Last week I was fortunate to attend the Transformation Forum organised by the Deming Forum. The teaching of Dr Edwards Deming is the foundation of the Quality Improvement movement, and much of what we do is influenced by his theories on systems thinking and profound knowledge.
I must admit I was only taught about the Deming approach when I was a Health Foundation Quality Improvement Fellow at the IHI in 2005–6. I had been a senior medical manager before then but had no knowledge of the management theory on systems thinking, and this is still the case for many senior managers in the NHS.
When I teach I usually ask participants if anyone has heard of Deming – and the vast majority have not. Deming is the thinker who is not known. Walter Shewhart, who went on to collaborate with Deming, developed the use of tools to measure improvement in the 1920s (including Statistical Control Charts and other ways of analysing change), but use of these tools is still in its infancy in the health service. We have failed to look at different ways of introducing change and making it sustainable, and perhaps we need to introduce this training at an early stage in the training of healthcare professionals.
At the Transformation Forum only 3 of the approximately 60 delegates were from healthcare. The Forum is a little esoteric, I suppose, but when you consider the case studies presented, its content is highly relevant to the healthcare landscape.
The first case study was around applying systems thinking to supply chains in the public housing sector in Portsmouth, leading to increased access and decreased waste. The cut in costs and increased efficiency are very relevant to the NHS where reducing supply chain costs could probably approach covering the £20 billion deficit.
The second was about reducing silo working in the Counter Terrorism Command by using systems thinking. The units used to work fairly independently – perhaps in a similar way to many healthcare departments. Again the NHS, which is riddled with silo thinking, could learn how to change.
The third case study demonstrated how an insurance call centre changed the way it works by introducing a clear focus on how the customer gains value – much of which could be applied in healthcare. The end result was increased staff and customer satisfaction at lower cost.
And what did I offer? Healthcare has many examples of change but the impact is too slow and outcomes are not effective enough. I spoke of the ongoing variations that exist in healthcare and how we still use a business model for the 20th century rather than the 21st, examining the early attempts we have made to reduce variation but also of the resistance to change. Healthcare is a late adopter in learning from other industries.
As we face the changes in the NHS in England, we need to consider how we can learn from others and bring the needed changes to affect value for the patients we serve. This will require more than the usual debate and less of the posturing that we are seeing now. Next year’s Transformation Forum would be a good place to learn from others.
Peter is a Consultant Paediatrician at Great Ormond Street Hospital and The Royal Free Hospital, and is a Health Foundation Quality Improvement Fellow.