HCA 675 Week 5 DQ 2: Deming and waste in health care

Get Deming right first, because the whole post depends on it and the popular version is wrong. Deming's central claim is that most variation and most waste are common-cause — built into the system rather than caused by the person working in it — and his estimate that the overwhelming majority of problems belong to the system rather than the worker is the point the discussion is circling. Waste in that frame is anything consuming resources without adding value for the customer: rework, defects, waiting, overprocessing, unnecessary motion and transport, excess inventory, overproduction, and the waste he took most seriously, unused human talent. Two of his other ideas belong here as well. Inspecting quality in at the end is itself waste, because it detects defects instead of preventing them. And exhorting staff to try harder is waste, because it asks people to compensate for a process that has not been changed.

Then apply it, and make the examples specific to health care rather than generic. Rework is a mislabelled specimen redrawn, a prior authorisation resubmitted, a claim denied and appealed. Defects are medication errors, hospital-acquired infections and readmissions, each of which consumes far more resource than the process that prevented them would have. Waiting is the patient in the emergency department awaiting a bed, the theatre idle for a missing instrument tray, the discharge held for a signature. Overprocessing is duplicate documentation and unnecessary tests. Unused talent is a nurse doing clerical work. Close on the managerial consequence, because it is what the question is aiming at: if waste is systemic, the remedy is redesigning the process and studying its variation over time, not disciplining the staff who work inside it or setting a numerical target with no method attached to it. That last point is Deming's, and it is the one health care managers still break most often.