Tuesday, January 3, 2012

An Outmoded Concept

Paul Borawski offers examples of the good and the bad of 2011 in his recent post .  His use of the word "quality" highlights the abstract nature of that word--something the world is no longer willing to accept.  You have to be more specific and tell us what you mean by "quality" before we're willing to agree with you that "quality works" or that it has a rightful place in society.  What good is it?  What has it done for me lately?  The Institute of Medicine assessed the impact of their publications, "To Err is Human" and " Crossing the Chasm."  These two works sharply criticized the US healthcare system for its many failings and prescribed broad approaches for improvement.  Ten years later, nothing has happened.  Various quality initiatives in healthcare have essentially failed to address either the incidence of errors or the cost of the services provided. One can point to various initiatives or projects that have demonstrated small improvements, but nothing has spurred the industry to emulate these successes everywhere.  The reason for this general failure is pretty clear--money.  It's not that there isn't money to implement change, but that there is no financial incentive to do so.  There is no financial incentive for improvement.

Following that negative note, what were the discrete disappointments of 2011?  Paul cites the discontinuance of funding for the Baldrige award.  ASQ has a financial interest in the Award, and it's always disappointing to lose a client, so he’s hardly an impartial observer.  Beyond that, Baldrige was a concept that came and went.  Applications have diminished in the last several years, and the whole system has degenerated into a commercial enterprise, with consultants and writers to enhance your application and improve your chance of success.  The original concept of identifying a few examples of excellence for others to model has become a competition.  The ideas and criteria are still valid and still provide an excellent guide to excellence in any industry.  We just don't need shining examples any more.

 Don Berwick/s departure from CMS should be on most people's list of disappointments.  A victim of Republican ideology, he brought credibility and stature to the position.  Not everyone agreed with all of his ideas, but then, not everyone agrees with me either.  I hope that's OK.

Paul cites the high point of his year as going to a meeting in China.  Maybe that's a sad commentary on the real absence of anything good. 


  1. I'm also disappointed that Dr. Berwick is no longer leading CMS, but he's also a victim of not being appointed in the first two years of the Obama administration when the Democrats controlled Congress. It's far more complicated than just blaming Republicans.

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