Why It Matters
In a turbulent health care environment, it's important to periodically get back to the basics of quality improvement.
Processing ...

Berwick Speaks about Red Beads and a Return to the Basics of Improvement

By David Williams | Friday, April 15, 2016

Don Berwick keynote

Dr. Don Berwick took a risk in his keynote at the BMJ/IHI International Forum on Quality and Patient Safety in Healthcare in Gothenburg, Sweden — he went back to the roots of the science of improvement.

He began with The Parable of the Red Beads, a famous exercise Dr. W. Edwards Deming used in his four-day workshops. Also known as the Red Bed Game or the Red Bead Experiment, it’s a simulation that teaches key lessons in improvement.

The setup was simple: Dr. Berwick is the leader of a fictional organization that makes “blue beads.” He hired four new “willing workers” and taught them the exact process to follow to produce the needed beads. With each day’s work that followed, workers presented their beads to an inspector (played by Göran Henriks, Chief Executive of Learning and Innovation of Qulturum in Sweden.)

Performances varied, but there was one constant: Each worker produced too many red beads. Not pleased, Dr. Berwick attempted traditional management approaches, including slogans (“Nine is Fine”), recognition of high performers, and financial incentives (bonuses). In spite of his efforts, it wasn’t long before the participants and the audience realized that his efforts have little impact. The system, of course, was designed for a predictable distribution of red beads. No matter what the workers did or how the leader attempted to tamper, the results didn’t change.

What was the lesson?

The red bead exercise provided a quick look into the trouble with traditional management approaches to improvement. It enabled Berwick to transition to an introduction to the roots of the science of improvement and dissect the four areas within Deming’s famous lens of improvement — understanding variation, appreciation of a system, theory of knowledge, and psychology.

Dr. Berwick admitted he didn’t “get it” the first time he heard Deming’s theories of the science of improvement and saw the red bead game. It was a significant shift in how he had understood how to improve quality. But as the disruptive ideas sunk in, they laid the foundation for his work and continue to play a significant role in IHI’s work today.

Take a break today and watch Dr. Berwick introduce the science of improvement. Let it sink in. If it doesn’t stick the first time, sleep on it and watch it again. I promise it will be worth the disruption.


Dr. Williams (@DaveWilliamsATX) is an executive director co-leading IHI’s work in Improvement Capability and a scholar-practitioner of the science of improvement.

You may also be interested in:

Understanding variation

View Your Organization as a System

Statistical process control as a tool for research and health care improvement

Video of the Red Bead Experiment with W. Edwards Deming

first last

Average Content Rating
(0 user)
Please login to rate or comment on this content.
User Comments