Podcasts about chief quality officer

This episode recorded live at the Becker's Hospital Review 15th Annual Meeting features Dr. Jay Grider, Chief Quality Officer and Chief Executive Officer, Kentucky Medical Services Foundation, University of Kentucky & Kim Adelman, principal, ECG Management Consultants. They discuss how investing in quality and patient safety drives efficiency, cost savings, and long-term sustainability—and why aligning leadership priorities is critical for success.This episode is sponsored by ECG Management Consultants.

In this episode, Dr. Nancy Beran, Vice President and Chief Quality Officer Ambulatory at Northwell Health discusses the organization's strategic focus on expanding outpatient care, improving data integration through the Epic EHR transition, and advancing quality and safety initiatives across nearly 900 ambulatory sites. She also highlights the system's leadership in behavioral health integration and chronic disease management.

In this episode, Dr. Nancy Beran, Vice President and Chief Quality Officer Ambulatory at Northwell Health discusses the organization's strategic focus on expanding outpatient care, improving data integration through the Epic EHR transition, and advancing quality and safety initiatives across nearly 900 ambulatory sites. She also highlights the system's leadership in behavioral health integration and chronic disease management.

In this episode, Dr. Nancy Beran, Vice President and Chief Quality Officer Ambulatory at Northwell Health discusses the organization's strategic focus on expanding outpatient care, improving data integration through the Epic EHR transition, and advancing quality and safety initiatives across nearly 900 ambulatory sites. She also highlights the system's leadership in behavioral health integration and chronic disease management.

In this episode of The MedTech Talent Lab, Mitch Robbins sits down with Elena Mack, Chief Quality Officer at Sanisure, to discuss her career journey and insights into the world of quality and regulatory leadership in the medical device industry. With over 25 years of experience, Elena has held key executive roles at companies like Olympus, BD, and Teva Pharmaceuticals. Now, as part of Sanisher, she is leading the charge to build and maintain a world-class quality program for the bioprocessing and biomanufacturing sectors.Elena shares her early career experiences, including her shift from medical technology to microbiology and how she got started at Wyeth in a regulatory compliance role. She reflects on pivotal moments in her career, including taking on a leadership role as a director at ACUPAC and the invaluable lessons she learned about leadership, delegation, and the importance of empowering her team.Throughout the conversation, Elena also delves into the challenges of being a quality executive, emphasizing the responsibility of ensuring that quality is a shared value across all levels of an organization. She highlights the critical importance of having a robust quality system and talks about the ongoing efforts at Sanisher to move from ISO 9001 to ISO 13485, aiming to meet the highest standards of quality required by their customers.With her unique perspective on quality as a critical but often underappreciated function in the industry, Elena offers valuable insights into the role of quality professionals and how they can drive real impact within their organizations.Key Takeaways:The importance of leadership by example and empowering teams.The challenges and rewards of stepping into executive roles and delegating responsibilities.The need for robust quality systems in bioprocessing and biomanufacturing, especially in meeting regulatory standards.Elena's personal connection to quality through her experiences with her son's health challenges.Links:Elena on Linkedin https://www.linkedin.com/in/elena-mack-bb57855/Sanisure Website www.sanisure.com

