2008年7月30日 星期三

漢寶德先生的『寫藝人間』展

2008年初夏,羅時瑋博士邀請我一起參觀漢寶德先生的『寫藝人間』展。我們會後還到漢先生的新辦公室去聊天,真是妙,我還牢牢記得1971年新生orientation時,漢先生用「真善美」來說明工學院三系的主導理念時的神情呢……


這發表在 中華日報副刊 2008/7/30 不知道為什麼日期寫7/18




寫藝人間   ■ 文、題字/漢寶德
《2008/07/18 16:54》

 難以置信的,我也開書法展了。
  我向來不認為自己是書法家,也不認為自己寫的字夠資格公開展覽,可是在宗教博物館同仁們的催促之下,盛情難卻,拿了幾十幅出來向朋友們請教。我正要離開宗 博館長的職位,同仁們依依不捨,就把我當成真正的書法家,認真的辦了一次展覽,展場的設計有高潔的品味,還設計了動畫,為我的字增色不少,我在此要特別感 謝他們。

 書法是中國人特有的藝術,它的最大特色就是與生活完全結合在一起。直到今天,我還不習慣用「書法」這個稱謂,我通常稱它為「字」或 「寫字」。中國人是重視文字的民族,把文字視為文化的核心,而讀書人幾乎一生都與文字為伍,字跡是他們的化身。把自己的思想與感情經由文字寫下來,是他們 的生活,也是生命。它是不是藝術,原不在他們的計較之中。只有落魄文人才會在不識字的群眾之中,賣字維生。它們的藝術價值常常到了後世才被重視。

  由於字跡是文人的化身,所以字跡是否被稱頌常與文人的人格連在一起。被我們景仰或尊重的人,潦草幾筆就被視為珍寶,為世人所唾棄的奸臣,即使寫得極好,後 世也難以流傳。自近處看,我們對於熟悉的友人,只要能寫字,我們都願意懸掛,因為字跡之間透露出友情。過年節時,對聯是必要的,很多人家貼的對聯都是名人 筆跡,有宗教信仰者,掛的是高僧的筆跡。這些都不能以藝術的標準來評判其價值,然而皆大歡喜!

 書法成為藝術,是自生活中昇華起來的。由必須寫 字而寫字,到因閒暇而寫字,只有一線之隔。文人不做官,或做清閒的官,怎麼打發其多餘時間呢?只有寫字才能無所為而為之,達到休閒、靜修的目的。因為寫字 確有其藝術的內涵。字寫得好是美的化身,與音樂一樣,它是線條組織成的音樂。只要不為任何目的,字跡中美的價值就呈現了。對於無所事事的文人來說,足可以 陶醉其中。

 坦白說,我就是這樣進入書法領域的。我算不上文人,但多少年來,寫些文章發抒胸中悶氣,除了工作外,不善交遊,閒時沒有打發時間的 良方。我的學生提醒我,並寄了大批紙墨,使我找到了傳統文人的休閒方式。所不同的是,當時我已近老年,對藝術有相當的認識,卻沒有最基本的書法訓練。

  我的書法背景是在讀小學的時候,在老師的督促下寫過字帖。記得寫的是歐陽詢,因為老師認為歐體沒有個性,只有基本架構,是寫字理想的初階。可是自從離開大 陸之後就沒有再認真碰毛筆字了,只有在寫週記時規定用毛筆。匆匆快半個世紀過去了,過了中年,開始對古文物發生興趣,同時也再次認識書法的價值。回想起 來,小學的那段習字的過程是很有用的,使我很快可以判斷書法之美,跟著藝術界友人的腳步,收藏了幾幅名家的作品。

 要自己提筆就完全不是那回事了,我不能不回頭找一個師承從頭學起。拜師以我的年齡已經太晚了,只好設法找字帖無師自通。我不是孩子了,我需要自己的主張。

  在字畫收藏的短短歲月裡,使我了解正統的書法,自王羲之到劉墉即使下很大的功夫,也無法使自己滿意。我看了清中葉以後的幾位名家的作品,知道他們曾面臨同 樣的問題,為求突破,必須越過晉、唐諸家的正統,回到更原始的年代。金農、尹秉綬、何紹基等都是走這條路才能別闢蹊徑,走出一條康莊大道來。我無成為大書 法家的意圖,但為了好玩,如每天在書法技巧上磨練豈不嘔氣?我只好跟著這幾位先賢的步伐探探古老的途徑。

