Dialogue Santé

Improving our health care system …. one patient at a time.

William Edwards Deming was a teacher and statistician whose work on industrial quality control have made his name a household word in Japan. His contributions to industrial quality control are the foundation of “Lean”, “The Toyota Way”, “Six Sigma”, and in fact much of what is now standard dogma in education, health care and manufacturing.

A central tenant of his work lies in grass roots problem solving. Key tenants include:

  • Quality is linked to process. He famously noted that you cannot improve an outcome if you do not understand the process(es) that lead to it.
  • You cannot understand a process unless you talk to all the people involved in it.
  • Quality is every bodies job. Creating a culture where everybody in invested in the outcome, is the first step in building a quality producing machine.
  • The more you understand your processes, the better you can streamline and improve them.
  • These tenants are captured and illustrated by the example of the factory worker in Japon who upon seeing an error on the floor (a defective machine, a safety issue, or something as simple as a bolt dropped into the wrong place), can pull a rope to bring the whole factory to a halt while the problem is analyzed and corrected. This has come to be known as pulling the Andon Cord (Andon is the Japonese term for paper lantern – as the story goes pulling the cord would turn on a light that would signal for a supervisor to come and help evaluate and resolve the problem). This could involve stopping the assembly line and involving whatever resources necessary to rapidly resolve the issue and hopefully prevent similar issues in the future.
  • In the end this leads to higher quality (better outcomes), and more efficient work (less cost).

In the health care setting, this means that by improving processes we can improve outcomes and save money. This is a hard proposition to argue with. However the dilemma in health care is that our processes are so complex that no one fully understands them.

In particular, we fail to grasp what our health care systems look like from the perspective of patients. If you have spent any amount of time on the “other side of the stretcher”, you will be struck by how our health care systems can too often be inefficient, impersonnel, … and sometimes dangerous. This perspective is essential if we seek to improve our system, however for many many reasons it is extremely difficult if not impossible for patients or their families to do the equivalent of “pulling the Andon cord”.

Our health care system and all its layers of bureaucracy, politics, professionals and other health care workers exists for one, and only one purpose. This project is about soliciting input from that most important (and arguably the only real) stakeholder – our patients.

A major step in this campaign is actively recruiting patients input. Physicians involved in this program hand out cards to their patients, with the following request for feedback:

The linked website is a simple and anonymous one page website that solicits patients input on the performance of the medical team, allied health care professionals, food services, and the hospital in general.