Content By Davis Balestracci

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Is It Time for a Self-Check?
By: Davis Balestracci 12/04/2018

I always enjoy my fellow columnist Arun Hariharan’s musings. He has worked in the field of quality for more than 30 years and, like me, has obtained reasonable results. But he has also made his share of the inevitable growing-pain mistakes—lessons we both had to learn the hard way in an environment totally different from today’s.

I would like to share some of his thoughts about qualities that make one successful as an improvement professional regardless of circumstances. This column will focus on one of the most important.

Ability to execute or implement

“Farming looks mighty easy when your plow is a pencil and you’re a thousand miles from the corn field.”
—U.S. president Dwight Eisenhower (1956)

Hariharan: “I’ve come across a few armchair philosophers who became quality professionals. They would complain that nobody in the business listened to them. I’ve learned that one of the most important qualities needed to be successful in quality is the ability to execute. Few people in the business will be interested in theories alone; the quality person must work with their colleagues in the business to implement what they preach.”

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‘Why Deming? Why Now?’... Why the Need for a Different ‘Method’
By: Davis Balestracci 09/27/2018

During the early 1990s, I was president of the Twin Cities Deming Forum. I had a wonderful board whose members were full of great ideas. One member, Doug Augustine, was a 71-year-old retired Lutheran minister and our respected, self-appointed provocateur. He never missed an opportunity to appropriately pull us right back to reality with his bluntly truthful observations and guaranteed follow through on every commitment he made.

After W. Edwards Deming’s death in 1993, we tried to keep the forum alive, but monthly meeting attendance started to drop off significantly. We were offering innovative meetings to grow in practice of Deming’s philosophy, but our members wanted static rehashing and worship of “the gospel according to Dr. Deming.”

The last straw was a meeting where a self-appointed Deming expert/consultant went too far: He lobbed one too many of his predictable, pedantic “gotcha! grenades” at the speaker for alleged deviations from “the gospel.” His persistence blindsided and visibly upset our wonderful guest speaker. I was furious and publicly told him to stop. It did not go over well—except with my board.

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Conscious Improvement: Start by Reducing ‘Silly Meeting’ Time
By: Davis Balestracci 04/24/2018

Customer satisfaction surveys are all the rage these days. Healthcare has a couple of “800 pound gorilla” surveyors whose services (and nontrivial expense) have been pretty much forced upon it. In many cases, targets are set that are used to drive reimbursement.

A client once shared a 186-page quarterly summary from one such vendor (most of it worthless; I gave up at page 28). I noticed two frequent tendencies: 1) when current percentile performance was less than 50th, the number was color-coded red (obviously nobody wants to be below average); 2) next to their number was what they called a “trend” showing the latest three months’ performances as a line graph.

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Proper Use of a U-Chart
By: Davis Balestracci 03/21/2018

Because of a growing movement in the health insurance industry toward not reimbursing hospitals for any expenses caused by a system-acquired infection, one health system made efforts to improve its infection rate starting in the last quarter of 2016. In June 2017, a year-over-year graph was presented to show progress to date.

Despite the impressive progress, there was obviously more work to do to eradicate these “should never happen events”:

The system consisted of five hospitals, and one analyst discovered monthly data for each all the way back to January 2015. He created the following graph (that I have dubbed a “copulating earthworm graph”), which for some strange reason executives (and many analysts) seem to love:

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Your ‘Swiss Army Knife’ of Control Charts
By: Davis Balestracci 02/26/2018

The Individuals chart is the “Swiss Army knife” of control charts. It usually approximates the supposedly “correct” chart under most conditions, and its use is much easier to understand and explain. It can also save you a major side trip into the swamp of unnecessary calculation minutiae, especially avoiding square roots!

Based on real data

Suppose a quality analyst (QA) comes to you saying, “We’re trying to reduce this particular infection, and I had some data: the number of infections and patient days for the past 30 individual months. My software led me down its decision tree and told me to do a u-chart, which you can see in figure 1:

Figure 1: U-chart of infection rate

“It’s obvious I need to investigate that special cause at month 22. And month seven got a zero! But since it’s right on the limit, it would probably be advantageous to investigate it anyway, right?”