Why would any leader choose to take on a transformation that requires rethinking how they lead, how their organization functions, and how they learn? In this episode, we dive deeper with Cliff Norman and David Williams, co-authors of Quality as an Organizational Strategy, exploring Chapter 11: “Getting Started.” They share powerful stories, practical steps, and the deep-rooted challenges leaders face when shifting from conventional methods to building true learning organizations grounded in Dr. Deming's philosophy. This conversation highlights why improvement cannot be delegated, why leadership transformation is essential, and how to begin the journey—with clarity, commitment, and courage. TRANSCRIPT 0:00:02.1 Andrew Stotz: My name is Andrew Stotz and I'll be your host as we dive deeper into the teachings of Dr. W. Edwards Deming. Today we are going to continue our conversation with Dave Williams and Cliff Norman about their book Quality as an Organizational Strategy. I found this book fascinating because I think it's addressing something where there's been a bit of a hole and that is how do we think about the strategy of our business? And so we already had our conversation in a prior episode about the overview of the book, but today we're going to be talking about specifically, now this is kind of funny because we're going to be talking about the back of the book and that is chapter 11, getting started. Dave, why don't you take it away?   0:00:53.3 Dave Williams: Well, thanks, Andrew. Thanks for having us back on the Deming podcast. So, as you mentioned, part of the way that the book is laid out is that it describes kind of the foundations that are behind quality as an organizational strategy and begins sort of with an introduction that explains a good bit about how Dr. Deming had this provocation of a need for leaders to transform the way that they approach leading organizations. And part of that was to move not just from process based improvement projects, but to start to think about major systems in the organization and to pursue quality as the overall strategy and create a continuous improvement organization or learning organization. And so the book lays some of the foundation behind the science of improvement or behind profound knowledge that underpin the thinking, walks through quality as an organizational strategy, as a method of five interdependent activities. Then at the end it comes back full circle to say, well, this is great, now you've learned about these theories and methods. But a natural question for any leader would be, how do I get started? And one of the first things that we talk about in that section actually is about why leaders would want to do this transformation.   0:02:30.9 Dave Williams: And this actually came from a conversation that Lloyd and Cliff and I had in 2020 where we were talking about getting on this journey of building the book. And we all kind of recognized that this was really, really hard work. And we were curious or we, we didn't have a good answer of what was our theory about why somebody would deviate from the way in which they work today and embark on a transformational change of the way that they approach leadership, the way that they approach organizations. And actually I ended up going on a journey of interviewing a whole host of leaders who had been influenced by Deming, who had been involved in improvement in healthcare, folks like Dr. Berwick and Paul Batalden and Brent James. I interviewed some folks in the UK and other places, like John Seddon, and asked them, oh and I should Blaine Godfrey, who had been the lead of the Durand Institute, and I posed the question, what causes somebody to want to embark on this change? And many people actually had a hard time articulating it. But the answer that emerged, or actually Blaine Godfrey was the one that kind of framed it the best, I think, for us, was a number of things.   0:03:57.7 Dave Williams: Sometimes it's something like a book like this comes out and people read it and it's interesting and new. Sometimes it's an event happens, a patient safety event or a major accident or something of which causes people to have to change or do something different. Sometimes it's a discouragement with a desire that you know you could do better, but you don't have methods or know how to. So there were a host of things that we listed, and those are some of a sample of them that might invite somebody to say, the way that we're working today is not getting us to the level that we want to. And now we want to embark on something different. And we might look to something like quality as an organizational strategy as a method for us to transform the way that we're working and build on the shoulders of Deming's philosophy and the science of improvement and do it differently.   0:04:56.0 Andrew Stotz: And when I look at the book, you guys are bringing together a lot of different stuff. It's not just a Deming book. It's Deming is a part of this, and that's fascinating. One of the questions I have is when we look at, let's say, a business owner, a business leader is looking for answers, as you said, maybe it's an event, maybe it's a discouragement, maybe it's a feeling like we can do better. Maybe it's just being beaten by competitors. They come to a point where they start looking for answers and they find some fantastic books, authors, ideas, consultants, all this and I think about whether that's Peter Drucker or whether that's the Lean movement or whether that's, let's say Taguchi or something like that is the teachings that you guys are talking about - and I'm going to specifically ask about the teachings of Dr. Deming. Is it more or is it more difficult or less difficult to implement than other books or styles or methods that someone's going to come across?   0:06:08.7 Cliff Norman: I have to quote one of my colleagues here who probably knew about more about Deming than anybody in API or all of us combined, that's Ron Moen, who did, I think it was 88 seminars, four-day seminars with Dr. Deming. Dr. Deming once told him, he said, Ron, I believe you've been to more of these and I've been to. And it's kind of a joke. He had a great sense of humor. But you know, Ron told me the problem with Deming is he's asking us to change. And there's all sorts of things out there that require the management and the leadership, they really don't have to do anything different. And there are several things out there. In fact, Philip Crosby, one of the three gurus during when they launched, he was more the evangelical and had a way of talking to management so that they understood it, which that was his contribution to all that. But when Six Sigma came up and black belts and all that, and Crosby looked at him and says, that's not going to change the system. He said, all you're doing is killing a bear for management, killing a bear for management, and then you'll get a black belt.   0:07:19.9 Cliff Norman: You know, And I thought, wow that's pretty profound. Because the management at that point doesn't have to do anything, just have the black belt ceremony. There's absolutely no change on their part. Where Deming, as Ron says, he's kind of a pain. You've got to learn about variation, you got to learn about Shewhart charts. You've got to be able to put together a family of measures for your organization. You've got to understand your organization's system. You need to understand psychology, you need to understand theory of knowledge and how people learn how they change. And nothing else out there puts that on leaders. And so that was a question that Dave was lending back to. Why would somebody do this to themselves? You know, why would they take on this whole extra thing to learn and all the rest of it. And for the people that I know that have made that, that bridge, the pure joy that they get and the rewards they get from people who are learning and that they're leading and that they're changing and they're able to go to other organizations and repeat this and call them up and say, thank you so much for helping me learn how to be a real leader.   0:08:35.8 Cliff Norman: I mean, that's the reward in it. But it requires a real change on the part of the leader. And I don't know of anything else, Andrew, that actually requires that kind of in depth change. And there was one of our leaders, Joe Balthazar, he had Jane and I do four years in a row with his leadership team, teach them the science of improvement. The same curriculum, same leaders, four years in a row. And the second year I was doing it, I said, don't we need... No, no, Cliff, I want you to do exactly what you did last year. He said, it takes years for people to understand this. And I thought, wow, this is unbelievable. But on the fourth year, the VP of sales walked up to me and he says, I think I figured it out. And I thought, wow. And it does it literally... Because you've got to depart from where you've been and start thinking about how you're going to change and let go of what's made you successful up to this point. And that's hard, that's hard for anybody to do.   0:09:47.2 Cliff Norman: And anybody's been through that four day seminar knows when they crossed that path that all of a sudden they had to say, you know what I've been doing, I can see where I've been, the problem and not the solution. And that's tough for us. That really is tough. And Deming says you have to give up that guilt trip. And once you understand the theory of variation, once you understand systems, once you understand psychology and theory of knowledge, it's time then for you to move on and let go of the guilt. I hope that makes sense. But that's the difficulty in this.   0:10:17.6 Andrew Stotz: It reminds me of two, it made me think about two things. I mean, I was just a 24 year old guy when I attended the seminars that I did, and they weren't even four day. I think they were two-day ones at Quality Enhancement Seminars in, what was it, George Washington, I think. But the point that I remember, as just a young guy who I was, I pretty much admired all these business leaders. And then to see Dr. Deming really nail em to the wall and say it's about you changing. And whether he was saying that directly or whether that he was implying that through the Red Bead experiment or other things, it's about you shaping the system. That really blew me away because I had already read some books and I was pretty excited. And then it also made me think about, let's say there's a really good book, I would say Good to Great by Jim Collins that highlights some things that you can do to succeed and make your business better. And you can just buy that book and hand it to your management team and go, hey, implement what you learned from this book.   0:11:20.8 Andrew Stotz: Whereas with the Deming book, it's like there's just so much more to it. So I guess the answer to this is it is more takes time. There's more thinking going on. And I think that's part of the whole point of what your book does, is to help us map it out. So why don't we go through and think about this and kind of maybe step by step through what is the starting point and how do we go?   0:11:45.4 Cliff Norman: Andrew, I just got to add to what you just said there and go back to Joe Balthazar at Hallmark Building Supplies. He shared with me that, and he's the one that said I want you to do these four year seminars dedicated Deming's idea of Profound knowledge. And he said, Cliff, the day I made it, I knew I'd made it. Is my son Joey spilled his milk. He's about three years old. And he said, I started to do my normal leap across the table and he said I was about mid air. And I thought, oh my, this is what they do. This is part of their system. This is common. And I'm treating this like it's special. And that was so profound for him. And when, when you move beyond the Shewhart chart and you see events in your life around you relative to the theory of variation, common and special cause variation at a deep way like that, that's the kind of transformation you want to see in a leader. And Joe will tell you he's forever grateful for Deming and everything he's learned, and I think that's the reward. But people need to be willing to go on that journey, as Dave was saying.   0:12:53.0 Andrew Stotz: So Dave, why don't you walk us through a little bit of what you guys are teaching in that chapter.   0:13:00.3 Dave Williams: Sure. Well, one of the next steps obviously is if somebody, if a leadership team thinks that they want to go on this journey, there's some considerations they got to think about. As we've already sort of alluded to or touched on, this is a leadership responsibility and a leadership change. And so there's got to be will amongst the leadership team in order to say we want to work together and work hard to do this work. That this is not something that, similar to Cliff's example of say, having black belts, that we can just hand it off, somebody else will do it, and we can just keep going about our business and hope. It's important that leaders spend time recognizing and thinking about the fact that this is going to involve them doing work, doing effort, changing the way that they think, changing the way that they practice. And I like to say it's good hard work. I mean it's going to be something that's deeply rewarding. But it does require them to have that will. And with will then it's going to come time and energy, right? They've got to make the space, they've got to create regular routines and opportunities for them to learn just in terms of content, learn in terms of practice or application and learn in the process of doing the improvement work and doing the change to the way that they work in the organization.   0:14:38.0 Dave Williams: So there's going to be a need to build in that ability. And then a third thing is to ask whether you think this is something that you can do on your own or whether it might be useful to have help. And help may be an internal, a consultant, but likely not to promote consulting it but, but there's a good chance that you're going to need somebody that has both experience in improvement and helping people do results-driven improvement as well as somebody who has experience doing system wide change through a lens like QOS. And, and the advantage of that often is it it gives you as a leadership team to focus in on your job of thinking and looking and learning and allow somebody else to be an external intervener, somebody who comes in and creates some of the support, some of the context, some of the ways that can make it easier for you to step back and look at your organization in a different way. And so many times those are some of the things that should be considered as teams working through it. Cliff, what would you add or improve upon.   0:16:07.3 Cliff Norman: The idea of external help. Deming was pretty black and white about that. I was kind of surprised. I went back and read one of his quotes. He said, "I should mention also the costly fallacy held by many people in management that a consultant must know all about a process in order to work on it. All evidence is exactly the contrary. Competent men in every position, from top management to the humblest worker know all there is to know about their work except how to improve it. Help towards improvement can come only from outside knowledge." And I was reflecting on that today with Jane who's been involved in this for 40 plus years also. I said Jane, when he said that, I think it was accurate because at that time she and I were going to Duran seminars. There's only two books out there with methods. One was Ishikawa's book on Guide to Quality Control. And the other was Feigenbaum's book. And then of course you had Duran's book on The Quality Handbook, which was a nice doorstop. But there wasn't that much knowledge about improvement. And the worst part where Deming was really getting to was there's very few people you'd run into that actually under the Shewhart methods and charts and understand the difference between special and common cause variation.   0:17:27.0 Cliff Norman: And so you had to bring that kind of knowledge in from the outside. And frankly, we've had people go off the rails here. You know, Dr. Deming in the teaching of statistics has identified analytic studies which is focused on looking at data over time and trying to understand that and simple methods and approaches and then what he calls enumerative statistics, which is use of T tests, F tests and all the rest of it, which assumes that under the IDD principle that data is independent and identically distributed. Well, if you have any special causes in the data set, it blows up both of those assumptions and the use of those methods doesn't offer any help in prediction. And as Dr. Deming often said, prediction is the problem. And then go back to Shewhart. And Shewhart said, things in nature are inherently stable, but man-made processes are inherently unstable. So when Dave and I first do a Shewhart chart for a client, we don't expect for it to be stable. We expect for to have special causes. And as Dr. Deming said and also Dr. Juran, that when you get a stable system, that in and of itself is an achievement, that means nobody's messing around with the system anymore.   0:18:43.0 Cliff Norman: And you see this in the simplest things, like in an office, somebody will walk in and they think that their body is the standard for what the internal temperature should be for that room. So then they walk up and they start tampering with the thermostat. And by the end of the day everybody's irritated because we've had so many bodies up there with their standard. Moving the funnel on us here, and just leaving it alone would probably all be better off. But you have to learn that. And I think that's what Dr. Deming was saying, is that that kind of knowledge is going to come from the outside. Now the good news is is that since he wrote that in 1986, we've got a lot of people out there and some of them are in organizations that do understand the Shewhart methods and can understand the difference between common and special cause variation. They do understand the difference between a new and analytic studies and statistics and they can be of help. So the Deming Institute has a room full of these people show up, but they're at their gatherings annually. So we're a lot further along than we were in 1986.   0:19:45.2 Andrew Stotz: Yeah. So let's go through that for just a second. Some considerations you've talked about. You know that it's a leadership change. Right. And you gotta ask yourself, are we ready to work on this? And you know, this is not a hands-off thing. The second thing you talked about is time and energy. Are we ready to make the space for this? We have to have regular meetings. You know, we've gotta really... There's some work involved here. And then the third part you've talked about is outside help. And you mentioned about this story of Joe Balthazar and how he asked you to do the same topic over and over for four years. And imagine if he was telling his team, let's meet and try to implement some of this stuff on our own. Everybody dig into a book and then let's try. It would be very difficult to make that kind of progress compared to bringing an outside person. Which also brings me to the last thing that you said, Cliff, which was the idea that Dr. Deming had mentioned, that you need an outside person to truly change something. Everybody's got the expertise on the inside.   0:20:44.5 Cliff Norman: I appreciate you summarizing that because my job and working with Joe and leadership team, I was meeting with him every month. But what the four years that Jane and I spent were the next levels of his leadership. You know, it wasn't the leadership team. And I'm glad you brought that up because it was the very next level that he wanted exposed to this and the VP of sales that came in, he was new, so he had to be part of this group because he wasn't there originally. And so there was that ongoing... He wanted that next generation that was going to take over for him and the others to really understand this. So I'm glad you summarized that for me to help.   0:21:30.5 Andrew Stotz: Yeah. And I think one of the starting points too, I mean, the body of work, not just this book, but the other books that you guys have been involved in and produced provide a lot of the starting points for this. So there's a lot there. Dave, where do we go after these considerations? And the people say, okay, yeah, leadership says, we want to make this change. We're ready to make some time for it. We're willing to get outside support and help. Where do we go next.   0:21:57.7 Dave Williams: Right. Well, one thing that we typically invite a leadership team to do is to take kind of a self assessment of where they sort of see their baseline in relation to the methods and activities of QOS. So in chapter one of the book, there's actually a table that is 10 different categories. And then each leader takes it independently and they rate their level of agreement with different definitions from 0 to 10. 0 being this really isn't present, and 10 is, I'm very, very far along on this journey that in the book that's out now, there's a summarized table, it's on a page. But actually in the QOS field guide that we're working on publishing this year, there's a much more detailed version that we use in practice that has deeper definitions, but basically it works its way through purpose and leadership and systems thinking and measurement and all the things that are tied into QOS and what... And as I mentioned, we have each individual member of the leadership team take it independently and then we bring those scores together to learn together.   0:23:32.5 Dave Williams: And there's different ways in which you can display it. In the book, we show an example of a leadership team's scatter plot where it shows the rating and then it also shows the standard deviation amongst that exists between the leadership team. It's very, very common for leaders to not be in agreement in terms of their score in each of the different areas. You know what I said, It's a 0 to 10 scale. Typically, in my experience using the tool, people tend to be between a 2 and a 6 and hovering around a 2 or a 4. But it sort of looks like a buckshot or shotgun blast where there's a very... If you were to put dots where everybody scores, where there's variation that exists. And that's good because it's useful for the team to pause and think about why they assess the organization the way that they did. Looking at it through this new lens, where are the places that there's agreement and also where are the places that there's variation? And that helps them to be able to think about the fact that through this process, they're likely to both improve their assessment of the organization, but also increase their agreement about where they are and what they need to do to move forward and what they need to do to improve.   0:25:05.2 Dave Williams: And so that's a useful starting point, gets everybody kind of on the same page, and it's something that we can use at intervals as one of the ways to continually come back and evaluate progress towards the destination of pursuing quality as an organizational strategy.   0:25:23.7 Andrew Stotz: Yeah, I mean, I imagine that self assessment, it helps you too when you work with companies to be able to really understand, okay, here are starting point with this company is really, they just really don't know much about all of this stuff, whereas you'll have some other clients that basically, wow, okay, there's a lot of knowledge here about it, but how's the implementation and all that? So are we ready to change? Are we prepared to devote the time and energy? Are we going to get outside help? And where are we now? What's our starting point that's great to help us understand exactly how you step through it. What comes next?   0:26:03.5 Cliff Norman: Well, in that very first milestone, in that table, is it table three, Dave? Anyway, the very first milestone is to establish formal improvement efforts. And the reason for that is that unless people experience what it takes to develop, test and implement changes in the organizations, they really can't appreciate the structure that comes with quality as an organizational strategy. Because it's very difficult for many organizations to launch three or four improvement efforts and then bring them to fruition. And there's all sorts of stuff that happens. And then you find out very quickly whether you have managers or leaders, and organizations they've brought me in, they say, let's do some leadership training. I said, no, let's just do some improvement and then we'll find out if we have leaders or not. And one group, I won't mention who it was, but they had five people on their leadership team and they had to replace two of them because they found out they couldn't actually manage an improvement effort. And then the CEO was wondering how they actually manage their organization, which they weren't either. And so it's a rather, it's an important test in the front.   0:27:22.2 Cliff Norman: But as Dr. Juran says, it's real important to develop the habit of improvement. And if you don't know what that is, if you've never experienced it, then it's hard to say to people, gee, I need a purpose that aligns my improvement efforts. I need to understand my system so I know where those improvements are going on. I need to build an information system, get information from customers outside, people inside. I need to put together a strategic plan that actually makes improvements on purpose. That's a lot of work. And once you understand how complicated it can get in terms of just doing three or four improvement efforts and then all of a sudden you got a portfolio of 30 to do your strategic plan. Now that needs some structure, that needs some guidance and all the rest of it. But I'll just go back one step further. My own journey. I was sent by Halliburton at Otis Engineering to go see Dr. Deming 1982 in February. And coming back, I had an audience with the president of our organization, Purvis Thrash. And I went on and on about Dr. Deming. He said, Cliff, you know what I'd like to have? I said, what's up, Mr. Thrash?   0:28:27.5 Cliff Norman: He says, if you'll take this 50 million dollar raw material problem and solve this for me, I'll be a happy man and I'll give you all the quality you want. But go take care of that problem for me first and then come back to me and talk about Deming and Juran and anything else you want to talk about. So I put together four or five people and over about three months we solved his 50 million dollar raw material problem. And then he had a meeting of all executives and I was sitting with the managers in the back row and he called me to the front and he says, Cliff, will you sign this card right here? And I says, well Mr. Thrash, what is this? He says, well, I'm giving you authority to sign $50,000 anytime you need it to get all the quality we can stand here at Otis Engineering. One of the vice presidents said, well, I don't have that authority. He said, you didn't save me $50 million. You know, but once that happens, Andrew, once you do that, then you've got people that are willing to help you. And then once that takes place, I can't tell you how important, it allowed me then to bring in Lloyd Provost to help me.   0:29:36.2 Cliff Norman: And they weren't about to pay out money. They didn't like consultants, in fact, they were anti-consultant. But you saved us $50 million. I gave you $50,000. And Lloyd doesn't make that much. So get him in here, do whatever you need to go do. And I just think it's so critical that we have that demonstration project that people understand at the leadership level what we're talking about when we talk about design and redesign of the system.   0:30:00.0 Andrew Stotz: Yeah. I mean, I appreciate in the book you're talking about this concept. I'm not going to call it quick wins, but the idea is we need to get results. You know, this isn't just about talking about stuff so that's one thing that as you just illustrated, that's one point. The second thing you mentioned, is this person a leader or a manager? You know, and I think for the listeners or viewers out there, they're probably... When they heard you say that, they're probably thinking. Okay, wait a minute. Are my team managers or leaders? How do I know? What would you say? What differentiates the two?   0:30:37.2 Cliff Norman: I was fortunate to hang around Dr. Maccabee, as Deming did, and I asked Dr. Maccabee that question. He said, Cliff it's actually pretty easy. He said leaders have followers, and if you have followers, you can be anywhere in the organization, be a leader, but if you don't have followers, you're not a leader. You might be a manager with authority. You're not a leader.   0:31:02.7 Andrew Stotz: Can I ask a little bit more on that? So I'm thinking about my own business, which is a coffee factory, and I have people that are running the business, but I also have people that are running departments like the roasting department. And that area when they're overseeing this and they're doing a very good job and they're keeping things up and all that. How do I understand in a sense you could say, are they followers? Well, not really. They're people working for them and they have a good time and so do I view that person as not necessarily a leader, but more of a manager, or how do I look at it in my own company?   0:31:35.5 Cliff Norman: It could be a manager, which is essential to the organization. And that's another big difference. You see, the leader can't delegate their relationship with the people who are followers. You can't do that any more than a teacher can dedicate her class to a substitute teacher. Anybody that's ever watched that knows that chaos is getting ready to break out here because that teacher has a relationship with those students. She knows them all in a big way. And when the substitute comes in is game time in most classrooms and so forth, the managers have skills and things that they're applying and they can actually delegate those. Like when I was a foreman, I could have somebody come in and take over my department and I say assign all my people tomorrow. And they could do that. Now, in terms of the people that I was leading that saw me as a leader in that department, they didn't have that relationship.   