind the learning advantage of handwriting is starting to be understood...
[Carol Holstead] "It turned out my theory was right and now is supported by research. A study published last year in Psychological Science showed that students who write out notes longhand remember conceptual information better than those who take notes on a computer."
I am also a fan of technology. And also a fan of learning and paying attention to research. Pen on paper has advantages for learning that technology has yet to equal. At the same time technology has many advantages also.
We seem to understand the advantages of using technology fairly well but under-appreciate the advantages of pen on paper. To make sure we don't lose out due to this bias we should think before we accept that pen on paper isn't worthwhile.
From a post I wrote in 2005, Measurement and Data Collection
I believe, it is better to focus on less data, really focus on it. My father, Bill Hunter, and Brain Joiner, believed in the value of actually plotting the data yourself by hand. In this day and age that is almost never done (especially in an office environment). I think doing so does add value. For one thing, it makes you select the vital few important measures to your job.
Lots of data will be kept in computers and that makes sense. But putting pen to paper has value that we too quickly dismiss.
Related: Experience Teaches Nothing Without Theory
- The Illusion of Knowledge
- Write it Down to Improve Learning (Ackoff)
Labels: data, evidence based management, information technology, learning, process thinking
Learning Can't Take Place Without Theory
Response to: The Secrets of Lean
I think you make good points, but I think you make a mistake stating:
"This system of learning has come from experience, not theory."
For some reason, culturally, we created this idea that theory was about disengaged people (away from the gemba) thinking in a way disconnected from practice. But this is not what theory is.
Learning can't take place without theory
. Experience doesn't lead to learning. Experience with a theory and an informed observer that questions what they see can lead to learning
It seems to me accept theory that is separated from the gemba
as what theory is and then say theory is not useful, experience is. But we are making a mistake when we think this way. The problem we see in theory being used disconnected from feedback from the gemba is a bad use of theory. But the problem is not that theory needs to be eliminated, but that theory disconnected from the gemba is not useful in learning about systems and improving our organizations.
Related: Experimentation is an iterative process
- Effort Without the Right Knowledge and Strategy is Often Wasted
Labels: evidence based management, experiment, gemba, process thinking, systems thinking
Lowering Expectations Isn't Respect
My comments on good post by Michael Ballé - How demanding can a lean leader be while remaining respectful of staff?
Being respectful means first not dismissing people’s difficulties but making the utmost effort to figure out the problems they mention and their origins.
Being demanding is a large part of lean leadership and, to be honest, in most cases, all goes well and people respond... there’s always one in ten who throws up a fuss, makes tantrum and will accuse you of being disrespectful in your very requests.
Being respectful means making sure people can succeed to the fullest of their abilities.
as a leader, your first job is to teach people to change.
A big problem we have (at least in the USA) is the opinion some people develop that respect has to do with not making anyone uncomfortable. That isn't respect, that is creating a dysfunctional mindset.
Fear driven culture that give mouth service to "respect" often create a climate in which managers find themselves fearful of being blamed for "disrespecting people" (which often means making someone uncomfortable). If they truly are being dis-respectful their boss needs to be dealing with that and helping them improve (which their boss should know because they are actually involved in management - but in many organization, probably most, the their boss would be clueless).
These management system concepts are all connected - weaknesses in critical areas create huge problems. If management doesn't know what is going on in the gemba
they are suppose to manage, problems are very likely. Sadly this is often the case.
What you say is well put. We need to have high expectations and expect that people will rise to the challenge. And if people can't (with help and good systems) we need to find them a new position at which they can excel. Babying people isn't respectful to them or everyone else
Helping people be as contribute is respectful. While ignoring poor performance is often easier for the manager than addressing the issue and helping the person improve doing the difficult task is what managers need to do if they respect people. And likely managers should be spending a lot more time doing this and eliminating other things taking up their time (unless they are in an amazing organization where coaching is a huge part of the managers job - in which case, wonderful).
I have written about this several times: Practical Ways to Respect People
- A Good Management Culture Encourages the Debate of Ideas
- Respect for People Doesn’t Mean Avoiding Any Hint of Criticism
Labels: change, coaching, leadership, managing people, organization as a system, psychology, respect for people
Patient Centered Doesn't Mean Patient Directed
One thing I find annoying is when people talk about patient "choice" as if that is the fundamental principle in health care. We often try to simplify things so much that they are untrue. Health care is complex and trying to point to pithy sayings does more harm than good I think.
Patient focus matters but there are conflicts between what is the best care and what patients want. And there are conflicts between what those paying for care want and drug companies want and hospitals want and doctors want. These require difficult choices and in order to optimize results we need very well designed systems that take these issues into account.
