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Deming, Quality, Education, and Health
A Management Guru's ideas are applicable
Cease dependence on inspection to achieve quality. Eliminate the need for massive inspection by building quality into the product in the first place.
W. Edwards Deming was an engineer whose ideas about process improvement were highly influential, first in Japanese manufacturing and later in the United States in business in general. I often wish that his principles were applied by policy makers in health care and education.
In manufacturing, Deming emphasized that outcomes are determined by processes. The defects in a car coming off of the assembly line reflect not just the errors that occurred while the car was manufactured. They are affected by the way management designed the car, set up the plant, chose suppliers, obtained and tested equipment, and trained workers.
In fact, to reduce defects, the highest leverage points are early in the process. Inspecting cars as they come off the assembly line can help identify and fix defects. But that is not as effective as tuning the assembly process in order to make it more reliable. And that in turn is not as effective as designing a car that is conducive to reliable assembly.
In the case of health, getting treatment is the equivalent of inspecting and fixing defects in cars as they come off the assembly line. The cost is high relative to the benefits. There is more leverage to be had in people choosing behaviors that promote health. Avoiding substance abuse and obesity. Obtaining treatment for mental illness.
Even higher leverage can come from good health during infancy. Infant nutrition and prenatal health can make a big difference.
To me, this suggests that less government money should go to fund fee-for-service medicine. Instead, more money should go to programs that achieve demonstrable results in improving infant health, reducing substance abuse, reducing obesity, and treating mental illness.
In education, trying to get marginal students through college is the equivalent of trying to get high-quality cars by inspecting what comes off the assembly line. If educational intervention is going to work at all, it is going to have to work early in the process, in elementary school or preschool. And in fact, it may not be education per se that has significant effects. The highest leverage probably comes from improving the home environment, giving young children safety and stability. Can we do something about parental substance abuse?
Another one of Deming’s concepts that applies to education is what he calls tampering. Tampering means changing a process without rigorously measuring the effect of the change.
Many years ago, I was seated at dinner next to a high-level bureaucrat in the Department of Education. I made a case for doing more controlled experiments in education.
He asked me if as a parent I would want to see my child used in an experiment, as if this was an argument against experimentation. My jaw dropped. Schools feel free to change teaching methods and curriculum whenever they get the whim to do so. My daughters were always subjected to ill-designed, never-evaluated experiments.
We will never be able to provide health and education with the same degree of engineering as refrigerator or a car. But we can learn from Deming to try to look early in the process. And we can learn to appreciate the design and evaluation of experiments, and to engage in less tampering.
This essay is part of a series on human interdependence.