Quality Production, Not Quantified People: How Management Science Shaped the Learning Healthcare System

Zachary Griffen, NYU

In the United States, medical treatment is increasingly standardized in accordance with the tenets of the ‘learning healthcare system’: an iterative infrastructure that mobilizes digital software to boost patient outcomes. Yet the historical origins of this paradigm in early twentieth century management science are poorly understood. This paper draws on the career and legacy of W. Edwards Deming, a physicist-turned-management consultant, to theorize how ideas about ‘statistical process controls’ shaped the ‘quality improvement’ techniques that underpin much of contemporary academic medicine. In particular, I emphasize the seemingly paradoxical importance of Deming’s insistence that while production processes are fair game for quantitative assessment, people tend to flourish without facing the constant threat of being ranked and punished. The paper explores how this philosophy has been institutionalized in healthcare, which has implications for the way we think about the ability of professions to resist or incorporate quantification and accountability schemas.

No extended abstract or paper available

 Presented in Session 138. Expertise and Accountability in Medicine: Case Studies from Around the World