From Davis Balestracci -- Don't Just Do Something, Stand There!

Published: Mon, 01/19/15

From Davis Balestracci -- Don't Just Do Something, Stand There!
Executive bragging to W. Edwards Deming (in the 1980s):  “We just bought a three-million dollar computer.”

Deming: “Too bad.  What you needed was three-hundred thousand dollars’ worth of brains.”

[~1300 words (a bit longer than usual, but designed as a breezy read:  take 5 or 7 minutes to read over a break or lunch]

The Quality vs. Transformation Disconnect Continues

Hi, Folks,

I’ve been presenting at the Institute for Healthcare Improvement (IHI) annual forum for 21 consecutive years. This past December, having done a new edition of my book, I was excited to present my synthesis of over 20 years of learning and experience with W. Edwards Deming’s improvement philosophy – “built-in” to organizational DNA driven by a deep management understanding of variation. In most organizations, one of the biggest unrecognized hidden costs of all is the data INsanity caused by the lack of this basic understanding. Maybe the biggest surprise of these 20 years has been the awesome power of simply “plotting the dots,” ie, plotting important organizational data in their naturally occurring time order.  I have evolved to using fewer, simpler tools in my consulting and have never been more effective.  

My all-day course demonstrated this with a wide variety of data from real situations. I showed how  the power of this simple philosophy could be the back door through which improvement practitioners could educate their management and executives the best way – by getting eye-opening results.  I also emphasized the need to learn and use common cause strategies, which are not generally taught.  All this requires very few tools, but it does require a total change in mindset regarding improvement. I am not comparing myself to Deming, but I realized that he was always criticized for the virtual lack of tools taught in his seminars. Twenty years of hard study has made me evolve to a similar approach to improvement.

I was surprised at some reactions to my seminar – I’ve never had the level of hostility exhibited by some evaluations, a higher percentage than I normally get.  Several people visibly and angrily stormed out because I didn't get to any tools soon enough.  Thank goodness there were also a few people who were truly excited about the potential for a quantum leap in their current results; but this percentage was lower than the past. I always get this dichotomy in my evaluations, but never to this extent.  This made me reflect on my history with IHI’s annual forum, its evolution into a predominant force, and improvement in healthcare.

From Passion to "Just a Job"

Something just felt different this year and I wonder whether the torch has finally been passed to the next generation of improvement practitioners.  I thought of the classic Rogers “diffusion of innovation” curve.  The early forums had lots of excitement and sharing via the “Innovators” (2.5%) and “Early Adopters” (13.5%).  There was a collegial atmosphere with a hunger for dialogue and new information – a true passion for improvement. There were generally 500 to 1000 people.

I remembered the 1998 forum (its 11th year) in particular having maybe10 vendors in the exhibition hall. That year,  I gave the first talk ever at a forum on culture as a factor in improvement.  The same was true in 1999.  It seemed moribund, but quality Improvement had begun to gain an increasing foothold in healthcare.  Jobs in quality began appearing.  With the risk of appearing to be a "boat rocker" lessened,  some folks adopted this new idea of quality because they could finally see how it fit into their lives and they could get paid for it.  

Things were now "diffusing" to the next level:  enter the "Early Majority" (34%).  They needed skills (especially quality tools) and wanted examples.  Organizational budgets for quality loosened because of increasing pressure for clinical results. The forum attendance hovered around 1000 to 1200.  There was still a passion of sorts, but, for many, quality had now become a “job.”  So, similar to what happened in manufacturing 60 years ago, a major quality sub-industry was beginning to evolve.

And then in 2005, IHI got media savvy and developed its “100K Lives Campaign.” Several things converged as a “perfect storm” to make it hugely successful – the attention-getting slogan, increased publicity about horrendous medical experiences, and a skillfully marketed “what’s in it for me” for attention-deficit executives to use for dealing with the intense pressure caused by the public and political outrage to such events.  And increasingly patients now wanted to exert their rights as customers, which had already been happening routinely in non-healthcare industries.

Then Six Sigma and Lean finally caught up to healthcare, and “belts” began appearing – more jobs.  Now the time was ripe for the “Late Majority” (34%), the folks who adopt in reaction to peer pressure, emerging norms, or economic necessity.  Quality has increasingly become a daily grind that is driven by goals…with a lot less passion.  What was formerly "innovation" has now become routine and in many cases hardened into bureaucracies driven by qualicrats.  Improvement cultures have evolved by default rather than formal design.

With the 68% consisting of both “majorities” added to the 16% of the “innovators” and “early adopters,” there were now a little over four times as many people involved in quality. In addition, healthcare quality had also gone international, which added a new audience component -- attendance this past forum was close to 6000.

