By Binseng Wang, ScD, CCE, FAIMBE, FACCE
When W. Edwards Deming died in December 1993, he left a legacy of quality and management principles that have benefited many manufacturing and service companies. Thanks to him, billions of people worldwide have gained access to better products and services at more affordable prices. Although he may not come to mind as one of clinical engineering’s most important thought leaders, many of his 14 Points, 7 Deadly Diseases, and 13 Obstacles1 are in fact still applicable to our field today. Twenty years after his passing, let’s consider how those principles can benefit clinical engineering.
Focus on Quality
Create constancy of purpose for improvement of product and service. Deming’s Point 1 reminds us that, due to the pressure to improve their financial results and satisfy the short-term whims of stakeholders, some healthcare leaders have lost sight of the need to continually improve care. Instead of focusing on one clear goal of improving the safety and reliability of medical equipment, CE professionals often have been asked to fight several battles du jour. Isolated initiatives such as infusion pump safety, alarm management, endoscope inventory, and adherence to OEM maintenance recommendations provided only temporary relief. Because they did not address root causes and behavioral changes, the problems re-emerged soon afterward.
Eliminate the need for inspection on a mass basis by building quality into the product in the first place. Point 3 underscores the futility of trying to ensure equipment reliability and patient safety through the so-called “preventive maintenance” (PM) that consists primarily of inspections for hidden and potential failures. Evidence collected from numerous hospitals2,3,4 has confirmed Deming’s insight of more than 30 years ago.5
Drive out fear and Remove barriers to pride of workmanship. Similar to Deming’s Obstacle of Meeting Specifications, his Points 8 and 12 should remind regulatory authorities (the “customers”) and CE professionals (the “producers”) that the goal should not be for the former to establish prescriptive requirements and for the latter to follow them blindly without evidence of need and benefits. Prescriptive mandates typically set only the minimum thresholds. Professionals do much better if they are given freedom along with responsibility. Workers who fear making mistakes will never try anything new and learn from their own errors (or, better yet, those made by others). Pride of workmanship needs to be nurtured in order to flourish. Scientific discoveries and technological innovations never occur when people are required to meet current specifications or doctrines.
Institute leadership. Deming’s Point 7 is that leadership is essential in driving out fear and removing barriers to pride of workmanship. Clinical engineering managers must lead by example instead of shouting commands or prescribing productivity targets. As Napoleon Bonaparte reputedly said, “There are no bad soldiers, only bad officers.”
The Fear of Change
Deming’s Obstacle Our problems are different probably sounds familiar to many clinical engineering professionals, particularly those who have had to deal with benchmarking. Yet the same people who raise this objection also buy clothing and footwear produced in a limited range of standard sizes, colors, and styles, even though no two persons have identical anatomy. A similar Obstacle is the belief that Anyone that comes to try to help us must understand all about our business.
In fact, both Obstacles are manifestations of the fear of exposing weakness and reluctance to change. Deming anticipated these reactions when he said, “Change is not necessary. Survival is optional.” Clinical engineering professionals not only must learn new techniques, they also must anticipate and stay ahead of changes. Healthcare is evolving rapidly worldwide to meet growing needs and expectations. Being responsible for one of the most important tools of care delivery, they need to find ways to reach the goal of enhancing safety and reliability and, at the same time, be more productive. Trying to hide behind the obstacle of uniqueness will ultimately make one miss the forest for the trees.
Deming was widely recognized for his pioneering application of statistical methods to production and management, summarized in his famous statement, “In God we trust. All others must use data.” In spite of more than 3 decades of documenting servicing of medical equipment, only recently have clinical engineering professionals started to analyze and use their own data to improve their work. This weakness became abundantly clear recently when they could produce very little quantitative evidence to prove to the Centers for Medicare and Medicaid Services (CMS) that their mandate to follow verbatim manufacturers’ maintenance recommendations is not only unnecessary, but also extremely costly and potentially unsafe for patients.
Improve constantly and forever the system of production and service. Deming’s Point 5 is arguably his most important legacy. Even though individual quality projects can be started and completed within a certain time frame, quality is a perpetual pursuit that never ends. Therefore, clinical engineering professionals should never cease to improve the safety and reliability of equipment, using not only maintenance services but also management tools and consultation support to other health professionals.
Unfortunately, it took many years for Americans to recognize the value of Deming’s teaching. The United States finally awarded him with the National Medal of Technology in 1987, long after the Japanese created an award in his honor in 1950. I must admit that it also took me quite some time to realize the value of his teachings, often only after confirming their validity through experiments and observations. I sincerely hope that my clinical engineering colleagues can learn from my mistake and take his teachings to heart more promptly. 24×7
Binseng Wang is vice president, quality and regulatory compliance, ARAMARK Healthcare Technologies, Charlotte, NC. For more information, contact [email protected].
1. Walton M. The Deming Management Method. New York NY: Dodd, Mead & Company; 1986.
2. Wang B, Fedele J, Pridgen B, et al. Evidence-based maintenance: Part I – Measuring maintenance effectiveness with failure codes. J Clin Eng. 2010;35(3):132-144.
3. Wang B, Fedele J, Pridgen B, et al. Evidence-based maintenance: Part II – Comparing maintenance strategies using failure codes. J Clin Eng. 2010;35(4):223-230.
4. Wang B, Fedele J, Pridgen B, et al. Evidence-based maintenance: Part III – Enhancing patient safety using failure code analysis. J Clin Eng. 2011;36(2):72-84.
5. Deming WE. Out of the Crisis. Cambridge, Mass: MIT Press; 2000.