I was recently perusing Time magazines “Top 100” list for 2008, and came across this entry for Peter Pronovost. I had never heard of Pronovost. Here’s part of what profiler Kathleen Kingsbury had to say about him:

“A critical-care researcher at Johns Hopkins University, Pronovost may have saved more lives than any laboratory scientist in the past decade by relying on a wonderfully simple tool…”

I know what you’re are thinking, but no, Six Sigma is not the tool. Before I tell you what it is, consider that after implementing it in hospital ICUs in Michigan, hospital-acquired infections dropped from 2.7 per 1,000 patients to zero. That means more than 1,500 lives were saved in the first 18 months.

So what is this ingenious invention? What critical breakthrough occurred? What fancy bit of science and statistics produced these stupendous results? Which process improvement methodology was put to work?

A checklist.

That’s right, Pronovost provided physicians with a list of steps as a reminding them how to complete routine procedures. 1500 lives were saved over 18 months in one state by writing down the steps for procedures, photocopying them, and handing them out. Pronovost estimates he could roll his system out across the entire US for three million dollars. Which, I think it’s worth noting, might be comparable to the annual budget for a corporate Six Sigma deployment in bigger companies.

One of the reasons I was so captivated by this story is that more and more, I find myself returning to the basics and fundamentals of process improvement methodology. I read the primary literature and wonder at the complexity of current process improvement methodology. I wonder where the power of elegance of simplicity has gone.

For example, one of my favorite books is Kaoru Ishikawa’s Guide to Quality Control. It’s long out of print, but you can still pick up used copies online and elsewhere. You might not know Ishikawa by name, but if you’ve ever done a fishbone diagram, you know his work. He introduced his now-eponymous diagram along with six other quality tools in the Guide. Each was elegant and simple. Things like check sheets, Pareto charts, scatter plots, basic control charts – simple tools explained concisely. It’s a slim volume, but everything is there. Every time I read it, I wonder to myself how on earth we’ve allowed the continuous improvement world to become so complex and unapproachable. I’m at a loss to explain what value Six Sigma and similar methodologies add to Ishikawa’s approach. Sure, they provide the sizzle that sells programs to organizations, but it’s quite possible that that’s all they do. Which is worrisome.

Ishikawa and Pronovost have proven that very clear and simple approaches can yield stunning results. Much as Deming and others did before them. Modern Six Sigma is anything but simple. Most Black Belts take four week to train. But I can get through Ishikawa on a flight from Chicago to Denver, and I’m guessing Pronovost can train his folks in about five minutes.

Have we taken a wrong turn?

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