Sadly I think the USA generally has very bad systems in place. The rest of the world isn't that great either, but by and large is better than the USA and much
cheaper. Most health care providers care about patient care and often make heroic efforts to provide it. But the systems are just lousy.
Those systems that seem the most lousy to me around extracting cash from payers - it is absolutely horrible in so many ways in the USA. Sadly this creates hugh
waste in the USA that is ripe for improvement (and has been for at least 30 years). Patient care also has plenty of room for improvement, but thankfully it isn't as messed up as the whole payment system is.
One of the things people ignore is that we are not talking about GM in the 1980s being pitiful compared to Toyota. When we look at how poorly the USA health care system does it is in comparison to other rich countries
it isn't a comparison to "Toyota." It is more like being pitiful compared to 1980s Fiat or something. When you are twice as expensive with no better results than Toyota that is somewhat lame. When you twice as expensive as not very well run systems with no better results that is super lame. And then add on the top of it that you bankrupt hundreds of thousands of people a year, force people to avoid health care so they don't go bankrupt...
We need to have systems that are patient focused but that doesn’t mean patients dictate treatment. And we need to see a much wider system than we normally do. We need to be focused on healthy living not just disease treatment. And given the mess that is the USA health care system we need to focus on reducing the burden of coping with the horrible USA health system bureaucracy - that system does great damage to those having to deal with it (and it is nearly all waste that shouldn't be creating such hardship).
Response to: A Story About a Hospital Putting Safety First Over Patient Satisfaction
Related: USA Health Expenditures Reached $2.8 trillion in 2012: $8,915 per person and 17.2% of GDP
- Our Failed Health-care System
- Overview of 5 Nations Health Care Systems
Labels: customer focus, health care, process thinking, systems thinking
Influential Women in the Field of Quality Management
My response, off the top of my head (there are plenty of others to include) to Who Has Inspired You About Quality?
by Nicole Radziwill.
I searched online and found a nice “List of Gurus” that someone put together that includes my extra picks! But!! There’s a problem with it. Where area the women? The one woman in this list is someone I’ve never heard of, which is odd, since I’ve read papers by (or about!) all of the other people referenced in the list. Which brings me back to my original point: Where are all the women quality gurus? It’s time to start celebrating their emerging legacy. If you are a woman who has made significant contributions to our understanding and/or practice of quality and improvement, Please contact me. I’d like to write an article soon.
and Gipsie Ranney
have done lots of good stuff. So has Clare Crawford Mason
Gertrude Mary Cox isn't known so much for "quality" as statistics but she was an impressive person and a generation or two ahead of others (and it really is related to quality).
has really good stuff at the intersection of quality and software development.
Meg Wheatley was really popular in the 1990s in the systems thinking area of quality. I thought her stuff was good, but wasn't as impressed with it as many people - I haven't seen her stuff in a long time.
There are a couple recent podcasts from the Deming Institute with Paula Marshall
, Andrea Gabor
and Monta Akin
(as well as others listed above).
Most, or all, of those could be good articles.
Related: My post on Who Inspires Your Management Thinking and Action?
- women in science and engineering
Labels: history, management, quality management
A Good Management Culture Encourages the Debate of Ideas
my comments on Political Correctness Comes To Lean
Criticism is one of the ways in which knowledge advances. It is a type of thoughtful feedback (and subsequent dialogue) that helps expose blind spots, identify misunderstandings, provide alternate explanations, or uncover errors that others cannot see or are unwilling to acknowledge.
Without criticism from others, we are unlikely to challenge our own thinking or escape the comfort of self-satisfaction. We fall prey to the confirmation bias and accept information that confirms one’s views and reject all information that does not. We also develop a love for the status quo. Criticism is rejected without consideration and attributed to people who are simply uninformed or who suffer from professional jealousies.
The outcome is blocked information flow, which is the opposite of what we seek to achieve in Lean management.
I agree with you. I put much of the blame on insecurity and mistaking respect for people with not making anyone uncomfortable. When people are insecure or unconfident they often take criticisms of ideas, plans, results, etc. as personal attacks. Then misunderstanding of don't be "dis-respectful" to people comes into play.
I have written about this several times
Respect for People Doesn’t Mean Avoiding Any Hint of Criticism
Building a Great Software Development Team
, a significant part of which was hiring people that would debate ideas without becoming overly personally defensive.
And those posts link to more related posts. The retreat into criticism of ideas is dis-respectful is a real problem for management improvement. Usually there are plenty of other more severe problems, but if you are doing well and getting rid of common failures to manage the organization as a system, experiment and base decisions on data (in many ways) you are likely to reach a point where the fear of debating ideas common in the USA becomes a serious problem.
