1.

    “Create constancy of purpose toward improvement of product and

service.” Pursue quality and service improvement from the prospective of the
patient. Pursue exceptional patient experience.

2.    “Adopt new philosophy. We are in a new economic age. Western

Management must awaken to the challenge.” Pursue continuous eradication
of waste and rework, through maximizing value-added patient interactions while
minimizing any non-value added but necessary activities.

3.    “Cease dependence on inspection to achieve quality”. Build quality into

each patient visit. Address current issues and anticipate future problems. Stop
managing by metrics. Metrics will improve with built in quality.

4.    “End the practice of awarding business on the basis of price

tag.” Build long-term relationships of loyalty and trust between departments.
Break silos. Support, coach, share resources, and learn with other parts of the
organization.

5.    “Improve constantly and forever the system of production and

service in order to improve quality and productivity, and thus
constantly decrease cost.” Improvement in quality and service will invariably
result in increased affordability, decreased cost and increased revenue.

6.    “Institute training on the job.” Create specific job aids, expectations,

standard work flows and visual aids. Use Training Within Industry to standardize
coaching on the job.

7.    “Institute leadership.” The goal of leaders is to help people do a better job.

Coach based on clear expectations and knowledge of standardized operations,
procedures and workflows.

8.    “Drive out fear, that everyone may work effectively...Cease to blame

employees for problems of the system. People need to feel secure to
make suggestions” Unleash individual talent to pursue quality and service. Stop
managing by fear.

9.    “Break down barriers between departments…We must break down

the class distinctions between types of workers within the
organization”: primary care physicians vs specialists, physician vs business
leaders, clinical vs nonclinical providers. People in various departments “must
work as a team to foresee problems” in service and create innovative
solutions.
10.“Eliminate slogans, exhortations, and targets for the work force…
asking for new levels of productivity. Such exhortations only create
adversarial relationships, as the bulk of the causes of low quality and
low productivity belongs to the system and thus lie beyond the power of
the work force”. Focus bulk of you time on process improvement and not
performance management. Performance will improve with improved systems and
workflows.

11.“Eliminate work standards (quotas) on the factory floor… Eliminate

management by objective. Eliminate management by numbers,
numerical goals. Substitute Leadership.” Institute management by process
and results. Go slow to go fast.

12.“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.” Do not focus on response time in the call centers
and clinics. Focus on one call resolution of patients' concerns.

13.“Institute a vigorous program of education and self-improvement” All

leaders need to be trained in standard work deployment, problem-solving, idea
management, etc. Focus on creating a learning organization.   

14.“Put everybody in the company to work to accomplish the

transformation. The transformation is everybody’s job.” Continuous
process improvement with patient in the center is everyone’s job from CEO down to
front-line staff.  

Just came across this one today, and I wanted to share and keep it in a place I'll remember.

1. Establish constancy of purpose toward service.

1. Define in operational terms what you mean by "service to the patient"
2. Define standards of service for a year and hence 5 years
3. Define patients whom you are seeking to serve
4. Constancy of purpose brings innovation
5. Innovate for better service
6. Put resources into maintenance and new aids into production
7. Decide whom the administrators are responsible to and the means by which they can
be help responsible
8. Translate this consistency of purpose to service to patients and the community
9. The board of directors must hold on to the purpose
2. Adopt the new philosophy. We are in a new economic age. We can no longer live with commonly
accepted levels of mistakes, materials not suited to the job, people of the job who do not know
what the job is and are afraid to ask, failure of management to understand their job, and
antiquated methods of training on the job, and inadequate and ineffective supervision. The
board must put resources into this new philosophy, with commitment to in-service training
3.
1. Require statistical evidence of quality of incoming materials, such as pharmaceuticals,
inspection is not hte answer. Inspection is too late and is unreliable. Inspection does
not produce quality. The quality is already built in and paid for. Require corrective
action, where needed, for all taks that are performed in the hospital
2. insititute a rigid program of feedback from patients in regard to their satisfaction with
services
3. Look for evidence of rework or defects and the costs that may accrue.
4. Deak with vendors that can furnish statistical evidence of control. We must take a clear stand
that price of services has no meaning without adequate measure of quality. Without such a
stand for rigorous measures of quality business drifts to the lowest bidder, low quality and high
cost being the inevitable result. Requirement of suitable measures of quality will, in all
likelihood, require us to reduce the number of vendors. We must work with vendors so that we
understand the producures that they use to achieve reduced number of defects
5. Improve constantly and forever the system of production and service
6. Restructure training
1. Develop the concept of tutors.
2. Develop increased in-service education
3. Teach employees methods of statistical control on the job
4. Provide operational definitions of all jobs
5. Provide training until the learner's work reaches the state of statistical control.
7. Improve supervision. Supervision is the responsibility of the management.
1. Supervisors need time to help people on the job
2. Supervisors need to find ways to translate the constancy of purpose to the individual
employee
3. Supervisors must be trained in simple statistical methods with the aim to detect and
eliminate special causes of mistakes and rework.
4. Focus supervisory time on people who are out of statistical control and not those who
are low performers. If the memebers of the group are in fact in statistical control, there
will be some low performers and some high performers.
5. Teach supervisors how to use the results of surveys of patients.
8. Drive out fear. We must break down the class distinctions between types of workers within the
organization - physicians, nonphysicians, clcinical providers versus nonclinical providers,
physician to physician. Discontinue gossip. Cease to blame employees for problems of the
system. Management should be help responsible for faults of the system. People need to feel
secure to make suggestions. Management must follow through on suggestions. People on the
job cannot work effectively if they dare not offer suggestions for simplification and improvement
of the system.
9. Break down barriers between departments. One way would be to encourage switches of
personnel in related departments.
10. Eliminate numerical goals, slogans, and posters imploring people to do better. Instead display
accomplishments of the management in respect to helping employees improve their
performance.
11. Eliminate work standards that set quotas. Work standards must produce quality, not mere
quantity. It is better to take aim at rework, error, and defects.
12. Institute a massive training program in statistical techniques. Bring statistical techniques down
to the level of the individual employee's job, and help him to gather informiaton about the
nature of his job in a systematic way.
13. Institute a vigorous program for retraining people in new skills. People mus tbe secure about
their jobs in the future and must know that acquiring new skills will facilitate security.
14. Create a structure in top management which will push every day on the previous 13 points. Top
management may organizae a task force with the authority and obligation to act. This task force
will require guidance from an experienced consultant, but the consultant cannot take on
obligations that only management can carry out.