0:32:30.2 Cliff Norman: But management or skills and necessary things to make the organization run like you're talking about, the coffee is not going to get out the door unless I have people with subject matter knowledge and competent managers to make sure that the T's are getting crossed, the I's dotted and the rest of it. But the leadership of the organization that has followers, that's a whole different person. And I think it's important. That could be anywhere in the organization. Like I had at Halliburton, I had a VP of engineering. Everybody went to him, everybody. He had 110 patents. You know, he built that system. He built the whole organization. So the CEO did not have the followers that the VP of engineering had. And it was well earned. It's always earned, too.   0:33:16.7 Andrew Stotz: Yeah. Okay, that's great. Leaders have followers. Leaders cannot delegate their authority. They have a different relationship.   0:33:24.0 Cliff Norman: They can't delegate the relationship.   0:33:25.8 Andrew Stotz: The relationship. Okay.   0:33:27.4 Cliff Norman: Yeah. Very important.   0:33:34.3 Andrew Stotz: So now let's go back to what, where we were. So we were saying some of the considerations. Are we ready to change? Are we prepared to devote the time and energy? Are we ready to get outside help and where are we now? And that self assessment that you talked about helps us to understand what's our starting point. I always tell a joke with my students about this when I talk about. I'd say, imagine you go to London and you're going to go visit your friend and you call your friend up, you say, I've arrived and I'm calling from a phone booth and just tell me how to get there. And the friend says, well, where are you? And you say, I'm not really sure. Well, do you see anything around you? Yeah, well, there's lots of buildings, but I don't really, you know. Well, do you see any names of any streets? No, I don't really see anything. But just tell me how to get there. There's something missing. If we don't know where we are, it's very difficult to get to where we're going. So now we understand where we are. We got that scatter plot that you guys have that you've talked about. Dave, where do we go next?   0:34:26.6 Dave Williams: Well, so Cliff already mentioned one of the fundamentals. And sometimes I think this is something that people struggle with because they want to jump into something new. But one of the best starting points is to focus in on improvement. And there's a number of different reasons for that. So one is that I don't know about you all, but in my experience, if I ask people, like, hey, I want to create some improvement projects and get started on improvement, I always tell people, like, if you remember the old Stephen Covey exercise where he put the rocks and the stones and the sand into a jar and poured water. And like you would do it in different orders. And I'm fascinated that people will stare at the big rocks or the things that are right in front of them, or the things that are on their agenda, or the things that are part of their strategy. And then they'll look to the side and grab some rare event or some extra thing that isn't related to that, but they've always wanted to work on. And where we try to focus people's attention is one, what are you already working on? Can you look through your and ask around, what are the things that are currently in play, projects that exist? And sometimes we won't ask, what improvement projects do you have? Because if you do that, you get a short list.   0:35:51.4 Dave Williams: Those are the things that people defined as an improvement effort, or maybe use some kind of framing to decide it was an improvement project. It may be better to in the beginning of the book, in the first chapter, we talk about different ways that you improve. And there's designing and redesigning a process. There's designing and redesigning a service or a product. There's changing a whole system. And so it can be useful to say, well, what are we doing in these areas? And that may actually create a bigger list of the various things where people are working on something that's about change to the system that may lend itself to be better activated through firing it up as an improvement project. And then, of course, there's a good chance that any organization, especially if they've done some kind of strategic planning, have some strategic objectives or some strategic priorities which they've committed to or already said, these are the things we're going to work on. So kind of crowdsourcing or bringing those together helps us to potentially find the early portfolio of projects without having to look much further, without having to say, what else do you want to work on.   0:37:07.0 Dave Williams: And then if we've got that, if we've got that list, a second thing that we can do is invite people to use the three questions of the model for improvement and reflect on can you answer these three questions? Do you know what you're trying to accomplish? Do you know how a change will result in improvement? Do you know what changes you'll make? What's your theory about how you'll get to improvement? And so having a list of the things that are already present or existing may be one first step. Another second step in the firing up a portfolio of improvement projects is asking the three questions for the model for improvement. And then a third one, if it's an active project is we have a project progress scale that you might use that can help you gauge. So I've got a project where is it on its journey towards achieving its aim or getting results? Those three can help us to sort of get a sense of the work that is at hand and that has already been sort of started in some fashion that is already in progress and maybe to get a sense of the level of definition and the progress that exists.   0:38:22.3 Dave Williams: They may not be the right projects, but that's a good place to start before trying to create new ones. And I'll hand it to you, Andrew.   0:38:30.4 Andrew Stotz: I find that interesting. Both the story that you told Cliff about fix my raw material problem and then, Dave, what you're talking about is as you talk in the book, focus first on improvement. What are we already working on? What's an improvement project we've got? What's a problem we've got? Because a lot of times, let's say in the teachings of Dr. Deming, it's like, no, get your mind right, read this stuff, read this, figure this out, think about this, go to a seminar, talk to other people before you do anything. I feel like that is oftentimes where people get caught is they get caught up in, I need a year to think about this. And can you explain a little bit more about why once we've done our self assessment and we're ready to go, that you focus on improvement rather than the thinking process?   0:39:21.7 Dave Williams: Well, because we want to... Well, one, we know that in order to get results or to get a different result than what we want, we got to change the system that we got. Right. So in order to do that, we've got to do improvement. The other thing is that there's already energy that's being expended here.   0:39:41.4 Andrew Stotz: That's a good point.   0:39:42.7 Dave Williams: The risk that often I find people run into is that they then add other projects that are not strategic into that bucket and take up more energy. I'll tell you an example. I was working with the health system here in the States and we crowdsource just the things that they were calling improvement projects. The health system had 25 active teams that were just the ones that were called out as improvement projects. When we looked at those 25 teams, the vast majority of them were not actually... They had been meeting for months and doing things for quite some time, but they actually weren't doing any changes and, or they've been testing changes for quite some time. So, now just this exercise alone by only asking, what improvement projects do you have? You realize you've got 25 teams that have been resourced or are spending energy or going to meetings or focused on something. They may not be the strategic thing that matters, but that's irrelevant right now. We just know that we already have invested some interest here. The second thing is these folks have been on this journey for quite some time and are not making progress.   0:41:01.7 Dave Williams: So that tells me something about maybe the way that they framed it. Did they charter it well? Did they have the right people in the room or the right team? Did they have the right tools and methods to be able to break down the problem and then figure out what to test and learn? So there may be some difficulty...   0:41:19.4 Andrew Stotz: Or did they even just dissipate their efforts across 25 projects too? Right in their resources, yeah.   0:41:26.1 Dave Williams: Yeah. Or there are overlaps? So there's a number of different factors. There's actually a paper that was published by a health system in the United Kingdom, and it was really interesting. They spent a lot of attention on generating will through training and getting people in the classroom and teaching them about improvement methods. And they fired up all this energy. They had a massive explosion of the number of projects that were started or where somebody went into their software. They had a software platform. Anybody could go and start a project. Well, something like 50% of those projects never actually got to PDSA testing where they changed anything. And then there were a slew of them that were stuck in PDSA testing but never saw any movement in their process measures or their outcome measures. And only a small number actually progressed in achieving their aim. And I asked the Chief Quality Officer about this, and and he admittedly said that it was very exciting that we we're generating will and getting things going, but that alone was only getting them to maybe some early design and some thinking, but they weren't getting them to results.                                                                         0:42:34.8 Dave Williams: And I said, well, what about the ones that were getting results? And he said, well, those are actually ones where we've got an improvement advisor who's got some skills and ability and improvement. There are things that are resourced, there are things that were prioritized. And man, when we did all those things, they moved from planning and organizing and thinking to testing changes and moving in a direction of goodness and getting at least results in their process measures, if not their outcome measures. And so in my mind, I was like, I appreciate you're trying to build this sort of culture, but it felt like a lot of burnt energy at the front end with all these teams getting into training and firing up their software and more energy might have been strategic in copying what was getting to results. And I think that's part of what we're trying to get to, is helping people learn. You've got if you don't have a method to figure out strategic projects, let's look at the ones you got. How are they going? Where are people at? And how effective is the capability that you have within your system right now? And the leaders want to be part of that, and they can learn within that to go, oh, wow, this is our current state.   0:43:47.2 Dave Williams: And so maybe we're going to agree to continue on with these projects. Maybe we're going to sunset some of them, but we're going to learn together about how do we get better at getting better, and how do we learn how to move projects forward and not to have them take two years. Let's try to get them down to four or six months, whether that's through scope or execution. But let's get better at getting better. And then as we're building... Developing the early activities of QOS, we'll eventually get to a point where we'll also be able to identify more strategic projects that are going to move us towards our aim or towards our purpose better. And this will help us as we're trying to build the capability to get there.   0:44:32.7 Cliff Norman: You know, Andrew, early on, when Dave went down this path, he said that we got to make sure that somebody's working on improvement. They're actually making changes. And Jane and I were working with a group, and the CEO said they've been meeting a long time. Could you down there and see what they're doing? Because nothing's happening. And we started looking through their agendas and they had everything well documented, and it was all about getting ready to get ready. And then they'd assign the dessert. Who's going to bring the dessert to the next meeting. And Jane looked at him and says this reminds me of something, Cliff. I said, what's that? Can I share my screen?   0:45:10.9 Andrew Stotz: Yeah. Yep, go ahead.   0:45:13.7 Cliff Norman: I may send this to. You may know about it, but this is Dr. Deming's Diary of a Cat. And everyday...   0:45:20.6 Andrew Stotz: It hasn't come up yet. Hold on one second. Hopefully you've got permission now.   0:45:28.6 Cliff Norman: Let me go back and check here.   0:45:33.9 Andrew Stotz: Okay. It looks like it's coming up. One second.   0:45:38.4 Cliff Norman: It said every day is today. There's no theory days of the week. But today I got up some food in a bowl, it was great. Slept some too. Play with yarn, got some food in a bowl, had a good nap, slept, food, yarn, fun. Play with a shoelace. There's a big change right there. Went from yarn to a shoelace. Some people call that a job shop. And ate, slept, had a good day, slept, ate some food, yarn, so forth. So, and the team meeting looked just like that. But there's really no changes going on relative to improvement. So Dr. Deming would often share this into four days seminar to make sure that we weren't involved in the Diary of the Cat, but we were actually doing something useful in terms of making changes in the organization.   0:46:24.4 Andrew Stotz: That's a great one. And it helps us to understand that we could be busy all day long and not improve anything.   0:46:31.8 Cliff Norman: You know, or actually confuse that with improvement. In fact, we have an operational API that my team, we were embarrassed in our first, wait a second, our first improvement guide we wrote. And Dr. Adamir Pente, who's a professor at the university in Brazil, he sent us a note and he said, I know you guys and he said you're real big on operational definitions, but you've written this book on improvement and nowhere have you, you've defined what you mean by improvement. And then he put together a three part definition that there's a design and redesign system, there's system measures and the change is sustainable and lasting and so we put that definition in the second edition. But I was confronted at a university, I won't mention which one it was, but they had 30 Keystone projects for a advanced degree program for nursing and they were convinced they were doing improvement. And when I had them apply that definition, they came up out of the thirty. They only could find two projects out of the 30 where they were actually designing and redesigning the system, which, that's the first thing Dave said are we designing and redesigning and making real changes? And people think just showing up and going through motions and all the rest of it is improvement. No, it means...   0:48:07.8 Dave Williams: Looks like we've lost...   0:48:11.9 Andrew Stotz: We lost you at the last, the last statement you just made. People are going through all this stuff and thinking that they're improving, but they're...   0:48:22.8 Cliff Norman: Yeah, it's showing up and going through motions and you know, having the meetings and making sure we assign who's bringing dessert. But we're not really designing and changing the system. We're not getting measurable changes of improvement. In other words, we haven't tracked the data over time and we can't say that the changes that we've made are going to in fact be sustainable because we haven't known what we've done to the system to deserve a sustainable change.   0:48:51.4 Andrew Stotz: By the way, what a buzzword these days, sustainability, sustainable and all that. And you just think do people really think about how we're building something that's really lasting and sustainable?   0:49:04.8 Cliff Norman: Well, we have a checklist and actually Jane designed it for the first edition and it literally lays out what changes did you make, which processes did you change, what's going to change in the documentation, whose role statements have been changed in the organization because of this change. And once all that's answered on that checklist, which is in the book, then we can... But we're pretty certain that we've created the structure to make it easy for people to do the right thing and hard to do the wrong thing. But unless that structure's changed, probably not much going to happen.   0:49:40.8 Andrew Stotz: Just for the sake of time, because I think we want to wrap up in just a bit. But there's so many stuff, so much stuff that we've been through. But I know there's even more in this chapter, but how would you start to bring this together for the person who is a leader, himself or herself, and they're listening to this and they're thinking, okay, I'm ready to make a change and I'm prepared to devote the time and energy because I see the outcome and I'm open to help, whether that's through the book and other books, whether that's through a consultant, whatever that is. And I can even do a self assessment to some extent and know where our level is, which is very low. We don't know much about this type of stuff and that type of thing. We talked about the first focus on improvement. How do they pull this all together and start moving on it?   0:50:35.0 Dave Williams: There's three things that follow the self assessment. The first one is this focus on doing improvement work and setting up a portfolio of projects. And we just kind of talked about many of the different methods that go into that. And like I said, sometimes that when you say that out loud, leaders don't initially get excited by it because they think they have it. But actually it's a powerful opportunity for you to learn about what's currently going on in the organization and about where this opportunity is to reduce a lot of the noise and a lot of the friction that's getting in the way from you getting to results. The second thing that often happens in parallel is that the leaders need to build a learning system where they're going to be able to learn together both about these projects and what these projects are telling them about their organization, about their culture, about their people, and about their capacity to get results, but also that they can start to be learning about the science of improvement and profound knowledge and the activities of QOS that are going to be part of what they're going to work on developing over the course of the first year or two.   0:51:50.6 Dave Williams: And so that typically is, that's making that space and energy. It's a blend of book learning and application and practical. Trying and looking at things within the organization. It's a very applied approach, but it's an ongoing piece of their discovery. And I often argue that this is a real opportunity for leadership because they're going to be able to see their organization in a way that they haven't seen it before. And when we talk about profound knowledge, they're going to gain this profound understanding and expertise about what they're charged with and what they own and what they want to change in a way that they haven't been able to have it before. And so it's a hard work, but rewarding work. And then third is that typically where the, where we invite people to start is to focus in on the first activity, which is to develop or establish or develop their purpose. When this work was initially framed, not everybody was as... Not everybody had a mission, vision and value statement or a purpose statement that wasn't as common, but today people do. But the difference here, and you'll see this in the chapter on purpose, is that organizations that are pursuing quality as an organizational strategy are organizations that are systems that are built to constantly be trying to match a need that exists out in the world.   0:53:34.7 Dave Williams: And so often a learning for people is to step back and have to reflect on, well, what is the need in which we are creating these products and services to match? And if we're creating these things to match the need, how do we understand what's important, what are the quality characteristics that matter? And then how do we define what our mission is in that context? And being able to say, here's why we exist and the need that we're trying to serve, and in what way? And how do we set a vision for where we want to get into the future and what are the tenants or the practical values that exist in our organization, that we want to define how we work together in terms of building in that way. And so purpose is a big focus. It's that clarity of the need, the clarity of the quality characteristics that it takes to match that need. Understanding what are the products and services that we have. I know that sounds a little trivial, but you'd be stunned how hard it is, especially in service organizations, for people to actually describe what it is that they do, what are the actual services.   0:54:54.3 Dave Williams: They might have the name of the service or the class or the whatever, but to actually say this is what we deliver, and then really think about how do I use this as our organization's sort of North Star, our aim, so that everything else that follows is going to be about building a system that produces the results that we want and produces the services that match that need. So going forward, that's going to be very, very important in instructing the direction and instructing the way in which we're going to work as a community of professional people together.   0:55:30.8 Andrew Stotz: So after self assessment, we're talking about focusing on improvement. We're talking about building a learning system, and we're talking about revisiting or establishing or developing our purpose?   0:55:43.3 Cliff Norman: Yeah, I'll just add to what you just said there, Andrew. There's three basic things that have to happen when we start working. Number one is create the habit of improvement. Start improvement right away. Second thing, Dave just went through some detail on building a system of improvement. And Dave called that a learning system, which I thought was interesting because that's what Dr. Maccabee called it when he saw the five activities. Said, these are really methods for building a learning organization. And he said, I've never really seen them before, but this is what will come out of this, which is the essence of what you want. You want people continually learning, as Dr. Deming said, so they can continually improve. But the third thing that has to happen is we have to develop internal capability for them to carry this on, because we're not going to be around with them. We've never advertised. We don't advertise for clients, and we only get word of mouth. And we're only in there to do those three things, get them started on the habit of improvement, start building the system improvement so they can take it over.   0:56:43.4 Cliff Norman: And the third thing, start developing internal capability so they can continue it on into the future. So those three things basically take off on day one. And depending on the organization, I think this is critical. Dave, you asked this question the other day, if the context is such they've got things in front of them are so bad and so challenging that they just need to work on improvement. That's where we're going to be focused. But now if they can chew gum and walk at the same time, we're going to start building the system of improvement. And the first people I want on those initial teams, I want people on there who are going to be future improvement advisors. And more importantly, they perceive them as future leaders in the organization. I don't want a cadre of a whole bunch of improvement advisors. I want leaders in the future who actually understand the science of improvement, understand these methods, so when they go to the next department, the next organization, they can carry this on. So those three things start improving, start building a system of improvement. And the third thing, start developing internal capability. Those have got to take off almost simultaneously, depending on the situation, of course.   0:57:49.8 Andrew Stotz: Well, on that note, that's quite a discussion. I'm so happy that we can have this to go in a little bit deeper into the work that you guys have done. Again, the book is Quality As an Organizational Strategy. I got mine on Amazon and it sent it to me. But I wonder if you have any last words that you'd like to share about what we've talked about today in relation to getting started.   0:58:18.3 Cliff Norman: So, Dave, why don't you talk a little bit about. Because I think this is critical. We've just finished Andrew, the book that's going to be for the people who actually have to build this system. So Dave, just say a few things about that if you would, because you.   0:58:32.0 Dave Williams: About the field guide?   0:58:33.8 Cliff Norman: Yeah.   0:58:35.5 Dave Williams: Yeah. Well, so when this body of work was first created, there was the content of which you see in this book. And then there were also a lot of exercises and methods and applications and examples that existed as well. And it was a pretty thick binder. We have created two volumes. One, the book that you have, which is the description of the theory and the method and gives you some of the tools. And we're now in the process of pulling together what we call the QOS Field Guide, which is a guide that is supporting people that are going down this journey. It follows the same structure as the book, with the exception of the, the Getting started chapter that we had at the end is now at the beginning. And it walks through in great detail various ways in which you leaders and practitioners can approach getting started and building the capacity and then working through each of the activities. And it's equal in size, I mean, it's about the same thickness. But what we tried to do is to give people really pragmatic things to do.   1:00:01.1 Dave Williams: So there are exercises where people are simulating an idea or a concept or a particular piece. There are what we call QOS applications, which are where you're actually taking the theory or the method and applying it to your own organization. There are case studies and things that have been built that might allow you to practice. There's wonderful examples of just about everything from all, from people that we have worked with over the years across multiple different fields, from my background in emergency services and healthcare to education to manufacturing to elevator companies, all kinds of great stuff. And so that will be helpful as people are trying to think about pursuing this journey and working through that first phase of developing QOS and moving into using it. And we're in the stages of having it done to be available later this year.   1:01:08.6 Andrew Stotz: Exciting.   1:01:09.2 Cliff Norman: We've tried to make it useful, Andrew, that the people have to stay overnight with the management and actually get something done and build it without being run off. That everything is there for them to make sure that they make it successfully. That's the thing we kept in mind as we kept writing this second volume.   1:01:25.2 Andrew Stotz: Yeah, I mean, I would say my experience with your guys's writing is that it's applicable.   1:01:34.1 Dave Williams: Well, Andrew, one thing I was going to add on you mentioned a lot of different examples. There are a lot of books in which people tell you a theory, but they don't tell you how to do it. Or they tell you about their own experience, but they don't actually convey the theory. The Quality as an Organizational Strategy book is laying out the theory and the methods of this approach built on the foundations of the science of improvement and profound knowledge and the Deming philosophy. The QOS Field Guide adds to that by giving you the methods and the tools and the things. It doesn't mean that that by itself you can't just go through like it's some kind of self guided tour and all of a sudden magic happens. There's a lot of work and learning and things that have to go into going through that process. But between these two volumes, a leadership team has the tools and methods that put them in position to be able to make this journey.   1:02:41.4 Andrew Stotz: Right. Well, let's wrap it up there. On behalf of everyone, I appreciate Dave and Cliff. All that you're doing and you're sharing with us and taking the time to do that. So from everyone at the Deming Institute, I want to thank you again for joining this and bringing your discussion on these topics. And for listeners, remember to go to deming.org to continue your journey. And you can find this book, Quality as an Organizational Strategy at Amazon and other booksellers. Are there even booksellers these days? I don't even know. They're mainly online these days. So this is your host, Andrew Stotz, and I'm going to leave you with one of my favorite quotes from Dr. Deming, which is "people are entitled to joy in work."  

