A 1% solution is a misnomer

This blog is my scratchboard. Like all of us, I have thoughts that seem to make a lot of sense. After I write them out, sometimes they do and sometimes they don’t. This time they didn’t turn out as I had thought. Either way, writing about them helps me understand better. If they make sense, I share with you and hopefully they help you. At least in this case I am sharing what I learned.

If you find these posts useful, it is another way I practice paneugenesis by engaging in selfish, selfless, synergy. I am being selfish, because I help myself, selfless, by helping you, and synergistic because it helps us improve comprehensiveness of the world which may lead to creative solutions.

I encourage all of you to do the same to see if your sudden thoughts are an epiphany, which is a sudden insight, that can stand up to scrutiny. I had one of those sudden thoughts after listening to two podcasts. The first was I listened to was on Freakonomics, How to Fix the Hot Mess of U.S. Healthcare (Ep. 456). During this broadcast the discussed the 1% solutions for Health Care Reform led by Zack Cooper and Fiona Scott Morton at Yale.

In this presentation it was indicated that they were having trouble getting traction because leaders want to improve by 15%, not 1%. They indicated they were not interested if the change could not be more impactful. As explained in the Freakonomics podcast:

…I got off the stage and a senior executive came up and said, “Hey, this is great, but we don’t want research that tells us how to save 1 percent. We want you to do the research that tells us how to save 15 percent.” 

COOPER: “There isn’t stuff that saves 15 percent. It’s a series of half-percent or 1 percent steps.”

Cooper and Morton rightly countered that implementing many of these 1% solutions would make a significant positive impact. This led to the One-Percent Steps for Healthcare Reform Project

The other podcast I listened to was from the W. Edwards Deming Institute: Deming Lens #46 – The Art of Tampering.

In this podcast they reminded listeners about the importance of variation in systems that are from either common or special causes. Variation makes the outcomes less predictable, decreases quality and increases cost. The point was that if they attempted to decrease variation incorrectly, they would be tampering with the system by using misguided efforts to decrease variation. Tampering results in even worse outcomes.

The Deming Institute provides information about variation in the Knowledge of Variation post. On this page, it is explained that common cause variation is the natural result of the system. In contrast, special cause variations represents a unique event that is outside the system: for example, a natural disaster. Knowledge of variation can help people learn why something went right or wrong and what to do about it. Control charts can be used to determine if there its a common or special cause in the process.

Eliminating variation, be it from common or special causes, dramatically improves the outcome quality. Quality processes determined that 94% of the causes of poor outcomes are common causes. This means most improvement can be made by improving the normal processes. It also must be understood that unique improvement strategies must be used to eliminate either common or special causes.

I skipped over a lot about common and special cause variation. I thought I had an epiphany from reviewing and listening to Freakonomics about 1% solutions and Deming about common causes and special causes. The overlap is that most of the 1% solutions are common cause solutions, or regular process improvements which should be regular continuous process improvement methods.

I shared the post with a Deming Expert, Allen Scott and he made me aware of the error in my thinking. He shared my understanding was not up to date. As Dr. Wheeler explained,

This whole dichotomy of special causes being external to the system and common causes being internal to the system, and who is responsible for them,is simply nonsense that does not hold water.

Allen Scott also pointed out, “

I watched the video.  A 1% anything is questionable.  Probably meaningless variation.  There will be a variation up and down.  Things will vary by more than 1%. Then he quoted Shewhart,
“The measure of quality no matter what the definition of quality may be is a variable.” (Shewhart, 1931)

Most importantly he explained, “The changes they speak of can only be proven or disproven statistically and the percent will then be found out.  How will they know a one percent improvement is something they did and not a routine fluctuation? …A one percent change in any measure is probably routine (no difference).  In math 2 numbers can be different and not the same.  In analysis two numbers can be different and yet the same (homogeneous). The central question in improvement and analysis is homogeneity. The improvement must breach control limits to signal an improvement.  That could be one percent or fifteen percent.  We have to make a plot to know.” 

My take away, 1% is probably mislabeled. It is probably just normal variation and it cannot be known without measures. If we want to improve, we should focus on continually improving the system in ways that are pervasive, reciprocal, selfish, selfless, and synergistic so everyone and everything benefits. We should continually ask, by what method might this work better? Critical thinking is key and asking experts (see Stop the Death of Expertise) will enable us to continually improve the process.

Please share your thoughts, what is your best technique for learning from experts?

Acknowledgement: Big Thank you to Allen Scott for his expert advice, with the help of Don Wheeler, for helping me with this post.

Be Well’r,

Craig Becker

Be selfish, selfless, & synergistic so everyone and everything benefits!

#SelfishSelflessSynergy

Please share your thoughts and questions below.

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