Podcasts about healthcare improvement

Despite decades of effort and innovation since the groundbreaking To Err is Human report over 25 years ago, preventable harm in healthcare persists, and violence against healthcare workers continues to rise. With record understaffing, burnout, mandatory overtime, and mounting documentation demands, the pressure to provide safe care has never been higher nor the stakes more urgent. In this first episode of our new series focusing on safety in healthcare, we explore a bold shift toward "total systems safety" with two leaders at the forefront of this movement who know these challenges all too well. Patricia McGaffigan, RN, MS, CPPS, Senior Advisor for Patient and Workforce Safety at the Institute for Healthcare Improvement, and President of the Certification Board for Professionals in Patient Safety, and Donald Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow at the Institute for Healthcare Improvement, and former Administrator of the Centers for Medicare and Medicaid Services. Together, they continue to shape national safety efforts including IHI's Safer Together: National Action Plan to Advance Patient Safety the first public-private collaboration of its kind. Spearheaded by McGaffigan and bringing together 27 major organizations that had never collaborated before. The plan aims to restructure the very foundation of healthcare, building safety into every level of the system around four interlocking pillars. Leadership & Governance: Strong, visible leadership and policies that make safety a strategic priority. Workforce Safety & Well-Being: Protecting nurses and healthcare workers – physically and mentally – so they can care safely for others. Patient & Family Engagement: Partnering with patients and family caregivers as co-designers of safe care. Learning Systems: Creating feedback loops and continuous improvement so lessons from one hospital spread everywhere.   At the heart of this movement is a truth long understood by nurses: safety is not a checklist or a policy, it's a culture, a commitment, and a collective responsibility. As Patricia McGaffigan reminds us, “You can't have patient safety if you don't have a safe workforce.” And as Don Berwick warns, “The illusion that safety is a matter of individual effort is one of the most toxic notions in the whole safety enterprise. It is we, not me.” Nurses have always led by example, holding space for healing while navigating broken systems. Now, their leadership is essential in building the future of healthcare safety: one that protects not only patients, but the people who care for them. Where healthcare is not only safer, but also is a culture that ensures we're all Safer Together.

St. Paul had a female traveling companion but we never hear about her; women suffering at all times of their lives from menstrual cramps to menopause are told by untrained doctors that it's in their heads, and even when mice are the subjects of medical experiments, they are almost always male. Long accustomed to taking a back seat and suffering in silence, women are increasingly speaking up for better treatment at the hands of medicine. Two of them from different generations, Abby Lorch, a UAlbany student, and Liz Seegert, a long-time health journalist talk about what should be done — and their despair that Health Secretary RFK will do it.Abby Lorch is a 21-year-old UAlbany student graduating with a journalism degree and a law and philosophy minor. She plans to attend Albany Law School starting in fall 2025. She has always been interested in women's issues, and reporting on the university community and the Capital Region has given her insight into how these issues affect her neighbors.Liz Seegert  is an award-winning, freelance journalist with more than 30 years experience writing for magazines, newspapers, radio and TV news, digital, PR, corporate, government, non-profit, and educational institutions. Her work has appeared in national, regional and local consume and trade outlets. She has done numerous fellowships with organizations such as  the Institute for Healthcare Improvement, the center for Health Policy and Media Engagement, and the Gerontological Society of America. She is active in the Journalism & Women Symposium and is an instructor at the Empire State College.

Long accustomed to taking a back seat and suffering in silence, women are increasingly speaking up for better treatment at the hands of medicine. Two of them from different generations, Abby Lorch, a UAlbany student, and Liz Seegert, a long-time health journalist talk to Rosemary Armao about what should be done — and their despair that Health Secretary RFK will do it. Abby Lorch is a 21-year-old UAlbany student graduating with a journalism degree and a law and philosophy minor. She plans to attend Albany Law School starting in fall 2025. Liz Seegert is an award-winning, freelance journalist with more than 30 years experience. She has done numerous fellowships with organizations such as the Institute for Healthcare Improvement, the center for Health Policy and Media Engagement, and the Gerontological Society of America. She is active in the Journalism & Women Symposium and is an instructor at the Empire State College.

In this episode of The Patient From Hell, host Samira Daswani speaks with oncology nurse Joshua Carter about his path into cancer care, shaped by personal experiences with family illness. They explore the differences between palliative and hospice care, the complexities of pain management, and the vital role nurses play as advocates. Josh also discusses misconceptions around pain medication, the promise and challenges of e-health tools, and the often-invisible workflows nurses navigate daily. He shares practical advice for patients, caregivers, and fellow clinicians, emphasizing the importance of early palliative care and being a bold advocate within the healthcare system.About Our GuestJosh Carter is an Oncology Nurse at Stanford Women's Cancer Center. His entire 17-year nursing career has been in oncology, with inpatient, industry, and outpatient experiences in Cleveland, Chicago, San Diego, and San Francisco. Josh holds undergraduate degrees from Kent State University and Ohio University and is currently on track to complete his Master's at the University of Michigan School of Nursing this Fall. He is a certified Oncology and Breast Care Nurse. His interests include Nursing Innovation, Digital Health, Patient Advocacy, Patient Education, Patient-Centered Design, Healthcare Improvement, Quality, and Implementation Science. With his interests in Healthcare Quality, Josh is currently a Site Assessor for the Michigan Oncology Quality Consortium. Josh has spoken at the National Oncology Nursing Society Congress and Authored Chapters of Oncology Nursing Society Text Books. Josh has been involved with research for caregivers of Cancer patients and has helped in the launch of newly approved cancer treatments. Josh has experience working on a cancer care delivery team at ASCO and has been awarded the DAISY Award for Extraordinary Nurses. Resources & Links:This episode was supported by the Patient Centered Outcomes Research Institute (PCORI) and features the PCORI study “A Stepped-Wedge Randomized Controlled Trial: Effects of eHealth Interventions for Pain Control Among Adults With Cancer in Hospice”Sections00:00 - Journey into Oncology Nursing03:22 - Understanding Palliative vs. Hospice Care07:04 - Pain Management in Cancer Care10:23 - Pain Management Strategies and Misconceptions20:32 - E-Health Interventions in Pain Management23:19 - The Complex Workflow of Oncology Nursing27:48 - Quick Tips for Patients and CaregiversConnect with Us:Enjoyed this episode? Make sure to subscribe, rate, and review! Follow us on instagram, facebook, or linkedin @mantacares and visit our website at mantacares.com for more episodes and updates.Listen Across Platform:Website: https://mantacares.com/pages/podcast?srsltid=AfmBOopEP5GJ-Wd2nL-HYAInrwerIVhyJw67salKT-r9Qb_gadBvbHie YouTube: https://www.youtube.com/@mantacares Spotify:  https://open.spotify.com/show/6gM1GxDBUgXrHwlO0Zvnzs?si=9edb8680461d4eaa Apple: https://podcasts.apple.com/us/podcast/patient-from-hell/id1622669098 Disclaimer:All content and information provided in connection with Manta Cares is solely intended for informational and educational purposes only. This content and information is not intended to be a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.This episode was supported by an award from the Patient-Centered Outcomes Research Institute.

In this episode of the WLEI Podcast, we speak with Steve Spear, a senior lecturer at MIT's Sloan School of Management, senior fellow at the Institute of Healthcare Improvement, and associated faculty member at Adriane Labs of the Harvard School of Public Health. Spear is also author of The High-Velocity Edge and Wiring the Winning Organization and principal of SeeToSolve. The conversation explores:  Stellar examples of product development innovation (and the learning cultures that made these achievements possible) What Lean, Six Sigma, Agile, DevOps, and more schools of systems thinking and management all have in common What business and product leaders across hardware and software can learn from each other Key ideas and core principles you should take away from his latest book  What kind of leadership Steve believes is needed now and what good leadership looks like in practice, given all of the organizational challenges companies face today

Howie and Harlan are joined by Alexi Nazem, a Yale-trained internist who co-founded the healthcare staffing company Nomad Health and now leads healthcare investments at AlleyCorp. Harlan reports on new research from the American College of Cardiology meeting; Howie examines the consequences of vast staffing cuts in the federal healthcare infrastructure.  Links: Research from the American College of Cardiology Meeting “Semaglutide and walking capacity in people with symptomatic peripheral artery disease and type 2 diabetes (STRIDE): a phase 3b, double-blind, randomised, placebo-controlled trial” “Early Intra-Aortic Balloon Support for Heart Failure-Related Cardiogenic Shock: A Randomized Clinical Trial” “Extended Reduced-Dose Apixaban for Cancer-Associated Venous Thromboembolism” Alexi Nazem The Human Genome Project Institute for Healthcare Improvement “100,000 Lives Campaign: Ten Years Later” “Continuous Improvement as an Ideal in Health Care” “The Science of Improvement” Health & Veritas Episode 145: Max Laurans: An Entrepreneurial Life in Medicine Nomad Health Yale School of Management case study: “Nomad Health: The disruption of physician staffing services" “Staffing Marketplace Nomad Health Raises $105 Million As It Expands Beyond Travel Nurses” “America Is Running Out of Nurses” “Staffing Marketplace Nomad Health Lays Off 17% Of Workforce” “Why AI deals in healthcare have grown faster than other areas of tech — and what VCs are paying close attention to” Turmoil at Federal Health Agencies “Mass Layoffs Hit Health Agencies That Track Disease and Regulate Food” “The top FDA vaccine official is forced out, cites RFK Jr.'s 'misinformation and lies'“ “NIH cuts halt 24-year program to prevent HIV/AIDS in adolescents and young adults” “Princeton's US grants frozen, follows Trump actions against other schools” “Trump Administration Abruptly Cuts Billions From State Health Services” “Texas measles outbreak grows to 90 cases, worst level in 30 years” “As Trump pursues his policies, Democratic states block his path” “Proposed foreign aid cuts could lead to millions of HIV deaths, study estimates” Learn more about the MBA for Executives program at Yale SOM. Email Howie and Harlan comments or questions.

Howie and Harlan are joined by Alexi Nazem, a Yale-trained internist who co-founded the healthcare staffing company Nomad Health and now leads healthcare investments at AlleyCorp. Harlan reports on new research from the American College of Cardiology meeting; Howie examines the consequences of vast staffing cuts in the federal healthcare infrastructure.  Links: Research from the American College of Cardiology Meeting “Semaglutide and walking capacity in people with symptomatic peripheral artery disease and type 2 diabetes (STRIDE): a phase 3b, double-blind, randomised, placebo-controlled trial” “Early Intra-Aortic Balloon Support for Heart Failure-Related Cardiogenic Shock: A Randomized Clinical Trial” “Extended Reduced-Dose Apixaban for Cancer-Associated Venous Thromboembolism” Alexi Nazem The Human Genome Project Institute for Healthcare Improvement “100,000 Lives Campaign: Ten Years Later” “Continuous Improvement as an Ideal in Health Care” “The Science of Improvement” Health & Veritas Episode 145: Max Laurans: An Entrepreneurial Life in Medicine Nomad Health Yale School of Management case study: “Nomad Health: The disruption of physician staffing services" “Staffing Marketplace Nomad Health Raises $105 Million As It Expands Beyond Travel Nurses” “America Is Running Out of Nurses” “Staffing Marketplace Nomad Health Lays Off 17% Of Workforce” “Why AI deals in healthcare have grown faster than other areas of tech — and what VCs are paying close attention to” Turmoil at Federal Health Agencies “Mass Layoffs Hit Health Agencies That Track Disease and Regulate Food” “The top FDA vaccine official is forced out, cites RFK Jr.'s 'misinformation and lies'“ “NIH cuts halt 24-year program to prevent HIV/AIDS in adolescents and young adults” “Princeton's US grants frozen, follows Trump actions against other schools” “Trump Administration Abruptly Cuts Billions From State Health Services” “Texas measles outbreak grows to 90 cases, worst level in 30 years” “As Trump pursues his policies, Democratic states block his path” “Proposed foreign aid cuts could lead to millions of HIV deaths, study estimates” Learn more about the MBA for Executives program at Yale SOM. Email Howie and Harlan comments or questions.

Send us a MessageIn this episode of Culture Change RX, I discuss the concept of high reliability in healthcare, emphasizing the importance of setting ambitious goals. The conversation delves into the challenges of goal setting, the significance of a growth mindset, and the systems necessary for fostering high reliability organizations. I highlight the upcoming Healthcare Executive Forum, where healthcare leaders will explore strategies for achieving high reliability and continuous improvement.Setting ambitious goals can drive organizational improvement.Leaders and employees can often feel that big goals are impossible goals and a set up for failure.Setting ambitious goals can lead to significant performance gains.Celebrating the positive gains is important, even when goals are missed.Goal systems are crucial for continuous improvement.High reliability benefits patients, employees, and communities.Need help improving the culture, performance, and results of your healthcare organization? If so, let's talk:  https://www.capstoneleadership.net/contact-usAre we connected yet on LinkedIn? https://www.linkedin.com/in/suetetzlaff/13th Annual Healthcare Executive Forum - June 18 (afternoon) and June 19 (morning)High Reliability, Just Culture & Psychological Safety Made Simple focuses on breaking down these critical concepts into practical, actionable strategies tailored for senior leaders in small and rural healthcare settings.

Rusty is the founder and CEO of Resonate Leadership Lab, a healthcare leadership development consultancy with a mission of “Building Leadership Capabilities.” His passion for developing leaders and shaping organizational culture are hallmarks of his 30 years as a physician executive. Rusty has degrees in both Religious Studies and Psychology, and considers himself a lifelong student of how leaders and teams accomplish great things.Rusty's leadership has been central to three health system mergers, integrations and ownership changes involving academic, non-profit, venture capital, private equity and publicly traded entities. Most recently, he was chief medical officer for Lifepoint Health, a national health system comprised of 89 hospitals in 30 states, where he led the organization to win the John M. Eisenberg Award for Innovation in Patient Safety and Quality. Previously, Rusty was chief operating officer and chief clinical officer of Cogent Healthcare, a provider of hospital medicine and critical care solutions in over 120 locations in 28 states. He began his career as faculty at the University of Minnesota and senior medical director of hospital services for HealthPartners. Rusty completed his undergraduate and medical school training at Washington University in St. Louis, and his Internal Medicine residency and chief residency at the University of Minnesota.Rusty has served as Past-President of the Society of Hospital Medicine, founder of the SHM Leadership Academies, is a Nashville Healthcare Council Fellow, voted a Top 50 Physician Executive for Modern Healthcare, and is an author and co-editor of the textbook, Comprehensive Hospital Medicine. His frequent speaking engagements have included the Institute for Healthcare Improvement, American Hospital Association, Society of Hospital Medicine and the American College of Healthcare Executives, among others. 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's Community Champion Sponsor is Ossur. To learn more about their ‘Responsible for Tomorrow' Sustainability Campaign, and how you can get involved: CLICK HEREEpisode Overview: In healthcare's technological revolution, the balance between innovation and patient-centered care has never been more critical. Our next guest, Dr. Craig Norquist, brings an extraordinary perspective as CMIO of HonorHealth, drawing from his unique journey from Navy nuclear operator to emergency physician. While together, Craig shares his vision for technology that enhances rather than compromises the sacred provider-patient relationship and how this approach is transforming care delivery. With dual board certifications in Emergency Medicine and Clinical Informatics, Craig champions high reliability principles learned in both nuclear power plants and hospital settings. As a 19-time Ironman triathlete and cancer survivor, his patient experience profoundly shapes his approach to healthcare technology. Join us to explore how Dr. Norquist is leveraging informatics to reduce provider burden, improve safety, and create a learning health system that truly puts patients first. Let's go!Episode Highlights:Navy Nuclear Experience: Craig brought high reliability principles from his Navy career to healthcare safety.Personal Cancer Journey: His lymphoma battle transformed his view on patient access and care delivery.Protecting Provider Focus: Craig shields clinicians from technology overload to preserve patient interactions.AI Enhanced Documentation: Language models can reduce chart review time and boost patient engagement.Health System Collaboration: Phoenix hospitals worked together during the pandemic to manage patient loads.About our Guest: Dr. Craig Norquist currently serves as the CMIO of HonorHealth after practicing as an Emergency Physician for almost 20 years. He is board certified in both Emergency Medicine and Clinical Informatics. He serves as the Program Director for the Clinical Informatics Fellowship at HonorHealth and as Clinical Assistant Professor in the Informatics Fellowship at University of Arizona College of Medicine – Phoenix Fellowship in Informatics.Prior to becoming the CMIO, he was the Network Patient Safety Officer for HonorHealth, and has previously served as Department Chair of Emergency Medicine as well as Chief of Staff for the Thompson Peak Hospital. In 2017-2019, he completed professional development programs through academic and professional organizations that prepared him for his leadership roles, including Intermountain Health's Advanced Training Program and the Institute for Healthcare Improvement's Patient Safety Executive training. His additional credentials include EPIC physician builder certification, executive training at Harvard Business School in healthcare delivery, and training in artificial intelligence from MIT.His areas of interest are process, quality, and outcome improvement as well as improving the patient and provider experience with information technology in healthcare. His expertise has resulted in invited membership on panels and reports with the ECRI Institute and the National Quality Forum. He continues to work on the state level on opioid prescribing, use disorder recognition and treatment, as well as risk reduction methodologies including naloxone distribution from the Emergency Department. He has organized and chaired the Arizona College of Emergency Physicians opioid prescribing summit for the past 9 years.Dr. Craig is passionate about the use of technology to facilitate the improvement of care and development of a learning health

Each year, the Institute of Healthcare Improvement holds its annual forum in December. Over 4 days, between 3 to 4 thousand healthcare quality improvers from across the world join together for a packed program of workshops, QI project reports, improvement science education and keynote lectures from renown speakers. This year, a large contingent of Canadians made the trip including some from Northern British Columbia so we decided to bring these Northern Physicians together for a fun panel discussion about their experiences and what they learned from this year's forum. This is the recording of that discussion moderated by our regular Qualitycast North host Dr. Shyr Chui. We talk about our key takeaways, Dr. Anthony Fauci's keynote, power networking and tips for first-time forum attendees. Links: Institute for Healthcare Improvement Dr. Kedar Mate and Dr. Thomas Lee Keynote

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Senior Deputy Editor Rob Lott interviews Don Berwick of the Institute for Healthcare Improvement about his paper as part of the Vital Directions for Health and Health Care: Priorities for 2025 package that proposes strategies for how health care in the US could be transformed.Order the February 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone. Subscribe to UnitedHealthcare's Community & State newsletter.

