Walter Shewhart's work was based on the ability to define and manage a process, some logic series of activities, and measure outcomes. It didn't matter what it was. An interesting book has been published outlining the use of SPC in a Geisha house. In the days of Deming, from the 1950s to the late 1980s, there was little use of computers in support of this. Deming famously stated that production managers should ignore computers. They are a waste of time, he said.
Surely the statement was fueled by the matters of creativity and control. If you can't manage the details of computerized processes and your job is to tweak process elements based on ongoing interpretation of data, computerization would mess with your success. The point is that just as the power of the process was made clear, computerization was presented en mass in the form of hugely complex systems based on breathtakingly difficult and complicated languages and models. People struggling to master knowledge of important subjects, the ones capable of carrying out Shewhart's methods, would have little time or energy to master such process design tools, regardless of their capacity to do so.
The result has been a world not unlike that of the world before the printing press became common, before the Gutenberg press in particular. Knowledge is bound up. Much of it is simply not used, certainly not in the particular contexts in which it is needed.
It's not that there isn't content on the Internet. Duh! But it is not the type of content that encourages the detailed application of science. We have many documents, but what we don't have is detailed acting out of the minute logical steps that must be followed, based on changing inputs, directly tied to the detailed knowledge of the experts in the field. In our day of mass computerization and ever-present networking, it would be more than nice to bring Shewhart's scientific method in sync with the devices everybody is carrying around.
Could there be a scientifically-grounded means of leveraging Shewhart's work? Yes, it exists in our day. The germ of this idea took place in Provo, Utah in the U.S., dating to the 1960s. Dr. Dell Allen, a manufacturing engineering professor, was considering perfection from a manufacturing standpoint. His point was, how could you know when you are manufacturing something that you are making it in the best way possible? The best equipment and processes, the best materials, the best steps.
He turned to a fellow professor, a botanist. He asked the botanist if classification such as biologists use, could be applied to areas such as manufacturing. The answer was, “No, classification is only for living things”.
Undaunted, Dr. Allen worked with the idea for many years along with a collaborative group of manufacturing managers from major corporations. They worked out how to turn a static taxonomy, or tree-based representation, into an ongoing process.. The objective was to turn the description of something into the steps of manufacturing that item or replicating that service. In retrospect, it was a fairly simple epiphany that made the shift possible. There was a measure of research and commercial success from the collaboration, but the approach did not enter the mainstream.
Dr. Tingey worked the model into some research projects. This he did at the head of a software development firm and later as a doctoral candidate. He now sees the taxonomy model as being a scientifically-grounded approach to knowledge, particularly the knowledge of how to do things. It is simple, yet powerful. Possibly it is powerful because it is simple. The idea is an extension of Aristotle's principle idea with respect to logic, what has been called the hypothetical syllogism. This may sound a bit academic, but the effect is quite the opposite. The thing being described is a tree, a branching structure that progresses from one situation to the next.
This structure is similar to other scientifically-grounded models such as music. How does music work? Everything that happens is based on the structure of sound, the pattern of vibrations that form pitches. Regardless of the sound-making devices in question – the human voice, a musical instrument, or a bell, the pitch structure is always the same. When a sound is formed, a similar pattern of pitches is created. In musical terminology, the pitches are referred to as the base tonic note, another tonic twice as high, major fifth higher than that, then a major fourth, a major third, a minor third, another minor third, a major second, and on. The higher the note, the closer together the interval between than note and the next.
When the musical system was developed, an information processing model was also negotiated that allowed all of the instruments to function together even though the compromises in question created difficulties with particular instruments. This is an excellent example of the effect of a good system grounded in the science and of the capabilities of the human race in such matters.
What wasn’t compromised was the adherence to the one thing that couldn't be negotiated away, the harmonic structure. Even the modern music that makes many of us cringe adheres to that structure. The result is that the people in question, the composers, the conductors, the instrumentalists, the vocalists, can together create something of beauty. They can create something perfect.
As we can see, organizational perfection can be achieved. Why not now in health care?