Adjust the March, Not the Mission
Why great leaders evolve the “how” without losing sight of the “why.”
If you’ve been responsible for anything related to quality in healthcare, you’ve probably heard the name Deming. But do you really know Deming?
W. Edwards Deming didn’t set out to be a leadership icon. Born in Iowa in 1900, he began his career in the unglamorous corners of science and government, first as a physicist, then as a statistician at the USDA and Census Bureau. His Yale PhD – titled A Possible Explanation of the Packing Effect of Helium – didn’t exactly scream destined to lead a global quality systems management revolution.
But what Deming lacked in flash, he made up for in clarity.
After World War II, the U.S. sent him to Japan to support industrial recovery. What happened next changed not just Japan but the world.
Deming proposed something radical to postwar Japanese manufacturers: the problem wasn’t the employees, it was the system. He believed most failures were caused by flawed processes, not flawed people.
“A bad system will beat a good person every time.”
He preached process over punishment, data over determinism, systems over scapegoats. And Japan’s industrial leaders listened.
Deming’s influence helped spark one of the greatest economic turnarounds in modern history. His fingerprints are still visible today on:
- The Toyota Production System
- Continuous quality improvement
- Lean
- Six Sigma
- PDCA and PDSA cycles
- Performance dashboards
- Even the way we talk about culture and psychological safety
If you’ve ever been part of a root cause analysis, redesigned a workflow to reduce unnecessary variation, or built an improvement feedback loop, you’ve lived Deming’s legacy.
And that legacy still has something important to teach us. Because Deming didn’t just show us how to improve systems… he modeled what it looks like to stay committed to purpose, even when the path has to change.
That lesson came to life for me at Mission Health, then an independent nonprofit system serving 18 counties in Western North Carolina.
It was a rural, resource-constrained region with a payer mix nearly 75% Medicare, Medicaid, or self-pay — and a population that was older, sicker, and less likely to be insured than state and national averages.
We knew long-term sustainability meant moving upstream toward population health and value-based care. So our system rallied around a bold goal called The BIG(GER) Aim:
“To get every patient to their desired outcome first without harm, also without waste, and with an exceptional experience for every patient, family, and team member.”
One of the strategies we used to pursue that goal was the development of Care Process Models (CPMs) — evidence-based clinical pathways embedded into our EHR.
The model was simple in concept:
- Clinicians defined the shared best practice,
- Informatics experts embedded that pathway in the EHR, making it easy to follow and hard to ignore,
- Data architects and engineers built near real-time dashboards, and
- The same clinicians who defined the pathway could the track adherence and outcomes, modifying the pathway as needed and holding each other accountable for their own and their colleague’s decisions.
But by 2016, the program was struggling. It was expensive, slow, and nowhere near its potential. A new CPM every 45 days wasn’t going to cut it. Some believed the program couldn’t be saved. At least one leader stepped away entirely.
That’s when Deming’s voice rang loudest: The system is the problem. Change the system, not the mission.
So that’s what we did.
Together with our CIO, Chief of Clinical Operations, outstanding PI leaders, and dozens of committed and engaged team members, we rebuilt the CPM engine from the ground up. New governance. New analytics. New team structure. New execution model.
Within a year, we were launching one new CPM every ten days — at a fraction of the cost, and with dramatically greater impact on both quality and cost.
We didn’t abandon the mission. We adjusted the march.
(For more detail: Healthcare Innovation and AHA Q4Q Report)
Here’s what I know now:
It would’ve been easier to quit. Scrap the program. Start something new with a cleaner origin story and a slicker name.
That’s the seduction of fresh starts. They’re emotionally tidy… and yet rarely what real leadership requires.
Deming reminds us: perseverance isn’t about rigidity, it’s about clarity. You can change the tools. Change the strategy. Change the pace. But you don’t give up the purpose.
That’s why his legacy matters more now than ever.
Because the truth is that most of the time, we don’t get it right on the first try. Most transformations don’t follow the slide deck. And most worthy goals demand we revise the how without sacrificing the why.
As W. Edwards Deming reminded us:
“Learning is not compulsory… and neither is survival.”
Resources
https://asq.org/about-asq/honorary-members/Deming
https://www.ebsco.com/research-starters/history/w-edwards-deming
https://www.aha.org/system/files/media/file/2019/09/Q4Q_2019.pdf
The Perseverance Playbook™ is a weekly newsletter about the middle miles, where purpose is forged and leadership is born. Written from airports, sidelines, and the spaces in between by Dr. Chris DeRienzo.
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