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

Send us a MessageIn this episode, Greg Opseth, a former Chief Nursing Officer and now Chief Operating Officer in rural Iowa, shares his insights on the importance of authentic leadership in healthcare, particularly in rural hospitals. Greg shares his experiences and emphasizes the need for a safe and enjoyable work environment. They explore strategic planning, employee involvement, and the unique culture of night shift workers. Greg also highlights the significance of community engagement through volunteering and the mission of Highland Medical Staffing in supporting rural healthcare facilities.Authentic leadership fosters a positive work environment.Creating fun in serious settings enhances team morale..Night shift workers have unique perspectives and needs.Memorable patient interactions can significantly impact care.Volunteering enriches personal fulfillment and community ties.Rural hospitals benefit from tailored staffing solutions.Cultural engagement in schools mirrors healthcare environments.

In this piece, recorded at Anesthesiology 2024 in Philadelphia, TopMedTalk explores the evolving landscape of patient safety and quality standards in anesthesia. What have been the significant shifts in patient safety culture? What is the importance of a proactive approach to risk management in anesthesia? We mention this excellent article: https://www.apsf.org/article/why-should-i-obtain-the-certified-professional-in-patient-safety-cpps-credential/ Desiree Chappell, Mike Grocott and Monty Mythen speak with their guest, Jonathan Cohen, anesthesiologist, Vice Chair of Quality & Safety in the Department of Anesthesiology at Moffitt Cancer Center in Tampa, Florida, Associate Professor at the University of South Florida, Clinical Assistant Professor in the Department of Medical Education at University of Illinois Chicago, Faculty for the Institute of Healthcare Improvement's (IHI) Certified Professional in Patient Safety Course.

On episode 120 of PSQH: The Podcast, Josh Clark, RN, MHA, Vice President of Quality and Safety Operating Systems at the Institute for Healthcare Improvement, talks about the concept of care operating systems. This interview was recorded at the IHI Forum in Orlando.

Send us a MessageIn this episode, Shelby Guevara, a Chief Nursing Officer in rural Iowa, shares her insights on leadership in healthcare, particularly in rural hospital settings. She discusses the importance of building trust and empathy among leaders, engaging frontline staff in decision-making, and the significance of understanding one's purpose in leadership. Shelby emphasizes the value of promoting from within and creating a supportive environment for leaders to grow and develop. The conversation highlights the challenges and rewards of leading in healthcare, especially in fostering a culture of collaboration and continuous improvement.Understanding individual motivations aids in leadership development.Investing in developing and strengthening relationships pays dividends.Individual growth and process improvement, and even conflict, require a supportive environment.Successful continuous improvement requires ongoing auditing and accountability.Leaders can reflect on their purpose to stay motivated for this work.Leaders play a crucial role in selecting and organizing change initiatives.

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.

Dr David M Williams is an internationally respected scholar-practitioner of the Science of Improvement. With 25 years of experience in Quality 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. Dave coauthored Quality as an Organizational Strategy: Building a System of Improvement. His writing on improvement is also found in many books and published papers. He was a senior leader at the Institute for Healthcare Improvement, where he was responsible for leadership and improvement science and methods. His other past roles include chief quality officer, university faculty member, board leader, consultant, Baldrige examiner, and paramedic. Dave holds a B.S. in Emergency Medical Services Management from Springfield College, an M.S. in Emergency Health Services Management from the University of Maryland, Baltimore County, and a PhD in Organizational Systems from Saybrook University. You can connect with Dave on LinkedIn and check his website here

Dr Jeff Jarvis joins Rob Lawrence to discuss the recently released National EMS Quality Alliance (NEMSQA) Measures Report – “Enhancing airway management one measure at a time.” The report begins with the following robust Foreword: “NEMSQA is not satisfied with the state of airway management safety in EMS. As you will see, the data clearly shows that we can do much better across our industry! Partnering with experts and EMS agencies around the country, NEMSQA is leading the second national EMS Quality Improvement Partnership (EQuIP), the Airway Management Collaborative to put the new NEMSQA airway measures to work.” “Enhancing airway management one measure at a time” is the sequel to the Lights and Siren Collaborative and will utilize the Institute for Healthcare Improvement's Breakthrough Series collaborative model. The goal of the project is to support national improvement in the safety and effectiveness of invasive airway management by focusing on two goals: Reducing the adverse events, such as peri-intubation hypoxia and hypotension Improving the use of waveform capnography to confirm and monitor all invasive airways Rob and Dr. Jarvis discuss the report and actions individuals and their agencies should take to improve their personal and organizational airway management and patient outcome results. Find more EMS One-Stop episodes here!

The Path to Healthcare Improvement: Collaborative Innovation Healthcare's future depends on embracing disruption and rethinking traditional approaches to patient care. On this episode, David Sylvan, Chief Strategy, Innovation & Marketing Officer at University Hospitals, shares his approach to addressing healthcare's inefficiencies by focusing on problem identification and leveraging technology, process reengineering, and partnerships. He believes healthcare must embrace disruption and innovation, with openness to partnerships across industries to drive positive change. Hosts: Stuart Hanson Rachel Schreiber Guest: David Sylvan, Chief Strategy, Innovation, and Marketing Officer, University Hospitals 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

Is your CME content scratching the surface or truly addressing the core issues in healthcare practice? As a CME professional, you're constantly striving to create educational interventions that make a real difference. But sometimes, despite your best efforts, the impact falls short of expectations. Root cause analysis (RCA) could be the missing piece in your needs assessment toolkit, helping you uncover the true sources of performance gaps and design more effective CME programs. By listening to this episode, you'll discover: How to apply RCA techniques to enhance your needs assessments and identify the root causes of practice gaps Step-by-step guidance and practical tools for conducting RCA Real-world examples of how RCA can lead to measurable improvements in healthcare outcomes Tune in now to unlock the power of root cause analysis and revolutionize your approach to CME program development. Resources Agency for Healthcare Research and Quality (AHRQ). Root Cause Analysis. Institute for Healthcare Improvement. Improving Root Cause Analyses and Actions to Prevent Harm. Singh G et al. Root Cause Analysis and Medical Error Prevention. StatPearls. Driesen B et al. Root Cause Analysis Using the Prevention and Recovery Information System for Monitoring and Analysis Method in Healthcare Facilities: A Systematic Literature Review. J Patient Saf. 2022;18(4):342-350

Today we're looking back to one of our favorite conversations from season 1 with Dr. Don Berwick, President Emeritus and Senior Fellow of the Institute for Healthcare Improvement. Dr. Berwick is a long-time advocate for improving healthcare for both patients and providers. During this conversation, we talk about the moral imperative of change in healthcare; how we can approach the challenges more effectively; and why working together will be critical. We want to hear from you. Send a voice memo or note to podcast@moralinjury.healthcare. CME: https://earnc.me/0aUaBU Support the podcast: https://www.fixmoralinjury.org/get-started Twitter - @fixmoralinjury Instagram - @moralinjury Facebook - @MoralInjuryofHC LinkedIn - Moral Injury of Healthcare

JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, interviews Kedar S. Mate, MD, an internal medicine physician, President and Chief Executive Officer at the Institute for Healthcare Improvement, and faculty at Weill Cornell Medical College, to discuss AI's role in health care quality and approaches to improving health equity. https://edhub.ama-assn.org/jn-learning/video-player/18822296Open Sessions for NeoMINDAI, 4th Thursdayof each month at 1 pm MST (statring in September). Join from the meeting link https://uwmadison.webex.com/uwmadison/j.php?MTID=m2219c21bc9c806093f09c9f0447098c8Join by meeting number Meeting number (access code): 2630 894 3434Meeting password: qMaA8xyXe92 (76228999 from phones) Tap to join from a mobile device (attendees only) +1-415-655-0001,,26308943434#76228999# US Toll +1-312-535-8110,,26308943434#76228999# United States Toll(Chicago) Some mobile devices may ask attendees to enter a numeric meetingpassword. Join by phone +1-415-655-0001 US Toll +1-312-535-8110 United States Toll (Chicago) Education tab on our NeoMINDAI website on education for AI in healthcare that is informative and constantly changingIHI and AI: https://www.ihi.org/resources/publications/patient-safety-and-artificial-intelligence-opportunities-and-challenges-care-deliveryNo content or comments made in any TIPQC Healthy Mom Healthy Baby Podcast is intended to be comprehensive or medical advice. Neither healthcare providers nor patients should rely on TIPQC's Podcasts in determining the best practices for any particular patient. Additionally, standards and practices in medicine change as new information and data become available and the individual medical professional should consult a variety of sources in making clinical decisions for individual patients. TIPQC undertakes no duty to update or revise any particular Podcast. It is the responsibility of the treating physician or health care professional, relying on independent experience and knowledge of the patient, to determine appropriate treatment.

Join Corey Dion Lewis in this insightful episode of The Healthy Project Podcast as he talks with Dr. Sandra E. Ford, the former special assistant to the President for public health and science in the White House Domestic Policy Council. She is also the principal author of the White House Action Plan identifying whole-of-government policy actions to address SDoH. This episode dives into the US playbook to address SDoH, offering valuable insights into policies and practices aimed at promoting health equity. Don't miss this essential conversation on transforming health equity and improving public health outcomes. 

How to reduce gun violence without taking people's guns ----------------------- Approximately 41,000 people are killed each year due to gun violence. That's more lives lost to guns than to car accidents. So why do we devote more attention (and money) to car safety than we do gun safety? As Northwell Health CEO Michael Dowling points out, the deaths are not the whole story. The physical, emotional, and psychological trauma reverberates through communities and the public at-large. “This is not just not about guns,” says Dowling,” this is a serious public health issue and we've got to look at it that way. Hospitals often deal with the aftermath of gun violence, but they can play a key role in preventing it. Medical staff are trained to assess health risk factors. Dowling argues that a similar approach is needed for guns. "We have to be much more holistic in our approach.” Interested in getting involved? On December 15th, Northwell Health is hosting a hybrid virtual / in-person Gun Violence Prevention Forum, where participants can engage around the shared goal of raising their collective voices and catalyzing action to enact needed systems change. Learn more and register for the public forum here: https://preventgunviolence.com/ -------------------------------- MICHAEL DOWLING: Michael J. Dowling is president and chief executive officer of Northwell Health, New York's largest health care provider and private employer, with 23 hospitals, more than 800 outpatient locations, and 75,000+ employees. One of health care's most influential executives, Mr. Dowling has received numerous awards, including the Ellis Island Medal of Honor, an honorary degree from the prestigious Queen's University Belfast and his selection as the Grand Marshal of the 2017 St. Patrick's Day Parade in NYC. He also serves as chair of the Institute for Healthcare Improvement. ---------------------------------------------------------------------------------- Learn more about your ad choices. Visit megaphone.fm/adchoices

Send us a MessageIn this Culture Byte solo episode, Sue discusses the importance of trust between executives and employees in the workplace. She emphasizes the need for both task trust and relationship trust and highlights the impact of individual executive behavior on the perception of the entire team and organization. She explains how defining and delivering on plans and goals can build trust and maximize momentum in an organization. This episode highlights actual data from a hospital that adopted Capstone's Framework for Achieving Great Results which resulted in significant improvements in many aspects of the organization, including year-after-year increases in the trust-related scores on their annual employee surveys.Closing the “Say-Do Gap” happens as we define and deliver on plans and goals; and in doing so, we build trust and maximize momentum."Trust in senior leadership went from 0.24 below the national average to 0.28 above in one year.""Employees' trust to act on their own without needing approvals increased from 0.09 above the national average to 0.42 above in five years.""Trust in the workplace aligns people around a purpose, embraces goals, and empowers collaboration."

For a full transcript of this episode, click here. Cognitive dissonance is kind of rampant in the healthcare industry. Cognitive dissonance is when what someone winds up doing, their actions, are in conflict with what they believe in. Cognitive dissonance also can mean when someone holds two contradictory beliefs at the same time. Let's say a person believes they want to do well by patients but their performance review depends on, as just one example, making care less affordable for patients. But somehow, this individual is able to conclude that what they're doing is a net neutral or a net positive despite (in this hypothetical, let's just say) obvious indications that it is not. In this hypothetical, there are, say, clear facts that show that what this person is up to is indisputably a problem for patients. But yet at every opportunity, this person talks about their commitment to patients. This rationalization, or earmuffs don't look, don't see, is cognitive dissonance. Now, it's harder to engage in cognitive dissonance the closer you are to patients because you see the impact up close. This is probably why moral injury and burnout is most associated with clinicians who are seeing patients. Unless these at-the-bedside clinicians enjoy a robust lack of self-awareness, those who are seeing patients don't, a lot of times, have the luxury of pretending that what is going on is good for patients when they can see with their own two eyes that it is not good for patients. The further from the exam room or the community, however, the easier it is to not acknowledge the downstream impact—if you can even figure out what that downstream impact is, which is also worthy of being mentioned. When the machine is really big, sometimes it's legitimately difficult to connect the dots all the way down the line to the customers, members, or patients. Kate Wolin, ScD, talked about this in an episode (EP432) a couple of weeks ago. But this whole dissonance exploration was a big reason why actually I created my manifesto, which is episode 400, because almost everything that we do in healthcare wherein we are making money or helping someone else make money is dissonant to some degree. And it literally keeps me up at night contemplating how much dissonance is too much dissonance or how much self-interest is too much self-interest. This is tough, subjective stuff. So, again … episode 400 for more on at least how I think about this. But in this healthcare podcast, I am talking with John Lee, MD, about what to do in the face of all this when working in the, as I call it, belly of the beast—working for a large healthcare organization such as a hospital. Because hospitals sometimes (and we certainly do not want to put all hospitals in the same category—they are a wildly diverse bunch), but sometimes some people at some hospitals do some things which are not things I think they should be doing anyway. They're fairly egregious breaches of trust, actually. But yet within that same organization, you have doctors and other clinicians or others who are working really hard to serve patients as best they can. This is the real world that we're talking about. And the question of the day is … so, now what? While it would be amazing if someday we build a whole new health system that didn't include some people doing things that I don't think they should be doing, that day is not today. And it's not tomorrow. I'm gonna hope that there's other people in our village who are full-on doing the disruption thing. But if we're not able to do that personally, for whatever reason, but we still want to inch forward within the existing environment and do the things that make us feel like we're achieving our mission, what's the best way to think about this? That is what I asked Dr. John Lee, and that's what our conversation is about today. Summing up his advice, which is really good advice, Dr. Lee talks at length about how it's so important to celebrate the small wins and feel good about care that is a little bit better than it was six months ago. He talks about acknowledging that you can't do everything. He talks about incremental improvement that helps both patients but also colleagues, and that's not insignificant to really consciously consider how to work together and help to support each other. Look, I just finished reading a post on LinkedIn about toxic medical culture and just how brutal and cruel some physicians and physician leaders and others can be to their colleagues. Ann Richardson writes about topics like this a lot. Follow her on LinkedIn if you're interested. So does J. Michael Connors, MD. But just saying, it's pretty cognitively dissonant to talk about the potential of team-based care and then condone or engage in toxic behavior with those same team members. There's like 90 studies on this whole topic linked to this book. But bottom line, fixing cognitively dissonant paradigms in any sort of durable or scalable way is, for sure, going to require a culture that inspires constructive criticism, innovation, and collaboration. It also requires—and this is Dr. Lee's last piece of advice—it's really important to seek out like-minded individuals as sounding boards and as a support network to commit to supporting each other. And I hope, all of you, that you feel like you've found your tribe here at Relentless Health Value. You guys are an amazing bunch, so know that and don't hesitate to reach out to each other when you need help. And I know, I know, I need to create a directory so you can all hook up more easily, so do subscribe to the weekly email because I am inching closer to finally managing to get this done and you won't know about it unless you're subscribed. Go to the Web site relentlesshealthvalue.com. You will be hit with a pop-up window fast enough, but back to easing cognitive dissonance and the why here. I thought Michelle Bernabe put how much of a difference the right culture can make for patients and those who work together really eloquently recently. This is a great why, since we spend so much of our life at work. She wrote, “Each day, we come together [ready to] roll up our sleeves, committed to our own growth, our boundaries, … and our teamwork. This collective dedication resonates throughout our organization and is, I trust, felt by our clients and [our] partners!” In the conversation that follows, Dr. John Lee offers a really nice array of examples of incremental, in the belly of the beast, stuff that might be possible in the real world (at least in the bellies of some beasts), plus some other points of contemplation. Dr. Lee is an ER (emergency room) doc by training, who is also an informaticist and chief medical information officer. I can tell you from personal experience that Dr. Lee is one of the most creative and pragmatic problem solvers that I have encountered. He says he's dedicated to trying to help move the ball forward and changing our healthcare system using information technology and using our ability to be far more transparent with the things that we try to do in a positive way in healthcare. Below are some additional episodes concerning heart failure readmissions: EP326: The Unfortunate News About HRRP, With Insight Into How to Fix It, With Rishi Wadhera, MD, MPP INBW34: The Absence of Collaboration Between Healthcare Stakeholders: What It Means EP361: The Gap in Closing Care Gaps, With Carly Eckert, MD, PhD(c), MPH Also mentioned in this episode are Kate Wolin, ScD; Ann M. Richardson, MBA; J. Michael Connors, MD; Michelle Bernabe, RN, KAT; Scott Conard, MD; Jodilyn Owen; Rob Andrews; Rishi Wadhera, MD, MPP; Peter Attia, MD; Barbara Wachsman; Kenny Cole, MD; and Mark Cuban.   You can learn more by following Dr. Lee on LinkedIn.   John Lee, MD, is both a practicing emergency physician and a highly regarded clinical informaticist. He has served as chief medical information officer at multiple organizations and has an industry reputation for maximizing the utility and usability of the electronic medical record (EMR) as a digital tool. He was the recipient of the HIMSS/AMDIS Physician Executive of the Year Award in 2019. He has deep expertise in EMRs, informatics, and particularly in Epic. He has multiple analyst certifications, which gives him a unique advantage in delivering solutions to Epic organizations. His vision is a healthcare system that is driven completely by transparent data, information, and knowledge, delivered efficiently.   07:37 What is cognitive dissonance relative to the healthcare industry? 08:57 What are the systems that start to bear down on individuals within the healthcare system? 10:14 EP391 with Scott Conard, MD. 10:48 EP421 with Jodilyn Owen. 10:59 EP415 with Rob Andrews. 12:30 EP326 with Rishi Wadhera, MD, MPP. 13:10 “The system has almost gamed them.” 17:49 EP430 with Barbara Wachsman. 19:07 How can alignment still be achieved in the face of cognitive dissonance? 20:34 EP431 with Kenny Cole, MD. 24:06 Why does it take more than one person to solve the dysfunction in the healthcare system? 26:26 What are some little changes that can help change the cognitive dissonance in healthcare? 28:22 Why is a hierarchal healthcare structure not necessarily beneficial? 30:38 The RaDonda Vaught story. 37:58 “Be happy in the small things.”   You can learn more by following Dr. Lee on LinkedIn.   John Lee, MD, discusses overcoming #cognitivedissonance on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Brian Klepper, Elizabeth Mitchell, David Scheinker (Encore! EP363), Dan Mendelson, Dr Benjamin Schwartz, Justin Leader, Dr Scott Conard (Encore! EP391), Jerry Durham (Encore! EP297), Kate Wolin, Dr Kenny Cole  