 到此我要先說說我對書法字體選擇的看 法。過去的書法家多能通真、草、隸、篆四體,涵蓋了自古至今的書寫方式,再選一種專精。像吳昌碩即以石鼓文篆字聞名。我曾藏過他一幅石鼓篆,為友人強迫出 讓。但我覺得既然是生活藝術,總以大多數人認得最為重要。中文四體中草書與篆書已不屬於生活範疇,要學習需要下特別的功夫,基本上是一種與真體不同的符 號,所以做為書法的字體是不適當的。我認為隸書雖有少數字為大家所不習慣,還算在可溝通的範圍內,而漢代為隸書通行的時期,在官家之外尚沒有制式化,所以 字型比較活潑。由於傳下來的是碑刻,經過地方石工之手,多了一份樸拙之感。因此該碑的隸書實可視為今天文字的原型,是我這種以寫字為消遣的人可以入手的範 式。

 我認真的摹寫石門頌與西狹頌。這兩個碑有些漫漶,要寫出那股拙勁真不容易,我就用破筆寫。過了一陣子,我又寫張遷碑,是比較規整的碑拓, 據說清季大家何紹基曾摹過數百遍。這三座碑都刻於二世紀的後漢西方邊陲,時間相隔幾十年,與太廟與孔廟的正式隸書大約同時,但風格差得很遠。老實說,我沒 有學到甚麼,只是體悟到一點:書法的用筆沒有常法,是可以隨意創造的,只要不失字型,能呈現美感就是好字。自己寫字消遣,自己欣賞,就是全看自己的天份能 揮灑到何程度了!

 至此我才體會到書法做為消閒的樂趣了,它可以是純粹的消遣,也可以是嚴肅的藝術,完全看我們如何對待它。

 一旦放 棄了做書法家的念頭,寫字就海闊天空了。大書法家總要有一個固定的風格做為自己的註冊商標。比如說,行書寫的非常好看的台靜農先生,他的商標就是行書。我 曾收藏過他的四體屏,牆上至今掛著他的一幅漢隸中堂,但都沒有行書那麼漂亮,所以他的作品百分之九十是行書。如同于右老的草書,尤其到台灣之後,幾乎所寫 百分之百都是他所主張的標準草書。可是我認為用這個方式寫出名聲實在太划不來了。

 我要活用書法藝術,使之融入生活,就有了形、情、意三位一體的觀念。
  在生活中有閒暇,我習慣以翻閱古人詩文消遣。看到有些文字反映了我當時的心情,就會起寫字的念頭,這時候,以表達當時心情為主軸,向形式與意涵的表現發 展。形與意如能交互詮釋就會心一笑,使自己心情輕鬆起來。如寫不成功,至少在形式上有些筆墨的美感,也可聊以解除心頭鬱悶。我眼高手低,滿意的作品極少。

 我一直覺得寫字用筆、用墨,筆有粗細,軟硬,墨有濃淡,在形式上的變化應該與畫同樣豐富才好。為了字跡清楚,讓大家識得文意,太過自由的運用 筆墨當然是不容易的。很多現代書藝家,在形式上過份發揮筆墨的變化,完全失掉字形,已經不能算是書法,是現代畫。可是完全用中鋒與濃墨寫字,就只能當成表 現線條的藝術,失掉了水份的趣味,實在太可惜了。所以我閒來無事,嘗試宿墨的效果,其目的就是想既有線條的組織之美,也有墨韻淋漓之美,而不失字形。我要 承認這些遊戲失敗的多,成功的少,即使成功也只有使我自己高興,很少示人。即使偶爾示人,別人也沒有發現有甚麼值得稱賞之處。

 我常自嘲是一個 浪費紙墨的人。我很幸運,有一個學生在大陸源源不絕的寄紙與墨來,使我可以隨意浪費,不愁缺貨。近十年來,脫離公職,閒暇多些,更使我有機會隨意揮筆,並 以此取樂,可惜到今天,實驗多,成就少,仍然眼高手低。只是時間磨得久了,被自己看習慣了,漸漸把家裡掛的名家作品,換上自己的遊戲之作。我己很難想像自 己沒有書法怎麼過日子了。

