Introduction

One day, several years ago, I received a call from a colleague who was organizing a conference on quality improvement in the healthcare industry. He asked if I could help him find a speaker who had successfully completed an improvement project involving healthcare processes. I had just begun consulting for an integrated healthcare organization that had been pursuing TQM for a number of months, so I called the Manager of Continuous Improvement and asked her. “No problem,” she said. “We have over 50 projects in the works, and some have been underway for several months. I’m sure that we can find one to showcase at the conference.”

She was wrong. Not a single project had produced tangible results. The organization had top-level commitment, ...

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