Thursday, February 26, 2015

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

Sunday, February 15, 2015

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.
Joyce Orsini 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).

Mary Poppendieck 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

Wednesday, February 04, 2015

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)