There are several theories behind improvement frameworks, such as the model for improvement. One theory to guide business improvement was developed by thought-leader and business expert W. Edwards Deming in the 1940s.

Who Created Deming’s Theory?

W. Edwards Deming worked as a statistician and researcher during World War II, and in the 1950s, he led efforts to bring statistical thinking and quality control methods to improve business, beginning with the manufacturing industry. Deming’s contributions include developing a system of Statistical Quality Control (SQC) and championing the importance of quality in product and production through his philosophies and principles. 

Deming’s philosophy on achieving quality has helped to form the manufacturing and service industries we see today. Many industries still draw from Deming’s work to improve their business models and build cultures focused on continuous improvement. 

What is Deming’s Theory?

Also called Deming’s Theory of Profound Knowledge, Deming’s Theory is a management philosophy based on systems theory, originally prototyped for use in the automotive industry with Toyota. It turned out that this systems-focused improvement framework translated well to many other industries, including healthcare. 

According to The W. Edwards Deming Institute, Deming’s Theory is a system-based management philosophy framework that “represents a holistic approach to leadership and management.” Deming outlined what he found to be the managerial changes necessary to improve quality. These changes are illustrated through four main areas as well as a list of 14 principles intended to guide improvement in organizational structure and behavior. 

In short, when executed, the framework creates continuous improvement in people and organizations. It gives leaders a roadmap for how to work with teams and organizations as systems, rather than focusing on problems with or actions of the individual people working within silos. 

Deming’s Theory informs that there is always a solution within the workings of the system. For example, to reprimand a person for a mistake without fixing the system error that allowed the mistake to be made in the first place is an unsustainable business model. The focus should be on system improvement, process improvement, and on the organization working as a whole organism. 

And to keep these systems and processes in place and ensure they’re followed? That takes management. Deming’s Theory takes the idea of managing people and expands it to the idea of managing a larger system, where every piece affects the other, and interrelated parts are viewed as a comprehensive whole.

In a paper published in the Journal of Applied Behavior Analysis (Donald A. Hantula, Volume 28, Issue 3, Fall 1995), research revealed that optimizing a system as a whole and using systems-level problem solving and interventions led to a significant improvement over individual-level problem solving. “It is contended that up to 85% of the variability in work performance is due to the system; and 15% is due to the individual.” (Deming, 1982; Rummler & Brache, 1990) 

85% is a significant percentage; enough so to reveal that Deming was on to something that could be applied cross-industry. Could it be that using systems-level problem-solving in the healthcare setting would lead to the same reduction in variability in work performance, and in turn, higher success rates and better quality care? 

Deming’s Theory Applied to Healthcare

While implementation in a clinical setting is still a newer exploration, there is evidence to suggest that implementing principles of Deming’s Theory can accelerate quality improvement in healthcare. 

John Haughom, MD, writes on the keys to quality improvement in healthcare, stating that quality improvement must be backed by good data when presented to clinicians, and that physicians are more open to change than many realize. The key is to begin with small process changes that promote autonomy for clinicians while engaging them in the process.

The clinical setting is composed of people; individuals. But, as noted in the study Understanding and Application of Deming’s System of Profound Knowledge in Healthcare,  challenges arise when management and caregivers who provide value are in disparate roles, with management removed from day-to-day operations and faced with the role of solving problems of which they aren’t necessarily immersed. 

Finding the root cause of quality issues in complex healthcare systems tends to trace fault back to individuals. But, what needs to be addressed instead is the system from within which the individuals are working. 

Deming’s Theory for Total Quality Management

Back to Deming’s Theory as a way to illustrate the possible benefits of implementing his principles to the healthcare industry. Deming’s Theory is explained via four main parts and 14 principles called the 14 points for total quality management. 

Let’s first take a look at the four main parts of the theory. Each part relates to one or more of the 14 points, explained further below.

Deming’s Theory: Four Main Parts

1. Appreciation for a system. A system cannot be improved or managed by anyone who does not understand the system. A leader must understand all parts and optimize the system as a whole. 

2. Knowledge about variation. Mishaps or causes for variation are as a result of the system and systematic processes, and not a result of people or individuals. Knowledge about variation transfers blame away from the person and looks instead at the system to identify flaws in workflow, training, or improvement opportunities. 

3. Theory of knowledge. Knowledge, information, and experience work together—knowledge does not mean simply copying provided examples. Leadership and training must be instituted, and continuous thinking, question-asking, and solution development lead to improvement. The PDSA cycle, also created by Deming, is an example of this theory.