Related: What Does Respect for People Actually Mean?
- Disrespecting most people in order to avoid confronting one person is not good management (or respect for people)
Labels: business, coaching, employees, leadership, lean thinking, management, managing people, psychology, respect for people
Most Popular Posts on the Curious Cat Management Comments Blog
I Don't Take "Better Management" for Granted
My response to a post on Management Innovation is at the Top of the Innovation Stack
and the authors reply to my first comment:
JD Meier: "I think we are so used to 'better management' now that we take it for granted."
You are much luckier than I (both as an employee and customer). I find very few companies show evidence of practicing what Deming, Drucker, Ackoff etc. talked about many decades ago. Better management is still a distant hope for most organizations in my opinion.
I do think Hamel talks about lots of good stuff. I admit my study of his is not extensive, but from what I remember he does tend to (as do nearly all these people trying to sell their ideas) make more of what he is saying than is merited.
It reminds me of college when about 50% of my professors in the first lecture had some version of: In [this class] we are studying the true core of knowledge, everything else is just a different take on what we will study here. If it was physics then chemistry, biology... are really sub-disciplines of physics. If it was philosophy everything else was a sub-discipline of philosophy. I thought it was pretty funny. And that passion likely made them great professors, even if I think they lost perspective on reality.
I think even many fairly good management thinkers get hung up on the wonderfulness of their thoughts and how critical their details are. I do still I do like Hamel but I think he is too caught up with his ideas and thinking what he has been looking at is more important than it really is.
My first comment:
I agree with what I think is the premise - that better management is critical for the ability for an organization to successfully innovate. And that bad management can kill otherwise excellent innovation in the other domains you list.
I think calling it management innovation however is misleading. It is true management at very valuable companies (and less valuable ones) needs a great deal of improvement. But it is mainly adopting good management practices people like Deming, Ackoff and Drucker talked about many decades ago.
Related: The Need to Improve Management While Building Organizations Fit For Human Beings
- Quality and Innovation
- New? Different? How About Better?
Labels: innovation, management, management consulting
One of the things I find amazing is how focused niche markets are. I noticed this as a kid collecting baseball cards and then paying attention to all the very focused niche markets I saw. When people find it surprising that people actual focus on that
I don't really find it surprising but I do still find it interesting.
Here is a good example of what I mean, a business focused on manufacturing bottle caps specifically for use in craft and jewelry projects
. That is not a market I think most people think of and say wow if only I could build a business in that market I would be set.
But by focusing on customers and building your business to give customers what they want you can build a good business. That is how the Bottle Cap Company built itself. It started out selling on bottle cap products at local farmer's markets and then ended up with an extra supply and sold that on eBay. And based on that response they saw a larger global market and expanded. And now they ship products and supplies daily all over the world from their warehouse located in Nampa, Idaho.
The success of companies like Google and Apple and Tesla are interesting. But far more success is gained in small companies providing needs to niche markets. I wrote about recent lean startup weekend in Johor Bahru, Malaysia recently along the lines of providing products and services to meet customers needs and not needing to try and become the next Twitter. Sure making billions sounds nice but that is extremely unlikely. However building a successful small business is possible by managing the business well and applying good customer focus principles
Related: What Works for One Business May Not Work For Others
- Pilot on a Small Scale First, Good Advice We Often Ignore
- The Customer Knows Best?
Labels: business, customer focus, customer service
It isn't Fair to be Judged for Performance Outside Your Control
My response to Simon Guilfoyle post
It’s also necessary to acknowledge that multiple variables affect crime rates; factors such as economic cycles, substance abuse, the weather, societal influences, changes in legislation, and so on. None of these are directly within the gift of the police to influence. Also, what about where the police cause an increase in reported crime by having the temerity to find someone carrying a weapon? Surely proactive problem-solving should not be discouraged on the basis that finding hitherto unreported criminal offences is incongruous with an over-simplified crime reduction narrative...
I would say many of the examples are outcome measures of the system - which is a better measure than is often used.
However, they are often beyond the control of individuals and even police departments overall (many other factors play a part - economic development, social services system, education system...).
Likely more directly relevant the measurement error is often so high that the figures have more to do with measurement than the actual outcome
. And when the figures are being used to blame then it dramatically increases the likelihood the figures will be a poor representation of outcomes.
I would rather see more focus on outcome measures
. We should also reduce incentives to misreport data (often blame related).
