Mike Taigman's Blog

March 11, 2009

Quality Management Books

One of my Quality Management grad students asked me to recommend the 10 best quality oriented books for his library. Here’s the list I gave him:

#1 Data Sanity by Davis Balestracci

#2 Hardwiring Excellence by Quint Studer

#3 The Improvement Guide: A Practical Approach to Enhancing Organizational Performance by Langley, Nolan, Noman, Provost, and Nolan (This is the primary text book for the Institute for Healthcare Improvement’s Improvement Advisor Course)

#4 The Fifth Discipline by Peter Senge

#5 Out of the Crisis by Edward Deming

#6 Escape Fire by Donald Berwick

#7 Zen and the Art of Motorcycle Maintenance by Robert Pirsig ( I know it sounds strange, but this may be the first good book on quality management ever written)

#8 Hot, Flat, and Crowded by Thomas Friedman (This is the single best book I’ve ever read on systems thinking)

#9 A Systems View of Education Concepts and Principles for Effective Practice by Bela Banathy (This is a very difficult book to read, however it provides you with set of mental models through which you can view systems that’s hard to beat.)

#10 Process Consulting Revisited: Building the Helping Relationship by Edgar Schein

There are quite a few others that are great, but there’s only so much room on a top 10 list.

January 22, 2009

Benchmarking: The Art of Swiping Good Ideas

When you chat with people in most organizations about their sources of frustration some version of Communications is always in the first couple of things they list. I’ve yet to visit a place where people say they know too much about what’s going on or have too much input into their leadership team.

In the quality management world one of the things we do when faced with frustrations is look for other organizations that excel in the area we are struggling with. We will study that organization’s process to learn about things that might help us at home. This is called “Benchmarking” or swiping best practices.

When it comes to communications, letting people throughout the organization know what’s going on and providing a way for them to share their thoughts and participate there are not many shining examples of success. There is one small organization that seems to be on a path to implementing a world-class set of practices to address the communications frustration. Check out their website www.whitehouse.gov

Is it possible that those who lead other organizations could adapt some of these best practices?

January 14, 2009


I’ve thought a lot about how to re-start this blog. I finally figure out that there would never be “enough time to do it right” or “a continuous stream of fabulous ideas” or “the perfect schedule to attend to it regularly.” I wanted to re-launch with something witty and had lots of ideas bounce around, none of which made it out of my head and onto the website. So I decided to just start without any grand plan.

I attended the Institute for Healthcare Improvement National Forum last month and heard the keynote delivered by John Kitzhaber MD the former Governor of Oregon. He spoke about healthcare reform and laid out a plan to make it real. I really loved the way he framed healthcare costs. He said that 9% of Federal tax dollars are spent on healthcare today and by the year 2025 it could be up to 32% based on current trends. That amounts to over 60 trillion dollars. I don’t know about you but it’s hard for my right brain dominant head to understand a trillion? He said, “A million seconds ago it was the beginning of last week. A billion seconds ago Nixon was just leaving the White House. A trillion seconds ago it was 30 thousand BC.” When you think of 60 trillion and realize that up to 50% of healthcare dollars are waste….providing no benefit to patients it makes the bailout of the auto industry and Wall Street seem like a pittance.

One of the things he said that’s been rattling around in my brain is, “Our system is designed to provide Healthcare not health.” I wonder what would happen to the economics of healthcare if reimbursement were aligned with prevention of disease and self management support for people with chronic disease rather than big dollars for big heroic procedures near the end of life?

April 22, 2008

Writing stories

If you give people just a little bit of information it is amazing how quickly they can make up a story. Lets say that you have discovered that 150 mg of morphine is missing from your organizations drug supply. The new guy working nights in materials has lots of scary tattoos, rides a Harley chopper (how can he afford that on his low wage?), and cuts off his cell phone conversations anytime someone from management walks through the department.
It takes most people a few seconds to write a story in their mind about this outlaw biker paying for his scooter with the money he is making selling narcotics pilfered from your inventory. One of the things about writing a good story is that you just have to share it. This invites other people to contribute their own color and spin, “did you see his girlfriend, she always looks stoned.” This practice of instantly writing stories like this is natural, happens fast, and is exhilarating. Most people, myself included, can not help themselves.
The risk comes when we start believing that our fictional story is actually a documentary. The danger comes when we act as if our made up story is true. One of the hallmarks of an effective leader is that they are able to recognize the difference between the facts and the story they have made up. They hold their stories lightly with anticipation that they will be proven wrong. BTW the missing morphine was found stored in the wrong bin.

April 3, 2008

Technology Test

I have lots of friends who have spent several years poking fun at my Apple computer. Ever since I made the switch to Mac from DOS (yes it was a long time ago) I’ve felt like the folks at Apple have managed to put together products with operating systems and user interfaces that work the same way my brain does. I’m aware that this may not be a compliment to Apple, but it really works for me. Last week I was visiting with friends when their 7 year old daughter asked if she could see my phone. I handed her my iphone (they are really hard to break) which has the same operating system as my computer. In less than 90 seconds she was snapping photos, emailing them to herself, and surfing her way through the phone’s features. I think that everything we use should be that intuitive.

April 2, 2008

It’s the System

People who experience sudden illness or injury are in no position to assess the knowledge and skills of the emergency medical folks who show up to care for them. They rely on the providers themselves and the EMS system leaders to ensure that EMS professionals know what to do and how to do it. Sadly many if not most EMS leaders don’t really know how skilled or knowledgeable their employees are. I was discussing this yesterday over a Grande, non-fat, no-syrup, green tea latte at Starbucks with Baxter and Todd from the UCLA Center for Prehospital Care. We were talking about designing a knowledge competency test for one of the EMS systems that we work with. Baxter said, “Why don’t we test everyone anonymously? That way we’ll learn what the system leaders and educators need to do to improve the overall knowledge and no individual employee will be singled out.” Baxter’s suggestion shows the essential difference between old style quality assurance where we work to improve people and quality management where we focus on making system improvements. It’s a lesson that we can’t learn too often.

March 31, 2008

My Generation

It’s happened with almost every leadership group I’ve met with. Someone will say some version of, “I don’t understand the young generation in our workforce. They have no work ethic. When I was a new paramedic my job was my life.” I usually point out to them that 20 years ago there was a group of folks with a touch of gray in their hair sitting around a conference table saying the same thing about them. My guess is that these same conversations have been going on for thousands of years in one form or another.

I’ve noticed that “young folks” (I can’t believe that I’m writing about young folks rather than being one of them when did this happen?) today seem kinder, more polite, and more willing to help than any generation I’ve experienced. I was just talking about this with my life long friend Thom Dick who reminded me that it is much more important to treat people as individuals, rather than lump them into some generational label. That’s good advice.

March 29, 2008

And So It Begins

For the last several years people have been saying things like, “You really need a blog” or “I can’t believe that you’re not a blogger.” I thought blogger might some kind of insult hurled by British rugby players or some type of ugly birthmark. It might be both and finally I’m taking the plunge. I’m excited about having a soapbox on which to share random thoughts on EMS, leadership, quality management, and life in general. Thanks for checking in.