At a time when health systems are under increasing pressure to improve care delivery models, UMass Memorial Health has reached a significant milestone in its Hospital-at-Home program, admitting its 3,000th patient. This initiative, spearheaded by Dr. Eric Alper, Senior Vice President, Chief Quality Officer, and Chief Clinical Informatics Officer at the health system, is proving […] Source: UMass Memorial Reaches Hospital-at-Home Milestone; Alper Reflects on Program's Keys to Success on healthsystemcio.com - healthsystemCIO.com is the sole online-only publication dedicated to exclusively and comprehensively serving the information needs of healthcare CIOs.

In this episode of Taking the Lead, host Geoffrey Rubin, MD, MBA, FACR, sits down with Robert L. Mittl Jr., MD, FACR, a neuroradiologist at Charlotte Radiology in Charlotte, NC, Chief Quality Officer at US Radiology Specialists, Chair of the US Radiology National Physician Leadership Board, and member of the US Radiology Corporate Board. After graduating from Washington University Medical School in St Louis, he completed an internal medicine residency at Barnes Hospital (Wash U). As a medicine resident in the 1980s he saw the impact of emerging imaging technology on diagnosis and patient care and decided to switch specialties and completed a Diagnostic Radiology residency and Neuroradiology fellowship at the Hospital of the University of Pennsylvania. Dr. Mittl joined Charlotte Radiology (CR) in Charlotte, NC in 1993, serving as Chair of Charlotte Radiology's Physician Operations Committee for 13 years and then President of the group for 10 years. In 2018 he led Charlotte Radiology in founding US Radiology Specialists with Welsh Carson. During his impressive career, Dr. Mittl has played a pivotal role in practice transformation, operational efficiency, and leadership development in private practice radiology and shares his journey from early career uncertainty to leading a large, subspecialized radiology group through technological advancements, organizational growth, and finding the balance between clinical excellence and non-clinical contributions.  From implementing PACS and optimizing workflow to navigating private equity partnerships and practice consolidation, his insights offer valuable lessons for radiologists at all career stages.

