Go Upstream for Quality Improvement

Improvement Insights Blog

Go Upstream for Quality Improvement

If you think your role in Quality Improvement is merely to prevent special cause variation, maybe it’s time to go “Upstream” with your thinking.

“Hi, this is Jay Arthur. I’m here in Ka’anapali in Maui and having a little vacation time.

“I just finished reading Dan Heath’s new book “Upstream,” and for those of you in Quality Improvement you would see the pattern in here instantly as just continuous improvement: get some data, figure out how to fix things and then fix them. He’s tackling bigger things like… “How do we reduce murders of abused women?” or “How do we reduce dropout rates in schools?” So he’s showing a little bit bigger problem but it’s the same game we’re in, which is get some data, figure out what’s going on. I think with the abused women they looked at 200 cases…

“I wrote a thing called “The Dirty 30 Process for Six Sigma Software.” It’s the same thing: you take a handful of the worst cases, and then you go figure out what the patterns are and then you figure out how to mistake-proof it, which is what they were doing and it reduced homicides against abused women. I think if you read this book you’ll see that it’s there, but he calls it “upstream.”

“Well, what’s he saying? You just can’t keep fixing stuff when it breaks. You can’t wait for a woman to be murdered before you decide to do something, right? You have to go upstream and figure out how to prevent that. Too often I see all kinds of people getting hung up thinking they’re doing Quality Improvement because they’re just doing… all they’re doing is fixing special causes. So consequently, that’s the kind of thing that I think we want to prevent, so go upstream.

“I’m Jay Arthur. Let’s go out and improve something this week.”

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