“It's the second largest line item that a company has, but they will stroke a check every month for a fully insured program without having data to support what those costs are for.” - Stephanie Koch Stephanie Koch joined the show to share what it was like to work in benefits and HR in a fully funded company before moving to one that self-funds.  I invited Stephanie on to hear the employer perspective on the industry, but ended up getting so much more, as she's truly on the cutting edge of healthcare benefits for her company Hendry Marine. We discussed what it's like to deal with Reference-Based Pricing as an employer, why mobile clinics save lives and are crucial to self-funded plans, and why it's so important to seek out nontraditional healthcare solutions in the current market.  No matter what aspect of our industry you work in, everything we do is for employers and employees, and there's so much insight to gain from forward-thinking benefits managers like Stephanie.  Chapters: 00:00:00 Meet Stephanie Koch 00:01:36 Empowering Employers in Self-Funded Healthcare Systems 00:12:37 Challenges in Renewing Fully Funded Healthcare 00:32:44 Maximizing Healthcare Savings Through Reference Based Pricing 00:43:13 Evolving RBP Plans for Employee Benefits 00:51:56 Early Detection Incentives Through Preventive Wellness Exams 01:03:07 Strategic Healthcare Partnering for Self-Funding Success Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/ Key Words:  #SelfFundedHealthcare #ReferenceBasedPricing #EmployeeBenefits #DataAnalysis #PreventiveExams #OnsiteClinics #CostSavings #ConsultingPartners #HealthcareImprovement #RBPStrategies #HealthcareCosts #TransparentSystem #selffunded #podcast Self Funded Healthcare, Reference Based Pricing, Employee Benefits, Data Analysis, Preventive Exams, Onsite Clinics, Cost Savings, Consulting Partners, Healthcare Improvement, RBP Strategies, Healthcare Costs, Transparent System, self funded, podcast --- Support this podcast: https://podcasters.spotify.com/pod/show/spencer-harlan-smith/support

Show SummaryOn today's episode, we feature Kate DeBartolo, a senior director for the Institute for Healthcare Improvement and the leader for the conversation project. IHI has public engagement initiative to help people share their wishes for care through the end of their lifeAbout Today's GuestKate DeBartolo is a Senior Director at the Institute for Healthcare Improvement (IHI) and leads The Conversation Project, IHI's public engagement initiative to help people share their wishes for care through the end of life. The Conversation Project was founded in 2010, on the belief that these discussions should begin at the kitchen table—not in the intensive care unit. The Conversation Project offers free tools, guidance, and resources to begin talking with those who matter most about your and their wishes.  Kate joined IHI in 2007, with earlier work designing and executing the national field operations for IHI's hospital-based programs. Prior to joining IHI, Kate worked as a grant analyst at The California Endowment. She is a graduate of Wellesley College and currently lives in Washington DC with her husband and son. Links Mentioned In This EpisodeThe Conversation Project WebsitePsychArmor Resource of the WeekThis week's PsychArmor resource of the week is the PsychArmor course Caring for Veterans through End of Life: Caregivers and Loved Ones. In this course, you will learn how to support and care for Veterans as they near the end of their lives. We will explore the impact of the final journey on caregivers and loved ones, and the importance of planning and respite care. We will discuss how a Veteran's service in different eras may impact their care and the unique challenges faced by caregivers and loved ones in the grieving process. By the end of this course, you will have the knowledge and skills necessary to provide compassionate care and support to Veterans and their families during this important time.  You can see find the course here:  https://learn.psycharmor.org/courses/caring-for-veterans-through-the-end-of-life-caregivers-and-loved-ones This Episode Sponsored By: This episode is sponsored by PsychArmor. PsychArmor is the premier education and learning ecosystems specializing in military culture content PsychArmor offers an. Online e-learning laboratory that is free to individual learners as well as custom training options for organizations. Contact Us and Join Us on Social Media Email PsychArmorPsychArmor on TwitterPsychArmor on FacebookPsychArmor on YouTubePsychArmor on LinkedInPsychArmor on InstagramTheme MusicOur theme music Don't Kill the Messenger was written and performed by Navy Veteran Jerry Maniscalco, in cooperation with Operation Encore, a non profit committed to supporting singer/songwriter and musicians across the military and Veteran communities.Producer and Host Duane France is a retired Army Noncommissioned Officer, combat veteran, and clinical mental health counselor for service members, veterans, and their families.  You can find more about the work that he is doing at www.veteranmentalhealth.com  

The engaging memoir of a legendary president of Wellesley College known for authentic and open-hearted leadership, who drove innovation with power and love. The Claims of Life: A Memoir (The MIT Press, 2023) traces the emergence of a young woman who set out believing she wasn't particularly smart but went on to meet multiple tests of leadership in the American academy—a place where everyone wants to be heard and no one wants a boss. In college, Diana Chapman met Chris Walsh, who became a towering figure in academic science. Their marriage of fifty-seven years brought them to the forefront of revolutions in higher education, gender expectations, health-care delivery, and biomedical research.  The Claims of Life offers readers an unusually intimate view of trustworthy leadership that begins and ends in self-knowledge. During a transformative fourteen-year Wellesley presidency, Walsh advanced women's authority, compassionate governance, and self-reinvention. After Wellesley, Walsh's interests took her to the boards of five national nonprofits galvanizing change. She kept counsel with Nobel laureates, feminist icons, and even the Dalai Lama, seeking solutions to the world's climate crisis. With an ear tuned to social issues, The Claims of Life is an inspiring account of a life lived with humor, insight, and meaning that will surely leave a lasting impression on its readers. Diana Chapman Walsh is President Emerita of Wellesley College and an emerita member of the governing boards of MIT and Amherst College. She was a trustee of the Kaiser Family Foundation, the Institute for Healthcare Improvement, and the Mind and Life Institute, and also chaired the Broad Institute's inaugural board and cofounded the Council on the Uncertain Human Future. Caleb Zakarin is editor at the New Books Network. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network

The engaging memoir of a legendary president of Wellesley College known for authentic and open-hearted leadership, who drove innovation with power and love. The Claims of Life: A Memoir (The MIT Press, 2023) traces the emergence of a young woman who set out believing she wasn't particularly smart but went on to meet multiple tests of leadership in the American academy—a place where everyone wants to be heard and no one wants a boss. In college, Diana Chapman met Chris Walsh, who became a towering figure in academic science. Their marriage of fifty-seven years brought them to the forefront of revolutions in higher education, gender expectations, health-care delivery, and biomedical research.  The Claims of Life offers readers an unusually intimate view of trustworthy leadership that begins and ends in self-knowledge. During a transformative fourteen-year Wellesley presidency, Walsh advanced women's authority, compassionate governance, and self-reinvention. After Wellesley, Walsh's interests took her to the boards of five national nonprofits galvanizing change. She kept counsel with Nobel laureates, feminist icons, and even the Dalai Lama, seeking solutions to the world's climate crisis. With an ear tuned to social issues, The Claims of Life is an inspiring account of a life lived with humor, insight, and meaning that will surely leave a lasting impression on its readers. Diana Chapman Walsh is President Emerita of Wellesley College and an emerita member of the governing boards of MIT and Amherst College. She was a trustee of the Kaiser Family Foundation, the Institute for Healthcare Improvement, and the Mind and Life Institute, and also chaired the Broad Institute's inaugural board and cofounded the Council on the Uncertain Human Future. Caleb Zakarin is editor at the New Books Network. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/gender-studies

The engaging memoir of a legendary president of Wellesley College known for authentic and open-hearted leadership, who drove innovation with power and love. The Claims of Life: A Memoir (The MIT Press, 2023) traces the emergence of a young woman who set out believing she wasn't particularly smart but went on to meet multiple tests of leadership in the American academy—a place where everyone wants to be heard and no one wants a boss. In college, Diana Chapman met Chris Walsh, who became a towering figure in academic science. Their marriage of fifty-seven years brought them to the forefront of revolutions in higher education, gender expectations, health-care delivery, and biomedical research.  The Claims of Life offers readers an unusually intimate view of trustworthy leadership that begins and ends in self-knowledge. During a transformative fourteen-year Wellesley presidency, Walsh advanced women's authority, compassionate governance, and self-reinvention. After Wellesley, Walsh's interests took her to the boards of five national nonprofits galvanizing change. She kept counsel with Nobel laureates, feminist icons, and even the Dalai Lama, seeking solutions to the world's climate crisis. With an ear tuned to social issues, The Claims of Life is an inspiring account of a life lived with humor, insight, and meaning that will surely leave a lasting impression on its readers. Diana Chapman Walsh is President Emerita of Wellesley College and an emerita member of the governing boards of MIT and Amherst College. She was a trustee of the Kaiser Family Foundation, the Institute for Healthcare Improvement, and the Mind and Life Institute, and also chaired the Broad Institute's inaugural board and cofounded the Council on the Uncertain Human Future. Caleb Zakarin is editor at the New Books Network. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/biography

The engaging memoir of a legendary president of Wellesley College known for authentic and open-hearted leadership, who drove innovation with power and love. The Claims of Life: A Memoir (The MIT Press, 2023) traces the emergence of a young woman who set out believing she wasn't particularly smart but went on to meet multiple tests of leadership in the American academy—a place where everyone wants to be heard and no one wants a boss. In college, Diana Chapman met Chris Walsh, who became a towering figure in academic science. Their marriage of fifty-seven years brought them to the forefront of revolutions in higher education, gender expectations, health-care delivery, and biomedical research.  The Claims of Life offers readers an unusually intimate view of trustworthy leadership that begins and ends in self-knowledge. During a transformative fourteen-year Wellesley presidency, Walsh advanced women's authority, compassionate governance, and self-reinvention. After Wellesley, Walsh's interests took her to the boards of five national nonprofits galvanizing change. She kept counsel with Nobel laureates, feminist icons, and even the Dalai Lama, seeking solutions to the world's climate crisis. With an ear tuned to social issues, The Claims of Life is an inspiring account of a life lived with humor, insight, and meaning that will surely leave a lasting impression on its readers. Diana Chapman Walsh is President Emerita of Wellesley College and an emerita member of the governing boards of MIT and Amherst College. She was a trustee of the Kaiser Family Foundation, the Institute for Healthcare Improvement, and the Mind and Life Institute, and also chaired the Broad Institute's inaugural board and cofounded the Council on the Uncertain Human Future. Caleb Zakarin is editor at the New Books Network. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/american-studies

The engaging memoir of a legendary president of Wellesley College known for authentic and open-hearted leadership, who drove innovation with power and love. The Claims of Life: A Memoir (The MIT Press, 2023) traces the emergence of a young woman who set out believing she wasn't particularly smart but went on to meet multiple tests of leadership in the American academy—a place where everyone wants to be heard and no one wants a boss. In college, Diana Chapman met Chris Walsh, who became a towering figure in academic science. Their marriage of fifty-seven years brought them to the forefront of revolutions in higher education, gender expectations, health-care delivery, and biomedical research.  The Claims of Life offers readers an unusually intimate view of trustworthy leadership that begins and ends in self-knowledge. During a transformative fourteen-year Wellesley presidency, Walsh advanced women's authority, compassionate governance, and self-reinvention. After Wellesley, Walsh's interests took her to the boards of five national nonprofits galvanizing change. She kept counsel with Nobel laureates, feminist icons, and even the Dalai Lama, seeking solutions to the world's climate crisis. With an ear tuned to social issues, The Claims of Life is an inspiring account of a life lived with humor, insight, and meaning that will surely leave a lasting impression on its readers. Diana Chapman Walsh is President Emerita of Wellesley College and an emerita member of the governing boards of MIT and Amherst College. She was a trustee of the Kaiser Family Foundation, the Institute for Healthcare Improvement, and the Mind and Life Institute, and also chaired the Broad Institute's inaugural board and cofounded the Council on the Uncertain Human Future. Caleb Zakarin is editor at the New Books Network. Learn more about your ad choices. Visit megaphone.fm/adchoices

The engaging memoir of a legendary president of Wellesley College known for authentic and open-hearted leadership, who drove innovation with power and love. The Claims of Life: A Memoir (The MIT Press, 2023) traces the emergence of a young woman who set out believing she wasn't particularly smart but went on to meet multiple tests of leadership in the American academy—a place where everyone wants to be heard and no one wants a boss. In college, Diana Chapman met Chris Walsh, who became a towering figure in academic science. Their marriage of fifty-seven years brought them to the forefront of revolutions in higher education, gender expectations, health-care delivery, and biomedical research.  The Claims of Life offers readers an unusually intimate view of trustworthy leadership that begins and ends in self-knowledge. During a transformative fourteen-year Wellesley presidency, Walsh advanced women's authority, compassionate governance, and self-reinvention. After Wellesley, Walsh's interests took her to the boards of five national nonprofits galvanizing change. She kept counsel with Nobel laureates, feminist icons, and even the Dalai Lama, seeking solutions to the world's climate crisis. With an ear tuned to social issues, The Claims of Life is an inspiring account of a life lived with humor, insight, and meaning that will surely leave a lasting impression on its readers. Diana Chapman Walsh is President Emerita of Wellesley College and an emerita member of the governing boards of MIT and Amherst College. She was a trustee of the Kaiser Family Foundation, the Institute for Healthcare Improvement, and the Mind and Life Institute, and also chaired the Broad Institute's inaugural board and cofounded the Council on the Uncertain Human Future. Caleb Zakarin is editor at the New Books Network. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/education

“In the United States we don't ration medicine, we ration people.”We are honored this week to welcome an esteemed author, pediatrician, educator and co-founder of the Institute for Healthcare Improvement, Dr. Don Berwick.Dr. Berwick has dedicated his career to reigniting our healthcare system, to ensure it can meet the needs of disadvantaged people, and limit the excess profits being hoarded as wealth by the powers that be.Formerly serving as the former Administrator of the Centers for Medicare and Medicaid Services under Barack Obama, he knows the details of our system inside out - challenging misinformation and calling out partisan refusals to collaborate for the good of everyone, not just the stakeholders.In our discussion, he shares his story, his experiences in government, common misconceptions about his philosophies, his worry at the corporatization of our system, and some seeds of hope amidst a climate of greed.“Anybody that says we can't meet the needs of the American public isn't reading the information. What they mean is, we can't meet the needs of the American public and satisfy all the greed that we've unleashed in the current system.”Follow me on Instagram and Facebook @ericfethkemd and checkout my website at www.EricFethkeMD.com. My brand new book, The Privilege of Caring, is out now on Amazon! https://www.amazon.com/dp/B0CP6H6QN4

Send us a MessageIn this episode, Sue discusses the impact of trust, or lack thereof, between the administrative team and the board of directors. She draws on examples from her experiences as a senior executive in healthcare and highlights the need for trust between the board and the executive team to facilitate more effective decision-making . . . and speeding up the timeframe to achieving the desired results. She suggests two tactics to build trust: changing the definition of 'old business' on the board agenda and creating a well-designed strategic plan.Episode Insights and TakeawaysTrust is essential for a culture of achievement and success in organizations.Lack of trust can lead to slow decision-making and excessive rework.To build trust, organizations should revisit the progress and outcomes of past decisions under 'old business' on the board agenda.Having a well-designed strategic plan can also foster trust and speed up decision-making.

