I can’t believe you would put Donald Berwick on a pedestal after his work in the United Kingdom, championing what amounts to a rationing system for healthcare (Up Front, May 2010). His view of the consumer is clear in this quote: "I cannot believe that the individual healthcare consumer can enforce through choice the proper configurations of a system as massive and complex as healthcare. That is for leaders to do."
Not only does he underestimate the power of the consumer to effect change, he violates the basic premise in quality assurance that says consumer preference is the cornerstone of quality.
The problem we have with healthcare in the United States is the constraints on choice the consumer has—for example, purchasing health insurance across state lines, which is a key component in improving cost and quality of service for everyone from healthcare providers to insurance companies. Equally critical is the choice consumers should be able to make between lower provider costs and higher insurance costs.
The more "massive and complex" healthcare becomes, the more inept the leaders of government have proven themselves to be. As with everything, responsibility and accountability are often the first casualties in government-controlled programs.
As for Berwick’s true colors, here’s a final quote, "Any healthcare funding plan that is just, equitable, civilized and humane must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent healthcare is by definition redistributional." That’s socialist self-justification, which ignores reality. Excellent healthcare is what the consumer dictates, not what the dictator mandates.
It is time for all of us to start working toward a standard for warranty management ("Discussion Warranted," May 2010). For this to happen, companies need to cast off the veils of secrecy about warranty costs and other data.
To reduce warranty failures, apart from other techniques, you need to go with the physics-of-failure approach. Accelerated testing and multiple environment overstress testing needs to be mandatory. If the space and aeronautics industries can have better warranty performance, why not automobiles? It is possible. What is required is an open dialogue and action plan.
SPC is A-OK
Knowing the goal, establishing processes to reach the goal and applying corrective actions in process requires data for decision making. In his article ("Waste Management," May 2010), Steven Prevette shares a real-world project—a big project—in which statistical process control is key to effective decision making.
This well-written article presents how-to and how-come insights related to making decisions that guide the work of many people and work teams. The role of employees in accommodating changes is a key factor considered by Prevette in the article.