The Lens of Profound Knowledge

Quality of care and patient safety are the highest priorities for healthcare organizations. At heart any organization's quality is building capacity improvement. Dr. W. Edwards Deming, father improvement, suggested that subject matter knowledge not sufficient managing healthcare, it must be complemented by “profound knowledge.” While professionals experts in areas medical practices, such alone inadequate to produce improvements delivery health care. Deming's profound a management theory provides framework improvement transformation system.The system consists four components interact with each other: appreciation system, about variation, knowledge, psychology (Fig. 1). The lens understanding optimizing which we work. following paragraphs will focus on explaining examples from setting.“Every perfectly designed get results gets.” Deming[1]A defined as an interdependent group items, people, or processes working together toward common purpose.[2] prerequisites achieving purpose follows: [3]Healthcare systems complex nature, if most chaotic comparison other industries. cannot simply understood knowing individual component but rather all components, their relationships, feedback loops.[4] Appreciation means step back see full picture understand various items system. A useful way accomplish this visualizing through flow charts. Flowcharts provide systematic visual display dissecting them into basic units, relations, loops. They offer enable shared system's problems gaps.[5]As example, Sandhu et al published project improve decrease preoperative delays diabetic patients undergoing ophthalmology surgery.[6] diagram was created several meetings frontline staff baseline were able reduce complexity cost adverse events. shows two protocols, initial (previous) protocol, new protocol.[6]“Uncontrolled variation enemy quality.” – Deming[7]This related data analysis interpretation. recommended reporting method plotting over time (e.g., day, week, month) instead using aggregate summary (before after).[8] judgment, added value relies ability variations measure impact interventions.In there always outcomes. Minimizing outcome vital concept management. An example includes reduced inpatient discharges weekends compared weekdays, leading prolonged length stay, hospitals efficiency, higher costs.The tools used run control chart. There types variations: cause special variations. Common deeply embedded DNA affect every component, process, outcome. On hand, arise due very specific circumstances.[9] It important highlight process stable than good bad.Run charts graphs distinguish between (Table 1, Fig. 2).[8] Both show measurements y-axis plotted (on x-axis). chart composed calculated median, goal, target line can well. addition medial/center upper lower limit lines. limits according type data. Special identified met:“Knowledge comes theory.” Deming[10]This describes how gain learn applying theories. Theories built current past experiences trial error, without them, make predictions what might happen. Team members suggest interventions changes based hypotheses From perspective, changes; however, certain change replicable different settings contextual variables. Those hypothesis theory-based require testing validation. If intervention fails lead predicted reasons failure need analyzed refine our theories.The Plan-Do-Study-Act (PDSA) cycle, developed Walter Shewhart later proposed popular model learning knowledge.[11] This begins forming making prediction (plan), (do), then assessing effectiveness local context (study), finally adopting abandoning change. Learning refining PDSA cycles. plan do cycles include (theory planning. After prediction, observations made, studied validated.For aimed rate no-shows clinics main reason no communication factor. confirmed survey showed one third did receive text messages follow-up appointments.[12]“Psychology helps us interaction people circumstances, manager his management.” Deming[9]Systems made up so obvious major part motivates people. According Herzberg's two-factor theory, factors work satisfaction: motivators hygiene factors.[13] Motivators i.e., growth, advancement, itself, recognition, achievement drivers job satisfaction. policies, salary, conditions, supervision) satisfaction, they met avoid dissatisfaction. Deming argued born (intrinsic motivators), substitute (extrinsic school grades merit systems.Managers predict own team respond changes, have deal responses know members' needs.The complements providing enables manage. interdependent, independent.