Cybersecurity breaches in healthcare demand industry-wide support and collaboration. In this episode at HIMSS 2024, Steve Low, President of KLAS Research, and Boyd Stewart, VP of Payer-Provider Collaboration at KLAS, reflect on the recent Best in KLAS event, which celebrated excellence in healthcare with a record-breaking turnout of over 700 attendees. Boyd highlights the importance of measuring payer-provider collaborations, emphasizing the need to focus on success stories rather than just challenges. Steve discusses the impact of recent cybersecurity breaches in healthcare, stressing the need for collaboration and support within the industry. The conversation touches on the evolving role of AI in healthcare solutions, with a shift towards tangible outcomes and real applications, and encourages listeners to take an active role in their healthcare, ask thought-provoking questions, and stay informed about industry developments. Tune in and learn how collaboration, cybersecurity, and AI are shaping the future of healthcare, and discover how you can make a difference in improving healthcare outcomes! Resources:  Watch the entire interview here. Connect with and follow Steven Low on LinkedIn here. Follow and connect with Boyd Stewart on LinkedIn here. Learn more about KLAS Research on LinkedIn and their website. Listen to Steve's previous interview on the podcast here. Find out more about Best in KLAS Rankings here.

Do you struggle to meet your goals or targets? Find out how you can change your thinking about goals and your process for setting them so you can keep moving forward. In this episode, John Dues and host Andrew Stotz discuss the first five of John's 10 Key Lessons for Data Analysis. TRANSCRIPT 0:00:03.0 Andrew Stotz: My name is Andrew Stotz and I'll be your host as we continue our journey into the teachings of Dr. W. Edwards Deming. Today I'm continuing my discussion with John Dues, who is part of the new generation of educators striving to apply Dr. Deming's principles to unleash student joy in learning. This is episode two of four in a mini-series on why goal setting is often an act of desperation. John, take it away.   0:00:32.3 John Dues: Hey, Andrew, it's good to be back. Yeah, in that last episode, that first episode in this mini-series, we talked about why goal setting is often an act of desperation and I basically proposed these four conditions that organizations should understand prior to setting a goal. So it's not the goals in and of themselves that are bad, but it's with this important understanding that's often lacking. So those four things that organizations should understand, one, what's the capability of a system under study? So that's the first thing, how capable is the system or the process? The second thing is what's the variation within that system or process under study? So that's the second thing we talked about last time. The third thing is understanding if that system or process is stable. And then the fourth thing was, if we know all of those things, by what method are we going to approach improvement after we set the goal, basically? So you gotta have those four things, understanding the capability of the system, the variation of the system, the stability of the system, and then by what method, prior to setting a goal. And so I think I've mentioned this before, but absent of an understanding of those conditions, what I see is goals that are, what I call it, arbitrary and capricious.   0:01:48.8 JD: That's a legal characterization. You look that up in the law dictionary. And it basically says that an "arbitrary and capricious law is willful and unreasonable action without consideration or in disregard of facts or law." So I'm just now taking that same characterization from a legal world and applying it to educational organizations and accountability systems, and I just switched it to "a willful and unreasonable goal without consideration or in disregard of system capability, variability, and/or stability." And we see these all over the place for education organizations, for schools, school districts, teachers, that type of thing.   0:02:31.6 JD: And so what I tried to do in the book and tried to do here in my work in Columbus is develop some sort of countermeasures to that type of goal setting and develop the 10 key lessons for data analysis. An antidote to the arbitrary and capricious goals seen throughout our sector. And this process behavior chart tool, looking at data in that format is central to these lessons. So what I thought we would do in this episode and the next is outline those 10 key lessons. So five today and then do another five in the next episode. And in the fourth episode of the series, what we would do is then apply those examples to a real life improvement project from one of our schools. It's helpful, I think too, to sort of, to understand the origin of the key lessons. So there's the lessons that I'll outline are really derived from three primary sources.   0:03:36.0 JD: So the first two come from Dr. Donald Wheeler, who I've mentioned on here before, a lot of Deming folks will, of course, have heard of Dr. Wheeler, who's a statistician in Tennessee, a colleague of Dr. Deming when Dr. Deming was alive and then has carried on that work to this day. The two books, two really great books that he wrote, one is called Understanding Variation, a thin little book, a good primer, a good place to start. And then he's got a thicker textbook called Making Sense of Data, where you get in really into the technical side of using process behavior charts. So I'd highly recommend those. And then the third resource is a book from a gentleman, an engineer named Mark Graban called Measures of Success. And I really like his book because he has applied it, the process behavior chart methodology, to his work and he's really done it in a very contemporary way. So he's got some really nice color-coded charts in the Measures of Success book and I think they're really easy to understand with modern examples, like traffic on my website, for example, in a process behavior chart, really easy to understand modern example. But all three of the books, all three of the resources are built on the foundation of Dr. Deming's work. They're, you know, Graban and Wheeler are fairly similar and I think Graban would say he's a student of Wheeler.   0:05:00.4 JD: He learned of this mindset, this approach to data analysis by finding a Donald Wheeler book on his own dad's bookshelf when he was in college and starting down that path as a young engineer to study this stuff. And basically what I've done is take the information from those three resources and make some modifications so they can be understood by educators, basically. I think it's also worth noting again that process behavior chart methodology is right in the center of this, really for three reasons. One, when you plot your data that way, you can start to understand messages in your data, I think that's really important. Second, you can then start to differentiate between special and common causes, special and common causes, translate that into regular language. I can translate between something that I should pay attention to and something that's not significant basically in my data. And then in so doing, I know the difference between when I'm reacting to noise versus when I'm reacting to signals in my data, so I think that's really important. So the process behavior chart is at the center of all this. So we'll go through five of these lessons, one by one, I'll outline the lesson and then give a little context for why I think that particular lesson is important.   0:06:25.4 AS: That sounds like a plan. So capability, variation, stability and method. You've talked about Donald Wheeler, excellent book on Understanding Variation, that's the one I've seen. And of course, Mark Graban's book, Measures of Success, very well rated on Amazon and a podcaster himself, too.   0:06:49.6 JD: Yeah. And if I was a person studying this and wanting to get into process behavior charts and really knowing how to look at data the right way, I would read Understanding Variation first because it's a good primer, but it's fairly easy to understand. And then I would read Measures of Success 'cause it's got those practical applications now that I have a little bit of a baseline, and then if I wanna go deep into the technical stuff, the Making Sense of Data, that's the textbook that drives everything home. Yeah. So we'll dive into the lesson then.   0:07:19.5 AS: Let's do it.   0:07:20.0 JD: Yeah. Okay. So the first lesson, and I've talked about this in various episodes before, but lesson one, the very first lesson is, "data have no meaning apart from their context." So this seems commonsensical, but I see this all the time where these things aren't taken care of. And what I'm talking about is answering some basic questions. So for anyone looking at my data, they should be able to answer some basic questions, very simply, anybody that looks at my data. First thing is who collected the data? That should be apparent. How were the data collected? When were the data collected? Where were the data collected? And then what do these values represent? So oftentimes I see data either in a chart or in some type of visualization and almost none of those things are known from looking at the data, all important questions.   0:08:18.6 JD: The second question would be, well, that first set goes together. The second question is what's the operational definition of the concept being measured? So we have to be on the same page about what it is exactly being measured in this data that I've collected. I also wanna know how were the values of any computed data derived from the raw inputs? That's important. And then the last thing is, have there been any changes made over time that impact the data set? For example, perhaps the operational definition has changed over time for some reason. Maybe there's been a change in formula being used to compute the data.   0:09:05.4 JD: So an example would be, from my world, high school graduation rates. You know, 20 years ago there was one definition of how you calculated a high school graduation rate, now there's a different definition. So when you compare those two sets of data, you've gotta be careful because you're actually, you're actually working from different definitions and I think that happens all the time. More recently here in Ohio, what it means to be proficient on a state test, that definition changed about 10 years ago. And so if you look at test results from 2024 and try to compare them to 2014, you're really comparing apples and oranges 'cause there's two different definitions of proficiency, but no one remembers those things a decade later. So you have...   0:09:52.3 AS: And then a chart will be presented where the different methodologies are shown as one line that says...   0:10:00.8 JD: Yes.   0:10:00.8 AS: That no one's differentiated the fact that at this point it changed.   0:10:04.6 JD: Yeah, at this point it changed. So first lesson, data have no meaning apart from their context. Second lesson is we don't manage or control the data, the data is the voice of the process. What we control is the system and the processes from which the data come. There's a difference there. Right? So I think this is one of the key conceptions of that system's view, that system's thinking in an organization. When we wanna make improvements in our schools, we need a few things in place. We need the people working in the system. So that would be the students for us, they're working in the system, people that have the authority to work on the system, so that'd be teachers if we're talking about an individual classroom, at the school building level, maybe we're talking about the principal. And those two things are, at least the teacher principal thing is usually in place, the students being a part of improvement projects, definitely less so, but maybe there are places where that's happening. But the third thing is someone with an understanding of the System of Profound Knowledge, I'd say that's almost always lacking in the education sector, at least. And I think the reason the System of Profound Knowledge becomes important, 'cause that's really the theoretical foundation for all the things that we're talking about when we're looking at data in this way.   0:11:38.8 JD: If you lack that conception, then it's hard to bring about any improvement, because you don't understand how to look at that data, how to interpret that data, you don't understand how to run a plan-do-study-act cycle. Because what you're gonna ultimately have to do is change some process in your system and there's some knowledge that you're gonna need to be able to do that, and that's, that third component of an improvement team has to be in place to do that. But I think the most important thing is that we're not in control of the data, we're in control of the processes that ultimately lead to the data. It's a distinction, maybe a fine distinction, but I think it's an important one.   0:12:17.5 AS: The idea of the System of Profound Knowledge and understanding what to do with the data and really understanding the whole thing, I was just thinking what would... An analogy I was thinking about is rain. Everybody understands rain as it comes out of the sky, but not everybody understands how to use that to make a pond, to make an aqueduct, to feed a farm, to, whatever that is. And so having that big picture is key, so, okay. So number...   0:12:57.8 JD: Yeah. Well, and a part of that is something really simple is constantly understanding data is the voice of the process. And so when you're looking at data, what often happens is I'm gonna walk into a meeting with my boss, and I'm looking for some data point, maybe we just got some type of performance data back or survey results or something. I'm gonna pick one of those items where the plot, where the dot from last time has improved when we look at it this time, and I take that and say, "Look how we've improved in this thing." And you need someone to say, "Well, wait a second, while there is a difference between those data points, if I look at the last 12, things are just moving up and down." And there's gotta be someone in the room that constantly points back to that, constantly. And that's where that person with the Profound Knowledge is helpful in improvement work.   0:13:54.5 AS: So the voice of the process is a great way of phrasing it that's been used for a while now and I think it's really good. I remember when I worked at Pepsi as a young supervisor, I saw some problem on the production line and I raised it to the maintenance guys. And they kept coming and fixing it and it would break and they'd fix it and it would break, and I basically got mad at him and I was like, "What the hell?" And he's like, "Bosses won't pay for the things that I need to fix this permanently, so get used to it constantly breaking down."   0:14:33.4 JD: And that's the best I can do.   0:14:34.0 AS: That's the voice of the system, here's what I can produce with what you've given me to produce.   0:14:40.8 JD: Yep. Yep. Yeah. Those guys had a very keen understanding of the system, no doubt in that example. Yeah. Yeah. And that kind of thing happens all the time, I think. That was lesson two. Lesson three is plot the dots for any data that incurs in time order. So a lot of people in this world know Dr. Donald Berwick, he started the Institute for Healthcare Improvement. He was a student of Dr. Deming's, he's done a lot of work in this area. He has a great quote where he says, "Plotting measurements over time turns out, in my view, to be one of the most powerful things we have for systemic learning." And that's what really plot the dots is all about, it's all about turning your data into a visualization that you can learn from. And the National Health Service in England has this #plotthedots. And I think the whole point is that plotting the dots, plotting the data over time helps us understand variation and it leads us to take more appropriate action when we do that. So whether it's a run chart or a process behavior chart, just connecting the consecutive data points with a line makes analysis far more intuitive than if we store that data in a table.   0:16:03.6 AS: Yeah. And I was thinking about if you're a runner and you wanna compete in a marathon, plotting the dots like that is so valuable because you can see when changes happen. For instance, let's just say one night you didn't eat and then you ran the next morning and then your performance was better. Was it just a noise variation or is there something that we can learn from that? And then just watching things over time just give you ideas about what... Of potential impacts of what something could do to change that.   0:16:42.0 JD: Yeah. And we can start with a simple run chart, it doesn't have the limits, it's just a line chart. And then once we have enough of the data collected, enough plotted dots, then we can turn it into the process behavior chart.   0:16:56.3 AS: Some people don't even want to see that, John, like when we looked at your weight chart, remember that?   0:17:03.0 JD: I do remember that. Yeah.   0:17:04.0 AS: So for the people out there that really wanna let's say, control your weight, put a dot plot chart on your wall and measure it each day and just the awareness of doing that is huge.   0:17:18.7 JD: Yep. It is huge. It really is huge. And that works for any data that occurs over time, so almost everything that we're interested in improving occurs in some type of time order, time sequence. So these charts are appropriate for a wide array of data. But the bottom line is that... Oh, yeah, sorry, go ahead.   0:17:33.5 AS: The bottom line?   0:17:35.0 JD: Well, I was just saying the bottom line, whether you're using a run chart or a process behavior chart, it's always gonna tell us more than a list or a table of numbers, basically.   0:17:44.5 AS: I was gonna explain this, a situation I had when I was head of research at a research firm, a broker here in Thailand. I, my goal was to get more output from the analysts, they needed to write more and we needed to get more out. So what I did and I had already learned so much about Deming and stuff at that time. So what I did is I just made a chart showing each person's, what each person wrote each week, and it was a run chart in that sense where people could see over time what they wrote and they could see what other people were writing. And I purposely made no comments on this chart and I'd never really discussed it, I just put it up and updated it every week. And one of the staff that worked for me, an analyst, a really smart Thai woman asked, she said, she went to... She said, "I wanna see you in your office." I was like, "Oh, shit, I'm in trouble." And so she came to my office and said, "You know I went to, so this was maybe six months after I had put that chart up, she said, "I went out to lunch with my counterpart, my competitor, and she's writing research just like me on the same sector, and she asked me how many research reports do you write in a week, and I told her my number, and she was like, "Oh my God, that's a huge number."   0:19:16.6 AS: And she said, "Oh, I didn't really even think about it. But okay." And then she says, "What is Andrew's goal or target for you?" And she had naturally had thought that I had set a target of that amount, that's where she said, "I think I really figured you out." And I was like, "Well, what do you mean?" She said, "You just put that chart up there and you didn't give us any goal, but you knew that we were looking at it, and then it would provide us information and incentive and excitement, and the fact that you said nothing about it, got us to probably a higher level of production than if you had said, "I want everybody to read my reports."   0:19:57.9 JD: Right. Yeah, that's great.   0:20:01.0 AS: The magic of data. What's number four?   0:20:02.4 JD: The magic of data. Number four, so two or three data points are not a trend. So the first thing is, as soon as you've decided to collect some set of data, plot the dots, that should start right away. And again, this really includes all data that we're interested in improving in schools. And I know before I understood this way of thinking, this way of data analysis, I often relied on just comparing two points, that's the most common form of data analysis. What did last month look like, what does month look like? What did last year look like, what does this year look like? What did last week look like, what does this week look like? So that limited comparison is the most typical form of data analysis, especially when you're talking about something like management reports or board reports, revenue over time, those types of things. What was revenue last January? That type of thing. But the problem with looking at just two or three data points is that it tells you nothing about trends, it also doesn't tell you anything about how the data varies naturally.   0:21:17.5 JD: I remember looking at attendance data at one of our schools, and they had up... Last month was 92%, and then had gone up to 94%, but then I just said, well, what did it look like... January is 92, February is 94 in this particular school year, and I just said, well, what did it look like before, and then when you plotted it, what saw very quickly is there was no improvement, the data was literally going like this, up, down, up, down, up, down, up down, right? But no one had that picture, because all you could see was, Here's January and here's February, just numbers written in percentage form, that's almost all the data that I see in schools is in a similar format.   0:22:02.7 AS: On this one, in the stock market, my area of expertise. People always see the up data, the people who have made a lot of money in the stock market, and they see that as evidence that they could make money in the stock market, or they attribute that to skill of that particular person as we want to, with Warren Buffett as an example. And I have, in fact in my class, I asked the students, "Do you think that Warren Buffet outperformed, underperformed, or performed in line with the market over the last 20 years?" And the answer to that is, he performed in line with the market, and I proved that by doing a demonstration through a website that I can do that with, but it was shocking because obviously he's gonna end up with the most amount of money because he let his money compound, and he made huge gains in the beginning years, which compounded over many years.   0:23:02.0 AS: And still he's doing very well, but the point is, is that... The reason why I say this, I also tell the story of, if you had 10,000 people in a stadium and you flipped coins, and asked them if they flipped heads consecutively or tails consecutively to remain standing, and you're gonna end up with 10 people at the end of 10 flips with 10,000, and if you've got a million, you can end up with 20 or 30 or 40 flips that could potentially be heads consecutively or tails consecutively. So my question is, given that long streaks can happen through just plain probability, what if two to three data points are not a trend, can we definitively say, what is a trend?   0:23:50.9 JD: Well, not with certainty, but what this type of data analysis does is it gives you some patterns in the data to look for that are so mathematically improbable that you can be reasonably assured that some changes happened.   0:24:09.4 AS: Right so this is enough of a trend that I'm gonna go with the assumption that there's something significant here.   0:24:21.9 JD: Yeah. I mean it's...well, think back to that attendance example that I just used, so if I went from... If I'm writing this up on, let's say a whiteboard that's in a teacher work room, it says, this month and next month, or last month and this month, and I write those attendance rates up and remember, it's a dry erase board, and I'm gonna erase the last month to put this month's up and so I'm not gonna be able to see that one anymore, I'll have two data points and I'll erase the old one, and so in that example, I used where they went from 92%. It was actually like 92.4% to 94.1%. So it wasn't even two full percentage points. And then you celebrate that as a win, as an improvement, but like I said, you didn't know what happened before, and then you didn't chart after, so you don't really know how things are just bouncing around naturally versus if you had it on a run chart and you did see, let's say, eight points in a row that are above the average attendance for that school, that's one of the patterns that suggest that something different has happened. So you just have increased mathematical probability that there has been meaningful improvement.   0:25:39.4 AS: So it sounds like what you mean in this number four is a little bit more on the end of, Hey, just a couple of data points doesn't have anything, you need to get more rather than somebody looking at a lot of data and trying to understand what is a trend or not?   0:25:56.9 JD: That's exactly right. That's exactly right. And that actually is a segue to Lesson 5, which is "show enough data in your baseline to illustrate the previous level of variation," basically. So this is gonna get a little technical for a second, but the non-technical thing is, we talked about when you have a run chart when you're starting and you have, let's say, three or four or five, six data points at a certain point, you can now have a process behavior chart, which is the addition of that upper and lower natural process limit that defines the bounds of the system, so the limits are not a part of the run chart.   0:26:34.9 JD: In making sense of data what Donald Wheeler basically says is that if you're using an average line, the mean for your central line, then those limits, you begin to have limits that solidify when you have 17 or more values, and then if you're using a median for that central line, that solidification starts to happen when you have 23 or more values. So there's a mathematical theory behind that. But the point is, at a certain point, you start to get enough data to be able to add the limits and feel confident that those limits actually represent the bounds of your current system. But that's getting fairly technical and what Wheeler does go on to say is that, in real life we often have fewer data points to work with.   0:27:31.4 JD: So you can actually compute limits with as few as five or six values, and they can still be meaningful, now they're gonna be not a solid, meaning that each individual data point for a while that you add could potentially shift those limits more than you'd like, because there are a few data points that the limits are based on. But once you get to 17, 18, 19, 20 points, they start to solidify pretty good unless there's some significant change, like one of those patterns I talked about in your data. But an important thing to keep in mind is, is we're using a process behavior chart for continual improvement, so we're taking improvement measurements, not accountability measurements. I'm not trying to paint a certain picture of what my system looks like, I'm not trying to write a fiction about what's happening in my system, I'm actually trying to improve, so I don't really care what the data looks like. I'm not worried about being judged or rated or ranked, it's not an accountability thing, it's an improvement thing. And so I'm just trying to represent the system accurately so that I actually know that what I'm trying is working or not working. It's a completely different mindset. That whole sort of like trying to look better is completely removed from the picture through this type of mindset.   0:28:55.7 AS: I'm just picturing some sort of process where there's a measurement of temperature and the temperature keeps rising, but the worker says, "Boss there's a fire." And the boss said, "There's not enough data yet to confirm that." It only seems like a small fire right now, so I need more data points. Well, sometimes you have to act without thinking about the data and make an assumption that you may be wrong. You turn on the fire sprinklers, boom, and it wasn't a fire, but the damage of letting that go for long and saying I need more data doesn't make sense.   0:29:34.1 JD: Yeah, yeah, that doesn't really work. But the idea with the baseline is, basically, if you wanna improve something, the first thing you do is before you try anything, just gather some baseline data first so you can understand the current conditions. And in that attendance as an example, maybe you don't wanna wait for monthly attendance data, maybe wanna look at daily attendance day, what you have in a school, and just plot that over 12 days, 15 days, two or three weeks, and you can start to get a sense for what this looks like on a daily basis, and then you could try to improve it and see if that improvement has an impact on the data over time.   0:30:15.6 AS: Good, well, let me summarize this, but I have to start off with... My grammar is not particularly great, and since you're more of a school teacher than I am, I may need help with what you said. I think what I got correctly was data have no meaning apart from their context.   0:30:33.6 JD: Yeah, what did I say? Let me see.   0:30:38.5 AS: I always get confused if data is plural or singular.   0:30:41.8 JD: Yeah. Well, it can be either. So in this case, I was using data as a plural, so that's my point. I think technically the singular of data is actually datum. Obviously, nobody uses that 'cause it sounds really weird, but data can be plural, I think so.   0:30:57.4 AS: That sounds awfully Latin of you, alright. Number two, the data is the voice of the process, and that we control the process, not the data, and number 3 we plot the data in time order. Number four, two or three data points are not a trend. And number five is show enough data to illustrate the baseline. Anything you need to say to wrap all this up.   0:31:20.4 JD: Yeah, I just think that... I've mentioned this multiple times. I think when you're talking about continual improvement, primary tool is that process behavior chart, it allows you to visualize your data in a way that makes sense, and then the skill set that you have to learn is how to interpret the process behavior chart. How to use them effectively, how to create useful charts and then underlying... Understanding that underlying logic of process behavior charts. There's other tools, obviously in the improvement tool kit, but I actually think that that particular chart is the most important in my view. And I think with those charts, that tool in hand, we can avoid then those arbitrary and capricious goals that are so pervasive in our sector, basically.   0:32:10.6 AS: Well, that's exciting, and I'm excited for our next session when we talk about the final five. So John, on behalf of everyone at The Deming Institute, I wanna thank you again for this discussion, and for listeners remember to go to deming.org to continue your journey. And you can find John's book, Win-Win: W. Edwards Deming, the System of Profound Knowledge and the Science of Improving Schools on Amazon.com. This is your host, Andrew Stotz and I'll leave you with one of my favorite quotes from Dr. Deming, "People are entitled to joy in work."  