The PDSA (Plan, Do, Study, Act) cycles theory is a framework for rapid-testing change on a small scale. In healthcare, PDSA cycles allow for small cycles of change to be implemented, tested, analyzed, and revised before expanding to a larger scale. The PDSA cycles process is effective for change implementation: it’s a low-risk method due to small-scale testing and analysis, it allows predictions to be tested reasonably and through data collection, it offers a high potential for buy-in from team members, and it makes change more incremental and therefore more acceptable to organizations. 

4. Knowledge of psychology. While this framework focuses on the system, within the system, there are human beings. When leaders understand psychology, they can make decisions that motivate and manage people in order to optimize the system in which they are working.  

Even by reading the four main parts of the theory without a very detailed explanation, you can see that Deming’s Theory effectively draws focus away from the individual element and focuses instead on improving the systems in which the individuals operate.

Deming’s Theory: 14 Points for Management

The four main points above relate to the list of principles that Deming called the 14 Points for Total Quality Management in his book Out of the Crisis. Deming’s 14 Points for Management illustrate the points that are to be followed by managers in order to guide organizational practice and behavior. The 14 points in summary are:

(Image Source: American Society for Quality)

Here are the explanations of the 14 points from Deming’s book Out of the Crisis:

  1. Create constancy of purpose toward improvement of product and service, with the aim to become competitive and to stay in business, and to provide jobs.
  2. Adopt the new philosophy. We are in a new economic age. Western management must awaken to the challenge, must learn their responsibilities, and take on leadership for change.
  3. Cease dependence on inspection to achieve quality. Eliminate the need for inspection on a mass basis by building quality into the product in the first place.
  4. End the practice of awarding business on the basis of price tag. Instead, minimize total cost. Move toward a single supplier for any one item, on a long-term relationship of loyalty and trust.
  5. Improve constantly and forever the system of production and service, to improve quality and productivity, and thus constantly decrease costs.
  6. Institute training on the job.
  7. Institute leadership (see point 12 and Chapter 8 in Out of the Crisis). The aim of supervision should be to help people and machines and gadgets to do a better job. Supervision of management is in need of overhaul, as well as supervision of production workers.
  8. Drive out fear, so that everyone may work effectively for the company (see Chapter 3).
  9. Break down barriers between departments. People in research, design, sales, and production must work as a team, to foresee problems of production and in use that may be encountered with the product or service.
  10. Eliminate slogans, exhortations, and targets for the workforce asking for zero defects and new levels of productivity. Such exhortations only create adversarial relationships, as the bulk of the causes of low quality and low productivity belong to the system and thus lie beyond the power of the work force.
  11. a. Eliminate work standards (quotas) on the factory floor. Substitute leadership.
    b. Eliminate management by objective. Eliminate management by numbers, numerical goals. Substitute leadership.
  12. a. Remove barriers that rob the hourly worker of his right to pride of workmanship. The responsibility of supervisors must be changed from sheer numbers to quality.
    b. Remove barriers that rob people in management and in engineering of their right to pride of workmanship. This means, inter alia, abolishment of the annual or merit rating and of management by objective.
  13. Institute a vigorous program of education and self-improvement.
  14. Put everybody in the company to work to accomplish the transformation. The transformation is everybody’s job.

Deming’s Theory still contains useful ideas within this framework for improving quality in modern settings. What about it makes it as pertinent now as it was throughout the 20th century and for other industries? 

The focus on efficiency, flow, and quality improvement of the system. Changing an organization from within means to support individuals, helping them to transform themselves within the system to accommodate the system, thereby improving the system. 

A framework based on deep systems knowledge and systematic change can pull focus and blame away from variables like the individuals that operate within a system, while achieving managerial and employee buy-in and building an environment for business longevity. These aspects work to create a continually improving system—the ultimate goal of the principles of Deming’s Theory.  

References:

  • Umble E.J. (2000) Quality: The Implications of Deming’s Approach. In: Swamidass P.M. (eds) Encyclopedia of Production and Manufacturing Management. Springer, Boston, MA.
  • Dr W Edwards Deming (1982 & 1986) Out of the Crisis: Quality, Productivity and Competitive Position. Cambridge University Press, Cambridge.
  • Donald A. Hantula (1995) Disciplined Decision Making in an Interdisciplinary Environment: Some Implications for Clinical Applications of Statistical Process Control. Journal of Applied Behavior Analysis, Volume 28, Issue 3.