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Understanding and Misunderstanding Variation in Healthcare

Posted on by CATALYSIS

Abstract

In a paper presented at the 20th Annual Deming Research Summit, the author described how Dr. W. Edwards Deming’s management philosophy was being applied in healthcare through efforts to learn and emulate the Toyota Production System style of management, referred to as “lean” (Stoecklein, 2014). That paper focused on the principles that were being emphasized and how these principles could be traced to the System of Profound Knowledge described by Dr. Deming. This author pointed to one apparent exception – understanding and managing variation, which seemed to be largely absent in the discussions. Five possible reasons for this absence were proposed, but not explored. This paper is an attempt to explore this question further, to verify the possible causes, to identify any additional possible causes, and to describe the consequences for not understanding variation for managers of healthcare organizations who wish to transform their culture to one of continual improvement. The paper includes a summary of interviews with 40 individuals from 33 healthcare organizations and consulting companies regarding three areas of inquiry: 1) the current state of healthcare management’s understanding and responding to variation when they have data, 2) their current understanding of how the principle of variation applies when data are not present (including the management of people), and 3) a description of what is being taught and advice given around the principle of “understanding and managing variation.”

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