Did Dr. Deming forbid setting goals? Dive into this discussion about healthy goal setting, learn why your process matters, and the four things you need to understand before you start on goals. This episode is the first in a 4-part series about goal setting. TRANSCRIPT 0:00:02.2 Andrew Stotz: My name is Andrew Stotz and I'll be your host as we continue our journey into the teachings of Dr. W. Edwards Deming. Today I'm continuing my discussion with John Dues, who is part of the new generation of educators striving to apply Dr. Deming's principles to unleash student joy in learning. This is episode 21 and we're talking about goal setting through a Deming lens. John, take it away.   0:00:26.9 John Dues: Yeah, it's good to be back, Andrew. Yeah, 'tis the season for resolutions, I suppose, so I thought we could talk about organizational goal setting and sort of doing that through a Deming lens. And I was thinking about, at a recent district leadership team meeting, I put the following quote up on a slide. I said, "Goal setting is often an act of desperation." You got to watch people's faces when they see that. And to give some context, we're sort of updating our strategic plan at United Schools Network and my point in putting that on the slide as a part of strategic planning was to start a discussion on sort of what I think is healthy goal setting and how that's not typical to what I've seen across my career in schools, education organizations.   0:01:22.4 JD: And I wanted to provide a framework for the team so that anyone that's setting a goal as a part of the strategic planning process sort of had this sort of mindset as we're going through the goal setting process. I think that the typical reaction to that quote, at least in my experience, has been something like, "But I thought that goal setting was something that highly effective people or highly effective organizations do." And my basic argument is that I think that that's the intention, but it's rarely the case, whether that's individuals or organizations. And there's these, what I've come to sort of frame as four conditions that have to be met during the goal setting process. And without those, you kind of get fluff for a goal setting, probably more likely just completely disconnected from reality. I think... Yeah, go ahead.   0:02:22.5 AS: I just wanted to talk to everybody out there that's listening and viewing. I mean, I'm sure you're going through goal setting all the time and as we talk about, it's the beginning of the year right now, this is actually, we're recording this in mid-January of 2024. So it's like I've been working on what's our vision? What's our mission? What's our values? Where are we going? What is our goal? What is our long term goal? What is our short term goal? And I don't know about you guys, but for me, it gets a little confusing and round in circles sometimes and overwhelming, and then this whole idea about, that goal setting is often an act of desperation. It's like I've been working on this stuff for recently over the last week or so and then I just heard you say that and I was like, "Oh, I'm really interested to learn more." So let's go through those four conditions.   0:03:18.5 JD: Yeah, I'll get to those in a second. But I... So I'm not saying don't set goals necessarily. And people have that same reaction typically to that statement, but it's goal setting is often an act of desperation. So it's not the goal in and of themselves, but generally it's the process that you go about and the lack of sort of logic behind the goals that I'm talking about. And I know on these podcasts, many of my examples have sort of I've been banging on like State Department accountability systems and stuff like that. I'm going to continue to do that today but I think the same sort of errors happen at the school system level, at the individual school building level, at the individual teacher or principal level, it's just the stakes are higher when you're talking about states and countries, systems of education.   0:04:11.8 JD: But what I've seen is over the last two decades, certainly post-No Child Left Behind, what it seems like is that there's often these goals set and they're sort of, the targets are sort of chosen out of thin air. And then there's this whole accountability system built around those goals and then in the case of states, we then rate and rank school systems or schools based on how they perform in relation to those goals. And again, the same type of thing is happening at the school system level, at the school level but probably the state accountability systems is what most educators are familiar with when I'm talking about goals. And in Ohio, like a lot of states, we give state tests, we give them third through eighth grade.   0:04:58.5 JD: They take reading and math every year, third through eighth grade in Ohio and you have to hit this 80% benchmark in terms of the percent of kids that are proficient in your school to meet the state standard. So the first question is, why not 60%? Why not 95%? Why not 85%? Why not 82.5%? Just random, you know? And my hunch is, the first problem is that that benchmark for passage rates, if you asked 100 people at the State Department or 100 people working in public school systems in Ohio, I'm not sure if anybody could give you that answer, why 80%? So the first problem is that that target itself is chosen arbitrarily and without sort of a deep consideration. And so that's sort of where the fork initially comes...   0:05:58.3 AS: And I would say that if I look at that 80%, it's like below that and you would seem like you're really underachieving, and above that, it's like, let's be realistic here of what the system can produce.   0:06:11.6 JD: Well, it's a B, it's a B minus. You know, that's familiar, a C, you're not allowed to bring home a C, but a B is okay. So, I mean, my guess is, I don't know where that particular target came from, but my guess is it's something maybe not too far off from, "well, it's sort of a B minus" in the typical grading scale in the United States.   0:06:32.4 AS: Probably came just the way we just discussed it.   0:06:35.1 JD: I would not be entirely surprised. So a lot of the problem with goal setting and when I'm saying act of desperation, it has to do with that arbitrary nature of the goal in and of itself. And so what I've sort of told the team here is that let's put forth some conditions that came up, I mentioned four, that we should understand prior to ever setting a goal. So the first thing we want to understand is what I call the "capability of the system" under study. So in this case, we've talked about third grade reading because that's such an important time period in a student's life.   0:07:13.4 JD: The states, lots of states put a lot of emphasis on it. In Ohio, there's a third grade reading guarantee that exists in other states as well. So we'll kind of look at data in that realm. So the first one, what's the capability of that third grade reading system? The second condition is we have to understand the variation that that system produces. So what are the ups and downs in the data? What are the patterns in the data? So capability, variation is the second condition. The third condition is, is the system that we're studying, is the data stable? When we look at the patterns of the data over time, is there predictability to it?   0:08:01.8 JD: Is there stability to that data or is it all over the place? And then the third thing or sorry, the fourth thing we want is a logical answer to the question, "by what method?" So let's take sort of a deeper look at each of those four conditions, kind of unpack those a little bit. We'll use third grade reading state testing data. I have some data on a chart, but I'll share my screen in a second for those that are viewing the data. And then for those that are only listening, I'll sort of narrate what we're looking at so you'll still get some value out of the description. So you see my screen now?   0:08:42.5 AS: Yep.   0:08:43.3 JD: Okay, cool. So we've looked at these charts before in previous episodes. It's been a while. So this is what some people call a control chart. I call it a process behavior chart because it's literally a description, a visual description of a process unfolding over time.   0:09:01.7 AS: And maybe I'll just describe it. At the title it says, Ohio Third Grade Reading State Testing Proficiency Levels. On the y-axis is the percent proficiency ranging from, of course, zero to 100. And on the x-axis, we have seven school years going from the 2015 to 2016 school year all the way to 2022 to 2023 school year. And then most importantly, we have points, that's a blue line here, but the points that are showing the movement of third grade reading state proficiency levels year by year or school year by school year. Continue.   0:09:51.1 JD: Yep, that's right. That's a good description. So those blue dots are the percent of third graders that are proficient each testing year. And to give you some context, in Ohio about 125,000 third graders take that state reading test each year. One thing you'll notice is that there is no data for 2019-'20. That's because we give the test in the spring of a school year. So in the spring of 2020, schools were shut down due to the pandemic so there was no state test. So we missed one year of testing, but that's really not, that's not really pertinent to this discussion. So the other thing you'll see on here is the green line is the average of the data running through there.   0:10:38.4 JD: And those red lines that are on either side of the data are, some people call them control limits, I call them the lower and upper natural process limit. And they're based on a statistical calculation. They're not where I want the lines to be, they're where they are based on the data. And for those watching, the data points are 54.9% proficient in '15 -'16. The next year in '16 -'17, 63.8% of the third graders were proficient. In '17 -'18, 61.2% were proficient. In '18 -'19, 66.7% were proficient. In 2021, er, 2020 -'21, kind of dipped down to 51.9%. Then in '21 -'22, 59.8% of the third graders were proficient. And then in our most recent year, 62.3% of kids were proficient.   0:11:35.3 AS: So out of all those points, let's just say a high of about roughly 70% and a low of a little bit higher than 50%.   0:11:45.5 JD: Yeah. Yep. Yep. So the low was like, I think 59%. I can look back. Low was 54.9%, the high was 66.7%.   0:11:57.5 AS: Okay.   0:12:00.3 JD: And that works out to about an average of 60% across that seven-year time period.   0:12:08.3 AS: And when we talked about the 80%, is that 80% related to these test results?   0:12:13.7 JD: Sure. Yep.   0:12:13.8 AS: This is what the state is saying it should be?   0:12:18.1 JD: So the state says that in any individual school building, in any individual school system, and so as a result, in the state as a whole, 80% of third graders should meet the proficiency benchmark, basically. So in the state, on average, across the state, when you look at all the third graders, 80% of the kids are not at proficiency. It's lower than that year in and year out across the last seven years. And I should say I picked the starting point as 2015-'16, that was the first year of a brand new test. So it's really a new testing system as of that year. And then it stayed pretty consistent in terms of what the kids are being asked to do. Prior to that, the test was a different format. So it was sort of like a different system.   0:13:04.6 AS: And this is from all schools, so it's Ohio, it's not your school?   0:13:09.6 JD: Right. So this is all Ohio public schools.   0:13:12.9 AS: Okay.   0:13:13.9 JD: Yep. Which are required to give the state test once a year. So, like I said, beginning with this spring 2016 testing season, Ohio began administering this new state test, which is why I started with 2015- '16. And that's where the data starts. So again, schools need to have at least 80% of their students score proficient or higher in each tested area, including reading. So what we're doing here is sort of looking at that first condition. We're trying to figure out what's the capability of this third grade reading testing system. And when I say system, I'm literally talking about everything that could impact third grade reading test scores.   0:14:00.4 JD: Now, I mean, you could almost make an infinite list, but I'm talking about the actual students in Ohio public schools, the third graders themselves, their teachers, the various reading curricula that's being used in schools, technology related to reading programming, supplemental materials, the schools themselves, how the schools themselves are organized. And you can go on and on about any number of in-school and out-of-school variables that might impact a third graders performance on a state test.   0:14:37.2 AS: And I think about resources like between schools and parents and teachers and administrators, everybody's putting forward... Putting forth resources to try to get to this.   0:14:46.9 JD: Yep. The reading standards themselves, the reading test, that's all a part of the third grade reading system. And basically, for those that are viewing the video or heard the description, the capability is outlined in the process behavior chart. I mean, that's literally what the process behavior chart doing. It's, it's, it's visualizing the capability of that third grade reading system. So one thing that's pretty clear when you look at this seven years worth of data is that it's very unlikely that the state of Ohio is incapable of hitting that 80% mark. Now, seven years of data is not 20 years of data, but we, in none of the seven years that have occurred have we gotten anywhere close to that 80% mark. So that's one thing we can see.   0:15:39.9 AS: Sorry, what was the conclusion that you just said?   0:15:42.8 JD: Well, we're, we can see from the data here, even though it's only seven data points, which is something to work with, but it's not 20 data points, it's not 25 data points but it's pretty likely that the third grade reading system, that we're incapable as a state of hitting 80%...   0:16:00.9 AS: Okay, so the capability of the system, the goal of the, of the state representatives that set the 80% seems to be slightly outside of the capability of the system.   0:16:14.4 JD: I'd say more than slightly.   0:16:15.8 AS: More than slightly. 0kay.   0:16:16.9 JD: Yeah, I'd say it likely... I would go as far to say, I try to talk scientifically so it's, we are likely incapable of hitting that 80% mark as a state.   0:16:26.5 AS: Okay. Got it.   0:16:27.7 JD: Not impossible.   0:16:29.0 AS: That's point number one.   0:16:30.5 JD: Yeah, well, and these red natural process limits actually tell us what we could expect from this particular system based on what we've seen so far. So those process limits, kind of way to think about them is as you get more data points, especially as you get 20, 24 data points, they sort of start to solidify. So an individual data point has less of an impact on the limits. So I would call them a little bit soft right now, an individual data point kind of could have an outsized impact because we don't have tons of data but what these red lines are telling us is that our reading system, this third grade reading system is capable of hitting rates somewhere between 41%, where that lower line is, and 79%, where that upper line is.   0:17:19.8 JD: That's why I say that the 80% is unlikely, rather than impossible. It's technically within the capabilities of this system as illustrated by this process behavior chart. But based on the way the limits are constructed, the limits come from the data itself, how the data, not only the magnitude of the individual data points, but it's also taking into account the point to point variation. So time is an important factor in that formula that's used to calculate the limits. And so based on how the limit is constructed, there's about a 3 in 1000 chance that we would hit that 80% mark. So that's why I say...   0:18:03.4 AS: So you're saying there's a chance?   [laughter]   0:18:06.5 JD: Very unlikely, very unlikely, right? So that's capability, that, this, that's sort of looking at the chart and talking about how capable is our system. The next thing we want to look at... Well, the last thing you could say is that that 60% average across those seven years is a pretty good descriptor, especially as you look at where the dots fall, some above, some below, that's a pretty good descriptor of the overall capability of the system, that's 60% proficiency.   0:18:37.6 AS: Right.   0:18:39.3 JD: So the second thing we'll take a look at is using the chart to understand the variation in our system. So again, we have seven data points. We just mentioned that they're bouncing around this average of 60%. And actually with seven data points, you have three that are below the line and four that are above. So about as even as you could be between how many points are below the line, how many points are above the line. So if you describe the year to year test results starting back in '15-'16, they increase and then decrease and then increase and then decrease and then increase and then increase again, a little bit in that last of the seven years.   0:19:27.8 JD: So when you look at the data, there's no sort of signals in those patterns that indicate that the increases or decreases are of significance. So in the Deming language, probably most people aren't familiar with the "common cause" language, but basically it's just saying that the thousands of variables that impact these test results are part of a common cause system. Just like, they're bouncing around, but the bouncing around is not meaningful. But what actually happens is, you know, inevitably when people describe these results, they'll pick two years. Let's say they look at, well, let's even say they look at the last three years and people will say, "Oh, we've increased the third grade reading test scores 'cause they went up a little bit from 2021 to 2022 to 2023."   0:20:19.5 JD: But again, the increases are meaningless when you're viewing this through the sort of understanding variation, knowledge about variation Deming lens. So, but again, even though seven data points isn't a lot of data, it's pretty clear from what we see so far that that, setting that 80% goal, holding schools and school systems accountable from a state perspective, it's not having any impact on the outcome of this third grade reading system. So that's what I mean to connect back to this goal setting is often an act of desperation. It's a hope and a dream that 80% of kids in this system are gonna meet this proficiency standard. It's just not happening by setting a goal.   0:21:10.2 AS: Right.   0:21:15.4 JD: The third thing is looking at stability. So we want to know if the results are predictable in this particular system. So the thing to think about here is if the system is in fact predictable, it means that the results are sort of performing as consistently as the system is capable of making it. And this Ohio third grade reading system is in fact a stable system. So based on these results so far, we can reasonably expect that future results will continue to bounce around this current average. That's just what's gonna happen. So the results might be a little bit below the average, maybe they'll remain a little bit above the average, but in all likelihood, unless something else of significance changes, this is what we can expect from this system. Now...   0:22:13.1 AS: And for some people that may not totally understand the Deming lens, point number two and point number three may be a bit confusing because you're thinking, what's the variation of the system? Well, doesn't the variation of the system also tell you if the data is stable? How would you describe the difference in those two points?   0:22:39.9 JD: Well, it's stable because there's no patterns in the data that signify instability. So there are different sets of patterns that different organizations like Western Electric had a set of patterns that they sort of established because that's sort of where these charts were invented. The Institute for Healthcare Improvement has a set of rules that they use. They are big in training and using control charts. I sort of, my basic approach is to try to keep things as simple as possible. So I default to Donald Wheeler who wrote a book literally called Understanding Variation among many others on using these charts and interpreting these charts. But he basically says, and I sort of have adopted this idea of just three simple rules that I look for.   0:23:29.0 JD: So I look for a single point outside of the red lines, either above or below that's so unexpected, that's a significant pattern, just one data point. I'll also look for three out of four that are closer to one of the red lines than they are to that average green line. And the other big thing I look for is eight successive data points that are on either side of that average line. So if a single point is outside either the upper or the lower limit, that's a pretty high magnitude chance that there is something very different going on now in your system. The eight points in a row is sort of like a moderate but sustained indication that something has changed in either direction. But in this case, we have a stable system. There's no patterns in the data that suggest instability.   0:24:33.0 JD: So it's good in the sense that the system is predictable. And so, let's say I sort of would then try something new, an intervention of some kind, and then look to see what happens. I know at the outset of the experiment that it was a stable system and I can be relatively assured that it's the thing that I introduced that brought about the change. But stability should not be an indication of good, necessarily. You can have a stable but unsatisfactory system, which is how I would describe this particular system. It's stable, meaning it's predictable based on what we see so far, but it's also unacceptable that 40%, two out of five kids are not proficient on the third grade reading test.   0:25:30.1 AS: The good news is your cancer is stable, the bad news is you have cancer.   0:25:33.4 JD: Your cancer is stable, right. It's the cancer is stable, but maybe not growing. How about that analogy?   0:25:39.5 AS: Yeah.   0:25:41.2 JD: Yeah. So we have a stable system but producing less than desirable outcomes. So at that point, the only thing that I can do is work on the design of the system itself. Something about the inputs, something about the throughputs. Maybe I... One big push here in Ohio is to sort of adopt the principles called the science of reading. So teaching reading in a scientific way, like a research-backed way. And so perhaps that's an intervention that could be attempted and Ohio's sort of attempting it. But that sort of everybody getting behind an approach that's been shown to work, that's very different than just setting a goal and then holding educators accountable to the goal.   0:26:26.3 JD: And that's typically what's happening. And when you do that, then you cause frustration. Because if people knew what to do to make things better, then they'd probably do it. So they're being held accountable for something that they maybe don't know how to improve, or maybe they don't have the resources to improve. And so that's why Deming would say "substitute leadership." And that's what he was talking about, leadership towards improvement. And that's a good segue to the last condition, we've mentioned this idea that the 80% goal is beyond the capability of system, so we have to think about methods. By what method then can we improve because this setting a target isn't gonna work. Nothing's changing just because we have this target.   0:27:21.3 JD: And so instead, what happens, and I've seen this my entire career, is that some schools in Ohio regularly surpass this benchmark. Many other schools are nowhere near it. But my sort of a priori hunch, so my pre-testing hunch would be sort of like the overall system, the individual school's third grade reading test results are fairly stable. So what I mean is that low scoring schools stay low scoring, and the high scoring schools stay high scoring. And we sort of admonish the low scoring ones and celebrate the high scoring ones but there are people doing great things in all of those different types of schools.   0:28:14.3 JD: But the fact is, if you took the staff at one high scoring school and put them into a low scoring school, I think you'd be hard pressed to get the same results because so many of the other things that are in place at that high scoring school would not travel just because the staff travels. You know? And so that's, again, where frustration comes in. Then this 80% target really just becomes this sorting mechanism. It's not a roadmap towards improvement and it's literally sorting the schools, the ones that don't hit this benchmark and the ones that do but then you have these other things that happen. What teacher wants to consistently work at a low scoring school when they don't feel like they can do anything else? They can't affect change, what do they...   [chuckle]   0:29:05.3 AS: Have you seen the chart of that school?   0:29:08.4 JD: What did you say?   0:29:09.4 AS: Have you seen the chart of that school you're gonna go work at?   0:29:11.5 JD: Have you seen the chart, and so I'm gonna go work somewhere else that gets all the awards. And so you have this, if anybody studies systems, you have this sort of self-fulfilling thing that the rich get richer, sort of, right? The resources tend to pile up. And so instead what we need to do is think about this last sort of condition, by what method, by what method. Okay, if you're gonna say we're gonna set this 80% goal, by what method can we work together and achieve that? So I brought up one possibility is to sort of implement the science of reading. Now, doing anything as an initiative statewide is very challenging for any number of reasons because the obstacles are gonna be different in different locations that are low scoring.   0:30:02.1 JD: So I don't want to paint the picture that you can just sort of, when people say use evidence-based stuff, well, the evidence-based stuff often doesn't take into account many, many different contextual factors that are important. So I don't want to say there's some silver bullet because there's not. But what I do know is that I think you could argue that having these targets set like this that just sort are not good for anybody. And so maybe they're doing more harm than they are good. And I just want to at least take that into account, because this could work, not only for people working in schools, but also policymakers to think about these things, to at least understand. So if you told me, I've looked at the data for 15 years, I understand the capability of whatever system that is being studied.   0:31:05.8 JD: I understand how the results have shifted up and down over those 15 years, I understand the stability level of those results and I'm still moving forward with the target, I mean, I could accept that a little bit more than just completely arbitrary, but it still sort of begs the question, by what method? Who can do this? So I just think that's... That's really what I'm talking about when I'm saying goal setting is often an act of desperation, that the targets are arbitrary and that this thinking that should underlie this substitution of leadership for just picking targets is really the sort of the approach that we should be looking as, especially systems leaders, school systems or state education system leaders, that type of thing.   0:31:56.4 AS: And for the technical listeners or viewers who want to understand how you calculated the upper and lower natural process limits, maybe you can describe using standard deviation or tell us how you're doing that.   0:32:12.0 JD: Yeah, well, so it's, in this particular type of chart, you can see up here it says X chart, which there's, typically with an X chart, there's another chart below that charts the moving ranges between each successive point. So usually it's two charts together and it's called an XMR chart. Just to simplify things, I just included the X chart, but the XMR chart is sort of like the Swiss army knife of charts, meaning that it basically works with any type of data. It doesn't need to be normalized, as long as it's data that occurs over time. Now, people have strong opinions that that's not the case, but again, I sort of follow the teachings of Donald Wheeler and that's sort of his take on things and I you know, I've subscribed to that.   0:33:00.2 JD: But basically what the chart is doing is it's looking at each data point and it's using the moving range along with some scaling factors that were sort of invented by Walter Shewhart 100 years ago and then refined over time by statisticians like Deming to develop the formula. So it's not standard deviation. Your standard deviation doesn't take into account time. Standard deviation is the distance from the mean, but it's a sort of a static measurement. Whereas this is taking into account not only the variability, but also the time that variability occurred. So that's the key...   0:33:46.6 AS: In other words, if you had a process where you had 20 years and you've made a significant shift in the way you're doing things, if you were calculating a standard deviation based upon the whole data set, you would be using a data set that's really not reflecting the behavior of the system now...   0:34:08.5 JD: That's right.   0:34:10.5 AS: As opposed to sort of a rolling style or using the most recent periods as what you should be using to set the control limits.   0:34:20.1 JD: Yeah, that's right. So I think, yeah, so the big factor is the process behavior chart, the XMR chart, takes into account the point-to-point differences and standard deviation doesn't take time and how the changes occurred over time into account in terms of that calculation.   0:34:40.3 AS: Okay, so let's just wrap up.   0:34:41.4 JD: And I should say someone smarter than me on these should definitely fact check me on that, but I think I have the basics right.   0:34:49.5 AS: I have to admit that you got me thinking about one of the goals I've been setting for admissions into my Valuation Masterclass bootcamp and is what I'm pushing for something beyond what the system's capable of? And so while you were speaking, I was gathering my data and playing around and thinking about it in relation to what you're thinking because I definitely understand point number four, by what method, that we have to think about new methods or else we're gonna get the same result. But I also can say that I didn't understand the number one capability of the system 'cause I didn't have a control chart on it. Now I do as a result of this conversation. And so I challenge anybody out there that's listening or viewing, it's time to make your control chart.   0:35:38.6 AS: The second thing is I had an intuitive feel for what was the variation of the system but when I look at the chart now, it's much bigger than what I had thought. So I can see, in fact, yeah. And then number three is, is the data stable? And I just kept it simple, for my data points I just used standard deviation. And what I found from my upper and lower control limits is that I have one data point that broke through the upper 1 standard deviation line and also the upper 2 standard deviation line. And there was something very unique that I did at that time that we stopped doing for good or bad, but at least I can attribute that to a specific action.   0:36:31.5 AS: And then the fourth point that you've made, so capability of system number one, number two, what is the variation of the system? Number three, is the data stable? And number four, by what method? Of course, that to me is the whole key, once we've got, I think most people don't understand points one, two, and three about their system that they're trying to get a goal out of. But then by what method is really hard. I mean, we've been doing it this way, now... And it's not producing the result that we want, so what's the method to get us to the goal that we want? And I think to me, that's a huge challenge.   0:37:08.5 JD: Yeah. And a key to that last point, and maybe a good point to wrap up on, from a Deming lens and thinking about the system of profound knowledge and let's say the understanding of psychology is that in the state accountability system, the by what method goes like this, "By what method are you going to improve?" Right? But in the Deming methodology, it's, "All right guys, by what method are we going to improve these third grade state reading results?" Right?   0:37:37.5 JD: And in that first case, the finger wagging, what do people do? They try to protect their corner. "No, it's not that bad. We improved a little bit." "No, no, no, it's not us, it's them." So all the energy gets put towards trying to sort of write fiction about our results, which we talked about before, versus actually trying to improve things. And that's part of that, why you need all parts of the System of Profound Knowledge, including psychology, to actually bring about improvement with a group of people.   0:38:10.4 AS: So a great place to wrap up, as you're thinking about improving things, instead of saying "by what method" as a command, why not say "by what method" as a question? John, on behalf of everyone at the Deming Institute, I wanna thank you again for the discussion. And for listeners, remember to go to deming.org to continue your journey. And you can find John's book, Win-Win: W. Edwards Deming, the System of Profound Knowledge and the Science of Improving Schools on Amazon.com. This is your host, Andrew Stotz, and I'll leave you with one of my favorite quotes from Dr. Deming, people are entitled to joy in work.

