We, especially those engaged in the health professions, need to stop the relentless attempts to normalize all data to fit the nice bell-shaped distribution that we assume is how the world works. Sometimes it does, but sometimes it doesn’t. We need to understand the words “It depends.”

Two decades ago, I was a Six Sigma Blackbelt deeply immersed in the applications of statistical quality control to healthcare. Our efforts were primarily focused on the process, and as such, the way to improve the outcomes depended entirely on optimizing the processes of care. Our work was organized around the “DMAIC” wheel: …

We would Define the problem and the process to improve it, Measure the process, Analyze it, take actions to Improve the process, and then make sure we could Control it. The Control would take the form of specialized charts that showed variation in our measures, such as this one on patient waiting time versus time of appointment: …

There would be variation in any process, split into the normal random common cause variation (such as the background up and down motion of the data points around the center line) and special cause variation (like the points in the box). Voila! Masterful! It took a chart to show that patient wait time increased over the lunch hour!

I don’t mean to be too sarcastic. There were many instances in which statistical process control led to significant improvements in patient care. For instance, we were able to reduce the time it took for a patient with chest pain from a blocked coronary artery to reach the Cath lab from 2 hours to 32 minutes. The problem came when we thought that everything could be improved this way. …

In the Pre-Covid era, there was a move towards what was called “Precision Medicine,” where it was recognized that optimum care often demanded individualized treatment plans. Precision medicine was effectively terminated with the massive standardization and mandates under Covid. It remains to be seen if it will be resurrected.

In addition, in a strict adherence to a protocol based on past performance or an AI regiment developed through a training set, positive deviants go unrecognized. Progress is limited to what worked in the past and innovation is stifled.

There is a high price that physicians, nurses, and all health care professionals pay in outsourcing their critical thinking. However, it pales in comparison to the price paid by the patients themselves. If organized medicine cannot or will not institute constructive adaptation and renounce the past compliance with rules seemingly designed to benefit Big Pharma or other extraneous stakeholders in the physician/patient relationship, society and individuals must take control of their own destiny and bring the pressure necessary for improvement.

Far from things to be avoided, variation, ambiguity, and outliers are the keys to innovation and optimal clinical care:

In much of what we do, some degree of variability, including variability in measurement, is unavoidable. In addition to variability in measurement, we have variability in surgeon experience, variability in patient physiology, variability in the inflammatory response, etc. As much as we may wish otherwise, we need to uderstand variability and not think the only answer is to reduce it. Our approach should not be to build a system so robust it will never fail, but to construct a system that is resilient enough to recognize failure early and take the necessary steps to correct course. Similar to leaders in business, those in both Academic and Clinical Medicine must embrace variation, ambiguity, and outliers as opportunities and not ignore them or keep insisting that they be neutralized

In short, medicine must learn to operate in a VUCA (Volatility, Uncertainty, Complexity, and Ambiguity) world, just as business has. The recognition of the importance of this is beginning, but it must be more widely disseminated and added to the clinical competencies at every step in the education of health professionals. Only then will health professionals stop trying to minimize variation and ambiguity. We can’t just ignore them and pretend they don’t exist. We must see them for the potential opportunities they present.

Imagine if leaders in Public Health, Academic Medicine, and Medical Organizations would have understood these concepts during the dark days of the Great Covid Disaster. Unfortunately, they did not. Even now, the medical establishment has not realized its folly and the high price society continues to pay for its willful blindness. Witness David Bell’s recent excellent essay on Brownstone, The American Academy of Pediatrics: Mining Children for Profit.

Mankind deserves better than physiology!