 宗博的同仁基於感情,把我提供的幾十幅作品作了詳細的研究、分析,把作品分為四類展出,分別為筆墨、寫意、構圖、述 志。書法以這樣的分類展出是破天荒的,這說明了近十年來我寫的字因時、因地、因情而變,沒有統一的風格。展出我的字,不是呈現一個書法家的造詣,而是呈現 我在書法上遊蕩的心路歷程。以衰老之年回顧這些紀錄,不免淒然。它們反映了我的內心世界,我的人生。
 

2008年7月26日 星期六

楊梅與David 和兩位董事長會談

2008年台灣自行車業普遍"大賺"
林董和他的公司更有專題報導介紹


2007年11月27日 星期二

補充

楊梅的董事長會談

Quote from W. Edwards Deming:
We must satisfy our customers.
Retroactive management emphasizes the bottom line.

2007/11/25 12點火車站見 楊梅

david hsu:“楊梅車站前有個大廣場 我們在廣場見 如果我們找不到停車地點 就會在廣場前的圓環繞 一兩分鐘就會過境廣場一次 請您稍微等候 ".......見面談

到楊梅車站前廣場等地 是頭一次---今年我才知道 鐵路局各地的站之建築 都採取各地顯神通的方式--楊梅車站比起苗栗市站遜色 不過 站前有兩機械人雕像和廣場之處理 都不輸苗栗市

我提前半小時到 所以可以逛一下車站附近的商街 感受一下地方風味甚至於可以光顧路邊的豆花攤了解她如何處理 one-pack 的訂單

我在廣場前的圓環的陽光下讀點 Emma by J. Austen

David 準時到 談他的車子 它 方便一家三代一齊外出打牙祭

他說日本的TDK公司還在 這是30年前專科生畢業生的就業第一志願

他說 朱董事長找一位自行車業最特別的名人--太平洋自行車董事長林正義先生---來談天

他並且簡單介紹一下太平洋的知名產品Birdy 等等

(事後我發現這些車迷的參訪記很有參考價值---太平洋自行車探索-Birdy柑仔的出生地

http://tw.myblog.yahoo.com/jupiter-hu/article?mid=4498&prev=-1&next=4296&sc=1 )

我們聊天近3小時

David 談他最近帶父親到長庚就診時 採取有效率的醫師分級診斷方式 不過 它沒有考慮到病人 病人痛苦的檢驗重複做 真是豈有此理 我建議他向醫院反映

太平洋自行車創辦人林正義是奇人 當面聽他講他個人(和公司)的許多故事--都遠比網路上的許多資訊來得精彩多多…..

前後的一些品質與經營管理的問題

W. Edwards Deming: 紅珠實驗不良率20%

這其實遠低於手機產業零組件和自行車業的不良率 換句話說 David 等可以大發揮也

兩位董事長會都是行業的專家 所以我說W. Edwards Deming:的書 Out of the Crisis 中舉高雄某自行車廠的實例時 他們很快就猜測可能那家

1970s台灣該產業的蓬勃發展 讓他們質疑學者所說的產業cluster效應是否"倒果為因"

2008年7月25日 星期五

教學相長 read about our topic, lecture about it

今天線上讀 胡適日記 1928/9/20(略)

中國公學 「文化史」從頭做小學生 真是「道聽塗說」

.dorsethouse.com 出版社讀他們的季刊

http://www.dorsethouse.com/pdf/DHQ-V13N1.pdf

其中Tom DeMarco 等人有新著作

Waltzing with Bears : Managing Risk on Software Projects

(書名取自The Cats in the Hat Songbook by Dr. Seuss)

作者們的訪問稿說到出書前的準備:We need to read about our topic, lecture about it.


1999? 舊文一篇

教學相長

  參加生產力中心劉/林主辦的「組織學習行動研習會」的閉幕式。我下定決心以身作則,昨天當”老師”,今天當”學生”。我參加由老美顧問公司辦的「教練式領導」──選它(三選一)的理由很簡單,因為我譯的《戴明領導手冊》很暢銷,對「領導學」也很有興趣,更重要的是,要謙虛從頭學起。其實「三人行必有我師焉」是很高的境界。

  洋老師作了些練習,多採取三種角色扮演方式:觀察者─教練─組員。我們通常不會善用這種團隊合作學習法,很可惜。(《戴明領導手冊》的讀者,可參考第284的活動4。)

