Total Quality Management in the New Millennium

by Mark S. Lerner

Most of us are already familiar with total quality management. The term first became well known during the 1980's, when American industries recognized that they were losing market share for their products to international competition. At the same time demand for Japanese goods was rising. Research into the reasons behind these financial reversals of fortune revealed that shortly after World War II businesses in Japan had embraced the ideas of statistician W. Edwards Deming to improve their manufacturing methods. Armed with this knowledge, corporations located not just in this country but throughout the world reacted quickly by educating themselves on Deming's fourteen points (Walton 34-6) and by attempting to integrate his management technique into their organizational culture. Later in the decade, when the U.S. government tightened its financial reimbursement for healthcare services, hospitals and other medical facilities also turned to Deming to increase work efficiency.

Now that we have reached a new century, and people have expended much energy reflecting on man's achievements over the last 100 years, I thought it would be an appropriate time to assess the current climate of opinion regarding total quality management. It turns out that you don't hear too much about this topic anymore. There was a time when Deming's name was repeated by managers as a mantra and we were all required to gather in regularly scheduled quality circles to solve all of our problems. What happened? Did we as a society decide that the concepts of Deming, Covey, and multiple others were unnecessary? Or perhaps, did we conclude these notions were simply wrong?

I think otherwise. The reason I believe these ideas are not being discussed to the extent they were just a few years ago is that we have, even without our awareness, accepted them as true. My contention is that we have incorporated into our beliefs and behaviors a set of three closely related threads of thoughts that woven together form the foundation of total quality management. This foundation is captured best by Deming's point number five: Improve constantly and forever the system of production and service (Walton 35).

Because this is a virtual age I imagine I can see across the globe all of us who supervise others nodding their heads in strong affirmation of the above statement. But before we give unanimous consent to the notion of continuous improvement, it important to understand the implicit commitment to premises, deeds, and actions inextricably linked to acceptance of this goal. My purpose is to explore these issues by dissecting the foundation of total quality management; a task that will lead us to the writings of Ayn Rand, Friedrich Hayek, and Robert Pirsig.

Thread 1: There Exists One Objective Reality Which We Perceive Through Our Senses and Comprehend through Our Minds

Ayn Rand was a Russian-born philosopher/novelist who expressed her ideas in two best selling works The Fountainhead (1946) and Atlas Shrugged (1957). In an effort to capture the essence of her philosophy, known as Objectivism, I thought it best to relate a story I heard her close associate Nathaniel Brandon tell when asked why he thought her books appealed so much to adolescents. He explained that people at this age often begin to question the meaning of life and the reason for their existence. Dr. Brandon said that they naturally look to their parent's lives for answers, and come to the conclusion that there must be something better. Ayn Rand supplies the something better. Here is an example of her style of writing from The Fountainhead, a novel about the architect Howard Roark:

The Temple was to be a small building of gray limestone. Its lines were horizontal, not the lines reaching to heaven, but the lines of the earth. It seemed to spread over the ground like arms outstretched at shoulder-height, palms down, in great, silent acceptance. It did not cling to the soil and it did not crouch under the sky. It seemed to lift the earth, and its few vertical shafts pulled the sky down. It was scaled to human height in such a manner that it did not dwarf man, but stood as a setting that made his figure the only absolute, the gauge of perfection by which all dimensions were to be judged. When a man entered this temple, he would feel space molded around him, for him, as if it had waited for his entrance, to be completed. It was a place where one would come to feel sinless and strong, to find the peace of spirit never granted save by one's own glory (356).

As shown in this excerpt, Ayn Rand's books paint a world of infinite possibilities with man as a heroic being. But she considered herself primarily a philosopher. Ayn Rand uses her novels as a vehicle to present, perhaps for the first time in the history of the field, a philosophic system in which all of its associated branches are interrelated and consistent. The science of philosophy is divided into five branches. The first, metaphysics, looks at descriptions of the nature of the universe. Epistemology is the study of how we gain knowledge. The third area, ethics, discusses criteria used to distinguish between right and wrong. Politics investigates the various systems societies use to organize themselves. The final branch, aesthetics, is the examination of art or beauty.

It is her view of metaphysics that is relevant to the study of total quality management. Ayn Rand contends that nature is composed of only one reality that is perceived through man's senses and integrated by the mind. Aristotle represented this view of metaphysics through the axiom "A equals A." To express the same idea much less formally: "what you see is what you get." Ayn Rand's theory of metaphysics is in direct contrast to that of mystics and others who insist there are multiple realities that are subjective in their appearance. But is she making an esoteric point interesting only to intellectuals in ivory towers? Or are there practical consequences of Ayn Rand's assertion? She would argue that the side we take in our view of metaphysics is critically important to the topic at hand.

