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- Looking Back at "Some Notes on Management in a Hospital" by W. Edwards Deming
The head nurse returned to say that the nurse that was to give the infusion had recorded the infusion as given. It is possible that she recorded it in advance, with the intention to give it, and did not correct the record. Is this the regular procedure, to record intentions? Who would know? An unsuspecting physician, looking at the record for his patient, would assume that the infusion had been given, and could draw wrong inferences about how the patient had been doing on the drug. In my case, as it turned out, no harm. But how would he know? A nurse, or a physician, has a right to suppose that the medication was delivered as ordered and as recorded.
What is the purpose of the record? To inform the physician about intentions, or to tell him what happened?
It is even more difficult than usual to avoid blaming people when you are being forced to suffer. But even in this situation Dr. Deming understood the problems were a natural result of poor processes not of failures by individuals to do their best.
continue reading Looking Back at "Some Notes on Management in a Hospital" by W. Edwards Deming
- The Worst Aspect of TPP That Gets Nearly No Attention
Sadly among the worst aspects of the Trans-Pacific Partnership TPP (and also the TTIP) is the promotion of the copyright cartel's agenda along with very bad patent policy. Almost no one with political power is even talking about these huge problems with it.
I support free trade. I don't support the politically motivated trade agreements that impose the USA political donors' wishes on citizens of the USA and other countries.
continue reading The Worst Aspect of TPP That Gets Nearly No Attention
- 2015 Health Care Price Report – Costs in the USA and Elsewhere
The damage to the USA economy due to inflated health care costs is huge. A significant portion of the excessive costs are due to policies the government enacts (which only make sense if you believe the cash given to politicians by those seeking to retain the excessive costs structure in the USA the last few decades buy the votes of the political parties and the individual politicians).
In 2015, Humira (a drug from Abbvie to treat rheumatoid arthritis that is either the highest grossing drug in the world, or close to it) costs $2,669 on average in the USA; $822 in Switzerland; $1,362 in the United Kingdom. This is the cost of a 28 day supply.
The report also includes the cost of medical procedures. For both the drugs and the procedures they include not only average but measures to show how variable the pricing is. As you would expect (if you pay attention to the massive pricing variation in the USA system) the variation in the cost of medical procedures is wide. For an appendectomy in the USA the 25th percentile of cost was $9,322 and for the 95th was $33,250; the average USA cost was $15,930. The average cost in Switzerland was $6,040 and in the United Kingdom was $8,009.
continue reading 2015 Health Care Price Report – Costs in the USA and Elsewhere
- Addressing Systemic Policing Issues in the USA
I have long been concerned about problems with our system of law enforcement in the USA. In recent years one good thing is that the problem is getting much more attention (the increasing militarization of police department however is a very bad trend that has gotten much worse over the last 10 years).
I strongly believe the former police chief of Madison, Wisconsin has very good ideas on what should be done. His blog has many useful ideas and he discusses Deming's ideas often. He also wrote a guest post for the W. Edwards Deming Institute blog: Quality Beginnings: Deming and Madison, Wisconsin.
continue reading Addressing Systemic Policing Issues in the USA
- US Fish and Wildlife Service Plans to Use Drones to Drop Vaccine Treats to Save Ferrets
To date, SPV has been applied by hand with people walking pre-defined transects and uniformly dropping single SPV baits every 9-10 meters to achieve a deposition rate of 50 SPV doses per acre. Depending on vegetation and terrain, a single person walking can treat 3-6 acres per hour. All terrain vehicles (ATVs) have been considered but have various problems.
If the equipment and expertise can be developed as proposed here, a single UAS operator could treat more than 60 acres per hour.
If the equipment can be developed to deposit 3 SPV doses simultaneously every second, as they envision is possible, some 200 acres per hour could be treated by a single operator.
continue reading US Fish and Wildlife Service Plans to Use Drones to Drop Vaccine Treats to Save Ferrets
- My First Trip To Japan by Peter Scholtes
At the Aisin Seiki Company:
Throughout the plant were the charts and graphs we had come to expect in companies pursuing quality. Each work station had formed it storage for tools, warning systems telling when drills should be changed and systems to assure the reorder of parts when the supply was low. Their kanban system applied not only to the component on which they were working, but to the drills, etc. which they used in their work.
I recommend reading Peter’s full report which includes thoughts on visits to: Toyota, Yokogawa Hewlett-Packard, Takeanaka Komuten, Kansai Electric Company and more.
continue reading My First Trip To Japan by Peter Scholtes
- Vanlife in the USA
The combination of where I want to travel (National Parks, National Forest and nature largely) and the cost effectiveness for van living works out very well. You can often park for free in US National Forest and BLM land. Also the cost of campgrounds is much less than any form of lodges, motels or hotels; so even in the instances you pay for lodging the costs are greatly reduced...
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- Export anything to a friendly country except American management
Part of the reason improvement has been so slow is that while many people seem to like sharing such quotes with their friends and colleagues very few people dig into the context of his quotes in order to learn how to actually improve. Humor is useful is piquing people’s interest. Sadly even if thousands of people appreciate and share such a quote, very few actually think about what they can do in their organization to improve the situation. Some people do, and that is wonderful.
continue reading Export anything to a friendly country except American management
- Autonomous Delivery Robots Launched in Europe and USA
Robots developed by Starship Technologies are meant for delivering packages, groceries and food to consumers in a 2-3 mile radius. The robots can drive autonomously while being monitored by human operators in control centers. Introduced to European and American cities since the end of last year, the robots have already driven close to 5,000 miles and met over 400,000 people without a single accident.
continue reading Autonomous Delivery Robots Launched in Europe and USA
- Management Tools for Quality Improvement Succeed When Practicing Respect for People
- Butterfly Park in Kuala Lumpur
- My Office in Laos
View from the porch of my cabin in Luang Prabang, Laos with my laptop in the foreground. This was a wonderful place to work.
continue reading My Office in Laos
- Unintended Consequences - distorting the system or distorting the data
Using data to understand your processes and improve them is very useful.
But using data often results in unintended consequences. If you don’t have a good understanding on the pressures collecting data will bring to bear on the system you can create pressure for results that damage the delivery of value to customers...
Distorting the system or distorting the data are often the result, instead of the process improvement that is desired and expected.
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- Backyard Wildlife: Great Tailed Grackle
Great tailed grackles are bueatiful birds with black base coloring that includes feathers with iridescent colors on closer inspection.
continue reading Backyard Wildlife: Great Tailed Grackle
- Minimize Total Cost
Another common way of explaining this point is to discuss the problems created when organizations have created management systems that encourage decisions based on what is best for parts of the organizations. So when each department is appraised on whether they cut their costs each will seek to do so, no matter how much that increases the costs for other departments. The problems of this are fairly obvious and it isn’t that those choosing to create systems that focus on improving the parts want to accept these consequences.
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