And then there are the remaining 16% “Laggards,” who will always be with us.

"Bigger...better...faster...more...NOW!" -- Activity is Not Impact

Think about what has happened to technology over the past 25 years, which isn’t necessarily a bad thing. But we must be careful. I can’t even begin to tell you how many hundreds of hours I’ve spent reading, learning, and assimilating all aspects of improvement.

It took Deming almost 50 years to finally synthesize his system of profound knowledge.  It evolved from an emphasis on “variation” (1950s to 1970s) to a management structure within which his teaching on variation could flourish – his “14 Points” (around 1980) – to, finally, his system of profound knowledge’s four elements (1989), the overall theoretical glue within which he realized improvement could truly flourish.

I was introduced to Deming and his ideas in 1983.  It took five years of hard study for me to only begin to truly understand them.  Today, I remain a student, and subtle insights that allow better implementation are still constantly manifesting..

Here is a sobering quote:

The modern world’s tech-giddy control and facilitation makes us stupid. Awareness atrophies. Dumb gets dumber. Lists are everywhere — the five things you need to know about so-and-so; the eight essential qualities of such-and-such; the 11 delights of somewhere or other. We demand shortcuts, as if there are shortcuts to genuine experience. These lists are meaningless…When you are not told what to do you begin to think what to do. You begin to see without distraction. – Roger Cohen   [NY Times 10/10/2013]

Society is now shaped by a “bigger, better, faster, more, NOW!” mentality. There is an increasingly dangerous assumption that everything one needs to know is just an “app” or Google search away via information supplied by ubiquitous self-appointed “experts” and computer packages that promise to guide one to “the answer.”  Given this and the fact that my seminar audience probably contained an increasing number of “Late Majority,” I suppose the reactions I received shouldn’t surprise me. 

Critical thinking as a skill has taken a back seat to tools and technology. I wonder whether most people would now have the patience to sit through a four-day Deming seminar.  Would Deming still get the respect he had earned the last 10 years of his life?  Would the current generation tolerate his famous crusty, rambling style that didn't suffer fools gladly?

For the level of excellence being demanded, there is no “app,” video, game, or role play that will teach the integrity, listening skills, creativity, coaching, critical thinking, or "level of caring and quality" needed to transform to a culture of excellence. These skills are not learned through conceptual understanding and rote practice.  People must discover these for themselves, within themselves and break through to new levels of understanding -- with resulting changes in behaviors. No technology in the world will do this.

So take Brian Joiner’s advice, “Don’t just do something, stand there!” and ponder:  how much of your work is driven by critical thinking?

This year, resolve to stop confusing activity with impact.  Simply “plot some dots,” change some conversations, and watch the reactions to your eye-opening results.

Despite all these transitions, my passion for improvement remains undeterred.  Like Deming, I hope I may keep teaching and learning and mentoring people until I'm at least 93.

Until next time...

Kind regards,

P.S. The Mayo Clinic can't wait for the new edition of Data Sanity to be released!
Someone called my attention to a  youtube video by the delightful Dr. John Bachman, who explains the Mayo Clinic quality improvement education and its use of Data Sanity as the major text.  Since many systems block e-mails with youtube links, those of you who are interested can copy the exact following text into a Google search and click on the "Introduction to Quality Improvement" result : 

youtube john bachman mayo clinic quality improvement

You can move it ahead to the nine-minute point to see the material they use.  Talk about a wonderful surprise!

Please take advantage of the pre-release discount of 20 percent when you pre-order the new edition of Data SanityClick here to order and use the code SANITY20 at checkout.

I was informed today that the release needed to be postponed from this month to early March.  My sincere apologies to those of you who wanted it this month!

If you'd like more information, please contact me to ask for the full Preface, Introduction, and chapter summaries of this revised edition.  As always, I welcome contact from my readers for just about any other reason as well.  I love corresponding and answering questions. ( )

And do please keep me in mind if you need a plenary speaker for an internal or professional conference, a leadership retreat using the 10 scenarios from Chapter 2 of Data Sanity and leadership skills of Chapters 3 and 4,  a staff retreat to get you "unstuck" in current improvement efforts, or some mentoring to help you "quantum leap" to a new level of eye-opening results.

Was this forwarded to you?  Would you like to sign up?
If so, please visit my web site -- -- and fill out the box in the left margin on the home page, then click on the link in the confirmation e-mail you will immediately receive.
Want a concise summary of Data my own words?
Listen to my 10-minute podcast. Go to the bottom left of this .