Under-Visioning Professionalism: Deming, Berwick & Sensemaking

Posted on | January 26, 2010 | Comments Off on Under-Visioning Professionalism: Deming, Berwick & Sensemaking

Mike Magee MD

The question: Can a health professional be “professional” in a fundamentally misaligned health system? If not, does a health professional have to contribute to health system transformation to behave professionally?

Professionals are generally members of a vocation with special training, highly educated, enjoy special trust and work autonomy, abide by strict moral and ethical obligations, and in return are generally self-regulating. Their academic training is expected to reliably provide those they serve with special skills, judgement, and services. When they deliver, society responds with confidence and trust and durable long-term relationships. (1,2)

Studies of the critical elements of the patient-professional relationship, both from the patients’ and the professionals’ point of view, are well aligned. The relationship must deliver compassion, understanding and partnership. Beyond nuts and bolts health care, they must also manage fear, reinforce important familiy and community linkages, and support hope-filled futures. The consummation of such relationships is heavily reliant on the consistent presense and interest of professionals in patients’ and families’ lives, their home settings and the many integrated variables that effect their human potentials and their futures. The ability of professionals to exhibit consistently such interest and presense is in term determined by the design, processes, reliability and accessibilty and value center of the health care system itself. (3,4)

W. Edward Deming, the father of Quality Control Management, credited with assisting the Japanese in transforming their auto industry into the leader in automotive innovation today, had this to say about transformation: “The prevailing style of management must undergo transformation. A system cannot understand itself. The transformation requires a view from outside… The first step is transformation of the individual. The individual, transformed, will perceive new meaning to his life, to events, to numbers, to interactions between people… The individual, once transformed, will: set an example; be a good listener, but will not compromise; continually teach other people; and help people to pull away from their current practices and beliefs and move into the new philosophy without a feeling of guilt about the past.” (5)

This well describes the life and work of Don Berwick MD, President of the Institute For Healthcare Improvement, who is widely recognized as the premier thought leader in health care quality improvement today. (CONTINUE…)