Join host Andrew Stotz for a lively conversation with Cliff Norman and Dave Williams, two of the authors of "Quality as an Organizational Strategy." They share stories of Dr. Deming, insights from working with businesses over the years, and the five activities the book is based on. TRANSCRIPT 0:00:02.2 Andrew Stotz: My name is Andrew Stotz, and I'll be your host as we dive deeper into the teachings of Dr. W. Edwards Deming. Today, we have a fantastic opportunity to learn more about a recent book that's been published called "Quality as an Organizational Strategy". And I'd like to welcome Cliff Norman and Dave Williams on the show, two of the three authors. Welcome, guys.   0:00:27.1 Cliff Norman: Thank you. Glad to be here.   0:00:29.4 Dave Williams: Yeah, thanks for having us.   0:00:31.9 Andrew Stotz: Yeah, I've been looking forward to this for a while. I was on LinkedIn originally, and somebody posted it. I don't remember who, the book came out. And I immediately ordered it because I thought to myself, wait, wait, wait a minute. This plugs a gap. And I just wanna start off by going back to Dr. Deming's first Point, which was create constancy of purpose towards improvement of product and service with the aim to become competitive and stay in business and to provide jobs. And all along, as anybody that learned the 14 Points, they knew that this was the concept of the strategy is to continue to improve the product and service in the eyes of the client and in your business. But there was a lot missing. And I felt like your book has started really to fill that gap. So maybe I'll ask Cliff, if you could just explain kind of where does this book come from and why are you bringing it out now?   0:01:34.5 Cliff Norman: That's a really good question, Andrew. The book was originally for the use of both our clients only. So it came into being, the ideas came out of the Deming four day seminar where Dr. Tom Nolan, Ron Moen and Lloyd Provost, Jerry Langley would be working with Dr. Deming. And then at the end of four days, the people who some of who are our clients would come up to us and said, he gave us the theory, but we don't have any methods. And so they took it very seriously and took Dr. Deming's idea of production viewed as a system. And from that, they developed the methods that we're going to discuss called the five activities. And all of our work with this was completely behind the wall of our clients. We didn't advertise. So the only people who became clients were people who would seek us out. So this has been behind the stage since about 1990. And the reason to bring it out now is to make it available beyond our client base. And Dave, I want you to go ahead and add to that because you're the ones that insisted that this get done. So add to that if you would.   [laughter]   0:02:53.0 Dave Williams: Well, thanks, Cliff. Actually, I often joke at Cliff. So one thing to know, Cliff and Lloyd and I all had a home base of Austin, Texas. And I met them about 15 years ago when I was in my own journey of, I had been a chief quality officer of an ambulance system and was interested in much of the work that API, Associates of Process Improvement, had been doing with folks in the healthcare sector. And I reached out to Cliff and Lloyd because they were in Austin and they were kind enough, as they have been over many years, to welcome me to have coffee and talk about what I was trying to learn and where my interests were and to learn from their work. And over the last 15 years, I've had a great benefit of learning from the experience and methods that API has been using with organizations around the world, built on the shoulders of the theories from Dr. Deming. And one of those that was in the Improvement Guide, one of the foundational texts that we use a lot in improvement project work that API wrote was, if you go into the back, there is a chapter, and Cliff, correct me if I'm wrong, I think it's chapter 13 in this current edition on creating value.   0:04:34.3 Dave Williams: In there, there was some description of kind of a structure or a system of activities that would be used to pursue qualities and organizational strategy. I later learned that this was built on a guide that was used that had been sort of semi self-published to be able to use with clients. And the more that I dove into it, the more that I really valued the way in which it had been framed, but also how, as you mentioned at the start, it provided methods in a place where I felt like there was a gap in what I saw in organizations that I was working with or that I had been involved in. And so back in 2020, when things were shut down initially during the beginning of the pandemic, I approached Lloyd and Cliff and I said, I'd love to help in any way that I can to try to bring this work forward and modernize it. And I say modernize it, not necessarily in terms of changing it, but updating the material from its last update into today's context and examples and make it available for folks through traditional bookstores and other venues.   0:05:58.9 Andrew Stotz: And I have that The Improvement Guide, which is also a very impressive book that helps us to think about how are we improving. And as you said, the, that chapter that you were talking about, 13, I believe it was, yeah, making the improvement of value a business strategy and talking about that. So, Cliff, could you just go back in time for those people that don't know you in the Deming world, I'm sure most people do, but for those people that don't know, maybe you could just talk about your first interactions with Dr. Deming and the teachings of that and what sparked your interest and also what made you think, okay, I wanna keep expanding on this.   0:06:40.0 Cliff Norman: Yeah. So I was raised in Southern California and of course, like many others, I'm rather horrified by what's going on out there right now with fires. That's an area I was raised in. And so I moved to Texas in '79, went to work for Halliburton. And they had an NBC White Paper called, "If Japan Can, Why Can't We?", and our CEO, Mr. Purvis Thrash, he saw that. And I was working in the quality area at that time. And he asked me to go to one of Deming's seminars that was held in Crystal City, actually February of 1982. And I got down there early and got a place up front. And they sent along with me an RD manager to keep an eye on me, 'cause I was newly from California into Texas. And so anyway, we're both sitting there. And so I forgot something. So I ran up stairs in the Sheraton Crystal City Hotel there. And I was coming down and lo and behold, next floor down, Dr. Deming gets on and two ladies are holding him up. And they get in the elevator there and he sees this George Washington University badge and he kind of comes over, even while the elevator was going down and picks it up and looks it up real close to his face. And then he just backs up and leans, holds onto the railing and he says, Mr. Norman, what I'm getting ready to tell you today will haunt you for the rest of your life.   0:08:11.8 Cliff Norman: And that came true. And of course, I was 29 at the time and was a certified quality engineer and knew all things about the science of quality. And I couldn't imagine what he would tell me that would haunt me for the rest of my life, but it did. And then the next thing he told me, he said, as young as you are, if you're not learning from somebody that you're working for, you ought to think about getting a new boss. And that's some of the best advice I've ever gotten. I mean, the hanging around smart people is a great thing to do. And I've been gifted with that with API. And so that's how I met him. And then, of course, when I joined API, I ended up going to several seminars to support Lloyd Provost and Tom Nolan and Ron Moen and Jerry as the various seminars were given. And Ron Moen, who unfortunately passed away about three years ago, he did 88 of those four day seminars, and he was just like a walking encyclopedia for me. So anytime I had questions on Deming, I could just, he's a phone call away, and I truly miss that right now.   0:09:20.5 Cliff Norman: So when Dave has questions or where this reference come from or whatever, and I got to go do a lot of work, where Ron, he could just recall that for me. So I miss that desperately, but we were busy at that time, by the time I joined API was in '88. And right away, I was introduced to what they had drafted out in terms of the five activities, which is the foundation of the book, along with understanding the science of improvement and the chain reaction that Dr. Deming introduced us to. So the science of improvement is what Dr. Deming called the System of Profound Knowledge. So I was already introduced to all that and was applying that within Halliburton. But QBS, as we called it then, Qualities of Business Strategy was brand new. I mean, it was hot off the press. And right away, I took it and started working with my clients with it. And we were literally walking on the bridge as we were building it. And the lady I'm married to right now, Jane Norman, she was working at Conagra, which is like a $15 billion poultry company that's part of Conagra overall, which is most of the food in your grocery store, about 75% of it. And she did one of the first system linkages that we ever did.   0:10:44.5 Cliff Norman: And since then, she's worked at like four other companies as a VP or COO, and has always applied these ideas. And so a lot of this in the book examples and so forth, comes from her actual application work. And when we'd worked together, she had often introduced me, this is my husband, Cliff, he and his partners, they write books, but some of us actually have to go to work. And then eventually she wrote a book with me with Dr. Maccabee, who is also very closely associated with Dr. Deming. So now she's a co-author. So I was hoping that would stop that, but again, we depend on her for a lot of the examples and contributions and the rest of it that show up in the book. So I hope that answers your question.   0:11:28.2 Andrew Stotz: Yeah, and for people like myself and some of our listeners who have heard Dr. Deming speak and really gotten into his teachings, it makes sense, this is going to haunt you because I always say that, what I read originally... I was 24 when I went to my first Deming seminar. And I went to two two-day seminars and it... My brain was open, I was ready, I didn't have anything really in it about, any fixed methods or anything. So, for me, it just blew my mind, some of the things that he was talking about, like thinking about things in a system I didn't think about that I thought that the way we got to do is narrow things down and get this really tight focus and many other things that I heard. And also as a young, young guy, I was in this room with, I don't know, 500 older gentlemen and ladies, and I sat in the front row and so I would see him kind of call them on the carpet and I would be looking back like, oh, wow, I never saw anybody talk to senior management like that and I was kind of surprised. But for those people that really haven't had any of that experience they're new to Deming, what is it that haunts you? What is... Can you describe what he meant when he was saying that?   0:12:42.9 Cliff Norman: I gotta just add to what you just said because it's such a profound experience. And when you're 29, if most of us, we think we're pretty good shape by that time, the brain's fully developed by age 25, judgment being the last function that develops. And so you're pretty well on your way and then to walk in and have somebody who's 81 years old, start introducing you to things you've never even thought about. The idea of the Chain Reaction that what I was taught as a certified quality engineer through ASQ is I need to do enough inspection, but I didn't need to do too much 'cause I didn't want to raise costs too much. And Dr. Deming brought me up on stage and he said, well, show me that card again. So I had a 105D card, it's up to G now or something. And he said, "well, how does this work?" And I said, "well, it tells me how many samples I got to get." And he says, "you know who invented that." And I said, "no, sir, I thought God did." He said, "no, I know the people that did it. They did it to put people like you out of business. Sit down, young man, you've got a lot to learn." And I thought, wow, and here you are in front of 500 people and this is a public flogging by any stretch.   0:13:56.1 Cliff Norman: And it just went on from there. And so a few years later, I'm up in Valley Forge and I'm working at a class with Lloyd and Tom Nolan and a guy named, I never met before named Jim Imboden. And he's just knock-down brilliant, but they're all working at General Motors at that time. And a lot of the book "Planned Experimentation" came out of their work at Ford and GM and Pontiac and the rest of it. And I mean, it's just an amazing contribution, but I go to dinner with Jim that night. And Jim looks at me across the table and he says, Cliff, how did you feel the day you found out you didn't know anything about business economics or anything else? I said, "you mean the first day of the Deming seminar?" He said, "that's what I'm talking about." And that just... That's how profound that experience is. Because all of a sudden you find out you can improve quality and lower costs at the same time. I'm sorry, most people weren't taught that. They certainly weren't taught that in business school. And so it was a whole transformation in thinking and just the idea of a system. Most of what's going on in the system is related to the system and the way it's constructed. And unfortunately, for most organizations, it's hidden.   0:15:04.2 Cliff Norman: They don't even see it. So when things happen, the first thing that happens is the blame flame. I had a VP I worked for and he'd pulled out his org chart when something went bad and he'd circle. He said, this is old Earl's bailiwick right here. So Cliff, go over and see Earl and I want you to straighten him out. Well, that's how most of it runs. And so the blame flame just takes off. And if you pull the systems map out there and if he had to circle where it showed up, he'd see there were a lot of friends around that that were contributing. And we start to understand the complexity of the issue. But without that view, and Deming insisted on, then you're back to the blame flame.   0:15:45.1 Andrew Stotz: Yeah. And Dave, I see a lot of books on the back on your shelf there about quality and productivity and team and many different things. But maybe you could give us a little background on kind of how how you, besides how you got onto this project and all that. But just where did you come from originally and how did you stumble into the Deming world?   0:16:08.9 Dave Williams: Sure. Well, sadly, I didn't have the pleasure of getting to sit in on a four-day workshop. Deming died in 1993. And at that time, I was working on an ambulance as a street paramedic and going to college to study ambulance system design and how to manage ambulance systems, which was a part of public safety that had sort of grown, especially in the United States in the '60s. And by the time I was joining, it was about 30 years into becoming more of a formalized profession. And I found my way to Austin, Texas, trying to find one of the more professionalized systems to work in and was, worked here as a paramedic for a few years. And then decided I wanted to learn more and started a graduate program. And one of the courses that was taught in the graduate program, this is a graduate program on ambulance management, was on quality. And it was taught by a gentleman who had written a, a guide for ambulance leaders in the United States that was based on the principles and methods of quality that was happening at this time. And it pieced together a number of different common tools and methods like Pareto charts and cause-and-effect diagrams and things like that.   0:17:33.1 Dave Williams: And it mentioned the different leaders like Deming and Juran and Crosby and others. And so that was my first exposure to many of these ideas. And because I was studying a particular type of healthcare delivery system and I was a person who was practicing within it and I was learning about these ideas that the way that you improve a system or make improvement is by changing the system. I was really intrigued and it just worked out at the time. One of the first roles, leadership roles that emerged in my organization was to be the Chief Quality Officer for the organization. And at the time, there were 20 applicants within my organization, but I was the only one that knew anything about any of the foundations of quality improvements. Everybody else applied and showed their understanding of quality from a lived experience perspective or what their own personal definitions of quality were, which was mostly around inspection and quality assurance. I had, and this won't surprise Cliff, but I had a nerdy response that was loaded with references and came from all these different things that I had been exposed to. And they took a chance on me because I was the only one that seemed to have some sense of the background. And I started working and doing...   0:19:10.1 Dave Williams: Improvement within this ambulance system as the kind of the dedicated leader who was supposed to make these changes. And I think one of the things that I learned really quickly is that frequently how improvement efforts were brought to my attention was because there was a problem that I, had been identified, a failure or an error usually attributed to an individual as Cliff pointed out, somebody did something and they were the unfortunate person who happened to kind of raise this issue to others. And if I investigated it all, I often found that there were 20 other people that made the same error, but he was, he or she was the only one that got caught. And so therefore they were called to my office to confess. And when I started to study and look at these different issues, every time I looked at something even though I might be able to attribute the, first instance to a person, I found 20 or more instances where the system would've allowed or did allow somebody else to make a similar error.   0:20:12.6 Dave Williams: We just didn't find it. And it got... And it became somewhat fascinating to me because my colleagues were very much from a, if you work hard and just do your job and just follow the policy then good quality will occur. And nobody seemed to spend any time trying to figure out how to create systems that produce good results or figure out how to look at a system and change it and get better results. And so most of my experience was coming from these, when something bubbled up, I would then get it, and then I'd use some systems thinking and some methods and all of a sudden unpack that there was a lot of variation going on and a lot of errors that could happen, and that the system was built to get results worse than we even knew.   0:21:00.7 Dave Williams: And it was through that journey that I ended up actually becoming involved with the Institute for Healthcare Improvement and learning about what was being done in the healthcare sector, which API at the time were the key advisors to Dr. Don Berwick and the leadership at IHI. And so much of the methodology was there. And actually, that's how I found my way to Cliff. I happened to be at a conference for the Institute for Healthcare Improvement, and there was an advertisement for a program called the Improvement Advisor Professional Development Program, which was an improvement like practitioner project level program that had been developed by API that had been adapted to IHI, and I noticed that Cliff and Lloyd were the faculty, and that they were in my hometown. And that's how I reached out to them and said, hey can we have coffee? And Cliff said, yes. And so...   0:21:53.1 Andrew Stotz: And what was that, what year was that roughly?   0:22:00.3 Dave Williams: That would've been back in 2002 or 2003, somewhere in that vicinity.   0:22:02.0 Andrew Stotz: Hmm. Okay.   0:22:06.8 Dave Williams: Maybe a little bit later.   0:22:06.9 Andrew Stotz: I just for those people that are new to the topic and listening in I always give an example. When I worked at Pepsi... I graduated in 1989 from university with a degree in finance. And I went to work at Pepsi in manufacturing and warehouse in Los Angeles at the Torrance Factory originally, and then in Buena Park. But I remember that my boss told me, he saw that I could work computers at that time, and so I was making charts and graphs just for fun to look at stuff. And he said, yeah, you should go to a one of these Deming seminars. And so he sent me to the one in... At George Washington University back in 1990, I think it was. And but what was happening is we had about a hundred trucks we wanted to get out through a particular gate that we had every single morning. And the longer it took to get those trucks out the longer they're gonna be on LA traffic and on LA roads, so if we can get 'em out at 5:00 AM, fantastic. If we get 'em out at 7:00, we're in trouble. And so they asked me to look at this and I did a lot of studying of it and I was coming for like 4:00 in the morning I'd go up to the roof of the building and I'd look down and watch what was happening. And then finally I'd interview everybody. And then finally the truck drivers just said, look, the loaders mess it up so I gotta open my truck every morning and count everything on it. And I thought, oh, okay.   0:23:23.7 Andrew Stotz: So I'll go to the loaders. And I go, why are you guys messing this up? And then the loaders was like, I didn't mess it up. We didn't have the production run because the production people changed the schedule, and so we didn't have what the guy needed. And so, and oh, yeah, there was a mistake because the production people put the product in the wrong spot, and therefore, I got confused and I put the wrong stuff on by accident. And then I went to the production people and they said, well, no, it's not us. It's the salespeople. They keep putting all this pressure on us to put this through right now, and it's messing up our whole system. And that was the first time in my life where I realized, okay, it's a system. There's interconnected parts here that are interacting, and I had to go back into the system to fix, but the end result was I was able to get a hundred trucks through this gate in about 45 minutes instead of two hours, what we had done before.   0:24:18.8 Andrew Stotz: But it required a huge amount of work of going back and looking at the whole system. So the idea of looking at the science of improvement, as you mentioned, and the System of Profound Knowledge, it's... There's a whole process. Now, I wanna ask the question for the person who gets this book and they dig into it, it's not a small book. I've written some books, but all of 'em are small because I'm just, maybe I just can't get to this point. But this book is a big book, and it's got about 300... More than 300 pages. What's the promise? What are they gonna get from digging into this book? What are they gonna take away? What are they gonna be able to bring to their life and their business that they couldn't have done without really going deeper into this material?   0:24:57.7 Cliff Norman: Dave, go ahead.   0:25:01.4 Dave Williams: Well, I was gonna joke by saying they're gonna get hard work and only half because this is just the theory in the book and many of the... And sort of examples of the method. But we're in the process of preparing a field guide which is a much deeper companion guide loaded with exercises and examples of and more of the methods. So the original guide that that API had developed was actually about an eight... Well, I don't know how many pages it was, but it was a thick three inch binder. This, what you have there is us refining the content part that explains the theory and kind of gets you going. And then we moved all of the exercises and things to the field guide for people that really wanna get serious about it.   0:26:00.3 Dave Williams: And the reason I say hard work is that the one thing that you won't get, and you should probably pass it if this book if you're on Amazon, is you're not gonna get an easy answer. This is, as a matter of fact, one of the things that emerged in our early conversations about was this project worth it? Is to say that this is hard work. It's work that a very few number of leaders who or leadership teams that really want to learn and work hard and get results are gonna embark on. But for those, and many of our clients, I think are representative of that, of those people that say, gosh, I've been working really hard, and I feel like we could do better. I feel like I could make a bigger impact, or I could serve more customers or clients.   0:26:44.0 Dave Williams: And but I am... And I'm in intrigued or inspired or gotten to a certain point with improvement science on my own, but I want to figure out how to be more systematic and more global and holistic at that approach. Then that's what QOS is about. It builds on the shoulders of the other books that you mentioned, like The Improvement Guide which we talked about as being a great book about improvement, and improvement specifically in the context of a project. And other books like The Healthcare Data Guide and the Planned Experimentation, which are also about methods, healthcare Data Guide being about Shewhart charts, and Planned Experimentation being about factorial design. This book is about taking what Cliff described earlier as that... I always say it's that that diagram that people put on a slide and never talk about from Deming of production views as a system and saying, well, how would we do this if this is the model for adopting quality as strategy, what are the methods that help us to do this?   0:28:01.3 Dave Williams: And this book breaks that down into five activities that are built on the shoulders of profound knowledge, built on the shoulders of the science of improvement and provide a structure to be able to initially develop a system, a systems view of your organization, and then build on that by using that system to continually operate and improve that organization over time. So the book describes the activities. The book describes some of the things that go into getting started, including being becoming good at doing results-driven improvement, building a learning system, focusing in on the things that matter to your organization. And then working towards building the structure that you can improve upon. The book creates that foundation. It provides examples from clients and from people that we've worked with so that you can see what the theory looks like in practice get, kind of get a flavor for that. And we hope it builds on the shoulders of other work that I mentioned in the other books that compliment it and provides a starting point for teams that are interested in taking that journey.   0:29:26.5 Andrew Stotz: And Cliff, from your perspective, if somebody had no, I mean, I think, I think the Deming community's gonna really dive in and they're gonna know a lot of this stuff, but is gonna help them take it to the next level. But for someone who never had any real experience with Deming or anything like that, and they stumble upon this interview, this discussion, they hear about this book, can they get started right away with what's in this book? Or do they have to go back to foundations?   0:29:49.6 Cliff Norman: No, I think that can definitely get started. There's a lot of learning as you know, Andrew, from going through the four-day to understand things. And I think we've done a pretty good job of integrating what Dr. Deming taught us, as well as going with the methods. And one of the things people would tell him in his four-day seminars is, Dr. Deming, you've given us the theory, but we have no method here. And he said, well, if I have to give you the method, then you'll have to send me your check too. So he expected us to be smart enough to develop the methods. And the API folks did a really good job of translating that into what we call the five activities. So those five activities are to understand the purpose of the organization.   0:30:35.6 Cliff Norman: And a lot of people when they write a purpose, they'll put something up there but it's usually we love all our people. We love our customers even more. If only they didn't spend so much, and we'll come out with something like that and there'll be some pablum that they'll throw up on the wall. Well, this actually has some structure to it to get to Deming's ideas. And the first thing is let's try to understand what business we're in and what need we're serving in society that drives customers to us. So that word is used not need coming from customers, but what is it that drives them to us so we can understand that? And then the second part of that purpose needs to define the mainstay, the core processes, the delivery systems that relate directly to customers. And just those two ideas alone, just in the first activity of purpose, most people haven't thought about those ideas.   0:31:27.8 Cliff Norman: And can somebody pick up this book and do that? Yes. And that will answer a big challenge from Dr. Deming. Most people don't even know what business they're in, haven't even thought about it. And so that we... That question gets answered here, I think, very thoroughly. In this second activity, which is viewing the organization as a system contains two components that's viewing the organization as a system. And that's difficult to do, and a lot of people really don't see the need for it. Jane Norman reminded Dave and I on a call we did last week, that when you talk about a systems map with people, just ask 'em how do they know what's going on inside other organizations, other departments within their organization? How do they know that? And most of us are so siloed.   0:32:11.2 Cliff Norman: Somebody over here is doing the best job they can in department X, and meanwhile, department Y doesn't know anything about it. And then three months later the improvement shows up and all of a sudden there's problems now in department Y. Well, somebody who's focused on the organization as a system and sees how those processes are related when somebody comes to a management meeting said, well, we've just made a change here, and this is gonna show up over here in about three months, and you need to be prepared for that. Andrew, that conversation never takes place. So the idea of having the systems map and this book can help you get started on that. The second book that Dave was just talking about, there are more replete examples in there. I mean, we've got six case studies from clients in there than the practitioners and people who actually are gonna be doing this work.   0:33:01.7 Cliff Norman: That's gonna be absolutely... They're gonna need that field guide. And I think that's where Dave was coming from. The third activity is the information activity, how are we learning from outside the organization and how do we get feedback and research into the development of new products and services and the rest of it? And so we provided a system there. In fact, Dave took a lead on that chapter, and we've got several inputs there that have to be defined. And people just thinking through that and understanding that is huge. When Dr. Deming went to Japan in 1950, he was there to do the census to see how many Japanese were left after World War II. And then he got an invitation to come and talk to the top 50 industrialists. And he started asking questions and people from the Bank of Tokyo over there and all the rest of it.   0:33:52.4 Cliff Norman: And Dr. Deming says, well, do you have any problems? And they said, what do you mean? He says, well, do customers call up and complain? And he said, yes. And he says, well, do you have any data? And he said, no. He says, but if they complain, we give them a Geisha calendar. And then Dr. Deming says, well, how many Geisha calendars have you given out? So it's like, in 1991, I'm sitting here talking to a food company and I asked him, I said, well, you get customer complaints? Oh yeah. Do you have any data on it? No, but we give 'em a cookbook. I said, well, how many cookbooks are you giving out? So I was right back to where Deming was in 1950, so having the information activity, that third activity critical so that we're being proactive with it and not just reactive.   