W. Edwards Deming changed all that. The third of his 14 points for the transformation of management suggests that inspection is too little too late: "Cease reliance on mass inspection to achieve quality. Eliminate the need for inspection on a mass basis by building quality into the product in the first place."
Note Deming's use of the term "inspection on a mass basis." He doesn't call for the elimination of inspection altogether, but rather for its reduction to the optimal level. Some inspection is always necessary, and is an important tool for gathering data about what you are doing. But 100 percent inspection is seldom appropriate, and is costly in both time and money. And most important, inspection cannot always catch problems that are inherent in the system itself.
Rafael Aguayo, author of Dr. Deming: The American Who Taught the Japanese About Quality (Simon and Schuster, 1990), makes this point vividly in his book: "The disastrous explosion of the space shuttle Challenger was apparently due to the failure of rubber O rings. The rings in the Challenger were within specifications. No amount of inspection would have prevented them from being used. But the rings tended to fail in extreme cold. It was only a matter of time before a tragedy occurred. Inspection cannot improve the level of quality that is designed into the product."
Too much reliance on inspection also supports a "blame the worker" mentality that is antithetical to today's understanding of what drives quality improvement. The health care field is richly populated with individuals who are highly committed to doing the right thing for their patients, no matter what is required. But even extraordinary people cannot consistently rise above a system that is poorly designed.
When organizations work to improve processes and systems, the opportunities for "defects" to occur are systematically reduced. Inspection then becomes useful as a means of gathering data to drive further quality improvement efforts, rather than a hunt for mistakes and those responsible for them.