At the 7th Annual National Minority Quality Forum/Congressional Black Caucus Health Brain Trust, Dr. Gary Puckerin reemphasized medicine’s failure at treating medical patients as customers. In my experience as a hospital manager, I’ve found the best health delivery systems and organizations pride themselves in recognizing patients as customers. As healthcare advocates, we should strategically implement and find ways to encourage more organizations to treat patients as customers.
In Dr. W. Edwards Deming’s memo to Sibley Hospital, he outlined his entire patient experience—what went well and what should have been improved upon. As a renowned international quality consultant, Dr. Deming was all too familiar with creating a customer focus via the implementation of sound business process—without process there would be no way to predict a successful customer outcome.
In his memo, Dr. Deming was shocked by the lack of a customer focus displayed in a healthcare setting. In his book, The New Economics for Industry, Government, Education 2nd. edition, Deming outlines 14-points for delivering quality and a customer focus in an organization and creating a “System of Profound Knowledge:”
1. Constancy of Purpose Towards Improvement. “Create constancy of purpose for continual improvement of products and service to society, allocating resources to provide for long range needs rather than only short term profitability, with a plan to become competitive, to stay in business, and to provide jobs.”
2. Adopt The New Philosophy. “We can no longer live with commonly accepted levels of delays, mistakes, defective materials, and defective workmanship. Transformation of Western management style is necessary to halt the continued decline of business and industry.”
3. Cease Dependence on Inspection. “Eliminate the need for mass inspection as the way of life to achieve quality by building quality into the product in the first place. Require statistical evidence of built in quality in both manufacturing and purchasing functions.”
4. Move Towards a Single Supplier for any One Item. “End the practice of awarding business solely on the basis of price tag. Instead require meaningful measures of quality along with price. Reduce the number of suppliers for the same item by eliminating those that do not qualify with statistical and other evidence of quality. The aim is to minimize total cost, not merely initial cost, by minimizing variation. This may be achieved by moving toward a single supplier for any one item, on a long term relationship of loyalty and trust.”
5. Improve Constantly. Improve constantly and forever every process for planning, production, and service. Search continually for problems in order to improve every activity in the company, to improve quality and productivity, and thus to constantly decrease costs. Institute innovation and constant improvement of product, service, and process.
6. Institute Training. Institute modern methods of training on the job for all, including management, to make better use of every employee.
7. Institute Leadership. Adopt and institute leadership aimed at helping people do a better job. The responsibility of managers and supervisors must be changed from sheer numbers to quality. Improvement of quality will automatically improve productivity.
8. Drive out Fear. Encourage effective two-way communication and other means to drive out fear throughout the organization so that everybody may work effectively and more productively for the company.
9. Break Down Barriers between Departments. Another idea central to Total Quality Management is the concept of the ‘internal customer’, that each department serves not the management, but the other departments that use its outputs.
10. Eliminate Slogans. Eliminate the use of slogans, posters and exhortations for the work force, demanding zero defects and new levels of productivity, without providing methods.
11. Eliminate Management by Objectives. Deming saw production targets as encouraging the delivery of poor-quality goods. Managers should create processes to reach objectives.
12. Remove Barriers to Pride of Workmanship. Remove the barriers that rob hourly workers, and people in management, of their right to pride of workmanship.
13. Institute Education and Self-improvement. Advances in competitive position will have their roots in knowledge.
14. The Transformation is Everyone’s Job. Clearly define top management’s permanent commitment to ever improving quality and productivity, and their obligation to implement all of these principles.
Many healthcare organizations implement Deming’s points in various ways. Some hospitals implement customer service programs that provide the opportunity for service recovery. At Sibley Hospital (Washington, DC), departments that deliver high customer satisfaction are given the Golden Coat Hanger Award in honor of W. Edwards Deming and Sibley’s commitment to high quality. Deming had been a patient at Sibley in the early 1990s and had called the CEO into his hospital room and said, “You don’t trust your patients, do you?”
Jerry Price, the CEO was puzzled.
“Look in the closet,” Deming roared.
Price looked in the closet and it was filled with the coat hangers used in hotels, the hangers that have little balls that must be fitted into tiny holes.
“How would you like to be 92 years old and sick and you couldn’t even hang up your clothes?” Deming demanded. “Do you think your patients want to steal your coat hangers?”
Following his stay, Deming wrote a letter to Sibley and sent a $25,000 check and instructions to buy new coat hangers for all the patients’ rooms.
Price did so, had a number of them sanded down and got Deming to sign them. Today, the quality awards at Sibley are sturdy wooden hangers with hooks and Deming’s signature mounted in a frame.
