Quality as an Organizational Strategy
Leaders in healthcare and other complex organizations have discovered the power of Improvement Science when applied to specific problems. Yet many wonder: How do we move beyond project-based improvement to make quality the fundamental strategy for leading our entire organization?
Let’s begin by understanding two foundational concepts that transformed Japanese industry in the 1950s.
Two Ideas That Changed Everything
Starting in the summer of 1950, Dr. W. Edwards Deming taught Japanese leaders principles inspired by Walter Shewhart’s work at Bell Labs. Two concepts, which he frequently drew on the blackboard (figure 1), sparked what he described as Japan’s quality awakening.
Figure 1. Dr. Deming lecturing in Japan
The Chain Reaction describes a powerful sequence:
Improve quality → Costs decrease through less rework, fewer mistakes, fewer delays → Productivity improves → Capture market with better quality and lower price → Stay in business → Provide jobs and more jobs
This simple chain reveals a profound insight: improving quality isn’t separate from business success—it drives business success. When we do the right work well the first time, we eliminate waste, reduce costs, and create capacity for growth.
Production Viewed as a System (figure 2) was Dr. Deming’s second breakthrough concept. He showed leaders that their primary job was designing and operating the entire system to meet customer needs, not just managing individual departments or processes. Improvement tools and methods help create reliable processes, but only when leaders see and manage the whole system.
Figure 2. Conceptual view of an organization viewed as a system
(Source: Quality as an Organizational Strategy, 2024, p.5)
From Theory to Practice: Quality as an Organizational Strategy
Working with Dr. Deming, the Associates in Process Improvement translated his theory of production as a system into a practical framework: Quality as an Organizational Strategy (QOS) (figure 3).
Figure 3. Quality as an Organizational Strategy (QOS)
(Source: Quality as an Organizational Strategy, 2024, p.28)
QOS provides leaders with five interrelated activities that build a system of improvement:
- Establishing and communicating the purpose of the organization – At the heart is defining what the organization exists to accomplish
- Viewing the organization as a system – Appreciating complex systems with a system map and vector of measures
- A system to obtain information – Gathering knowledge systematically from multiple sources and converting the information into action
- Planning process for operating and improvement – Connecting strategic objectives to changes in the system to achieve results
- Managing improvement efforts – Managing and executing a portfolio of improvement projects with discipline and fidelity
These activities work together as an integrated system. Leaders who adopt QOS experience the transformation Dr. Deming described. Their management philosophy shifts toward constancy of purpose, customer focus, systems thinking, rigorous learning, and continuous improvement. The result is pride in doing excellent work consistently.
Beyond Projects: Working on the System
Most organizations apply Improvement Science to specific projects or functions—reducing infections, improving patient flow, addressing safety concerns. This work matters and produces results. But as Dr. Deming noted, it affects only a small proportion of the opportunity.
Real transformation happens when leaders apply Improvement Science to the organization itself. QOS enables this shift from working in the system to working on the system.
This isn’t quick or easy work. Building QOS requires commitment, discipline, and years of sustained effort. Leaders must develop new approaches, establish routines, and learn together. But organizations that make this journey build capability that compounds over time, enabling them to achieve strategic aims more reliably and sustain performance year after year.
Want to explore each activity in depth? Read the detailed posts on each of the five QOS activities: Activity 1 – Purpose, Activity 2 – Organization Viewed as a System, Activity 3 – System for Obtaining Information, Activity 4 – Planning to Improve, and Activity 5 – Managing Improvement Efforts.
Sources:
Clifford M. Norman, Lloyd P. Provost, and David M. Williams. Quality as an Organizational Strategy: Building a System of Improvement. (Provident-Heierman Press, Austin, TX). 2024
Clifford M. Norman, Lloyd P. Provost, and David M. Williams. The QOS Field Guide: Guidance, examples, tools, methods, and exercises for using Quality as an Organizational Strategy to build a system of improvement. (Provident-Heierman Press, Austin, TX). 2025
—
David M. Williams, Ph.D. works with leaders and improvement teams to learn and apply Improvement Science to achieve results and adopt quality as a strategy. He is coauthor of Quality as an Organizational Strategy and The QOS Field Guide.