The body politic

I just received the July 2010 QP and found it very disturbing you would run a cover story praising Don Berwick as a quality champion. I was even more appalled by the fact ASQ has publicly endorsed him as an appointee to head up Medicare and Medicaid.

First, I didn’t know ASQ was a political advocacy organization, but after learning it is, I’m questioning the use of my dues to endorse political appointees. I’m wondering if I would be better served belonging to organizations that advocate for my own views.

Also, political advocacy is not in line with ASQ’s vision, which states it is for "everyone who seeks quality." Well, there are Republicans and Democrats who seek quality, so I would consider your political advocacy to be outside the scope of the ASQ vision and outside the scope of what I pay dues for.

Second, Berwick is an extremely controversial figure, as evidenced by President Obama’s unwillingness to have Berwick’s views exposed to the scrutiny of Congressional investigation.

Since reading your article, I’ve spent a fair amount of time researching Berwick on the internet. I’ve gone to the Institute for Healthcare Improvement website and read blog posts, as well as news articles, written by conservatives and liberals. I wanted to give him a fair hearing in my own mind. But after doing so, it has become very evident to me what it is that Berwick believes.

It’s been all over the news about how he has praised the British healthcare system and how he said rationing has to be a part of any healthcare system. And then there was this statement: "Any healthcare funding plan that is just, equitable, civilized and humane must redistribute wealth from the richer among us to the poorer and less fortunate."1

He could have said a just healthcare system needs to provide adequate care for the poor and less fortunate, and I would have bought that (it’s in line with my Christian values. But when he starts talking about redistribution of wealth—too many of our American soldiers have died to prevent that ideology from threatening our freedom as Americans. That statement, in my opinion, demonstrates a complete lack of understanding of economic principles and what it is that really improves everybody’s lives.

I’ve also found instances where he has used the word "stupid" to define arguments he doesn’t agree with.2 I think arguments in which one side calls another side "stupid" are just lazy and immature because it doesn’t demonstrate any effort to counter the other side’s argument with rational arguments of their own.

Overall, I am disappointed in QP for its cover story, and I am disappointed in ASQ for not representing all of its membership in making political endorsements that we, as members, did not give our ASQ leaders authority to do. If ASQ leaders want to make personal endorsements, that’s fine. But in representing the society at large, I think it was not in line with the ASQ vision statement, and it was a misuse of member dues.

J.L. Smith
Richland, WA


  1. Donald M. Berwick, "A Transatlantic Review of the NHS at 60," July 1, 2008, www.pnhp.org/news/2010/may/a-transatlantic-review-of-the-nhs-at-60.
  2. Robert Galvin, "‘A Deficiency of Will and Amibition’: A Conversation With Donald Berwick," HealthAffairs, Jan. 12, 2005, http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.1/DC1 (case sensitive).

Defective system

The most systematic study of healthcare quality in the United States by the RAND Corp. found a defect rate of 45%.1 By any objective standard, we have a high-cost, low-quality healthcare industry.

Donald Berwick has been the single-most effective leader in bringing ASQ quality improvement tools into healthcare. We are lucky Berwick was willing to go into public service.

Outside of elective politics, Republican and Democrat healthcare leaders are on the same page on what needs to change in our healthcare system. Let’s hope the realm of elective politics can learn some bipartisanship on healthcare.

Michael Rothman


  1. Elizabeth A. McGlynn, et al, "Quality of Healthcare Delivered to Adults in the United States," New England Journal of Medicine, No. 26, June 26, 2003.

Professional opinion

I have yet to read any dissension from actual medical professionals. The Institute for Healthcare Improvement (IHI), under Don Berwick’s leadership, has been an instrumental resource for many of the top-ranked hospitals and medical organizations in the United States.

If you have a family member who survived a complex surgery or procedure without complications or an infection, many of you can thank Berwick and the IHI. It’s that simple.

By the way, the previous presidential administration used the same method for avoiding confirmation hearings for federal judge court appointments. It’s not a new, left-wing strategy or conspiracy.

Jim Bugg
Virginia Beach, VA

On Target

"Bull’s-eye" (June 2010) is a very well-written article that provides substantive guidelines on how an organization such as Target can ensure quality in the products it sells through the use of quality tools.

It is revealing to see how Target minimizes variability through the use of statistical methods, including statistical process control. Overall, this is a very good article about a very good quality business.

K.S. Krishnamoorthi
Peoria, IL

Balanced method

"Added Traction" (June 2010) is a very interesting article that introduces a concept that is a marked deviation from the existing disparate methods.

Embedding lean Six Sigma and theory of constraints into a comprehensive balanced scorecard program will provide more granularity in performance levels and greater clarity of problem areas, which can then easily be dealt with to improve overall effectiveness in the functioning of the organization.

Harish Narayanan
Dubai, United Arab Emirates

"Added Traction" helps to provide the missing link as my organization works to align continuous process improvement and lean Six Sigma projects with strategic priorities.

Understanding how to create the balanced scorecard so it is all working together, the leaders can see this is what we aim to do. Excellent article, and the information is very well explained. Thank you!

Karin Warner
Armed Forces Pacific

Warranty worries

"Discussion Warranted" (May 2010) is a very good summary of some major areas that warranties typically touch. I think I may cite the article in the introduction of a research paper I am working on.

I recently worked for a company (that I will not name) whose warranty costs were obscene. Extremely poor business processes in the warranty department, along with a lack of some of the fundamental "blocking and tackling" items Andre Kleyner described, were costing the company millions of dollars.

I did nearly all of the statistical analysis associated with warranties, and one thing became very obvious very quickly: Warranty data have the ability to expose major problems throughout the organization.

This does not always go over well with the owners of those processes and can create a political minefield for the analyst. There were times I did really good work, and it was buried—never to see the light of day—because it "made a process owner look bad."

This leads me to believe that because of the ubiquitous nature of warranties, the analysts must be autonomous while doing the work and must be strongly supported by senior management.

Unless the warranty analysis group serves independently as a truth commission and reports directly to the company’s president, the group will be limited in its effectiveness.

I just wanted to make mention of the nasty underbelly that can exist. Again, nice write-up.

Jason Overstreet
Nashville, TN

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