  我當了幾次教練,由於每次都自覺地學習,每次都有收穫。例如我知道陳腔濫調的「筆不離紙面,而用四條線把方塊中九個點連結起來」,至少有20種解法(有次Harvard Business Review把規則改鬆點,向讀者徵求,結果各種創意湧現,我最近又看到一個小孩子的妙招)不過,重來當過教練,也重來「看」別人如何實際做(求解),這些學習過程,其實也很有意思。

  另外,我也當了一次某公司政風課長的”部門願景”角色,與組員交換「企業倫理」及「民營化」、「轉型」等的對談,也有一些收穫。

  我一向以很會帶人自豪(部屬多年後成就比你大,而又肯給我差事幹,就是明證),不過,學習和修煉永無止境的。真的「三人行必有我師焉」。

:〔美〕M.蓋爾曼著《夸克與美洲豹》湖南科學技術出版社 pp..265-66

2008年7月23日 星期三

"Middle - aged school boys" to "Lifelong learner" (1995-2008)

中年學童

歲末,把年前經濟學人出版的《1995年的世界》拿來溫習一下,發覺其中管理學名家談的,都是可以令人深思的主題。Tom Perers十來年前的《追求卓越》,曾經風行全球,而他卻早已否定有所謂「卓越」,轉而倡導《亂中求繁榮》、《解放管理》。現在他談的是《追求狂野(In
Search of Craziness)》,鼓動超越「效率」而追求創新及想像力,不要被經典、習慣所困,例如以往研究發展等等活動,都局限在「溫室」方式,反而應到野草叢生處去發掘最有活力、野氣的繁花。

最令人感動的則是Charles Handy的《中年學童(Middle - aged school boys)》。他力陳人生應追求多重事業,不斷學習。Handy先生是組織學的名家,曾擔任過某大石油公司主管多年,轉業為教授,出版的《非理性時代》、《了解組織》都曾洛陽紙貴,可惜他用希臘諸神來譬喻不同組織形態的佳作,最近才有美國版本。他教授之餘,也轉業為神職人員,之後,再成為自由作家。台灣有他的名著《覺醒的年代》譯本,是本好書,以後有機會再詳談。現在我們介紹他的「中年學童」說法,我認為台灣十年內就會到達此境界--終生教育學習,人生事業群組構成人生四季之美等前景。

現在的「組織人」,應把學習機會看成是個人的「權利」。因為以後社會、經濟情勢的演變,會使一般人前途的唯一安全憑藉,在於能賣得出去的技能,而且它必須常常更新。所以有遠見的洋公司,己要求其成員投資一定的金錢(通常公司出錢)及時間「充電」或做各種「志工」、「義工」,而在公司內部,也以「平行調職方式豐富化工作」,不再強調升遷。

Handy先生引以為憂的是,大部分組織內的上班族,尚未意識到公司的工作,不再有終生保障,公司也不再能凡事妥善照顧員工。值得警惕的是,「學習」必須由「學習者」自行覺悟,自發有此不斷學習的需求才能開始。所以,現代政治的最大挑戰,是在於喚醒眾人的危機意識,因為社會上永遠會「人浮於事(工作)」,然而社會對於許多尚未被創造出的產品及服務,卻仍是需求孔殷。換句話說,要不斷創新,才談得上工作或事業的「供需暫時平衡」,而大眾要徹底轉變以「工作」為主導的事業規劃,而要以「顧客」為主導,從而學習發展出服務顧客的「技能」與「訣竅。」

Handy先生認為世界性的工作革命,必須由供給面來領導,而學校必須是這種大轉型的充電站。換句話說,學習性社會要由學者自行決定其命運,而腦力的開發,固然價值高,然而也更加困難。不管怎樣,人生不再一戰決勝負,而有多重機會、選擇,這些都是美事。
在這種脈絡下,人人不要以成為「學子」是「小朋友」上學的事,能夠儘早脫離苦海為妙。學校的新角色,也很值得我們深思。
----台灣立報1995 .12.8.----

Lifelong learner would impress literary giant

2008/7/23

The other day, I wrote in this column that novelist Natsume Soseki (1867-1916) declined a government offer to award him a doctorate. A detailed account of how Soseki felt about the title is given in the memoirs "Soseki no Omoide" (My memories of Soseki) written by his wife, Kyoko.

