Remember the early days of TQM? When I present to healthcare audiences, all I have to do is mention “lab turnaround time” to get a collective groan and smile. That was always one of the initial forays into what was called total quality management (TQM) or continuous quality improvement (CQI).

Most initial projects like lab turnaround time quickly turned into the project from hell due to over-collection of lots of vague data resulting from a huge cause-and-effect (Ishikawa) diagram that answered a vague question such as, “What causes long turnaround times?” It can be so tempting to naively jump right to today’s strategy before even knowing where to focus I’d like to revisit this situation using 20–20 hindsight to teach some lessons. (Of course, today you would first connect any project work to a “big dot” in the boardroom, right?)

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