Reflection on Deming’s Principle in Healthcare: A Resident Physician’s Perspective

I’ve come to appreciate the truth in one of Edwards Deming’s ?most famous principles :

Every system is perfectly designed to get the results it does.

This principle resonates deeply with me as I witness daily the inefficiencies and outcomes within our healthcare system that seem inevitable yet preventable.

The reality is that many of the inefficiencies we encounter are not random anomalies but the predictable outcomes of a system designed with certain priorities and constraints.

Take, for instance, the issue of emergency department overcrowding . In one of my earlier Inefficiency Insights articles, I discussed how ED overcrowding is largely driven by “boarding”—patients waiting for inpatient beds that aren’t available due to systemic issues like delayed discharges to post-acute care facilities. This bottleneck isn’t just a fluke—it’s the result of a healthcare system that prioritizes certain procedures and patient flows over others, often driven by financial incentives rather than patient care optimization.

Similarly, consider the overuse of antibiotics in the telehealth setting , another topic I’ve tackled in my Inefficiency Insights . While telehealth services are beneficial in many ways, their convenience and rapid access have inadvertently led to an increase in antibiotic prescriptions for conditions that may not warrant them. Again, this outcome is not surprising when you consider that the system is designed to prioritize quick resolution of patient concerns, sometimes at the expense of careful diagnostic evaluation.

These inefficiencies are symptomatic of deeper systemic issues. Whether it’s the fragmented communication systems during nursing handoffs or the struggles with shift change delays , these problems persist because the systems we operate within are designed—intentionally or unintentionally—to produce these outcomes.

The question we must ask ourselves is: how do we redesign these systems to achieve better results?

As I reflect on my experiences and the insights shared through Inefficiency Insights , it’s clear that solutions exist. But they require us to challenge the status quo and redesign our processes with a focus on long-term outcomes rather than short-term fixes.

Ultimately, embracing Deming’s principle means acknowledging that the flaws in our healthcare system directly result from how our systems are designed. As a resident physician, I see this as both a challenge and an opportunity.

• The challenge is in recognizing that real change requires systemic redesign, not just individual effort.
• The opportunity lies in our ability to influence that redesign through thoughtful, data-driven improvements that prioritize patient outcomes over convenience or cost.

I’ll end by saying: we must question the systems we inherit and strive to build better ones—because the results we see today are the results we’ve designed our systems to achieve.

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