Systems Thinking

CC-M Productions

Better Questions, Wiser Answers

Clare Crawford Mason

July 1, 2007
Washington Times Commentary

Why is no national leader or candidate discussing or studying solutions for
three of the country’s most pressing problems: unsafe and wasteful
hospitals, the failing auto industry and an inadequate K-12 school system?
This is especially puzzling when there is an answer—unexpected — nearby.

A significant number of hospitals and schools are applying Toyota management
principles — originally developed by an American — and cutting costs,
reducing errors and deaths and turning out pleased patients or educated
students. But there is little notice or discussion of these successes.

American auto companies are exporting jobs and losing money. Toyota is
building more factories in the United States and making big profits.

The hospital crisis discussion is about funding health insurance for more
people. More effective, efficient and safer hospitals would save enough
money to extend care to all. No national leader or political candidate
questions the wisdom of extending insurance coverage for an American
hospital system that daily allows hundreds of patients to die from
preventable errors and infections.

Hand-wringing over the failing auto industry focuses on worker and retiree
benefits and foreign manufacturers. The school policy to combat lack of
quality is to administer more tests. It hasn’t helped teachers or students
to achieve the real objective of better-prepared minds.

The long-term solution to all of them is not more money or better
technology. The problem is managerial. Surprisingly, although the auto
assembly line, the surgical unit and the classroom seem vastly different,
productive questions and solutions are similar and can be found in the same
management thinking.

The solution requires looking with “new eyes” at the 2007 school, hospital
or organization as a system and using problems as opportunities for
continual learning and improvement. This is the “Toyota method” and it
allows us to manage what we can’t control. The idea of lack of control is a
difficult hurdle for Americans and their politicians.

Meanwhile, each day hundreds of people die from avoidable errors and
infections and millions of dollars are wasted in hospitals. Auto companies
and jobs are declining more rapidly than auto profits. And more and more
students are dropping out or not learning.

Americans like quick fixes and are suspicious of solutions “not invented
here,” so it is important to note that the man who developed the theory to
better manage modern organizations began to devise his ideas as a young man
on the Wyoming frontier in the early 20th century. W. Edwards Deming
understood that Western towns prospered from barn raisings, quilting bees
and other cooperative efforts, not lone rugged individualists.

From 1950, he led Toyota and other Japanese export companies to work
“smarter not harder” with his revolutionary ideas of continual improvement
of products, processes and workers. His methods led to lower costs and
better products and more profits. Dr. Shoichiro Toyoda, chairman and former
president of Toyota, said, “Dr. Deming is the heart of our management.”

Mr. Deming warned that hard work, cost-cutting and people doing their best
would not work in the complex enterprises of the 21st century.

For example, doctors and nurses from SSM Health Care, a Midwest system, with
22,000 employees and the Pittsburgh Regional Health Initiative, a group of
40 competing hospitals, report how they did their best in the past, working
overtime, while hospital conditions worsened. They were initially dubious
and then delighted to learn systems thinking and Toyota methods to improve
patient care dramatically and reduce unnecessary deaths, suffering, errors,
infections and costs without additional resources or government regulations.

SSM is the first hospital system to win the Baldrige National Quality Award,
which is a Commerce Department program based on the Japanese Deming Prize
dedicated to spreading these quality management ideas.

The Baldrige criteria, a practical approach to better management, are
virtually ignored by most government agencies and American businesses or
practiced piecemeal, which does not work.

Scotland‘s National Health Service uses these ideas to train its clinical
workers and a government task force is at work on a plan to make Scotland
the world’s first learning society based on this approach.

The Deming-Toyota-Baldrige method and systems thinking can improve schools,
government agencies or any organization, even military invasions and
occupations, because it offers new ways to look at the bigger picture. It
allows an organization to be greater than the sum of its parts as the people
in the system learn to work together more effectively.

One thing more. The doctors and nurses in the successful hospitals frankly
say the patient has been lost amidst new technology, regulations,
reimbursements, etc. They say the Toyota approach allows the medical staff
to spend more time with patients and deliver more effective care. So the
solution is not computers or information. It is a new way of seeing and

And the puzzling question is why more hospitals, schools, government
agencies, etc. are not trying it.

Why is there no national debate on more effectively managing these critical
systems of our society? Why don’t leaders/candidates investigate and discuss
new ways of approaching problems? The role of leadership is to identify
problems and propose solutions. If new ways of thinking and defining
problems are needed, that should be the subject of the presidential

Television news interested in delivering audiences to advertisers will
continue to concentrate on sick celebrities and missing persons, so raising
the pertinent issues is up to the candidates.
Effective management ideas don’t fit in 15-second sound bites or on bumper
stickers. Perhaps our leaders and candidates have too short attention spans
to propose and debate complex solutions or are worried about boring the

Hopefully, it is not as G. K. Chesterton said, “It isn’t that they can’t see
the solution. It is that they can’t see the problem.”

Clare Crawford-Mason is the producer of “Good News: How Hospitals Heal
Themselves” on PBS stations and co-author with Louis Savary of the companion
book, “The Nun and the Bureaucrat — How They Found an Unlikely Cure for
America‘s Sick Hospitals” and co-author with Lloyd Dobyns of “Quality or
Else: The Revolution in World Business,” and “Thinking About Quality:
Progress, Wisdom and the Deming Philosophy.”

Washington Times Commentary

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August 8, 2007 Posted by | Baldridge National Quality Award, CC-M Commentary, CC-M Opinion, Deming Institute, Deming Prize, Deming's Teachings, Dr. Shoichiro Toyoda, G. K. Chesterton, Hospitals Healing Themselves, Japanese Deming Prize, K-12 School System, PBS, PBS Series, Pittsburgh Regional Health Initiative, Scotland's National Health Service, SSM Health Care, System Application, Systems Thinking, The Deming-Toyota-Baldrige, Toyota, Toyota Management, Toyota Method, Toyota Motor Corp., W.Edwards Demings, Washington Times | Leave a comment