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Deming's systems thinking and quality of healthcare services: a case study

Robert M. Gerst (Converge Consulting Group, Calgary, Canada)

Leadership in Health Services

ISSN: 1751-1879

Article publication date: 19 July 2013




The purpose of this paper is to examine the large negative impact command and control thinking has had on the Alberta provincial healthcare system. The assumptions of this thinking and devastating consequences for health services delivery in Alberta and across Canada, are contrasted with Deming's system thinking.


The author has been following and writing about the use of the command and control management model in Alberta healthcare for 20 years, treating its expanding use in the system as an experiment in the effectiveness of this model in improving system performance.


The assumptions of command and control thinking combined with a limited enumerative, as opposed to analytic understanding of the system, has largely manufactured the present crisis. Equally important, systemic issues continue to worsen the system until the command and control model will get replaced.


There is a comparison of two distinct models of management, management style, and the linking of Deming's enumerative and analytic studies to these models. An analysis of healthcare system evolution over two decades is detailed on how the command and control model of professional management has failed and why.



Gerst, R.M. (2013), "Deming's systems thinking and quality of healthcare services: a case study", Leadership in Health Services, Vol. 26 No. 3, pp. 204-219.



Emerald Group Publishing Limited

Copyright © 2013, Emerald Group Publishing Limited

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