TQM In Intensive Care
What Happens When Quality Is Job 1?
Edward Deming redesigned Japanese industrial methods in the aftermath of WWII. When the Ford Motor company struggled to overcome the debacle of the Pinto and compete with the rising Japanese auto industry, his Total Quality Management became their operating principle, and “Quality Is Job 1” their slogan. The profitable Taurus-Sable line was the result.
Now the Quality Movement is about to be applied to medicine. Perhaps it’s time.
From what has been called a perfect storm of disgruntled patients, legislators and medical professionals, the quality movement in health care has been born.
Thanks to its efforts, those hospital walls are slowly becoming transparent. Revealed is a world of tangled routines, many obsolescent, many downright stupid, that no one had carefully examined. The reformers are out to streamline the routines, retrain the workers and keep them permanently on display — an ant farm behind clear glass — to make sure things never get out of control again.
Would you care? Would it help if you could directly compare hospitals, the comparisons made using numerical metrics that together revealed the quality of care a patient might receive? I suspect that in many cases, the answer is “You betchya!” Abigail Zuger, M.D. tells us more as she reviews the book The Best Practice How the New Quality Movement Is Transforming Medicine By Charles Kenney.
That is just the first installment of such data on display. Soon both hospitals and individual practitioners will be publicizing their own report cards. Insurers will be paying them for good grades, penalizing them for bad. Incentives to minimize errors, complications and inefficiency will mount. Health care will become perfectly safe, perfectly smooth, perfectly perfect.
But yes, of course this is just a bit too good to be true. Consider that NASA too adopted TQM methodologies in the aftermath of the Challenger explosion. It did not – could not – prevent the Columbia tragedy. Ford survived the Pinto, but would you really want a Fusion over a Civic?
But readers should be aware that Mr. Kenney’s story ignores a wide array of questions that have some thoughtful members of the health care world a little troubled by the quality evangelism.
What does quality care mean, for instance, in cases of hopeless illness? When the outcome of care will not be good, how should good care be redefined? Suppose patients sabotage their own care, as so many unwittingly do. Who takes the blame?
And most important, what does it mean when science impudently undercuts accepted quality benchmarks
That last is interesting. What does it mean for – not only health care, but for patient confidence and for TQM itself when it’s discovered that they’ve been measuring the wrong thing with their metrics? Or when (not if, but when) the science tells them that they’ve been giving the wrong treatment perfectly?