"The doctorate is a very dishonorable title that declares that the person may know somewhat about what they study, but knows nothing outside of his realm," he was quoted as having said.

Perhaps the wry remark was typical Soseki cynicism. Maybe there were many people who shared such views in the old days.

But a doctor who even Soseki, if he were alive, would approve of appeared on The Asahi Shimbun's "Hito" (newsmaker) column the other day. He is Sokichi Kametaka, former president of Kobe Steel Ltd., who received a doctorate in pharmacology at the age of 82. Kametaka had majored in economics and was an amateur in science. But after he retired, he spent 10 years on his studies to earn the degree. I am very impressed.

The businessman, who weathered oil shocks and recession in the steel industry, must also have a broad knowledge of "things outside his realm."

He lost his former wife to leukemia. His current wife was felled by a subarachnoid hemorrhage and suffered from the side effects of medication. The experience made him want to make better drugs and served as the driving force for his studies, Kametaka said.

Not many people go so far as to earn a doctor's degree but a growing number of people are eager to pursue "lifelong learning."

According to a recent survey by the Cabinet Office, the trend is particularly noticeable among people in their 60s. Apparently, this is because "baby boomers" who reached retirement age are enthusiastic about acquiring new knowledge. Learning is fun. The nourishment brought by knowledge and culture also makes life more profound.

Who was it that made the following remark? "I will ceaselessly keep on reading the one and only book called my life." In it, "reading" appears to mean "relishing." In other words, we should write our own life stories and relish them.

Wouldn't it be great if "students of advanced age" who retired from work came to write stories one after another that would impress even master Soseki?

--The Asahi Shimbun, July 22(IHT/Asahi: July 23,2008)

2008年7月21日 星期一

World Santa Claus Congress meets in Copenhagen

World Santa Claus Congress meets in Copenhagen

COPENHAGEN, Denmark (AP) — It's July — and the Christmas tree is lit, bells are jingling and jolly elves are doing "yula-hoops" on stage.

What else could it be but the annual World Santa Claus Congress — filling a Danish amusement park with summer Christmas merriment for the 51st consecutive year.

Five months ahead of the holidays, nearly 140 St. Nicks kicked off their three-day convention Monday at the Bakken park north of Copenhagen. Most were from Scandinavia but some came from as far away as Russia, Japan and the United States.

Visitors lined up to watch the Santas, the Mrs. Clauses and all their little helpers parade through the park, bellowing "Ho-hos" and singing Christmas carols. Other activities included a bicycle parade, "yula-hoop" twirls and a brief swim in Copenhagen's famous harbor.

These jobs are not for couch potatoes. One of Monday's highlights was the obstacle course, where bearded Kris Kringles raced past a sleigh and up a small hill built of ice before climbing down a fake chimney.

Later this week, they were also to visit children in a nearby hospital, cruise through the Danish capital in a sightseeing boat and hold tounge-in-cheek seminars about the 21st century challenges facing their vocation.

"We have real modern-time problems we need to discuss with our colleagues," said Fred Rootveld, a Dutch Sinterklaas. "How do we get into people's homes when there are no chimneys on the houses to climb down?"

Delegates go by a range of different names — from the French Papa Noel to the Danish Julemand to St. Nick — but the Bakken park said "they are all real Santas."

While that claim could not be confirmed, there's no doubt the festival has become increasingly popular since it was first held in 1957 as a purely local event.

"You really get in the Christmas spirit ahead of time," said Tony Zehavi, spokesman for the event.

Photo 1 of 3

A Musicians in a Santa Claus outfit marches at an amusement park in Copenhagen Monday July 21, 2008 .It's beginning to look a lot like Christmas in a Danish amusement park where Santa Clauses from around the world are gathering for their annual three-day congress, in Copenhagen,Now in it's 51st year, the World Santa Claus Congress starting Monday brings together 136 red-clad delegates, mostly from Scandinavia but also as far away as Russia, Japan and the United States. (AP Photo/Jens Panduro/POLFOTO)

2008年7月19日 星期六

自由談 八月二十三號 (2008 )主題:「左派 右派」;「獨立出版」;「翻譯學」

這個會因引言人另外有要事而取消 特此通知

如果造成不便 請原諒


漢清,我在高雄的伙伴告訴我,23日要我南下主持高雄社區大學和高雄市原住民族部落大學的聯合課程博覽會,由於我是理事長,必須去宣揚我們的理念,並給工作人員和老師們打氣,所以原訂的左派右派的談話會,不得不改期。非常抱歉,我知道你已把信息廣發出去,你們是否還是如期舉行,如有必要,我們擇期再加一場?抱歉!抱歉!