0:34:43.7 Cliff Norman: And so I think people can read through that and say, well, what are we doing right now? Well, I guess we're not doing this and move on. Then the fourth activity is absolutely critical. This is where you know that you've arrived, because now you're going to integrate not only the plan to operate, but a plan to improve. That becomes the business plan. For most people in business plan they do a strategy, and then they have a bunch of sub strategies, and they vote on what's important, and they do some other things, and then a year later they come back and revisit it. Well, what happens here is there's some strategic objectives that are laid out, and then immediately it comes down to, okay, what's gonna be designed and redesigned in this system? Which processes, products and services are gonna be designed? 'Cause we can all see it now, Andrew.   0:35:31.6 Andrew Stotz: Mm.   0:35:31.6 Cliff Norman: We can, it's right in front of us. So it's really easy to see at this point, and now we can start to prioritize and make that happen on purpose. As an example when Jane was a vice president at Conagra, they came up with five strategic objectives. Then they made a bunch of promises to corporate about what they were gonna do and when they were going to achieve it. When she laid out the systems map for them, they were horrified that over 30% of the processes that they needed to be having precooked meat didn't even exist. They were gonna have to be designed. And so Jane and I sat there and looking at 'em and said, well, if you'd had this map before you made the promises, would you have made those promises? No, no, we're in trouble right now. I gotta go back to the CEO of the holding company and tell 'em we're not gonna make it.   0:36:22.4 Cliff Norman: But there's a whole bunch of people that sit around in goal settings. We're gonna do this by when and have no idea about what they're talking about. So that's a little bit dangerous here. And then the fifth activity, it's probably the most important. And where I want people to start, I actually want 'em to start on the fifth activity, which is managing individual improvement activities, team activities. And what I mean by that is, nothing can hold you up from starting today on making an improvement and use the model for improvement. The three basic questions, you can write that on an envelope and apply it to a project and start right away. Because learning the habit of improvement, and when you identify, and this is typical in the planning process, again, a chapter that Dave took a lead on in the planning chapter.   0:37:03.8 Cliff Norman: When you lay that out, you're gonna come up with three to five strategic objectives, but that's gonna produce anywhere between 15 and 20 improvement efforts. And when people start three improvement efforts, and they see how difficult that is to traffic through an organization, particularly if you have a systems map, makes it a lot easier. If you don't have that, then there's all sorts of things that happen to you.   0:37:21.3 Andrew Stotz: Hmm.   0:37:22.8 Cliff Norman: But the, the idea of that all coming together is critical. And where you... Where that really shows up for the reader here is in chapter one. So Lloyd Provost took a lead on chapter one. If you read chapter one, you got a pretty good idea of what's gonna happen in the rest of the book. But more importantly, in that book, in chapter one, there's a survey at the end. And every time we give this out to people, they feel real bad.   0:37:48.1 Cliff Norman: And well, Cliff, any, on a scale of one to 10, we only came up with a four. Well, what I would tell 'em is, if you can come up with a four, you're pretty good. And those fundamentals have to be in place. In other words, the management needs to trust each other. There are certain things that have to be in place before you can even think about skating backwards here. And quality as an organizational strategy is all about skating backwards. The people who don't have the fundamentals can't even start to think about that.   0:38:15.0 Cliff Norman: So that survey and the gap between where they are at a four and where they're going to be at a 10, we've integrated throughout the whole book. So as you're reading through the whole book, you're seeing that gap, and then you have a good plan forward as to what do I need to do to get to be a six, an eight, and what do I need to do to finally arrive at a 10? Dave, why don't you add to what I just said there, and I gotta turn on a light here, I think.   0:38:39.2 Dave Williams: Well, I think one of the things that, and Cliff has probably been the one that has helped me appreciate this to the biggest degree is the role in which improvement plays in quality as an organizational strategy. So, I mean, I think in general, in our world, improvement is seen as kind of like a given, but in our case, what we've found is that many times people are not working on the things right in front of them or the problems in which they have, that they are on the hook... I like to say, are on the hook to get accomplished right now. And like Cliff mentioned, many of my clients when I engage with them, I say, well, what have you promised this year? And they'll give me a list and I'll say, well, okay, what are you working on to improve? And they'll be working on projects that are not related to that list of things that they've got to affect. And so usually that's a first pivot is to say, well, let's think about what are the things that you're working on or should be working on that are either designing or redesigning your system to achieve these strategic objectives.   0:39:48.8 Dave Williams: And the reason to put the attention on that fifth activity and get people working on improvement, there's a good chance that the improvement capability within the organization currently isn't to the level that you need it, where you can get results-driven projects happening at a clip that will enable you to chip away at 20 projects versus four in a year. And that it's not well integrated into the leadership, into the support structures that you have. In addition, if you're trying to use improvement on things that you're on the hook for, and Cliff noted, especially if you've got a system map while you're on that journey, you're gonna start to pick up on where the disconnects are. Similar to your example, Andrew, where you were describing your experience working backwards in the process, you're going to start to recognize, oh, I'm working on this, but it's linked to these other things. Or in order for me to do this, I need that. Or... And so that amplifies the project to be kind of just a vehicle to appreciate other things that are interconnected, that are important in improving our work together.   0:41:05.1 Dave Williams: And so I think that that's a critical piece. I mean, I sometimes describe it as the disappointment that people have when they open QOS because they want to have a new method or a new thing to work on. I said, well, there's a lot new in here. And at the same time, we want to build on the shoulders of the fundamentals. We want to build it because it's the fundamentals that are going to be able for you to activate the things that are necessary in order for you to skate backwards, like Cliff was describing earlier.   0:41:36.2 Cliff Norman: I got to add to what Dave was saying because this actually happened to me with a... I'm not going to mention the name of the company, but it's a high-tech companies worldwide. And we got up, a good friend of mine, Bruce Bowles, and we were introducing the idea of quality as an organizational strategy. And one of the guys in the front row, he says, Cliff, this just sounds like common sense, why aren't we all doing this? I said, that's a real good question. Let me put that in the parking lot here. So I put it up on a flip chart. And so we went through the idea of... We were working on Shewhart control charts. And so we showed him one of those. And at the end of all that, he raised his hand and I said, yeah, he says, Cliff, this is hard. I said, well, let me put that up here. This is hard. Then we went through the systems map and he says, look, this is hard. By the end of the two days, it was, this is hard, this is hard, this is hard, this is hard. This goes back to what Dave was saying earlier about once you open this page, there's some work that takes off, but more importantly, there's something new to learn here.   0:42:40.3 Cliff Norman: And that's frustrating to people, especially when they've got to quit doing what they've done in the past. It's what Deming says, you got to give up on the guilt and you got to move forward and transform your own thinking. So there's something here for the management to do. And if they're not willing to do that work, then this is probably not a good thing for them. Just go back to the blame flame and circling org charts and that kind of stuff and then wonder why we're losing money.   0:43:11.8 Andrew Stotz: Yeah, and I think that that's one of the things that we see in the Deming community is that, why are people doing it the way they are, dividing things up and doing KPIs and saying, you take care of that. And we're gonna optimize by focusing on each... We see how that all kind of falls apart.   0:43:27.9 Cliff Norman: It all falls through reductionism.   0:43:29.8 Andrew Stotz: [laughter] Yeah.   0:43:32.5 Cliff Norman: It doesn't understand the system, yeah.   0:43:32.5 Andrew Stotz: Yeah, so what I want to do now is I was just thinking about a book on my shelf called "Competitive Strategy" by Michael Porter. And there's a whole field of study in the area of strategy for businesses. Now you guys use, and you explain a little bit about the way you come up with... Why you come up with organization rather than let's say company as an example. But let's just talk about strategy for a moment. Generally we're taught in business school that there's two main strategies. One is a differentiation strategy. I like to teach my students like Starbucks. It's very differentiated from the old model. And you can have a low cost strategy, which is like McDonald's, where it's all about operational efficiency.   0:44:18.4 Andrew Stotz: And those are two different strategies that can get to the same goal, which is to build a strong and sustainable business that's making a good profit for the employees to get paid well and for shareholders. And so for somebody that understands some of the foundations of typical strategy, it's hard for them to think, wait, wait, wait, what? You're just talking about just better quality is the strategy? How should they frame this concept of quality as a strategy in relation to what we've been taught about low cost and differentiation and other types of strategy? How do we think about this book in relation to that?   0:45:03.2 Cliff Norman: When Deming wrote his book, his very first one of the four "Out of the Crisis", which was the whole idea about quality and competitive position. But he was kind of answering that. And at that time, what we had is we had three companies in the United States that were going at each other, Ford, GM, and Chrysler. And they'd call each other up, well, what are you doing this year? Oh, we're making cars that don't work. Sometimes they break down. That's why we have Mr. Goodwrench to repair them. That's an extra revenue source for us. As one of the executives that are challenged, a colleague of mine, he said, you don't realize how much money we're gonna lose here taking the repair business out because we make a lot of money out of repair. So making cars that don't work has been a good revenue stream for us. Well, all that works out great, until somebody shows up like Toyota that has a car that works and doesn't need to be repaired by Mr. Goodwrench all the time.   0:45:58.8 Cliff Norman: So the mind shift there, and what Dr. Deming was saying is that he was focused on the competition's already licked. And I don't think Porter's thought about that very much, not to be overly critical, because I'm an admirer of his, but the idea of focusing on the need and why is that customer coming to us so that we make a journey, and the Japanese call that being in the Gemba, being in the presence with the customers as they use the product or service and doing the research and the rest of it. And then coming back and then redesign that product or service so that it not only grabs the current customer, but we start thinking about customers that are not even our customers and innovate and actually come up with a design that actually brings new customers to us through products and services that we haven't thought about yet. So if I show you three products just to make a picture of it, we often show like an abacus, which was a hand calculating machine about BC. Then there's a slide rule that came out about the same year that Columbus discovered America. And that was good till about 1968.   0:47:06.0 Cliff Norman: And then the calculator, the handheld calculator came out. Well the need for all three of those products is to do handheld calculations. So we've had that need since BC. Now in 1967, K&E Calculator was making that slide rule, which I used in junior high school. If you'd have come up to me and said, Cliff, what do you need in the way of a better slide rule? I said, well can you get me a holster for it? 'Cause I don't like having to stick me in the face. I put it in my pocket and it sticks me in the face. And if you can give me a holster for that, that would be my view of that. I wasn't about to come up with the TI calculator. That wasn't gonna happen. Not from Cliff. It's gonna come from an engineer at TI. Now, K&E Calculator, if they'd been doing research in the marketplace and saying, is there something that can totally disrupt us going on here? Rather than just looking at figuring out a way to make the K&E slide rule better, they might've discovered that.   0:48:07.0 Cliff Norman: Most people don't do that. They just go back. They just lose their business. And it was interesting in '67, their annual report put out, what's the world gonna look like 100 years from now? So they had dome cities, they had cars flying, they had all sorts of things going on that were great innovations, but they didn't have the TI calculator in there, along with the HP calculator. And that wiped out their business. And so if people understand the need, and that's what Dr. Deming is getting at, he says, they really haven't thought about what business they're in. So why are the customers coming to us? He says, no customer ever asked for pneumatic tire. No customer ever asked for a microwave oven. That came from people with knowledge that were looking at how the customers are using the current products and services and say, now, is there technology innovation going on that we can actually do a better job of providing a better match in the future?   0:48:56.9 Andrew Stotz: And can you explain why you use the word need as opposed to want?   0:49:06.5 Cliff Norman: That's a good question. The idea is that there's a need that's constant in society. So that need of having to do handheld calculations or needing healthcare or to pay bills, that need is constant throughout civilization. And so if I want something that's interesting, that might be the match. That might be something to do with some features what I'm offering and so forth. I'd like to have this, I'd like to have that. But the need and the way we're using that is it doesn't come from customers. It's what drives customers to us. And it's always been there. It's always been there. Need for transportation, for example. Whether you're walking or driving a bicycle or a car or a plane.   0:49:53.6 Andrew Stotz: And Dave, how would you answer the same question when you think about a person running a business and they've had many strategy meetings in their business, they've set their corporate strategy of what we're doing, where we're going and that type of thing. And maybe they've picked, we're gonna be a low cost producer. Thailand's an interesting one because Thailand had a ability to be low cost producers in the past. And then China came along and became the ultimate low cost producer. And all of a sudden, Thai companies had a harder time getting the economies of scale and the like. And now the Chinese manufacturers are just really coming into Thailand, into the Thai market. And now it's like, for a Thai company to become a low cost leader is almost impossible given the scale that China and the skills that they have in that. And so therefore, they're looking at things like I've got to figure out how to get a better brand. I've got to figure out how to differentiate and that type of thing. How does this... How could this help a place like that and a management team that is struggling and stuck and is looking for answers?   0:51:07.0 Dave Williams: Well, I go back to what Cliff said about that many organizations don't pause to ask, why do they exist? What is the need of which they are trying to fulfill? Much of my background involved working in the service industry, initially with public safety and ambulance systems and fire systems, and then later in healthcare and in education. And in many of those environments, especially in places where in public systems where they've been built and they may have existed for a long time, when you ask them about what are they trying to accomplish as an organization or what is it that they... The need that they're trying to fulfill? Typically, they're gonna come back to you with requests or desires or wants or sort of characteristics or outcomes that people say they expect, but they don't pause to ask, like, well, what is the actual thing of which I'm trying to tackle? And Cliff mentioned like, and we actually, I should mention in the book, we have a list of different strategies, different types of strategies, all the different ones that you mentioned, like price and raw material or distribution style or platform or technology.   0:52:30.9 Dave Williams: There's different types of strategies, and the one that we are focusing in on is quality. But I think it's important for people to ask the question. Cliff mentioned transportation. There's a number of different great examples, actually, I think in transportation, where you could look at that as being an ongoing need as Cliff mentioned from the days when there was no technology and we were all on foot to our current day. Transportation has been a need that existed and many different things over time have been created from bicycles, probably one of the most efficient technologies to transport somebody, wheels and carts. And now, and you were referencing, we've made reference to the car industry. It's a fascinating experience going on of the car world and gas versus electric, high technology versus not, autonomous vehicles. There's, and all of them are trying to ask the question of, are there different ways in which I might be able to leverage technology to achieve this need of getting from point A to point B and be more useful and potentially disrupt in the marketplace? And so I think the critical thing initially is to go back and ask and learn and appreciate what is that need?   0:53:58.6 Dave Williams: And then think about your own products and services in relation to that. And I think we include four questions in the book to be able to kind of think about the need. And one of those questions is also, what are other ways in which you could fulfill that need? What are other ways that somebody could get transportation or do learning or to help sort of break you away from just thinking about your own product as well? And that's useful because it's super tied to the system question, right? Of, well, this is the need that we're trying to fulfill and these are the products and services that are matching that need. Then the system that we have is about, we need to build that and design that in order to produce, not only produce the products and services that match that need, but also continually improve that system to either improve those products and services or add or subtract products and services to keep matching the need and keep being competitive or keep being relevant. And maybe if it's not in a competitive environment where you're gonna go out of business, at least be relevant in terms of the city service or community service, government service that continues to be there to match the need of the constituents. So I think it's a really important piece.   0:55:17.0 Dave Williams: It's that North star of saying, providing a direction for everything else. And going back to your original comment or question about strategy, and many times people jump to a strategy or strategies or, and those might be more around particular objectives or outcomes that they're trying to get to. It may not actually be about the method or the approach like cost or technology that they may not even think that way. They may be more thinking about a plan. And I really encourage people to be clear about what they're trying to accomplish and then start to ask, well, how's the system built for that? And later we can bring a process that'll help us learn about our system and learn about closing that gap.   0:56:05.1 Cliff Norman: Yeah. Just what I'd add to that, Andrew, because you mentioned China, a few other countries, but I think the days are coming to an end fairly quickly where somebody can say, oh, we can go to this country. They have low wages, we'll put our plant there and all that. There's a lot of pushback on that, particularly in the United States. And if that's your strategy, that hadn't required a lot of thinking to say the least. But in 1966, over 50% of the countries in the world were, let me rephrase that, over 50% of the population of the world lived in extreme poverty. So there were a lot of targets to pick out where you want to put your manufacturing. And in 2017, and you and Dave were probably like myself, I didn't see this hit the news, but that figure had been reduced from over 50% down to 9%. And all you have to do is just, and I worked in China a lot, they're becoming very affluent. And as they become very affluent, that means wages are going up and all the things that we want to see throughout the world. And I think that's happening on a grand scale right now, but you're also getting a lot of pushback from people when they see the middle class in their own country, like here in the United States, destroyed, and say, I think we've had enough of this. And I think you're gonna see that after January. You're gonna see that take off on steroids.   0:57:31.7 Cliff Norman: And that's gonna happen, and I think throughout the world, people are demanding more, there's gonna have to be more energy, every time a baby is born, the footprints gets bigger for more energy and all the rest of it. So it's gonna be interesting, and I think we are going into an age for the planet where people as Dr. Deming promised that they'd be able to live materially better, and the whole essence of this book is to focus on the quality of the organization and the design and redesign of a system to a better job of matching the need and cause that chain reaction to go off. When Jane and I went over to work in Sweden, Sven Oloff who ran three hospitals and 62 dental clinics there and also managed the cultural activities and young shipping. He said, Cliff, I report to 81 politicians. I don't wanna have to go to them to put a bond on an election to get more money for my healthcare system, I wanna use Dr. Deming's chain reaction here to improve care to the patients in my county and also reduce our costs. A whole bunch of people that don't even believe that's possible in healthcare.   0:58:39.9 Cliff Norman: But that's what Sven Oloff said that's what you're here for. And that's what we proceeded to do, they launched about 350 projects to do just that, and one of their doctors, Dr. Motz [?], he's amazing. We taught him a systems map, I came back two months later, and he had them in his hospital on display. And I said, Motz, how did you do this? He said well Cliff, I'm an endocrinologist by education as a doctor, of course, that's a person who understands internal systems in the body. So he said the systems approach was a natural for me. But I'd like to say it was that easy for everybody else, that systems map idea and as you know, being in the Deming seminar, that's quite a challenge to move from viewing the organization as an org chart, which has been around since Moses father-in-law told him, you need to break up the work here a little bit, and the tens of tens reporting to each other, and then of course, the Romans took that to a grander scale, and so a centurion soldier had 100 other soldiers reporting to him. So we've had org charts long and our federal government took that to a whole new level.   0:59:46.1 Cliff Norman: But the idea is switching off the org chart from biblical times to actually getting it up to Burt [?] about 1935 and understanding a system that's kind of a nose bleed in terms of how much we're traveling there to get us into the 21st century here.   1:00:04.0 Andrew Stotz: And I left Ohio, I grew up outside of Cleveland, and I left Ohio in about 1985, roughly. And it was still a working class, Cleveland had a huge number of jobs and there was factories and all that, and then I went to California, and then I moved to Thailand in 1992. So when I go back to Ohio now, many years later, decades later, it's like a hollowed out place, and I think about what you're saying is... And what's going on in the world right now is that I think there's a desire in America to bring back manufacturing to bring back production and all of that, and that's a very, very hard challenge, particularly if it's gone for a while and the skill sets aren't there, maybe the education system isn't there, I talk a lot with John Dues here on the show about the what's happening in education and it's terrifying.   1:01:05.9 Andrew Stotz: So how could this be... Book be a guide for helping people that are saying, we've got to revitalize American production and manufacturing and some of these foundational businesses and not just services, which are great. How can this book be a guide?   1:01:25.8 Dave Williams: One thing I would say that I think is interesting about our times, many times when I reflect on some of the examples that you just provided, I think about how changes were made in systems without thinking about the whole system together. And there may have been changes at various times that we're pursuing particular strategies or particular approaches, so it may have been the low-cost strategy, it may have been to disrupt a marketplace. And oftentimes, they don't think about... When somebody's pursuing one particular view, they may miss other views that are important to have an holistic perspective. One of the things that I appreciate about QoS in the methods and overall as a holistic view of looking at organizations that it's asking us to really think initially about that North Star, what we're trying to do, our purpose, and what are the tenants. What are the things that are important us, the values...   1:02:38.7 Dave Williams: That are important to us in pursuing that particular purpose? And in doing that, really thinking about how does the system work as it is today, and if we make changes, how does it move in alignment with the values that we have and in the direction that we wanna go? And appreciating, I would say, part of the value of the scientific thinking that is in the Science of Improvement is that it encourages you to try to see what happens and appreciate not only what happens in relation to the direction you're trying to go, but also the... Have a balanced view of looking at the collateral effects of things that you do, and I think that systems do is really important there. So I think from that perspective, the quality as an organizational strategy brings a holistic picture into these organizations, or at least...   1:03:45.1 Dave Williams: To be paying attention to the system that you have, maybe the direction you wanna go, and what happens as you... What are your predictions and what do you see when you study the results of making changes in the direction of the vision that you have. And I think that's at a high level that is one of the ways that I think about it. Cliff, how would you add on there?   1:04:09.1 Cliff Norman: Your question made me think of something that happened about two years ago, Jane and I got a call from a lady that worked for her in one of the chicken plants, and she said, Jane, I had to call you because I need to order some of those Shewhart charts. But what happened today, you should have been here and Jane said, what... She said, Remember that 10 year thing we buried in the ground that we're gonna open up in 10 years, and she said, yeah, said, well, we opened it up today, and the new plant manager was here, and those Shewhart charts came out, and he looked at the costs on them. He said, you were operating at this level? She said, yeah, routinely. And he said what happened? He said, well, they had new management come in and they got rid of the charts, that's the first thing they did, and then gradually they try to manage things like they normally did, and then they forgot everything that we had learned. And that's kind of where we are right now.   1:05:11.0 Cliff Norman: So just think of that a decade goes by, and it just as Dr. Deming said, there's nothing worse than the mobility of management, it's like getting AIDS in the system. And they basically destroyed their ability to run a low-cost operation in an industry that runs on 1 or 2%. And when you watch that happen and understand that we still have food companies in this country, and we have to start there and start looking at the system anew and start thinking about how it can actually cause that chain reaction to take off, and that comes from focusing on quality of the system. And then as Dr. Deming says, anybody that's ever worked for a living knows why costs go down with two words less rework, but instead of people will put in extra departments to handle the rework. Next thing they start building departments to handle...   1:06:01.8 Cliff Norman: The stuff that's not working because the system they don't understand. So that was a... What do they call those things, Dave, where they put them in the ground and pull him out?   1:06:11.0 Dave Williams: Time capsule.   1:06:13.4 Andrew Stotz: Time capsule yeah.   1:06:13.5 Cliff Norman: Yeah. Time capsule. The a 10-year time capsule.   1:06:19.2 Andrew Stotz: It's a great, great story. And a great idea. We had a company in Thailand a very large company that the CEO of it came upon the idea of the teachings of Dr. Deming and over time, as he implemented it in his company, the Japanese Union of Scientists have their prize and his company won that prize and then he had about 10 subsidiary companies that also were doing it and they also won over time. And so Thailand is actually is the second largest recipient of the Japanese Deming Award outside of India. But he left and he retired and another guy took over, a very bright guy and all that, but he threw most of that out and focused on newer methods like KPIs and things like that. And just at the end of last year, maybe six months ago, they reported a pretty significant loss, and I was kind of made me think how we can spend all this time getting the Deming teachings into our business, and then one little change in management and it's done.   1:07:26.9 Andrew Stotz: And that made me think, oh, well, that's the value of the book, in the sense that it's about building the concept of quality as a core part of strategy as opposed to just a tool or a way of thinking that could go out of the company as soon as someone else comes in. Go ahead, Dave.   1:07:41.9 Dave Williams: I was gonna say, Andrew, you raise a point, I think it's really, really important and Cliff mentioned this in terms of the problem of mobility of management. One thing that I don't know that we outline probably in dark enough ink in the book is the critically important piece of leadership, building the structures and the capability. I know we talk a little bit about it, but doing it in a way that both builds up the people that you have... So Cliff emphasiz

