Deming's systems thinking and quality of healthcare services: a case study
Bibliographic record
Abstract
Purpose The purpose of this paper is to examine the large negative impact command and control thinking has had on the Alberta provincial healthcare system. The assumptions of this thinking and devastating consequences for health services delivery in Alberta and across Canada, are contrasted with Deming's system thinking. Design/methodology/approach The author has been following and writing about the use of the command and control management model in Alberta healthcare for 20 years, treating its expanding use in the system as an experiment in the effectiveness of this model in improving system performance. Findings The assumptions of command and control thinking combined with a limited enumerative, as opposed to analytic understanding of the system, has largely manufactured the present crisis. Equally important, systemic issues continue to worsen the system until the command and control model will get replaced. Originality/value There is a comparison of two distinct models of management, management style, and the linking of Deming's enumerative and analytic studies to these models. An analysis of healthcare system evolution over two decades is detailed on how the command and control model of professional management has failed and why.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.012 | 0.011 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".