----

新生南路 自由談

主題:「左派 右派」;「獨立出版」;「翻譯學

時間:八月二十三號 (2008)14:00-16:00

地點:台北市新生南路三段882樓: TEL. 23650127

與談人:【引言人】陳巨擘先生(政治大學出版社)

報名:請發EMAILHCSIMONL@GMAIL.COM

說明:

主要因緣是7月12日有朋友訪問這兒,多少會被窗外的園林景觀吸引。我之前正與一位對於趙元任等先進的專家聊天。我們說,說不定可以來談談。後來,陳巨擘先生說,他受邀講「你是左派還是右派?──教師會幹部的意識型態」*,可以來引言。


陳巨擘:「左派或右派是種生活態度、處事原則,在實踐上,很難有純左派或是純右派,但每個人大概都會有個自己所認同的生活態度或處事原則。再以Said的話來說,沒有純粹的 private intellectual,也沒有純粹的 public intellectual。」


我們認為,他在出版界的翻譯經驗豐富,如果有人對出版的世界有興趣,他也可以談談呢。他說,我們共同的朋友有許多高手,下次可以請東海大學的羅時瑋先生談『華嚴經與日本建築』呢…..

更多細節請參考

http://hclectures.blogspot.com/

*

附上「你是左派還是右派」的講綱。
你是左派還是右派? ──教師會幹部的意識型態
1. 我是左派或右派關你什麼事?
a. 教育可以是中立的嗎?
b. 教育在台灣百年來的發展實況
c. 意識型態在教育上的作用:潛在課程
i) 阿圖塞(Louis Althusser)-- 政治、哲學
ii) 波勒和金蒂斯(Bowles & Gintis)-- 經濟
iii) 艾普爾(Michael Apple)-- 社會

2. 教育思潮中左右派之戰爭 a. 資本主義 vs. 社會主義 b. 保守主義 vs. 進步主義 c. 新自由主義 vs. 批判理論

3. 教師做為教學工具 vs. 教師做為知識分子 a. 葛蘭西(Antonio Gramsci) b. 弗雷勒(Paulo Freire) c. 薩伊德(Edward Said) d. 吉魯(Henry Giroux)

4. 結論:你/妳想當左派還是右派?
a. 教育的目的
b. 當今台灣左派教育工作者所面臨的挑戰
c. 如何empowering education





聚會時程:


東海戴明學者講座【2008特邀威廉‧謝爾肯巴赫先生(Mr. William W. Scherkenbach.)擔任三場演講-討論。】

I 開幕大戲【Lecture One: Dr. Deming's System of Profound Knowledge and Its Applications. 1016 (四)】 1500-1700,中華民國品質學會【台北羅斯福路】

II. 壓軸戲【Lecture two: Statistical Thinking and Psychology and Actions. 1017 10/17() 16:10-06:00 台中東海大學工業工程

III 大軸子【Lecture Three: Systems Thinking and Knowledge.. 1018() 上午10:00-12:00 台中東海大學推廣部】





2008年7月11日 星期五

How the New Quality Movement Is Transforming Medicine.

W. Edwards Deming (1900-93)生前就這樣說過

“The best way for a student to learn a skill is to go to work in some good company (or hospital), under masters, and get paid while he learns.” W. Edwards Deming, Out of the Crisis




Re: QRDC開會7/11記錄
我常說 我可以寫出不在會議記錄中的許多事情
上次會議中 我強力建議品質學會成立healthcare 委員會
我說日本科技連盟 JUSE多年前就出版過"醫療品質手冊"
我說..... 我說.....

現在 用紐約時報的一篇書評代替"我說"

唯一要補充的是 提議人似乎也可以當跑腿...

謝謝王主委

Books

Crusaders for Quality, a Health-Care Intangible


By ABIGAIL ZUGER, M.D
Published: July 29, 2008

Correction Appended

There are more than 800,000 doctors in this country, more than two million nurses and several million other health care workers. Until recently no one really knew what any of them were up to. Hospital walls bulged with frenetic activity, but all the public saw were the happy successes and the occasional tragic complications.