In this episode, Laura Dyrda interviews Dr. Rajan Gurunathan, Vice President and Regional Chief Quality Officer at Hackensack Meridian Health, Southern Market. Dr. Gurunathan shares transformative initiatives in patient safety, health equity, and hospital-at-home programs, offering a glimpse into the health system's strategic goals and workforce engagement efforts for 2025.

In this episode, Karen Miller, RN, MS, CPHQ, Chief Quality Officer at BayCare Health Systems, shares her perspectives on succession planning, nurturing growth in future healthcare leaders, and embracing novel ideas from the next generation to ensure organizational success and sustainability.

In this episode, Bernie Adams, Chief Quality Officer at North Country Healthcare, discusses the organization's journey towards system integration, its commitment to high reliability, and key initiatives like barcode scanning and Six Sigma training. He shares insights into the challenges and opportunities of improving healthcare in rural settings, highlighting their goals for 2025, including standardizing medication reconciliation and achieving a 99% barcode scanning rate.

In this episode, Sam sits down with Karly Campbell, Chief Quality Officer at TennCare, Tennessee's Medicaid Agency, to explore how Medicaid is transforming care delivery through value-based care and payment reform. They discuss TennCare's innovative programs, like Patient-Centered Medical Homes and Tennessee Health Link, and dive into the role of social determinants of health and health equity in improving outcomes for vulnerable populations. Karly also shares her vision for the future of Medicaid and healthcare policy, offering practical lessons for leaders navigating the evolving healthcare landscape.

In this episode, Shawn Tittle, MD, Senior Vice President, Chief Quality Officer at Houston Methodist, shares his perspectives on healthcare's evolving landscape. From leveraging AI to improve patient outcomes to addressing challenges like health equity and system standardization, Dr. Tittle emphasizes the importance of innovation, leadership, and a people-first approach in driving quality care.

In this episode, Danielle Scheurer, MD, MSCR - Chief Quality Officer at MUSC Health System, discusses the health system's rapid expansion across South Carolina, innovative telehealth initiatives, and a commitment to addressing social determinants of health. She shares strategies for building community partnerships, tackling healthcare affordability, and evolving as a leader in today's complex healthcare landscape.

In this episode, Catherine Chang, MD, MMM, FCCP - Vice President and Chief Quality Officer, Ambulatory and Clinical Councils at Prisma Health, discusses the health system's continued growth, commitment to quality care, and initiatives to enhance access for patients. She also highlights the challenges of managing healthcare resources, provider demand, and integrating AI into clinical operations while evolving as a leader in an ever-changing landscape.

In this episode, Dr. Edward Juhn, Chief Quality Officer at Inland Empire Health Plan, shares how IEHP is tackling challenges within the Medicaid system through innovative technology, AI-driven solutions, and community-focused initiatives. Discover how IEHP is addressing provider shortages, advancing care quality, and fostering future healthcare leaders to better serve their vulnerable populations.

This episode, recorded live at the Becker's Healthcare 2024 Fall Payer Issues Roundtable, features Edward Juhn, Chief Quality Officer at Inland Empire Health Plan. Edward shares strategies for improving member outcomes, addressing provider shortages, and leveraging technologies like AI and machine learning, all while emphasizing the importance of ethical data stewardship and member-centered care.

David M. Williams, PhD is an internationally respected scholar-practitioner of the Science of Improvement. With 25 years of experience in improvement, he has worked with leaders and teams worldwide to develop people's abilities to make rigorous, results-driven improvements and adopt quality as an organizational strategy. Dr. Williams coauthored Quality as an Organizational Strategy: Building a System of Improvement. His writing on improvement is also found in many books and published papers. Dr. Williams is a former chief quality officer, consultant, and senior leader at the Institute for Healthcare Improvement. He is a lead faculty in IHI's Improvement Advisor Professional Development Program and developed and led IHI's Chief Quality Officer program. He created the Mr. Potato Head and Coin Spin PDSA exercises, which are used worldwide to teach PDSA testing and measurement for improvement.Dr. Williams is a former city paramedic and a subject matter expert on ambulance service system design.Link to claim CME credit: https://www.surveymonkey.com/r/3DXCFW3CME credit is available for up to 3 years after the stated release dateContact CEOD@bmhcc.org if you have any questions about claiming credit.

This episode, recorded live at the Becker's Healthcare 2024 Fall Payer Issues Roundtable, features Edward Juhn, Chief Quality Officer at Inland Empire Health Plan. Edward shares strategies for improving member outcomes, addressing provider shortages, and leveraging technologies like AI and machine learning, all while emphasizing the importance of ethical data stewardship and member-centered care.

Hvis du vil være fremtidens leder – eller i virkeligheden den leder, som de fleste medarbejdere efterspørger for tiden, så er der én superkraft, som trumfer de fleste andre. Det er tillid. Hvis man kan skabe tillid i teamet, så kan det meste andet lade sig gøre. Maja Herold Pedersen er Chief Quality Officer hos Fujifilm Diosynth Biotechnologies, og hun er bedre end de fleste til at skabe tillid i teamet. Det er ikke en evne, hun har læst eller studeret sig til at have, det er nærmere noget, der ligger i hendes natur. Og så er hun ret kompromisløs med det – hun insisterer på at investere i det, der skal til for at tillid opstår. Maja Herold Pedersen leder et team, der kun mødes fysisk fire gange årligt. Resten af tiden sidder teamet spredt rundt om i verden, for virksomheden har fabrikker seks forskellige steder i verden. Det får hende ikke til slippe ambitionerne om at bygge psykologisk tryghed og tillid. Tværtimod, ser hun det som en forudsætning for at kunne lykkes med de ambitioner, de har sat sig for at lykkes med. Lyt med, når vi i podcasten prøver at blive klogere på, hvad det er Maja Herold Pedersen gør for gang på gang at bygge teams med meget stor tillid, psykologisk tryghed og uddelegeret beslutningskraft. Vært: Louise Orbesen  Gæst: Maja Herold Pedersen, Chief Quality Officer hos Fujifilm Diosynth Biotechnologies Podcastredaktør: Kasper SøegaardSee omnystudio.com/listener for privacy information.

In this conversation, Lauren Smith, Chief Quality Officer at OrcaBio, shares her journey into the field of quality assurance, discussing her early career, leadership experiences, and the importance of connecting work to patient outcomes. She emphasizes the challenges and rewards of working in quality assurance, the significance of practical quality, and the need for purpose-driven leadership. Lauren also highlights the importance of employee development, self-awareness, and the impact of pivotal moments in her career.Takeaways:Lauren fell into quality assurance rather than choosing it intentionally.Her early experiences in environmental monitoring were invaluable for her career.Quality roles allow for direct impact on patient safety and product quality.The quality assurance field is constantly evolving and challenging.Lauren values authenticity, integrity, and kindness in her leadership.She emphasizes the importance of connecting work to a greater purpose.Practical quality and team dynamics are crucial for success in quality assurance.Employee development should be tailored to individual goals and needs.Self-awareness is key to effective leadership and personal growth.Lauren believes in leaving a quiet legacy through her interactions with others.For anyone looking to learn about how to hire great people, build a purpose driven culture, and develop their people, this is a great episode to listen to!Thank you Lauren for joining us!Hope everyone enjoys the show!

In this episode, we're diving into the fascinating journey of quality improvement in healthcare—from its humble beginnings in the 1800s to the cutting-edge strategies shaping its future. Join Dr. Michael Calderwood, Chief Quality Officer at Dartmouth Hitchcock Medical Center, as he uncover the stories of groundbreaking pioneers like Florence Nightingale and Ignaz Semmelweis and connect their legacies to today's tools like Lean Six Sigma, the Model for Improvement, and the emerging role of AI in transforming care. But this isn't just a history lesson. We'll explore real-world applications and actionable insights for anyone passionate about improving healthcare quality and safety. Whether you're a seasoned healthcare professional, a curious student, or just someone intrigued by how systems evolve, this episode will inspire you to think differently about making a lasting impact. Stay tuned to learn why quality improvement is an infinite game and how we can all contribute to better care for the future. Hit play, and let's get started!

In this episode, Dr. Ryan Nicholas, Chief Quality Officer at Mercy Medical Group, part of CommonSpirit Health, discusses how his team is integrating AI while safeguarding patient data, navigating payer-provider complexities, and preparing for a future focused on value-based care and workforce flexibility.In collaboration with R1 (https://www.r1rcm.com/)

In this edition of Lessons in Leadership, Steve Adubato and Mary Gamba are joined by Andy Anderson, MD, MBA, Chief Medical Officer and Chief Quality Officer, RWJBarnabas Health, talking about the keys to leading quality efforts in healthcare and creating a culture of coaching, mentoring and wellness on your team. Then, Steve and Mary share … Continue reading Lessons in Leadership: Andy Anderson, MD, MBA and “Don't Sweat the Q&A” Mini-seminar

Join Dr. Seth Kaufman, Chief Medical Officer and Chief Quality Officer at NorthBay Health, as he discusses the health system's innovative efforts to ensure equitable access to care in Solano County. From new clinic expansions to addressing social determinants of health, Dr. Kaufman shares how NorthBay is breaking barriers to provide high-quality care for one of the most diverse communities in the nation.

In this episode, Mark Fellin, Chief Quality Officer at Melissa & Doug, discusses his career journey from politics to quality assurance in the toy industry, emphasizing the importance of support networks and mentorship. He highlights the unique challenges of ensuring product safety and quality in wooden toys, and the importance of regulations in maintaining standards. Mark shares personal anecdotes about his family and work-life balance, emphasizing joy and creativity in his role. He also discusses the importance of engaging and supporting team members and the fulfillment that comes from seeing the positive impact of one's work.   Episode Highlights: 01:12 Meet Mark Fellin: Quality Leader at Melissa and Doug 02:28 Mark Fellin's Career Journey 04:46 Balancing Work and Family 08:16 The Toy Industry and Product Safety 22:34 Leadership Insights and Challenges   Mark S. Fellin is a seasoned leader in Quality Engineering, Compliance, and Safety, currently heading these efforts at Melissa & Doug. With a focus on enhancing product performance and integrity, Mark's work ensures a superior consumer experience. Before joining Melissa & Doug, he led global product safety teams at Amazon, where he also spearheaded regulatory and compliance initiatives. Mark's extensive career spans roles in retail, manufacturing, and government, including positions at the Juvenile Products Manufacturers Association and the U.S. Consumer Product Safety Commission. He holds degrees in Politics, Theology, and Strategic Public Relations, and lives in Alexandria, VA with his family.   Connect with Mark: Website: www.melissaanddoug.comLinkedIn: https://www.linkedin.com/in/markfellin/   For more insights: Follow me on my YouTube Channel: https://bit.ly/47GgMdn  Sign up for my Weekly Newsletter:  https://bit.ly/3T09kVc Sign up for my LinkedIn Newsletter: https://bit.ly/49SmRV3 See omnystudio.com/listener for privacy information.

Host Dr. Joshua Liu, Co-founder & CEO of SeamlessMD, and marketing colleague, Alan Sardana, chat with Dr. Eric Alper, VP, Chief Quality Officer and Chief Clinical Informatics Officer at UMass Memorial Health Care, about "Strategies for Scaling Hospital at Home, Exploring the Intersection of Informatics and Quality, How Incentives Drive Patient Care, and more." Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

The scope, scale and timeline of what California is trying to do with CalAIM is truly breathtaking. It's been almost a year-and-a-half since the launch of the program and Dr. Palav Babaria joins us to discuss how it's going and what comes next. Dr. Babaria is a primary care physician who leads quality and population health management for California's Medicaid program - Medi-Cal. We discuss:Which community supports are used most, or least? One of the big learnings from CalAIM: the enhanced care management models that work for adults dont work for childrenHow Medi-Cal is leveraging health plans as the organizers of social care because that's where the members areThe soon-to-be-released population health management service will address two big issues: standardized and equitable approaches to identifying high risk members and integrating state level benefits data, like for WIC Palav reminds us that CalAIM was built through listening:“Not everyone may know this, but CalAIM was generated from a statewide listening tour. Our previous state Medicaid director went around the state and literally asked communities… rooms full of plans, members, providers, what do you need from Medi-Cal that isn't working today? [The] smorgasbord of recommendations is what turned into CalAIM … Listening to the community and responding to the community's needs is in the core DNA of this program.”Relevant LinksListen to our related episode “Reflecting on Year One of CalAIM with Jacey Cooper”CalAIM dashboard Population health management policy guide California and other states require managed care plans to reinvest in local communitiesNY waiver summaryAbout Our GuestDr. Palav Babaria was appointed Chief Quality Officer and Deputy Director of Quality and Population Health Management of the California Department of Health Care Services beginning in March 2021. She was formerly the Chief Administrative Officer of Ambulatory Services at Alameda Health System. In that capacity, she operationally and clinically oversaw 26 specialty clinics, four large primary care FQHCs, specialty and integrated behavioral health, and is responsible for all outpatient value-based payment programs. Prior to that role, she served as Medical Director of K6 Adult Medicine Clinic. She also has over a decade of global health experience and her work has been published in the New England Journal of Medicine, Academic Medicine, Social Science & Medicine, L.A. Times, and New York Times. Her areas of interest include ambulatory transformation in resource-limited settings, shifting to value-based care, and issues of gender in medicine. Babaria received her bachelor's from Harvard College, as well as her MD and Masters in Health Science from Yale University. She completed her residency training in...

Edward Juhn, Chief Quality Officer of Administration at Inland Empire Health Plan, shares his strategies for ensuring top-tier care in clinical services, data innovation, and public health in this fascinating episode. Emphasizing the importance of partnerships, Edward discusses the continuous efforts to enhance all aspects of healthcare delivery. He also sheds light on the groundbreaking “pay for performance program,” which has led to remarkable improvements and outcomes.