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How Many Cylinders Are Firing in Your Improvement Efforts?
By: Davis Balestracci 11/20/2017

During the early 1990s, I was president of the Twin Cities Deming Forum. I had a wonderful board to work with, one of whom was Doug Augustine, our self-appointed provocateur. Doug was a 71-year-old retired Lutheran minister, and we all loved him because he always pulled us right back to earth with his bluntly truthful observations and followed through on every commitment he made.

After W. Edwards Deming’s death in 1993, we tried to keep things alive, but attendance started to drop off significantly. We offered innovative meetings to grow in practice of Deming’s philosophy, but our members wanted static and, for lack of a better term, traditional “Deming Sunday School,” chapter and verse.

After a year of this, we were all frustrated, and Doug finally “named” it during one board meeting: “Are we in the ‘entertainment’ business, or are we in the ‘changing the world’ business? I want the latter; our members want the former. I say we pull the plug on the forum.”

He was right. Exactly one year after Deming’s death, we did. I have often used his quote to challenge groups and even myself as I’ve considered potential consulting work.

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Two Valued Stealth Mentors
By: Davis Balestracci 10/18/2017

In my last column, I reflected back on my career to date and issued a challenge. Based on the relatively lukewarm response, let’s see whether I can engage a few more of you to join me on my quixotic journey.

“Trying to manage your career or your organization in a world changing as rapidly as ours is like dancing with a gorilla. You don’t stop when you get tired. You stop when the gorilla gets tired.”
—Dr. Sheila Sheinberg

I heard Sheila Sheinberg speak at several Deming-based conferences almost 30 years ago. She might be one of the few people who can actually make me look sedate. Hardly a curmudgeon, but rather a provocateur and visionary. During the 1980s, in the early days of the improvement renaissance, she developed the following:

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Some Reflections... and a Challenge
By: Davis Balestracci 09/13/2017

I have reached one of those life landmarks (receiving my Medicare card) and have been reflecting back... a lot. I will remain every bit as passionate about improvement and don’t think I will ever formally retire, but I also doubt I will have W. Edwards Deming’s tenacity to keep at it until I (hopefully) turn 93.

I’ve been writing columns for Quality Digest for more than a dozen years. Are all of my topics still relevant? I believe so.

What about progress in improvement? Going back even further than 12 years, I also reflected on and concluded that despite all the mind-blowing technological advances that have taken place during my 35-year career, improvement progress remains glacial.

Tick... tick... tick.... Is the next “magic bullet” fad du jour lurking to create further distraction from true root causes?

David Kerridge, one of most brilliant Deming thinkers in the world, had a wonderful quote: “If we are actually trying to do the wrong thing, we may only be saved from disaster because we are doing it badly.”

And the last few years, especially in healthcare, seem stuck in “rearranging the deck chairs on the Titanic.”

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Count Data: Easy As 1-2-3?
By: Davis Balestracci 08/14/2017

Many of you work in organizations that keep track of customer complaints. Have you ever thought of how they are recorded and tallied? What could possibly be wrong with this process: The customer brings a concern to your attention. Record it.

Let’s say a certain pediatrics unit reported the number of concerns on a monthly basis. The values for one period of 21 months were, respectively, 20, 22, 9, 12, 13, 20, 8, 23, 16, 11, 14, 9, 11, 3, 5, 7, 3, 2, 1, 7 and 6. But even though you know the counts, you don’t know the whole story because you don’t know the context for the counts. Before anyone can make sense of these counts, certain questions must be answered.

How is “concern” defined? Is it just an antiseptic term for complaint? Are these customer complaints, internally generated counts, or a mixture of both? In the data above, why does the number of concerns drop? And what about the rumor that the hospital administrator is using these numbers to rank departments for bonuses? What exactly constitutes a complaint? Does a complaint about a chilly reception room count?

What else does your organization “count” besides complaints?

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New Results Equal New Conversations
By: Davis Balestracci 07/17/2017

Recently I demonstrated a common incorrect technique for comparing percentage rate performances—based of course in the usual normal distribution nonsense. Let’s revisit those data with a superior alternative.

To quickly review the scenario: In an effort to reduce unnecessary expensive prescriptions, a pharmacy administrator developed a protocol to monitor and compare individual physicians’ tendencies to prescribe the most expensive drug within a class.

Data were obtained for each of a peer group of 51 physicians—the total number of prescriptions written and how many of them were for the target drug. During this time period, these 51 physicians had written 4,032 prescriptions, of which 596 were for the target drug—an overall rate of 14.8 percent.