I have a little light

by | May 20, 2018 | Thought Piece

This is the name of a game I played as a child with my great aunts at Christmas.

Someone would start the game by saying “I have a little light” and then would describe the object or place or idea in deliberately oblique terms that appeared to be meaningless using descriptions like “People use it a lot” or “It’s far away”. That person would talk like this giving out snippets of its characteristics, or uses, or colour, or what is wasn’t, until someone else would say “I have a little light”.

The first person then says “what is your little light?”. They would then exchange possible characteristics about it in oblique terms. Sometimes it turned out to be correct and sometimes not. If they were right the others would continue questioning those who “understood”.

The last one left was the loser.

There are equivalents in healthcare management. I wish I had read about Dr W. Edwards Deming in detail years ago. I love a particular quote from one of Dr Deming’s Japanese colleagues “that Dr Deming taught us that if you manage by cost, cost goes up; but if you manage by cost and quality cost goes down and quality goes up”.

He had a little light that the Japanese understood and they almost destroyed the American manufacturing industry as a result. These ideas were eventually adapted to become “Lean Manufacturing” with the Toyota Production System it’s most famous example. They could learn, test, think and change. They had an overarching concept and understood.

Even after Dr Deming returned to the USA, American manufacturing still didn’t get why the Japanese were so successful even when they tried to copy them. Dr Deming wasn’t understood in the US for decades until there was a looming catastrophe there from Japanese competition.

Maybe both countries needed to have their own catastrophe to be receptive enough for innovation? Maybe we do too?

Our healthcare costs are rising too fast and we manage primarily by cost. Our quality and outcomes are poorly measured and understood. Our private health coverage in Australia is dropping rapidly and may soon reach a tipping point where services will fail.

I feel like we are playing this game in healthcare management innovation. I know what my little light is. I can describe it – but it can sound oblique even though it is so obvious.

It can be described in many ways and has many facets but it is so clear when you see it.

It is created by managing by both quality and cost simultaneously and continuously in the pursuit of value.

It is not the same as managing both in isolation. This doesn’t work.

It happens by managing them together in the services that create the outcomes.

It’s not working to a budget. It is managing by reducing cost and increasing quality together in a continuous improvement process over time. It is not a fixed target.

It needs leadership, it needs enquiry, allowance, decentralisation and theorising. It needs a method for learning, testing, sharing and changing.

It needs an emphasis on measuring outcomes that matter to our patients first.

It needs our currently available data to be used and understood differently.

It needs service specific outcome and costing feedback as close to real time as possible.

It will require staffing changes and different teams.

It needs collaboratives with a unifying principle of “value”.

“I have a little light”

“What is your little light?”

“Does it have something to do with survival?”

“It could”

“Does it pay for itself ?”

“It certainly should”

“Could it free up a lot of money for further investment?”


“Is it something to do with a concept that starts with V ?”


“It does!”

“We have a little light!”


Dr Chris Farmer

Clinical Director, Metrixcare