HCA Addendum

Attached is "Systems Have Their Place: SECOND Place." It is directly related to my remarks concerning the absolute necessity of "culture change" to address intractable hospital problems such as patient safety.

Herewith the paper's origin: This essay indirectly stems from the current American presidential primaries. Two candidates suggested that the Department of Defense's wasteful ways could be curbed by ordering the adoption of "6-sigma management." Having put in two years of Pentagon duty as a naval officer (1969-1970), I was struck by the hilarity of such a notion; I'd observed the "adoption" of miracle systems before in the DOD (PPBS/Program Planning and Budgeting System, the brainchild of SECDEF Robert McNamara), and watched their inevitable byproducts—more bureaucracy and more waste. Moreover, ideas like this, and the issues associated therewith, are near the heart of my last 35 years of professional work. Hence, with some outside urging, and with no political axe to grind on this score, I prepared this brief paper.

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