Process improvement perfected. In his own bios Dr. James credits "medical pioneers Florence Nightingale and Abraham Flexner" for inspiring his devotion to quality improvement tools. More recently, Dr. James was described to us as a "disciple of Deming" -- that being, W. Edwards Deming, the legendary American statistician and manufacturing guru. Most people in healthcare didn't know who Deming was when James began talking about him in the mid-1980's. Heck, most people still don't. Deming went to Japan after WWII and is widely credited, by the Japanese, with helping to establish the processes and quality controls that evolved into the Toyota Production System ( Gary Kaplan). Here is the original list of Deming's 14 Points. We call attention point number three, which has been interpreted to mean the elimination of "variation", which is most easily achieved through establishment of routine: a.k.a checklists and checklists. Meanwhile, back in Utah, Dr. James has tooled, and retooled, his own quality improvement methods in his role at the Institute for Health Care Delivery Research, at Intermountain. James uses it all now, Deming, Toyota, and lots of data. Most recently IMH was able to reduce the length of hospital stays for patients with pneumonia by an entire day. IMH has been recognized by the Dartmouth Atlas and President Obama for operating at costs 30 percent lower than peers. Matt Holt called James, "the best known name in clinical process improvement." In 2005, the National Committee for Quality Assurance (NCQA)recognized Dr. James' "vision and energy in making the U.S. health care system better." In addition to his role at IMH, Dr. James is adjunct professor at the University of Utah School of Medicine, Department of Family and Preventive Medicine.

Testifying before the Senate:

"Even with major advancements in measurement, for most clinical conditions quality measurement is not sufficiently precise.. .That fundamental truth has another face: It is easy to scientifically demonstrate that, for most clinical conditions it is impossible to build an evidence-based best practice guideline that perfectly fits any patient. As a result, achieving 100% performance on most quality measures means that a subset of patients received substandard care."