Edward Juhn, Chief Quality Officer of Administration at Inland Empire Health Plan, shares his strategies for ensuring top-tier care in clinical services, data innovation, and public health in this fascinating episode. Emphasizing the importance of partnerships, Edward discusses the continuous efforts to enhance all aspects of healthcare delivery. He also sheds light on the groundbreaking “pay for performance program,” which has led to remarkable improvements and outcomes.

Well Said has invited Dr. Peter Silver, Senior Vice President, Chief Quality Officer, and Associate Chief Medical Officer for Northwell Health to talk about where hospital ratings come from, are they meaningful, and are they reliable?

On episode 104 of PSQH: The Podcast, Dr. Komal Bajaj, Medical Director of Sustainability at NYC Health + Hospitals and Chief Quality Officer at Jacobi and North Central Bronx Hospitals, talks about integrating environmental sustainability into healthcare quality and safety.

Host: Shahid Shah Guest: Eric Alper, MD On this epsode host Shahid Shah & guest Eric Alper, MD, VP/Chief Quality Officer, Chief Clinical Informatics Officer at UMass Memorial Health dive deep into the transformative world of healthcare. Originally recorded at HIMSS 2024 the discussion is focused on the innovative "Hospital at Home" model, exploring its integration with Epic's Electronic Health Records (EHR) system to enhance patient experience and care delivery. Eric shares his insights on how "Hospital at Home" is reshaping patient interactions and the role of technology in making healthcare more accessible and effective. Shahid discusses the technical advancements and challenges in integrating Epic EHR with home-based healthcare solutions. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

Tune in as Dr. Brian Wagers, Chief Quality Officer at Children's Health, shares insights on the pressing healthcare matters of 2024, from his background to the evolving challenges and opportunities in the field. Delve into the strategies and qualities essential for healthcare leaders to navigate the ever-changing landscape over the next few years.

Being a healthcare worker at NYC Health + Hospitals means embracing an incredible mission, to serve all New Yorkers. But, the pressures of a healthcare job can often lead to stress, burnout, and depression, impacting the mental health of frontline health care workers. In this episode of The Remedy from NYC Health + Hospitals, host Dr. Michael Shen is joined by Dr. Eric Wei, Senior Vice President and Chief Quality Officer at NYC Health + Hospitals, and Jeremy Segall, our System Chief Wellness Officer. Together, they discuss how NYC Health + Hospitals supports the mental health of more than 40,000 health care workers with the Helping Healers Heal program, addressing the stigma around mental health, using Arts in Medicine to de-stress, and much more. So press play and listen to another episode of The Remedy from NYC Health + Hospitals.Follow UsTwitter @NYCHealthSystemFacebook @NYCHealthSystemInstagram @NYCHealthSystemLinkedIn @NYC Health + Hospitals YouTube @NYCHealthSystem Presented by NYC Health + Hospitalswww.NYCHealthAndHospitals.org

Hospital-acquired infections affect every health organization. These infections may be caused by a variety of pathogens including bacterial, viruses, fungi and parasites. They can lead to increased mobidity, mortality and healthcare costs. Joining us to discuss their efforts to reduce hospital-acquired infections at SSM Health are Dr. Shephali Wulff, System Vice President of Quality and Safety and Chief Quality Officer and Chris Zirges, System Director of Infection Prevention.   Guest speakers: Shephali Wulff, DO System Vice President of Quality and Safety, Chief Quality Officer SSM Health Chris Zirges, DNP, APRN-BC, CIC, FAPIC System Director of Infection Prevention SSM Health  Host: Courtney Furrow-White, MPM, RN Senior PI Program Director Vizient    Show Notes: [:56] SSM Health infection prevention overview [1:35] Current infection disease collaboration between four teams: infection disease physicians, infection prevention, microbiology and infection disease pharmacists [2:43] Partnering with continuous improvement team to put hospital-acquired infection guidelines into a change package [3:05] Over a span of two years, efforts led to 60% infection reduction for three targeted infections [3:20] Challenges with standardizing the work [4:15] Standardizing process structure and change framework [7:00] Process checks to support freezing and/or unfreezing behavior for validity and sustainability [10:00] Training modules and tools [11:45] Focus strategy for monitoring and reducing other hospital-acquired infections   [14:40] Different processes are needed for patients that are entering care in different ways: i.e., elective vs emergent surgery vs. in-patient surgery [15:20] Lessons learned   Links | Resources: For more information: picollaboratives@vizientinc.com   Subscribe Today! Apple Podcasts Spotify Google Podcasts Android RSS Feed  

Dr. Josh Lumbley, Chief Quality Officer at NorthStar Anesthesia, joins the show today to share his career journey and where he sees the future of anesthesia going. In this episode, he opens up about the challenges he faces in ensuring consistent anesthetic outcomes, navigating the complexities of negotiations in the healthcare sector, and setting future goals for quality assurance. Learn more: https://apmsuccess.com/225               Watch the video: https://apmsuccess.com/225v         

Connect with Deb here: https://dropinceo.com/ or here: https://www.linkedin.com/company/illumination-partners-llc/ My guest on today's podcast is an accomplished engineer, business leader, and published Author. Over her career, she's held titles such as “Quality Engineer”, “Director of Quality Assurance”, “Operational Excellence Manager”, “Chief Quality Officer”, and multiple chief officer roles in a fractional capacity, a concept that aligns greatly with her nickname, “The Drop in CEO ™”. Deborah Coviello is the founder of Illumination Partners, where she, the Drop in CEO, brings her knowledge and experience gained through the many roles listed and left unlisted previously to identify, assess and solve issues that are preventing business growth. Deb is the author of “The CEO's Compass: Your Guide to Get Back on Track”, a book that “tells the CEO's Hero Journey through the unknown and how to guide them to Peace of Mind.” and she has another book, The Secrets of The C-Suite due to be published in 2024. (One day, I too aspire to be a published author, but today, I can live vicariously through Deb.   Deb is the host of The Drop In CEO Podcast, where she connects her listeners with business leaders and CEO's who are “Doing the work of transforming their businesses from the inside out” to help her audience “learn how to be an inspirational leader, take care of [their] career and build a strong foundation of purpose”. Don't miss a blog post or a podcast episode, subscribe to my newsletter on ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.ENGRingSuccess.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Support the on podcast on Spotify or on Patreon: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.patreon.com/ENGRingSuccess⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Top tier supporters - shout out each episode of the month for $10 monthly donation. Follow along on all social medias: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://linktr.ee/ENGRingSuccess⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ To submit your question, email ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠daniel@ENGRingSuccess.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Subscribe on YouTube to watch short excerpts of podcast episodes addressing specific topics: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.youtube.com/channel/UCj86alc3a7_A_PibgYpkWFg⁠⁠⁠⁠⁠⁠⁠  ⁠⁠⁠⁠⁠⁠⁠ Daniel is a Mechanical Engineering graduate of Trinity University's B.S. in Engineering Science and currently works in Commercial Management in the Engineering and Construction Consulting Industry. All views expressed on this podcast are his own and do not reflect the opinions or views of his employer. Music by Maxgotthetracks: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://open.spotify.com/artist/0Pclog68AY1⁠⁠⁠⁠⁠⁠ --- Send in a voice message: https://podcasters.spotify.com/pod/show/engineering-success/message Support this podcast: https://podcasters.spotify.com/pod/show/engineering-success/support

Anesthesiology 2023, a huge event in the perioperative calendar for us here at TopMedTalk; the annual general meeting of the American Society of Anesthesiologists (ASA). Part one of this podcast is here: https://topmedtalk.libsyn.com/anesthesiology-2023-digest-part-1-topmedtalk The pieces linked to in this podcast are here: Opportunities in Anesthesiology | #ANES23 https://topmedtalk.libsyn.com/opportunities-in-anesthesiology-anes23 The GAP study: Gabapentin and perioperative pain, results and analysis | #ANES23 https://topmedtalk.libsyn.com/the-gap-study-gabapentin-and-perioperative-pain-results-and-analysis-anes23 Artificial Intelligence in your practice | #ANES23 https://topmedtalk.libsyn.com/artificial-intelligence-in-your-practice-anes23 TopMedTalks to… the Chief Executive Officer and Chief Quality Officer of NorthStar Anesthesia | #ANES23 https://topmedtalk.libsyn.com/topmedtalks-to-the-chief-executive-officer-and-chief-quality-officer-of-northstar-anesthesia-anes23 Patient Safety in Anesthesiology | #ANES23 https://topmedtalk.libsyn.com/patient-safety-in-anesthesiology-anes23 Anesthesia Patient Safety Foundation; Intraoperative Hypotension and Hemodynamic Stability | #ANES23 https://topmedtalk.libsyn.com/anesthesia-patient-safety-foundation-intraoperative-hypotension-and-hemodynamic-stability-anes23 Alternative study designs for the future | #ANES23 https://topmedtalk.libsyn.com/alternative-study-designs-for-the-future-anes23 TopMedTalks to ... BobbieJean Sweitzer | #ANES23 https://topmedtalk.libsyn.com/topmedtalks-to-bobbiejean-sweitzer-anes23

This episode features Dr. Matthew Miller, Associate Chief Quality Officer at Cleveland Clinic. Here, he discusses his background, the pride he has for his team & Cleveland Clinic, how an organization of its size controls quality, and more.

Recorded live at the 11th Annual Becker's Healthcare CEO + CFO Roundtable, this episode features Dr. Sharda Udassi, Associate Chief Quality Officer at WVU Medicine. Here, she discusses her background, how payer / provider relationships are changing, her thoughts on the current regulatory environment, her top priorities for 2024, and more.This episode is brought to you by R1 RCM, a leading provider of technology-driven solutions that transform the financial performance of hospitals, health systems, and medical groups. R1 delivers proven, scalable operating models that power sustainable improvements to net patient revenue, while reducing operating costs. To learn how you can build a future-ready revenue cycle today, visit us at www.r1rcm.com/beckers 

On this episode of “Steve Adubato's Lessons in Leadership,” Steve and Mary talk with Jose Azar, MD, Executive Vice President, Chief Quality Officer, Hackensack Meridian Health Network about his book, “The Agile Network,” and the importance of innovation and challenging the status quo. Then, Steve and Mary share tips and tools on how to lead … Continue reading Lessons in Leadership: Dr. Jose Azar, and Effective Meetings Mini-Seminar

On this episode, I was joined by Martin Van Trieste, Author of Protecting the Patient at All Costs: The Drug Watch Dogs and is the Former Chief Quality Officer at Amgen and Former CEO at Civica Rx. Martin and I discuss: - Protecting the Patient at All Costs - Quality Leadership and being a Chief Quality Officer in Big Pharma - Supply Chain Security - Generic Drugs and Shortages Martin Van Trieste is an accomplished entrepreneur, board governance expert, executive coach and biopharmaceutical executive. Martin Van Trieste is the Former President and CEO of Civica Rx. Prior to joining Civica Rx, he worked with Amgen, a leading biotechnology company and also previously served as vice president of worldwide quality for Bayer Healthcare's Biological Products Division and vice president of quality assurance for the Hospital Products Division for Abbott Laboratories. Van Trieste has also taken on ventures of his own. He's the founder of Rx-360, an international nonprofit organization that enhances patient safety by increasing security and quality in the biopharmaceutical supply chain. He has also served as the chairman of the Parenteral Drug Association (PDA) Board of Directors and was honored with the 2020 Joseph B. Sprowls Lecturer award. 

Ron Stiver sits down with Greg Kiray, MD (Chief Medical Officer, System Health Solutions) and Paul Calkins, MD (vice president and Chief Quality Officer, IU Health) for an in-depth look into our culture of safety. Hear about this year's survey findings, key areas of progress in SHS, and the newly implemented tiered huddles.

Today, we're excited to get to know Dr. Michael Howell. He's the Chief Clinical Officer at Google where he leads the team of clinical experts providing guidance for Google Health products, research and services. He has dedicated his career to improving the quality, safety and science of how care is delivered and helping people get the best information across their health journey. He previously served as the Chief Quality Officer at the University of Chicago and was an Associate Professor at Harvard Medical School. He's published more than 100 research articles, editorials, and book chapters and is a nationally recognized expert on patient safety and quality. In this episode, we talked about why Google got into healthcare, Google's 3Cs for health, how to create a clinical team within a tech company, the implications of artificial intelligence, and advice for founders in the AI/LLM space. 

Quality is a word that carries immense importance at Bridgestone, but it can mean different things to different people. Join THRIVE host Keith Cawley as he quizzes quality leaders about the crucial role their team plays in fulfilling Bridgestone's mission. Chris Lasko, Chief Quality Officer, and Nick Turk, the Executive Director of Quality Operations, join Keith to discuss how quality spans the enterprise, sets the tone for customer experience, and connects the dots across a massive enterprise to ensure Bridgestone's unyielding standards are achieved at all times.

Welcome to our coverage of Anesthesiology 2023; the annual meeting of the American Society of Anesthesiologists (ASA); it's the largest and most important gathering of anesthesiologists in the world and we're your free front row seat. For more on the ASA go here: https://www.asahq.org/ Check out our YouTube page for a record of the live stream video of this podcast: https://www.youtube.com/@topmedtalk7687/streams This piece looks at the management of anesthesiology in the US, what are the challenges and solutions, the realities of 'provider squeeze', broader market trends and the opportunities for long term growth? Presented by Desiree Chappell and Mike Grocott with their guests Adam Spiegel, CEO, NorthStar Anesthesia and Josh Lumbley, Chief Quality Officer, NorthStar Anesthesia.

Get ready to talk all about ears- everything from ear rashes to ear inflammation and ear infections! Also, this is another FIRST for The Healthy Skin Show. I've never had anyone come on to talk about ears! So, if you've had issues with your sinuses or ear drainage and wonder if it could be related to inflammation in your body, stay tuned to hear from today's guest who dives into what could be a root cause. My guest today is Dr. Haley Overstreet. She is a highly accomplished physician with a passion for improving the lives of her patients. Beginning her medical journey in Family Practice, she later embarked on a specialized path focused on allergy and sinus care in 2017. Since then, Dr. Overstreet has successfully aided numerous individuals in conquering their allergy and sinus issues using innovative treatments such as allergy drops and ExACT Immunoplasty. Her expertise extends beyond patient care, as she also serves as Chief Quality Officer for Aspire Allergy & Sinus. In this capacity, Dr. Overstreet ensures the adoption of safety measures and proper protocols across all Aspire clinics nationwide. Have you ever dealt with a major ear problem and found relief?  Tell me what worked for you or what didn't in the comments below! In this episode: The different parts of the ear and how ear inflammation forms How the whole face is connected The number ONE reason patients have fluid in their middle ear Different appearances of bacterial, viral, and fungal ear infections Using antihistamines for ear problems Dr. Haley's big piece of advice- nasal rinses! Quotes "Allergies are probably the number one reason when I have a patient who has fluid in their middle ear, that's usually why." [06:01] "External ear infections are treated oftentimes with drops and those are antibiotic drops. But if those are used enough, it actually can create an environment where yeast or fungal infections can set up." [24:26] Links Find Dr. Overstreet online | LinkedIn Follow Aspire Allergy on Instagram Healthy Skin Show 291: Can You Stop Eczema, Allergies + Asthma In Kids? w/ Dr. Chris Thompson Healthy Skin Show 269: Allergy Testing: Everything You Need To Know w/ Dr. Stacy Silvers Healthy Skin Show 265: Problem with Antihistamines That No One Tells You w/ Dr. Chris Thompson, MD

Catherine Chang, VP and Chief Quality Officer at Ambulatory and Clinical Councils joins the podcast to discuss her background, top 3 trends she's following in healthcare and ASCs today, current excitements, and how she's thinking about growth over the next year.