What's the difference between education and training? Why is the distinction important? How does the Deming lens offer a new perspective on teacher effectiveness? In this episode, John Dues and host Andrew Stotz talk about why it's important to go beyond skills training and encourage education for personal growth.  TRANSCRIPT 0:00:00.0 Andrew Stotz: Here we go. My name is Andrew Stotz, and I'll be your host as we continue our journey into the teachings of Dr. W Edwards Deming. Today I'm continuing my discussion with John Dues, who is part of the new generation of educators striving to apply Dr. Deming's principles to unleash student joy in learning. This is episode 19 and we're continuing our discussion about the shift from management myths to principles for the transformation of school systems. John, take it away.   0:00:31.2 John Dues: Andrew, good to be back. Yeah, principle 13 today, Institute a Vigorous Program of Education. I'll just start by reading the Principle, "Institute a vigorous program of education and encourage self-improvement for everyone. The school system needs not just good people, but people that are improving with education. Advances in teaching and learning processes will have their roots in knowledge." It's interesting, when I was reading about sort of this particular principle, Dr. Deming took this actually pretty far when he was asked where would you draw the line? And he basically said, I would allow any educational pursuits that people are interested in. So that was his sort of take on this particular principle. But I think it's maybe the first thing is to differentiate between training and education. When he was talking about those things, we talked about instituting training on the job back when we talked about principle six, and he basically said the training is for a skill and a skill is something that's finite because it ends when performance has reached a stable state for a person when thinking about that particular skill.   0:01:51.3 JD: The differentiator with Principle 13 is that it's focused on education and it's meant for growth. And in the Deming philosophy, this is sort of a never ending process of education. So skills, so training is focused on skills, whereas education is focused on knowledge and theory. And this is really an important distinction in my mind, and you need both, training and education are complimentary components I think of an effective school system or really an effective organization in general. So I think, I mean, obviously training is important. It's something that's necessary, especially when you come into a new job. We have lots of new teachers that come to us 'cause we're a relatively young organization. And it's pretty typical for these new teachers to come even if they majored in education many times, they don't have sort of the basic classroom management skills, the basic lesson planning skills, the basic lesson delivery skills that they need to be successful in the classroom.   0:03:00.9 JD: So we have a training program, and in the absence of that training program the teachers would probably flounder or it would take a lot longer time to get their legs under them. So training is important, but we have to sort of shorten that runway. So we have to be good at training 'cause we're like a relatively young organization and we have students that come to us on average that are below grade level. And so they can't wait a long time for these sort of teachers to get up to speed. And I think we've talked about the fact that we have this sort of three week training program before the school year starts for new teachers for that reason. And so training is obviously important, very important. But I think what I've sort of come to appreciate is this idea of... And Deming stressed this, that leaders, systems leaders understand this idea of a stable system.   0:04:00.7 JD: One of the things that he said was that "The performance of anyone that can learn a skill will come to a stable state upon which further lessons will not bring improvement of performance." And this for me, reading Deming at this point in my career was really an interesting revelation because for many years I had heard sort of policymakers, education reform types sort of lament the fact that teachers improvement largely levels off in about year five of their career. Now, there has been some more recent longitudinal teacher research in terms of effectiveness over time. And basically people have found that that's not quite true. And that teaching experience is positively correlated with student achievement gains sort of across the teacher's career. But it's definitely true that the gains and effectiveness are steepest in those initial years.   0:04:55.2 JD: And so when you put those two ideas together that there's sort of this leveling off in about year five with Deming's sort of concept of stable systems, it really sort of dawned on me that it was this perfect explanation for this phenomenon. When a teacher is in their first five years there's a lot of foundational skills like the things I was talking about, like lesson planning, lesson delivery, classroom management, those basic things. There's sort of this period of rapid improvement or growth, and then it sort of levels off after you get the basics of how to be a teacher. And then after that happens, you have this... The potential for improvement sort of lies within the organization, within the system itself and not in the individual. So this really lined up with this thing I had heard for a long time, even though I think sort of it was misinterpreted.   0:05:52.0 JD: And I think a lot of those people that were talking about teacher skills leveling off after five years, they didn't have this lens of a stable system. They didn't have that part of it. And so they were saying, well, teachers aren't improving. Well, it really wasn't the teachers not improving. It was the fact that most of the capacity, like we've talked about here for improvement lies within the system itself and not the individuals. And I would also make the argument that this is not just educators, that this is other sectors as well, healthcare or whatever that thing is.   0:06:27.0 AS: Yeah. I mean, a good way of imagining that is a person who knows nothing that has the prerequisites, the education or whatever's necessary to get the job. And they know nothing about teaching and about the school system or anything that you can just imagine that so much of the initial phase is just understanding how the system, how they operate within that system to do certain tasks, which can be a process of trying to understand all of that. But then it's like they become, it's like entering the stream and then they become the stream floating down the river where everybody's kind of doing the same thing. And then you realize, okay, by this time now their, their, the amount that they can improve has been hit for some specific tasks and things like that. And then all of a sudden their output is a function of the system.   0:07:23.0 JD: Yeah. Yeah. And I think where this can really go off the rails is when people don't understand the stable state of systems. I think that, and I think a lot of the educators from reformers were sort of talking about it as if teachers were kind of replaceable because they didn't improve after those initial five years, especially 10 years ago that was sort of the common way people talked about this. And you could then sort of the next step is to draw the conclusion that experienced educators aren't that important since that improvement sort of levels off pretty early in their career. But I think that is the completely wrong conclusion to draw. I think experienced teachers are incredibly important because of the stability they provide a school. They can provide mentorship to inexperienced teachers, they have longstanding relationships with families as multiple students come through the system.   0:08:25.0 JD: That stability is really important for all those reasons, which are hopefully fairly obvious to anybody that's worked in a school. But I think even maybe more importantly is this idea that once teachers have that baseline level of knowledge and skills, they can run a classroom, they can deliver a well-planned lesson. The reason that it then becomes important for improvement to have those folks is because once those basic things are in place, now we can actually start to work on the system where the real potential for improvement lies. And I think that was a point that was missed or glossed over in a lot of those conversations about education reform and this idea of the teacher skills leveling off after year five.   0:09:23.8 AS: Mm-hmm. One of the the things about education that I have a story that's... I guess one of the conclusions is that the next level of improvement of the system oftentimes comes from outside the system. And that's where education takes the mind into another space.   0:09:40.9 JD: Yeah.   0:09:49.2 AS: From that other space, they're getting knowledge and theories of what's going on out there. And I had an example, John, that was... When I was the head of research at Citibank, and I had been head of research before taking care of a team of analysts, and analysts are always late in their reports, they're writing long reports about whether to buy or sell a company. They're trying to gather as much information, talk to the company, things get delayed. They set their deadlines and then they... The job of a head of research is juggling those delays so that the sales team and the clients need an idea day. And it's always the case that you're juggling around and okay, we don't have something this day, let's make something up with what we've got. Okay, this guy couldn't produce on that day, but he's gonna come in on Monday. So I felt pretty good about my skills at managing that process. And then I got a job at the number one foreign, the number one broker, let's say, or investment bank at that time in Asia called CLSA. And when I talked to them, I asked them how do you handle the flow and how bad is it here [chuckle] with the analysts being late? And they said, the analysts are never late.   0:11:13.3 AS: And I was like, that's impossible. My whole career it's been about handling the analysts being late. And they said, no, analysts are never late here. And I was like, how are you doing that? And they're like, well, we have a three week plan ahead. Everybody knows it. You know your day. There is no excuse, there's no shifting, there's nothing, it has to be delivered on that day. So it's up to you to kind of bring your project to a head so that you're ready to present on that day. And if you have some kind of major setback or problem, talk to another person and switch the day with them and sort it out. And every single day we had great stuff coming out. And I would've never, I mean, I was operating at a certain level thinking I was really knocking it out of the park, 'cause I was accommodating. I was careful, I was thoughtful. I understood the pressures that people were feeling. I was doing my best, but I didn't have a knowledge that it could be a very different way of doing it. And that's where I think about going outside of your own system to observe and learn and see. And then all of a sudden you're like, oh, [laughter] Okay. And that's where I feel like what you're talking about, about the education aspect is really the most amazing part.   0:12:33.2 JD: Mm-hmm. Yeah. That actually... I hadn't planned to talk about this, but I've been reading recently about the... Called the... Well, there's a book called Toyota Kata and Kata is from martial arts. It's the various movements that you have to do sort of repeated deliberate practice so you can sort of, they become ingrained in your muscle memory. Well, the same idea is in place in Toyota. They call... Well, they don't, but the author called it... They don't call... They don't have a name for it, but he sort of observed it and gave it the Improvement Kata name Mike Rother. Yeah, there it is. Yep. There it is. That one. And one of the things that was interesting, and it kind of reminded me of this as you were talking, is that part of the improvement kata is there's a sort of a target that's aligned with the organization's vision that guides anything that the folks in the organization are working towards.   0:13:27.0 JD: And so there's always a target condition. There's an understanding of sort of where each individual is and the departments are. And they're always setting a new target on the way to that sort of vision target and running these experiments all the time. And they constantly set those targets so that they are ambitious but within reach. And then they're coached on the way repeatedly. And in that way they're sort of always moving forward the organization. And so I think of when you've changed investment banks and you're at this new bank and they're saying, Hey, this thing is possible, it's possible to do this. Here's the way we do that. Here's how we work towards that. And so you can imagine a place like Toyota being so successful, because if everybody has got this mindset, this scientific thinking where they're constantly moving towards a target and there's a method for doing so, [chuckle] that is an incredible education right there if you're an employee working in an environment like that. So that just made me think of the Toyota Kata.   0:14:41.4 AS: Yeah. And it's a great example of how reading books is part of education because you're getting exposed to new ideas and exploring and thinking about things. And that's where, well, think about the repetition in let's say a martial arts as an example. And when Dr. Deming talks about opening up education to everything for everybody, there's something to learn in almost everything out there. Like if it is about... What is it about those repetitions and why is that important and could that benefit our business? And he talked about painting and other things, you know? Like education very widely can bring you new ideas that can come back to improve your system.   0:15:27.3 JD: Yeah. And I think you have to invest in that sort of broader education, 'cause it's sort of an investment in the future, you know? Especially right now, things are changing fast. And you could have the best training program in the world, but if you are not also sort of looking out for what's next beyond that, to adapt to whatever's changing in your environment... A good example is this, we have a much better understanding of cognitive science than we did 20 years ago. And so if we didn't adapt... If we didn't sort of learn that and then adapt that and sort of include that learning in our training system that we're gonna start falling behind pretty quickly. And I think this can get... This may be part of the most important responsibility of a leader on the learning front.   0:16:28.5 JD: Because what I also see is that education leaders are often getting enticed by many, many fads that sort of come along. And so how to sort of actually latch onto something that represents a potential advantage, that's a real important skillset to have. And I don't think... That's a key... I think a key function of systems leaders is sort of to know what to let go of or what not to latch onto at all and what to sort of sink resources into because if you're gonna go do these educational pursuits, you're obviously gonna have to sink time and money resources into these things. And so being able to differentiate between what is good and what is bad is a real key skill.   0:17:22.6 AS: And one of the things about Toyota is it's like the ultimate Asian family business. And although it's now a big public company, the largest automaker in the world, and the family's ownings in the company is relatively low, it still has the influence of the family. And I was thinking about another huge company that I know of in Thailand here that shifted its focus away from, let's say, Deming in this case, to when a new CEO came in, he said, well, there's a different way and this is my way. And one of the things that's interesting about what Toyota's done, you know, Toyota gets a lot of blame for being slow to progress and stubborn and all of that, but man, they have built a machine and a... You just can't change the direction of that quickly, you really nurture what has been developed and how do you not just throw away. I was presenting to my students last night in my finance class here at Sasin School of Management in Thailand and I was showing them the DuPont Analysis in the world of finances where you break down the return on equity of a company. And I explained why they call it the DuPont Analysis, and that's because the DuPont company bought shares in General Motors in 20- or 1912 or something like that and they instituted this method of financial controls on General Motors. And I said to my students in passing, General Motors has been going bankrupt since 1912.   [laughter]   0:19:00.9 AS: And it's like every... It's not a cumulative level of learning. And that's where I feel like Toyota, what Toyota has achieved is a cumulative learning process.   0:19:16.9 JD: Mm-hmm. Yeah. You know, and it's a part of their DNA. I think certainly there have been challenges as they've grown across Europe and the United States and the world really. And a lot of the challenges that I understand is because people... That improvement Kata is sort of combined with a coaching Kata, like an approach to coaching and managers at different levels coach folks that are sort of a level down from them. And everybody in the organization, especially early, had sort of this mentor-mentee relationship. And so part of the challenge with growth was the fact that there are only so many of these folks that are grounded in this scientific thinking in the coaching part of this. And so that was a challenge as they grew, you know, in California and Kentucky and other places across the world.   0:20:17.9 JD: They had to build this coaching capacity across all of these new production facilities and other types of facilities across the world. So... But I think that what I really like about this principle...I, you know, if push came to shove, I started this by talking about Deming would basically allow almost anything when it came to allowable educational pursuits. And I think I would be much closer to that than I would be to limit those things. I think that is a really... That's a good sort of approach to take as a leader. I think here where I am at United Schools Network, one of the things that I was able to do was go take an improvement advisor course which required significant resources and time and money at the Institute for Healthcare Improvement.   0:21:19.6 JD: And so someone could look at that very easily and say, well, why are you an educator going to a healthcare organization? And I think it's one of those things where people maybe don't realize that the Deming philosophy and some of the continual improvement stuff, it's sector agnostic. And so when you can learn the philosophy, the methods, the techniques, you can bring them back to your own organization. So I think had I not gone down this path to study Deming, I wouldn't have made it to IHI and then bring this stuff back to my organization. I think it's benefited our organization in lots of ways, even though that might not have been immediately apparent to folks, you know, initially.   0:22:09.8 AS: So how would we wrap this up for the listeners to make sure that they truly understand the idea of vigorous education, self-improvement, this type of stuff?   0:22:14.0 JD: Yeah. I mean, for me the main point is that systems leaders should really encourage education among the whole workforce with a pretty wide latitude for allowable pursuits. I think especially for educators, when we seek those types of opportunities, we're also modeling this idea of continual learning to students as well. They see that just because I have a degree or a master's degree or even folks here that have a PhD, we have I think an organization that's pretty hungry for learning. And that's a model for students. Oh, this doesn't end when you graduate high school. This doesn't end when you graduate college. It doesn't even end when you graduate from graduate school. People all across the organization have books piled up on their desks and we're sending people to various learning programs and stuff like that.   0:23:09.4 JD: And I think that's a good model for students. And I think within that another big thing is to think about do you have an understanding of the stable state of systems and understanding that training programs are only gonna take you so far? Individuals are gonna come to a sort of a stable state once they've sort of maxed out on any particular skill. And that's why this idea of education is so important. Skills are important, training is important, but this other side of the coin, you have to pay attention to education. What's on the horizon? How are you gonna push the boundaries within your system? And I actually think to your point about outsiders or having an outside perspective, that's sort of, I think the benefit of education, because I think without that sort of push from an outsider, the push from the education, breakthrough improvements aren't possible in our school systems. They're not gonna come from training programs. They're gonna come from this continuous learning, this idea of continually pushing the targets, having sort of an improvement mindset. Having a coaching mindset that's always pushing towards those things. And I think this requires not just skills, but it requires new knowledge and new theory continually. And I think that has to come from this vigorous program of education.   0:24:39.7 AS: And the beauty of capitalism is that if you don't go out and get the education, your competitors will, and you don't want your source of learning to be facing constant defeat from your competitors.   [laughter]   0:24:56.2 JD: Yeah, you can't sit around and wait, that's for sure. That's for sure.   0:25:00.0 AS: Exactly. Or someone's gonna take it. And that's the beauty of the capitalist system, the adversarial aspect between companies definitely gets people riled up when they see that all of a sudden someone's doing much better with some new technique or idea. Well, I think that was a great discussion to help us understand the difference between training and education and why it's so important. John, on behalf of everyone at the Deming Institute, I want to thank you again for this discussion. For listeners, remember to go to deming.org to continue your journey. You can find John's book "Win-Win: W. Edwards Deming, the System of Profound Knowledge and the Science of Improving Schools" on amazon.com. This is your host, Andrew Stotz. And I'll leave you with one of my favorite quotes from Dr. Deming. "People are entitled to joy in work."  