I think the issues you raise about the system being larger than the police can tackle alone should be a reason to INCREASE the view of the SYSTEM. The important system is LARGER than the police department. When we have institutional walls that break up the system we need to find ways to knock down those walls so the system can work together. Granted this seems nearly impossible given how much difficulty we have even just breaking down barriers inside tiny pieces of our organizations.
Nevertheless that is where the focus should be. We shouldn't decide the outcome measures are not fair given where we put organizational barriers. We should decide that we need to realize when we cut funding for x it drives bad results in section a. And when we allow y to retain fitfully outdated management practices that doesn't just impact their ability to succeed it likely creates lots of other problems all over the place.
Related: Be Careful What You Measure
- Millennium Development Goals
Labels: customer focus, Deming, evidence based management, government, management, society, systems thinking
Sustaining Management Improvement Through Personnel Changes
My reply to a comment on Reddit
about my interview: Leadership While Viewing the Organization as a System
So if a new manager is able to mess it up, the system was necessarily weak? Not sure I agree.
Looking at the context the interviewer asked about a new CIO coming in a gutting the management system. I said if they have a strong management system that can't happen. Executives can't just have whims (usually driven by a desire to "make their mark") that throw out the principles used to manage the company if there is actually a strong management system.
Most organizations just float with whatever fads are going on, so in most they can flip flop as new executives come into place.
On the question of new managers making mistakes. Yes, I agree they can. Once again good management systems make a significant effort to bring new managers up to speed. Those management systems reduce the likelihood of failures created by new managers making mistakes. Again, most organizations do a poor job of brining new managers up to speed: Toyota does a good job, the USA military does also, Costco does a good job, I think P&G does
(but my information could be outdated). Many others do this well, but the majority of companies do this extremely poorly. That is a serious failure of a management system and I would put more of the blame for those failures on the poor management system, that the managers making mistakes when they were put in a position they shouldn't have been (being made responsible without proper preparation).
Related: Poor Results Should be Addressed by Improving the System Not Blaming Individuals
- Management Training Program (2005 Curious Cat post)
- Curious Cat Management Improvement Dictionary
Labels: business, career, coaching, management, organization as a system, process thinking
Data Must be Understood to Intelligently Use Evidence Based Thinking
How to Deal with Motivation Problems.
Data on Medical Errors
How Many Die From Medical Mistakes in U.S. Hospitals?
In 1999, the Institute of Medicine published the famous “To Err Is Human” report, which dropped a bombshell on the medical community by reporting that up to 98,000 people a year die because of mistakes in hospitals. The number was initially disputed, but is now widely accepted by doctors and hospital officials — and quoted ubiquitously in the media.
In 2010, the Office of Inspector General for Health and Human Services said that bad hospital care contributed to the deaths of 180,000 patients in Medicare alone in a given year.
Now comes a study in the current issue of the Journal of Patient Safety that says the numbers may be much higher — between 210,000 and 440,000 patients each year who go to the hospital for care suffer some type of preventable harm that contributes to their death, the study says.
That would make medical errors the third-leading cause of death in America, behind heart disease, which is the first, and cancer, which is second.
I wish these reports would provide some detail on what these really mean. Is it 250,000 people that were completely healthy coming in for a physical and they die when they would have been healthy if the medical system didn't exist? I doubt it. Is it 2,000 completely healthy people and 248,000 people that were under intensive medical care for years keeping them alive and now we slipped up and they died? Probably not, again, but my guess is it is closer to the second.
Preventing errors is obviously important. And in health care it is very important, of course. But just because you use data doesn't mean it isn't misleading. Medical errors leading to death is just too big an operational definition to be very meaningful in my opinion. For these numbers to provide much insight I really think they need to be segmented more:
- perfectly health person that was going to be perfectly healthy for decades but were killed by medical error.
- person that needed life saving care of they were going to die that month and we routinely should be able to provide the very easy care to make them perfectly healthy again but they were killed.
- person that was extremely sick with many problems for years and was saved with medical care over and over again. Complex care was needed and much of it was done well but in the very challenging situation there was a mistake and that mistake is the proximate cause of death.
We should be working on making everything better and eliminating medical errors that cause damage and death. But there are huge differences between a medical error conditions that caused death and to me those differences are so huge lumping them together is hardly useful.
My understanding is we do use risk based assessment to compare things like survival rates or operations at different hospitals. A figure of survival rates comparing two hospitals when one was the hospital where all the most difficult case for the Western USA were sent to a local hospital that dealt with the easy operations for that health issue would not be very useful. So they try to adjust for the severity of the problem (as I understand it). It would seem to me a similar thing would be much more useful for medical error death rates. Was the person in such a risky state that the tiniest misstep (error or whatever else) would kill them or was it someone who is perfectly health and dies immediately due to an error.
