Jaded Julie Learns about Dr. Deming

"Julie, when we met last time you convinced me that the training of nurses prepares them to be excellent problem-solvers. All you need is to learn the language of Lean problem solving, and you’ll be off and running.”

“That’s a good choice of words, Curmudge, since nurses are either running or walking fast most of the time. By the way, I hope that the ‘language of Lean problem solving’ doesn’t mean that I have to learn a bunch of new Japanese words.”

“Not a problem, Julie. Lean problem solving is based on the Deming Cycle: Plan, Do, Check, Act. It’s named for an American, Dr. W. Edwards Deming, and the cycle is also used for process improvement. Of course, before you can implement the Deming Cycle, you have to understand the nature of the problem you are working on. So of necessity, the cycle is preceded by a fifth element, Grasp the Situation. Here it is shown as a diagram.”
“That ‘Grasp Situation’ sure looks a lot like Assessment and Diagnosis in the Nursing Process. I’m beginning to see what you are driving at.”

“Grasping the situation is a universal starting point for any investigation. In industry we used to call it penetrating the problem. It’s logical that one must know where he is before planning how he’s going to get to where he wants to go. Getting to the true source of a problem—the so-called root cause—will be the topic of a separate discussion. However from your experience as a nurse, Julie, I’m confident that you can understand the concept. Plan and Do in the Deming Cycle correspond to Planning and Implementation in nursing, and Check—sometimes called Study—is the same as your Evaluation.”

“What about Act, Curmudge? To me, that sounds a lot like Do.”

“You’re right, Julie. The difference is simply its location in the cycle. It’s what you do following evaluation. Actions might include accepting at this point the problem solution you have achieved or the process improvement you have developed. If the process meets the targets established in the Plan, accept it as a standard. Otherwise one could plan ways that might yield a better solution or process and go around the cycle again.”

“I understand, Curmudge. If this is typical, Lean tools should be easy for a nurse to use.”

“Lean tools are straightforward. The real challenge of Lean is learning, accepting, and implementing its culture. The basic Lean culture originated in Japan, and those of us in the older generation grew up not thinking very highly of those guys.”

“Nevertheless, I bet if you and I put our heads together, we can resolve some of those cultural differences. Don’t forget, Curmudge, yours is a much, much older generation.”

“Watch that much, much older stuff, Julie. These are my fingers on the keys.”

“Sayonara, Curmudge.”

Affinity’s Kaizen Curmudgeon