Warning:  read to the end before you dismiss this entry as a rant.

Hey, healthcare colleagues:  stop pushing for zero defects.  Yup, I said it.  Here's why.

The trouble with the "zero defects" mentality in healthcare is severe and insidious.  This is why.

NO ONE wants anything bad to happen to a patient, ever.  That's why the siren song of "zero defects" is so insidious and pervasive...it's like politicians who promise to put more cops on the street.  Who could want anything else?  If someone did say they disagreed with zero defects, well, it would be easy to label them as a bad person.  I, for one, don't want anything bad to happen to a patient ever!

Next, a common illusion in healthcare is that the staff who directly deliver treatment exert a lot of control over the production of defects.  Yes, providers exert some control, but the systems in which they practice set them up for certain outcomes.  The system makes certain outcomes much more likely.  A bad system does beat a good doctor (or nurse, or advanced practitioner, or respiratory therapist...) every time.  Or at least over the long hall.  The dedicated men and women of healthcare can achieve a super human outcome despite the lousy system every once in a while, but, over time, the system will win and the batting average will be bad.  That's just how it is.

Telling staff to chase zero doesn't work well because (watch out, spoiler coming up) in fact many defects are actually beyond the control of front line staff.  (More on that later.)

So, now that we've discussed part of why zero defects is such an attractive (and easy) call to arms in healthcare, let me tell you why it's a bad idea to throw the term around in that field.

First, zero defects isn't even on the map for most healthcare systems.  Instead of a grandiose "zero defects" exhortation, try something that you can get done like continuous improvement over time.  

If you achieve meaningful continuous improvement, which takes significant skill development for most healthcare systems along both quantitative and culture lines, you'll get to the lowest number of defects you think you can achieve...and maybe even move beyond that level eventually.  So, try to achieve your "zero defects" by way of something realistic, would you?

The "zero defects" call in healthcare is a bad idea because zero defects isn't even in the ballpark for many healthcare entities.  Unfortunately, players in healthcare often don't have a culture aligned around how to meaningfully respond to data OR the ability to obtain and interpret data in a useful way.  Remember, healthcare is about 10-15 years behind when it comes to quality improvement sophistication (click here for more on that).

Want zero defects?  Of course, who doesn't!  Get at it by way of quality improvement that focuses on doing better tomorrow than you did today.  Given that we are 10-15 years behind in healthcare PI, let's reign it in a bit.  We all would love zero defects, so how about we come at it from the perspective of significant reduction in defects over time.

Swinging for the fences, when you're not too sure how to bat, probably won't get you there.

Think this was just my rant?  Guess what:  nope.  These aren't even my ideas.  Remember the PDCA (PDSA) cycle that many of us love to use in healthcare quality improvement?  An important progenitor for much of what we do in healthcare quality, including the PDCA cycle, is W. Edwards Deming.  And the ideas above are his, not mine.  Take a look beneath at what one of the fathers of quality improvement has to say about targets like zero defects!