Today's episode, with Dr. Candice Chen, is about a new framework for health worker and first responder distress developed by the Workplace Change Collaborative through a federal grant. The WCC, which includes George Washington University, Moral Injury of Healthcare, the Institute for Healthcare Improvement, and the American Federation of Teachers union, thought it was critical to expand the work on distress and its solutions to include moral injury. We talk through the background of the WCC, the framework, and next steps.   Explore the framework: https://www.wpchange.org/explore-the-framework Support the podcast: https://www.fixmoralinjury.org/get-started Twitter - @fixmoralinjury Instagram - @moralinjury Facebook - @moralinjuryofhc LinkedIn - Moral Injury of Healthcare

This episode of “Inside Health Care: a Podcast by NCQA” features three interviews recorded live at our Health Innovation Summit in October 2023. Among many panels and presentations was an incredible session titled “Health Equity Trailblazers: Where Vision Meets Commitment.” Health equity leaders discussed their organizations' health equity strategies, vision and lessons learned, delving into how leaders can commit to and advance health equity priorities. Each of this episode's guests sat on that panel then sat with me for a deeper dive. These leaders, each in their own way, want to inspire us to action.Dr. Joneigh Khaldun is Vice President and Chief Health Equity Officer for CVS Health. In this role, she advances the company's data-driven strategy to improve access to services, address social determinants of health and decrease health disparities. She is a sought-after speaker and thought leader who has appeared on Meet the Press, MSNBC and CNN, among others, and she has testified before Congress.In her past work, as the top doctor leading Michigan's COVID response, she is credited with the state's early identification of and actions to decrease disparities, and in 2021 was appointed by President Biden to the national COVID-19 Health Equity Task Force. She is a practicing emergency physician who earned her MD from the Perelman School of Medicine at the University of Pennsylvania.Dr. Ronald M. Wyatt is a renowned global health care quality and safety expert with a passion for advancing health equity worldwide. Dr. Wyatt is Founder and CEO of Achieving Health Equity, LLC. As a distinguished Senior Fellow with the Institute for Healthcare Improvement, he holds pivotal roles as Chief Science Officer and Chief Medical Officer at the Society to Improve Diagnosis in Medicine, an organization dedicated to enhancing diagnostic accuracy in health care. As an expert in hospital safety oversight, Dr. Wyatt holds a significant role in shaping the National Patient Safety Goal on Health Equity. His contributions to the National Patient Safety Plan, authored by AHRQ and IHI, underscore his commitment to advancing health care on a global scale.Dr. Bryan O. Buckley moderated the Health Care Trailblazers panel at NCQA's 2nd annual Health Innovation Summit. Dr. Buckley is NCQA's Director for Health Equity Initiatives. In this position, he plays a key role in developing partnerships with funding and research organizations, care delivery systems, the managed care industry and communities to translate research knowledge and real-world evidence into development of equity-oriented products and programs. These include NCQA's Health Equity Accreditation programs.