In the application of total quality management, when a customer makes a complaint we look for ways to improve service to prevent the issue from arising again. But what if we believe that the person issuing the comment sees a reality different from our own? Here's what we get: the manager who immediately rejects a suggestion by an employee because he considers it just the personal opinion of one staff member. Or the receptionist who, in response to negative remarks from patients, shrugs them off with "They are just plain wrong" or "It really doesn't matter what we do, they always see things in their own way."

These instances are symptoms of the disease I call "reality evasion," a condition I have witnessed repeatedly throughout my years in healthcare. Sometimes, it results in catastrophic outcomes for businesses, such as customers going elsewhere for services or employee turnover. Lost, perhaps forever, are the positive changes that could have been made in reaction to information we receive from those around us.

In fact, I have found that almost daily improvements are possible through listening closely to customer feedback. And once we decide that we are truly serious about taking advantage of these opportunities, the key first step is embracing the concept that A indeed does equal A.

Thread 2: Managers Must Respect the Ideas of Front Line Employees

Deming's fourteen points emphasize making improvements through the recommendations of both internal and external customers. But he places special importance on implementing the suggestions of front line employees. He argues that because these individuals are closest to the job they can provide information about organizational practices that is not available to others. But at the time Deming was advocating this concept, it flew in the face of the widely accepted bureaucratic scientific management theory advocated by Frederick Taylor. Which approach to management is best? Support for Deming's perspective comes from the field of economics.

Friedrich Hayek was an Austrian Nobel Prize winning economist whose work forms much of the basis for the libertarian political movement. During the period that Russians were living under communism and some in this country thought that it should be considered for adoption here, Hayek asserted that the ideas of Marx and Engels would never lead to a viable political system. He maintained in books such as The Road to Serfdom (1944) and The Constitution of Liberty (1960) that communism would fail, but not for the usually assumed causes. It would not be, for example, because those in charge would misapply its theory or because they would make erroneous decisions. Communism would collapse, according to Hayek, simply due to a lack of information by its leaders.

Hayek explained that in a society there are literally millions and millions of bits of information dispersed amongst a multitude of individuals. Economics, Hayek said, involved the transmission of this knowledge from one person to another. He called this the discovery process. Here's how the discovery process works.

When you go to a store for a loaf of bread you are communicating the fact that possession of the bread is more important to you than the money you are going to use to buy it. The purchase also makes known the price you are willing to pay. This sharing of values is repeated through countless transactions in a market economy.

In the Soviet Union this transmission of values was stopped. Gone was the discovery process that revealed what goods should be produced, the price to charge, the quantity to produce, and the best manufacturing procedures to use to maximize efficiency. Those trying to control the economy attempted to make these determinations themselves and the results for their citizens were severe shortages of desperately needed products and abundance of items for which there was little or no demand (Hayek 183).

Deming applies Hayek's discovery process to management theory. The front line employees, according to Deming, gain innumerable bits of information as to the best way to accomplish their jobs. Managers who attempt succeed in their positions without taking advantage of this unique knowledge will get about as far as those Russian leaders trying to run their economy. They will find that they do not have the data necessary to make significant lasting improvements in the function of their business.

It is up to managers to establish a work environment where an open exchange of information takes place. Of course front line employees will be reluctant to make suggestions unless those in charge demonstrate clearly and continuously that these ideas are valued.

Thread 3: Quality has Romantic and Classic Components

The doctrine of continuous improvement presupposes that we are able to make an assessment of quality. After all, if we had no way of evaluating reality qualitatively then how would we understand if an action on our part has made something better, or even more fundamentally, whether some kind of intervention is even necessary?

I believe that the best understanding of quality, not just in regard to organizations, but in regard to everything around us, appears in the book entitled Zen and the Art of Motorcycle Maintenance (1974) by Robert Pirsig. Pirsig sought to understand how we define what is good.

The author observes that quality has two components, the romantic and the classic. Romantic quality equates to aesthetics, incorporating overall appearance or design of an object. For example, the romantic is the scene depicted in a painting or the style of a house.

Classic quality corresponds to the substance of an object. In the example of the painting the classic includes the specifications of the paint or the rules governing the style of the piece of work. Classic quality for a home comprises the materials used to construct it and their interrelationship in contributing towards the final product.

When I first read of Pirsig's dissection of quality into the romantic and classic I saw the applicability of his ideas to radiology. We have all met technologists who tend to focus on either patient care (romantic quality) or technical expertise (classic quality). Pirsig asserted that true quality went beyond either the classic or the romantic but was a unity of the two. This is true with technologists. The highly rated ones find a way to complete excellent images at the same time that they deliver first rate customer service. If we apply Pirsig's framework to our question as to what makes a quality organization, it appears that we just have to strengthen and maintain both the romantic and classic aspects of our operations. I'm afraid, however, it is not that simple.