Skip to next paragraph
Clare Mallison

The Best Practice
How the New Quality Movement Is Transforming Medicine.
By Charles Kenney. PublicAffairs. 315 Pages. $26.95

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Those days are pretty much over. From what has been called a perfect storm of disgruntled patients, legislators and medical professionals, the quality movement in health care has been born.

Thanks to its efforts, those hospital walls are slowly becoming transparent. Revealed is a world of tangled routines, many obsolescent, many downright stupid, that no one had carefully examined. The reformers are out to streamline the routines, retrain the workers and keep them permanently on display — an ant farm behind clear glass — to make sure things never get out of control again.

Their early work was invisible to the public, but even that is changing. Take, for example, the latest benchmark in transparency: on a Wednesday late last May, newspaper readers across the country could compare how local hospitals performed on two measurements of the quality of care, not by slogging through a news article but by scanning a large government-sponsored advertisement complete with graphs and a Web address (www.hospitalcompare.hhs.gov) for more details.

That is just the first installment of such data on display. Soon both hospitals and individual practitioners will be publicizing their own report cards. Insurers will be paying them for good grades, penalizing them for bad. Incentives to minimize errors, complications and inefficiency will mount. Health care will become perfectly safe, perfectly smooth, perfectly perfect.

How did this messianic movement arise and take root, and who are its prophets? These are the questions Charles Kenney valiantly tries to answer in what is the first large-scale history of the quality movement.

Mr. Kenney, a former Boston Globe reporter and editor who is a consultant for a Massachusetts health insurance company, has set himself a giant assignment. While the book is not a success — an uncritical paean to his subjects, it reads like a corporate annual report — he provides a reasonably complete and up-to-date picture of the ambition and complexity of the enterprise.

Part of the problem is that he is trying to describe a target in motion, with roots almost as tangled as the chaos it seeks to eradicate. Poor-quality health care takes a variety of forms, each attracting a different set of crusaders.

Some have taken on the big blunders — errors of misdosed medication and operations on the wrong leg. Some have tackled "complications," like catheter infections, that were once thought to be inevitable risks of hospitalization and now seem entirely preventable.

Some have focused on the smaller inefficiencies — little details with costly consequences, like medical records that disappear just when they are most needed and laboratory results that vanish into giant black holes.

Some aim to rearrange the physician-heavy hospital hierarchy so that all health care workers, and even family members, have the opportunity to call the shots in a patient's care.

Still others focus on getting sick people correctly cared for: tight blood-sugar control for diabetics, regular Pap smears for women, flu shots for all.

Government and industry have been sources of inspiration for these goals. Experts from NASA to Toyota have tutored health quality gurus in the basics, like needing to prevent errors rather than punish them and respecting the right of any worker to stop the assembly line when a mistake threatens.

Mr. Kenney is scornfully dismissive of unnamed physician naysayers who point out that "human beings are not cars" and shy away from health quality control. It is these doctors' "crust of hubris," he argues, that prevents them from seeing the merits of new algorithms. Indeed, it is hard to imagine how any sane person could fail to leap on the quality bandwagon as presented here; it is all so self-evidently fabulous.

But readers should be aware that Mr. Kenney's story ignores a wide array of questions that have some thoughtful members of the health care world a little troubled by the quality evangelism.

What does quality care mean, for instance, in cases of hopeless illness? When the outcome of care will not be good, how should good care be redefined? Suppose patients sabotage their own care, as so many unwittingly do. Who takes the blame?

And most important, what does it mean when science impudently undercuts accepted quality benchmarks? Only this past spring, for instance, two giant trials suggested that for some diabetics, tight blood-sugar control did nothing to safeguard them against some feared complications of diabetes and might actually endanger them.

Quality is a clear goal in product development, but in health it is still a shimmering intangible. All credit to the quality mavens; they are certainly fighting the good fight, and most of them deserve every laudatory adjective in Mr. Kenney's thesaurus.

But fortunately for us all, most of them are smart enough to realize that human beings are not cars.

This article has been revised to reflect the following correction:

Correction: July 30, 2008
The Books column on Tuesday, about "The Best Practice," by Charles Kenney, misstated the name of the publisher. It is PublicAffairs, not Public Affairs Books.