Our guest is Dr. Laura Clapper, the Medical Director of Commonwealth Care Alliance California (CCA). Dr. Clapper has focused her health career on making health care more equitable and aligned with the needs of our communities. She believes that by focusing on the ecosystems of our community care systems and the social determinates of health that we can address health equity gaps. As the CCA California Medical Director -- a position she chose because of CCA's mission she works diligently to ensure that the health plan responds and innovates health care for their members.HealthCare UnTold honors Dr. Clapper's success and her lifetime commitment to community health.

EPISODE 1921: In this KEEN ON show, Andrew talks to Dr Robert Pearl, author of UNCARING, about how the American healthcare system is rigged against ethical doctors and poor patients and what needs to change in 2024Dr. Robert Pearl is the former CEO of The Permanente Medical Group (1999-2017), the nation's largest medical group, and former president of The Mid-Atlantic Permanente Medical Group (2009-2017). In these roles he led 10,000 physicians, 38,000 staff and was responsible for the nationally recognized medical care of 5 million Kaiser Permanente members on the west and east coasts. Named one of Modern Healthcare's 50 most influential physician leaders, Pearl is an advocate for the power of integrated, prepaid, technologically advanced and physician-led healthcare delivery. He serves as a clinical professor of plastic surgery at Stanford University School of Medicine and is on the faculty of the Stanford Graduate School of Business, where he teaches courses on strategy and leadership, and lectures on information technology and health care policy. He is the author of “Mistreated: Why We think We're Getting Good Healthcare—And Why We're Usually Wrong,” a Washington Post bestseller that offers a roadmap for transforming American healthcare. His new book, “Uncaring: How the Culture of Medicine Kills Doctors & Patients” is available now. All proceeds from these books go to Doctors Without Borders. Dr. Pearl hosts the popular podcasts Fixing Healthcare and Coronavirus: The Truth. He publishes a newsletter with over 12,000 subscribers called Monthly Musings on American Healthcare and is a regular contributor to Forbes. He has been featured on CBS This Morning, CNBC, NPR, and in TIME, USA Today and Bloomberg News. He has published more than 100 articles in medical journals and contributed to numerous books. A frequent keynote speaker at healthcare and medical technology conferences. Pearl has addressed the Commonwealth Club, the World Healthcare Congress, the Institute for Healthcare Improvement's National Quality Forum and the National Committee for Quality Improvement (NCQA) Board certified in plastic and reconstructive surgery, Pearl received his medical degree from the Yale University School of Medicine, followed by a residency in plastic and reconstructive surgery at Stanford University. From 2012 to 2017, Pearl served as chairman of the Council of Accountable Physician Practices (CAPP), which includes the nation's largest and best multispecialty medical groups, and participated in the Bipartisan Congressional Task Force on Delivery System Reform and Health IT in Washington, D.C.Named as one of the "100 most connected men" by GQ magazine, Andrew Keen is amongst the world's best known broadcasters and commentators. In addition to presenting KEEN ON, he is the host of the long-running How To Fix Democracy show. He is also the author of four prescient books about digital technology: CULT OF THE AMATEUR, DIGITAL VERTIGO, THE INTERNET IS NOT THE ANSWER and HOW TO FIX THE FUTURE. Andrew lives in San Francisco, is married to Cassandra Knight, Google's VP of Litigation & Discovery, and has two grown children.

Our focus on reducing disparities led to a partnership with the Institute for Healthcare Improvement. A gap in care with our Somali patient population was discovered after reviewing numbers for colorectal and breast cancer screenings, pediatric immunizations and diabetes. Two HealthPartners colleagues, family nurse practitioner Munira MaalimIsaq and senior project manager Greg Fedio, share how the Equity Action Lab project helped assess and better understand the gaps and determine steps for changes.Hosts: Kari Haley, MD, and Steven Jackson, MDGuests: Munira MaalimIsaq, FNP; and Greg FedioHealthPartners website: Off the Charts podcastGot an idea? Have thoughts to share? We want to hear from you. Email us at offthecharts@healthpartners.com.

Episode page with video, transcript, and more My guests for Episode #493 of the Lean Blog Interviews Podcast are Gene Kim and Steve Spear, co-authors of the new book Wiring the Winning Organization: Liberating Our Collective Greatness through Slowification, Simplification, and Amplification. Joining us for the first time is Gene Kim, a Wall Street Journal bestselling author, researcher who has been studying high-performing technology organizations since 1999 – He was the founder and CTO of Tripwire for 13 years. He is the author of six books, The Unicorn Project (2019), and co-author of the Shingo Publication Award-winning Accelerate (2018), The DevOps Handbook (2016), and The Phoenix Project (2013). Since 2014, he has been the founder and organizer of DevOps Enterprise Summit, (now the Enterprise Technology Leadership Summit) studying the technology transformations of large, complex organizations. He lives in Portland, OR, with his wife and family. Dr. Steven J. Spear, DBA, MS, MS is a senior lecturer at the MIT Sloan School of Management, a Senior Fellow at the Institute for Healthcare Improvement, and author of influential publications like the book The High-Velocity Edge, and the HBR articles “Decoding the DNA of the Toyota Production System,” and “Fixing Healthcare from the Inside, Today.”  An advisor to corporate and governmental leaders across a range of fields, he is also the founder of See to Solve, a business process software company. He has a doctorate from Harvard, masters degrees in mechanical engineering and management from MIT, and a bachelor's degree in economics from Princeton.  Steve was previously a guest give times in episodes 58, 87, 262, 358, and 386. Questions, Notes, and Highlights: Gene — what's your “Lean” origin story or however you would frame or label it? Steve — what's a key highlight of your Lean origin story? “The ultimate learning machine” – Toyota Backstory on working together on this book? How many copied 2 pizza teams from Amazon and failed?? What puts some companies in the “danger zone” and how is that detected if it's not obvious? The andon cord was a way to speak up Steve – see, solve, share? A 4th step? See, safe to speak, solve, share? You write about recurring problems in a workplace. How do you think the behavior of managers punishing people for problems gets in the way of solving problems? The podcast is sponsored by Stiles Associates, now in its 30th year of business. They are the go-to Lean recruiting firm serving the manufacturing, private equity, and healthcare industries. Learn more. This podcast was also brought to you by Arena, a PTC Business. Arena is the proven market leader in Cloud Product Lifecycle Management (PLM) with over 1,400 customers worldwide. Visit the link arenasolutions.com/lean to learn more about how Arena can help speed product releases with one connected system. This podcast is part of the #LeanCommunicators network.   

In this podcast episode, Dr. Jonathan H. Westover talks with Joann Wortham about how to mobilize the creativity and productivity that diverse teams can offer. Joann Wortham (www.linkedin.com/in/joann-wortham) is a seasoned international thought leader who uses insight from lived experiences along with her background in education, healthcare, business, and risk management to create novel approaches to today's most critical workplace concerns. With over twenty years of experience, as well as a Master of Science in nursing education and a Juris Doctorate, Ms. Wortham has presented and consulted for such prestigious groups as the Institute of Healthcare Improvement and Yale Health. She was also a consultant and contributor for the American Society of Healthcare Risk Management (ASHRM) Human Capital Playbook.   Check out all of the podcasts in the HCI Podcast Network! Check out the ⁠HCI Academy⁠: Courses, Micro-Credentials, and Certificates to Upskill and Reskill for the Future of Work! Check out the LinkedIn ⁠Alchemizing Human Capital⁠ Newsletter. Check out Dr. Westover's book, ⁠The Future Leader⁠. Check out Dr. Westover's book, ⁠'Bluer than Indigo' Leadership⁠. Check out Dr. Westover's book, ⁠The Alchemy of Truly Remarkable Leadership⁠. Check out the latest issue of the ⁠Human Capital Leadership magazine⁠. Each HCI Podcast episode (Program, ID No. 627454) has been approved for 0.50 HR (General) recertification credit hours toward aPHR™, aPHRi™, PHR®, PHRca®, SPHR®, GPHR®, PHRi™ and SPHRi™ recertification through HR Certification Institute® (HRCI®). Each HCI Podcast episode (Program ID: 24-DP529) has been approved for 0.50 HR (General) SHRM Professional Development Credits (PDCs) for SHRM-CP and SHRM-SCPHR recertification through SHRM, as part of the knowledge and competency programs related to the SHRM Body of Applied Skills and Knowledge™ (the SHRM BASK™). Human Capital Innovations has been pre-approved by the ATD Certification Institute to offer educational programs that can be used towards initial eligibility and recertification of the Certified Professional in Talent Development (CPTD) and Associate Professional in Talent Development (APTD) credentials. Each HCI Podcast episode qualifies for a maximum of 0.50 points.

One of the questions I often get asked is this (actually, it's more of a comment usually than a question): Someone says, “Seems like this whole transformative primary care thing is pretty much just, let's go back to the old country doctor. Let's just have a single doctor out there taking care of patients like a Norman Rockwell painting.” To which I reply (and I'm channeling many experts, including my guest Robert Pearl, MD, when I do), “Yeah … except no.” In the golden olden days of the “ye olde country doctor,” there was a lot of art in medicine and a lot less science. If someone got cancer or even heart disease, what was required, fairly exclusively, was comfort and compassion. Now, first and foremost so there's no confusion, am I dismissing the importance of bedside manner and of providing comfort and compassion? Hell no. Would rather have that any day of the week than deal with a “drive-by PCP” or “drive-by specialist” with the throughput of a freeway who has no idea what I may befall the second I step out of his or her exam room. But in the olden days, medicine was fundamentally art with a lot less science … because there wasn't much science. For the most part, we didn't have data. Or MRIs. This was before the whole pharma industry for the most part. We had weird heroin-infused tinctures, but we didn't have oncology meds or biomarkers or even statins for Pete's sake. Consider all the new diabetes meds and biologics and artificial joints and sub-subspecialists who have, through data and advanced analytics by looking at patients across the country, proven out some best practices that might be fairly unintuitive—or disproven some conventional wisdom. It's a different and much more complicated world today, and what's required now is a healthy appreciation for not only the art of medicine but also the science. And science inherently means that, yeah, there are standards of care to be adhered to. That's what science means. There are rules and better ways to do things as proven by looking at the data and not relying primarily on personal recollections of what may or may not have worked in the past. Listen to the shows with Bob Matthews (EP315) or Alex Akers (EP154) for more on this topic, but this all leads me to the interview with Dr. Robert Pearl in this healthcare podcast where we get into some concepts that he covers in his new book, Uncaring. In this episode, we're talking about some how-tos for being a leader of doctors, going about that against the backdrop of this evolving art and science of medicine dynamic, and the impact of this evolving art and science dynamic on physician culture and self-esteem. Because (spoiler alert) if a doc is following evidence-based guidelines, not relying solely on their own personal experience, does that make said doc feel like they are being devalued and that they are but a cog in the wheel and practicing so-called “cookie cutter” medicine? So many nuances, so little time. But, yeah, there's a lot going on which, at its core, is this tension that can play out in some big bad ways. I asked Dr Pearl for some advice for today's healthcare leaders, and he did not disappoint. He suggested using a model that he calls the A to G model, and, in short, you've got to have: A: an aspirational vision B: behaviors C: context D: data E: engagement (throughout the organization and also with the patient) F: faculty G: governance You'll have to listen to the episode for the why and how of each of these. My guest today, as aforementioned, is Dr. Robert Pearl. I am sure that most of our Relentless Tribe who are listening to the show today already know Dr. Pearl, but in short, he was the CEO of Kaiser Permanente for 18 years. Now he hosts a podcast called Fixing Healthcare. He teaches at the Stanford Graduate School of Medicine and Business. He writes articles for Forbes and elsewhere. He's also an author. He wrote a great book called Mistreated, and now there's a new one called Uncaring. I would recommend both. Also mentioned in this episode is Zeev Neuwirth, MD.   You can learn more at robertpearlmd.com.   Robert Pearl, MD, is the former CEO of The Permanente Medical Group (1999-2017), the nation's largest medical group, and former president of the Mid-Atlantic Permanente Medical Group (2009-2017). In these roles, he led over 10,000 physicians and 38,000 staff and was responsible for the nationally recognized medical care of 5 million Kaiser Permanente members on the west and east coasts. Named one of Modern Healthcare's 50 most influential physician leaders, Dr. Pearl is an advocate for the power of integrated, prepaid, technologically advanced, and physician-led healthcare delivery. He serves as a clinical professor of plastic surgery at Stanford University School of Medicine and is on the faculty of the Stanford Graduate School of Business, where he teaches courses on strategy and leadership and lectures on information technology and healthcare policy. He is the author of Mistreated: Why We Think We're Getting Good Health Care—And Why We're Usually Wrong, a Washington Post bestseller that offers a roadmap for transforming American healthcare. All proceeds from the book go to Doctors Without Borders. His most recent book, Uncaring: How the Culture of Medicine Kills Doctors and Patients, was published May 2021. Dr. Pearl hosts the popular podcasts Fixing Healthcare and Medicine: The Truth (formerly Coronavirus: The Truth). He publishes a newsletter with over 13,000 subscribers called Monthly Musings on American Healthcare and is a regular contributor to Forbes. He has been featured on CBS This Morning, CNBC, and NPR, and in TIME, USA Today, and Bloomberg News. He has published more than 100 articles in medical journals and contributed to numerous books. A frequent keynote speaker at healthcare and medical technology conferences, Dr. Pearl has addressed the Commonwealth Club, the World Healthcare Congress, the Institute for Healthcare Improvement's National Quality Forum, and the National Committee for Quality Improvement (NCQA). Board certified in plastic and reconstructive surgery, Dr. Pearl received his medical degree from the Yale University School of Medicine, followed by a residency in plastic and reconstructive surgery at Stanford University. From 2012 to 2017, Dr. Pearl served as chairman of the Council of Accountable Physician Practices (CAPP), which includes the nation's largest and best multispecialty medical groups, and participated in the Bipartisan Congressional Task Force on Delivery System Reform and Health IT in Washington, DC.   04:50 What is the idea of the art of medicine? 09:29 EP407 with Vivek Garg, MD, MBA. 09:32 Why has the intrinsic motivation of doctors plummeted? 09:48 Patient perspective versus doctor subjective response. 12:36 Why is there a fundamental change in what doctors and medical professionals can take pride in? 14:38 What did change management look like in the past? 15:24 “What does a patient really want? They'd like not to have a stroke, a heart attack … in the first place.” 20:23 “How do leaders achieve evolution?” 23:57 “Incentives always work … the problem in medicine is, they rarely work the way you planned.” 24:20 What's the way to make change happen, and why doesn't it involve financial incentives? 28:10 What do leaders in organizations today consistently underestimate? 29:11 What are the three parts of leadership? 29:25 What is the hardest part about leadership? 31:31 Dr. Pearl's two books, Mistreated and Uncaring.   You can learn more at robertpearlmd.com.   @RobertPearlMD discusses art vs science and leadership in #medicine on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Larry Bauer (Summer Shorts 8), Secretary Dr David Shulkin and Erin Mistry, Keith Passwater and JR Clark (Summer Shorts 7), Lauren Vela (Summer Shorts 6), Dr Jacob Asher (Summer Shorts 5), Eric Gallagher (Summer Shorts 4), Dan Serrano, Larry Bauer, Dr Vivek Garg (Summer Shorts 3), Dr Scott Conard (Summer Shorts 2)