Clinical Quality Improvement

Clinical Quality Improvement

William Edwards Deming (October 14, 1900 – December 20, 1993) was an American engineer, statistician, professor, lecturer, and management consultant. His renowned book The New Economics of Industry, Government, and Education is critically acclaimed and its principles have been used widely across industries. He developed the sampling technique and had a great impact on the practice and science of quality management. Some of his principles also referred to as Deming Principles discussed extensively in the link

Dr. Edwards Deming outlined 14 points for total quality management and quality improvement. Those 14 points are:


  1. Create constancy of purpose for improving products and services.
  2. Adopt the new philosophy.
  3. Cease dependence on inspection to achieve quality.
  4. End the practice of awarding business on price alone; instead, minimize total cost by working with a single supplier.
  5. Improve constantly and forever every process for planning, production, and service.
  6. Institute training on the job.
  7. Adopt and institute leadership.
  8. Drive out fear.
  9. Break down barriers between staff areas.
  10. Eliminate slogans, exhortations, and targets for the workforce.
  11. Eliminate numerical quotas for the workforce and numerical goals for management.
  12. Remove barriers that rob people of pride of workmanship, and eliminate the annual rating or merit system.
  13. Institute a vigorous program of education and self-improvement for everyone.
  14. Put everybody in the company to work accomplishing the transformation.

These 14 principles have been applied and translated to various concepts over the years including healthcare. These 14 concepts can be applied and adapted in any service industry with little modification, however, its adaptation has to be well thought out and applied efficiently.

Health organizations have to decide how to best apply these principles to specific situations and make adjustments where necessary. This requires more skill and experience than following the management recipe to the tee. Interpretation oftentimes presents a challenge but can be very rewarding for health practitioners when it’s met. Thinking is required and health practitioners must continue on the path of thinking, analyzing, learning, unlearning and improving. To make intelligent decisions and effectively apply these principles, health organizations need to understand variation. Some of these variations come from small nuances in management style differences, cultural differences etc. Understanding the organization is paramount because without an understanding of these variations and how they fit into decision making, solutions might end up being faulty and cause more damage than good.

For example, the 10th principle which states “Eliminate slogans, exhortations and targets for the workforce” is a valid principle. However, an exception might have to be made if the slogan was created by employees for themselves. In this case, eliminating the slogan will achieve a counter effect than intended. Another example, in point 13 “Institute a vigorous program of education and self-improvement for everyone”, training is very important but how this is applied is also important. If employees are made to receive training on personal time or weekends then it could reduce employee morale. Now though it is a good principle, how management implements it could either lead to the intended positive result or could be negative.

There are some principles that apply in every situation without the need for a variation such as respect for people. In the healthcare industry respecting health, practitioners are essential as their work involves a lot of patient interaction and most importantly life and death situations. If employees are happy it affects the quality of service. In healthcare, a drop in the quality of service could lead to life-threatening situations.

Now implementing these management principles could present a challenge to management due to the nuances and care needed in its interpretation but when these challenges are overcome, there is a great reward.

Clinical Quality Improvement and  Performance Improvement 

You don’t set out to make improvements if you don’t know where to focus your attention. It is not accidentally found or ever truly achieved because there is always more that you can do. Does that mean that you quit before you start due to the overwhelming amount of work that will go into change? Obviously not, performance improvement in healthcare just requires more knowledge, insight and willingness to admit that you don’t know it all.

Healthcare has an unspoken expectation of high quality due to the fact that people’s lives and livelihoods are on the line. As such, it is necessary to measure performance against previous numbers as well as other healthcare organizations to develop a clearer understanding of how you rank and whether you are getting better or worse at providing care.

In some cases, performance standards and goals are out of your hands and are requirements that must be met by government and other organizations to which you report. That still doesn’t negate the fact that one person usually doesn’t have the clout, ability or support to navigate an entire organization toward a new destination. For this reason, it is necessary to measure performance throughout the organization to provide a picture of fact-based analysis showing deficiencies or less than ideal outcomes. There are also more specific reasons to performance measurements.