Related: Errors in Thinking
- Epidemic of Diagnoses
- Health Care Crisis
- Great Visual Instruction Example (taking pills)
Response to comment on my comment
Right, l think the thing I am getting at is there is a big difference between making a mistake while you are in a complex situation where any of 30 bad decisions in a pressure situation could result in death (and where doing nothing results in death) versus a situation where there is no risk of death until you do an absolutely idiotic thing that turns my visit to get a physical into death.
Everything should be constantly improved and made safer with mistake-proofing thinking... And healthcare needs this more than most everything due to the dangers and consequences involved.
When there are headlines like 100,000 deaths due to medical error every year that reads to me like John was walking along the street and boom a medical-error/piano dropped on his head and killed him. But I don't believe that is true. I bet it is true that are lots of deaths due to just unforgivable errors - someone is given a drug which was indicated in numerous sensible ways would kill them due an allergy but they were given it anyway and died.
But I don't trust how much of the deaths attributed to error are really 20% error, 19% cancer, 18% diabetes, 17% cardio-vascular disease, 16% long term high level use of powerful drugs ravaging the body, 10% car accident (which also someone else might say is 5% error, 30% cancer, 25%...). The error is still bad, and the system needs to be improved to reduce the frequency and consequences of errors. But I just don't know how to take the error to death data without much more explanation.
In reading more details on the studies they comprehend this issue with the data but I haven't found where they provide more meaningful data. What I read just talks about the contributing nature of "blame" on medical error etc..
Labels: ethics, evidence based management, management, mistake proofing, organization as a system, process thinking, statistics
Managing the Organization as a System with Many Stakeholders
Comments on "Deming’s thinking is alive and well…in China! That's why those looking for evidence of Profound Knowledge in the US may be looking in the wrong place." (my response is to a discussion on The W. Edwards Deming Institute LinkedIn group - I can't link to the original comment because it is a private forum)
(Jack Ma) If you want to invest in us, we believe customer number one, employee number two, shareholder number three. If they don't want to buy that, that's fine. If they regret, they can sell us.
(Lara Logan) In the U.S., the shareholder is usually first.
(Jack Ma:) Yeah. And I think they were wrong. The shareholder, good. I respect them. But they're the third. Because you've take care of the customer, take care of the employees, shareholder will be taken care of.“
Deming couldn't have said it better. And it illustrates why he often insisted that the CEO, who invited and introduced him to his staff, actually stay and listen.
The problems are real. But there is a significant minority of companies that don't accept the Wall Street conventions. There are very few companies that don't allow CEOs to steal from the corporate treasuries - through completely unjustifiable "pay" packages (but there are some - Berkshire Hathaway, Costco and I believe Bezos, Larry Page and Sergy Brin also don't behave like kleptocrats
But I can't include Google and a company that doesn't let those with power take the companies gold, Senior executives have taken lidicras pay including past CEO Eric Schmidt. I must say I think Schmidt has done an excellent
job at Google (the lame decisions by Larry Page only make it more obvious) but even so his pay was insane.
If you look at Google and Amazon they both also refuse to bow to the idea there job is to please wall street analysts. A fair amount of the interest business companies in the last 15 years don't place much faith in wall street "wisdom."
Google from their start with their IPO didn't accept wall street dictates. They are actually moving to become much more conventional, ever since Larry Page became CEO. The new non-voting class stock they created GOOG (GOOGL is the stock that has actual ownership voting rights) could be seen as fighting wall street convention or could just be seen as founders greedily setting up the rules so they control no matter what.
Jeff Bezos is a former Wall Street analyst and knows the games and what matters. If your business NEEDS to get cash from Wall Street - raising equity or bonds you might have to listen some. Otherwise the talking heads regurgitating wall street dictates are entirely pointless. While Amazon has very little profit, the cash flow situation is much better (Bezos doesn't need to raise capital and therefore what wall street says just doesn't matter and he is smart enough to know that unlike the majority of CEOs that do as Wall Street wishes).
But even the companies that are doing some things very well (Google, Amazon, Apple...) have a very long way to go in learning about managing organizations. But those companies have some aspects of they are doing very well.
"At Berkshire, managers can focus on running their businesses
: They are not subjected to meetings at headquarters nor financing worries nor Wall Street harassment."
- Warren Buffett
Related: Google is Diluting Shareholder Equity with Massive Issuing of New Shares
- Amazon Innovation
Labels: business, leadership, management, respect for people
The Management Culture Impacts How People Respond to Statements