In Search of Quality
That day, I went to Sibley Hospital in the District to preregister for the hysterectomy. The young woman taking my information followed the usual questions and answers with, "At Sibley, you are not just a patient, you are a consumer, a customer. Let me explain what that means."
I laughed and said she did not have to explain. I was familiar with the concept of pleasing the customer, having worked for years with the late W. Edwards Deming, the legendary management analyst and statistician who developed the philosophy of customer-driven management and continual improvement. An NBC program I had produced in 1980, "If Japan Can, Why Can't We?" had introduced his ideas in the West. His work eventually reached corporate America and became adopted throughout the economy as Total Quality Management.
Deming had been a resident of Washington, too. Over 10 years, I had spent months interviewing him for a library of videos and two books about his ideas, including the concept of making decisions based on data.
Somehow deep in my subconscious, this encounter at Sibley must have triggered an important question, though I did not realize it at the time.
I returned home. Surgery was less than 24 hours away. In the late afternoon, I took a long walk with my husband and then did some stretching. As I started mourning that I was not going to be able to stretch in the coming weeks, a thought or a voice – I can't remember which – came to me.
"Would you really make a decision about something as important as this with a single data point – just one reading of one slide?" Dr. Deming seemed to be asking me.
I thought about it. Then, with trepidation, I walked downstairs to speak with my husband. "I don't think I can have surgery tomorrow," I said, "I just heard from Dr. Deming, and he wanted to know why I was making this major decision with information from just one data point."
I expected him to be annoyed. He had moved the beds around and been through all these weeks of discussion and preparation. Instead he said, "You're right. There is no such thing as a fact." He had worked with Deming, too.
But the second reading of the slide was still not available. I called the surgeon/gynecologist; she said if she couldn't get to the other doctor, she would just do a D&C – the minor, in-and-out surgery – the next day. By now, I imagined the second reading, if it got done at all, as being done on the fly. I assumed the doctor would just confirm the obvious and recommend the hysterectomy.
At that moment, I decided I would ignore whatever he said and have only a D&C.
I went out and returned home to find a message on my answering machine from the second doctor.
"Don't have a hysterectomy unless you want one," he said. "That slide was over-read."
He called back later and said to go ahead and have the D&C – but based on the slide as he saw it, he expected no problems to be discovered during the procedure.