Pirsig began his study of what constitutes the good during a period in which he was a university rhetoric professor. He tried teaching writing using traditional methods but he was not satisfied with the final products. He found that his pupils were simply imitating his examples. After struggling with this problem in his mind he eventually inverted his system. Pirsig told his new students to complete assignments to the best of their ability without first instructing them on the principles of composition. In response to the question by some, "Well, how do we know what is good?" he responded, "You know what quality is." After the essays were finished Pirsig read them to his class and had them select those with quality. He found almost universal agreement on which papers to include. He then worked with the students to identify the techniques that could help them improve their creative writing skills, the same techniques that he had purposely not discussed with them earlier.

What Pirsig discovered is that it is not the joining of the classic and romantic that form quality, but our awareness of quality that allows us to discern its classic and romantic characteristics. This point can be further illustrated using the example of the house. How many times have we noticed residences in which the design elements have romantic or classic quality but after they are thrown together the sum has far less value then each of the individual sections? We find Ayn Rand echoing this point, again in the Fountainhead. Here, Howard Roark is explaining to Austen Heller his design for his home:

Well, look at it. Every piece of it is here because the house needs it- and for no other reason. You see it from here as it is inside. The rooms in which you'll live made the shape. The relation of masses was determined by the distribution of space within. The ornament was determined by the method of construction, an emphasis of the principle that makes it stand. You can see each stress, each support that meets it. Your own eyes go through a structural process when you look at the house, you can follow each step, you see it rise, you know what made it and why it stands. But you've seen buildings with columns that support nothing, with purposeless cornices, with pilasters, moldings, false arches, false windows. You've seen buildings that look as if they contained a single large hall, they have solid columns and single, solid windows six floors high. But you enter and find six stories inside. Or buildings that contain a single hall, but with a facade cut up into floor lines, band courses, tiers of windows. Do you understand the difference? Your house is made by its own needs. Those others are made by the need to impress (143).

We think that if we start with quality parts then they must add up to a quality whole. Pirsig, realized that it is only the whole that determines which parts are necessary.

But just how do we "see the big picture," "think outside the box," and utilize other skills which will allow us to discern the ingredients of continuous improvement? The author explains that we first have to reach a peace of mind:

The reason for this is that peace of mind is a prerequisite for a perception of that Quality which is beyond romantic Quality and classic Quality and which unites the two, and which must accompany the work as it proceeds. The way to see what looks good and understand the reasons it looks good, and to be at one with this goodness as the work proceeds, is to cultivate an inner quietness, a peace of mind so that the goodness can shine through (Pirsig 288). Anything that promotes or interferes with the development of this peace of mind impacts an individual's ability to contribute towards continuous quality improvement. This says much about the culture of the organization in which we are employed, the relationship we have with superiors, and, most significantly, our own personal values and attitudes.


With the advent of the Internet and numerous other new technologies we have more opportunities and choices in life than man has ever had before. The world is a much more complicated place then it was even five years ago. A natural reaction to this new complexity would be a corresponding rise in the number of principles relied upon when performing our jobs. But this would be a mistake. As Richard Epstein points out in his book Simple Rules For A Complex World (1995) this "conventional view of the subject has matters exactly backwards" (21). Our response should be to reduce the quantity of guidelines through which we complete our work. The alternative is that we could create a situation in which we have so many goals that they become indistinguishable or that our objectives increase to the point that there really are no objectives at all.

Therefore I believe, and I contend that most of us agree, that Deming had it right when he asserted that we should focus our professional energy on one central purpose, to constantly and forever improve our systems of production and service. We have turned to Ayn Rand, Friedrich Hayek and Robert Pirsig to add three related concepts, what I have called threads of thought, to substantiate his point and expand its ramifications. My hope is that these ideas will aid in the successful implementation of total quality management. And we now can appreciate the value of applying Deming's teachings based on an understanding that there is one objective reality, that managers need to respect the ideas of front line employees, and that quality has romantic and classic components. In this way an environment of quality can be created that is vastly greater then the union of its parts.

Works Sited

Epstein, Richard A. Simple Rules For A Complex World. Cambridge, Massachusetts: Harvard University Press, 1995.

Hayek, Friedrich A. "Competition as a Discovery Procedure," New Studies in Philosophy, Politics, Economics and the History of Ideas. Chicago: University of Chicago Press, 1978.

Pirsig, Robert. Zen and the Art of Motorcycle Maintenance. New York: William Morrow and Company, 1974.

Rand, Ayn. The Fountainhead. New York: Bobbs-Merrill, 1943.

Walton, Mary. The Deming Management Method. New York: Perigee, 1986

Back to the Forum index.