Prakash Dhanabal : A student of Improvement Science.

I am interested in blogging about meta-theoretical issues at the intersection of Healthcare Improvement , Epistemology and Philosophy of Science .

I hope to blog separately on StatisticalThinking and Applied Clinical Informatics, which are  other areas close to my heart.

I have trained intermittently in Critical Care and Cardiology; taught Bio-Statistics and Epidemiology to undergraduates in Medicine .

Several years ago , I trained at the Institute for Healthcare Improvement[IHI], Boston.

I am currently pursuing my Masters in Philosophy at the University of Mumbai, with Western Epistemology and Philosophy of Science as my optional subjects.

Disclosure : I head a non profit organization called Healthcare Progress and recently founder and director of the Institute for Healthcare Quality, Mumbai.

A note on my intention:

This blog is a side- ways- look at the evolving field of Improvement Science. It consists of a series of essays which are more in the form of ‘meditations’: A bunch of ‘insights’ which I was afraid of loosing , un-apologetically threaded together as ‘essays’. I have personally found it difficult to understand what is the nature of the ‘Science in Improvement.’

On an auto- biographical note, I tumbled into Quality Improvement in the mid nineties , with the mistaken belief [I was a freshly minted physician] that it would hold the key to mastery as a physician:  Can a well trained novice, apriori [or at-least limited experience], aspire to practice  as well as an expert. Could a better way of organizing medical knowledge, increase the yield from experience. For example, I started with  asking  simple questions such as, could schemas such as Herbert Simon’s categories of programmed and non- programmed decisions, guarantee more reliable performance at the bedside. I continue falteringly to believe, that some day, as we gain better understanding of the ‘deep grammar’ in clinical decision making and improvement thinking,  it could turn out to be true!

Improvement Science is a field that borrows concepts and tools from Industrial Quality Management Science. This is true of its origins, but this blog is an attempt to ‘look inside’ healthcare and medicine , for the sources, bases and structures of improvement.

These essays are not meant to seek originality or priority, they are more a struggle of one person thinking aloud in public, along a long and winding road. The essays are offered more as  ‘messages in a bottle’, which, those who find them may further develop them as they wish. There is absolutely no compulsion to believe them or any need to give credit. At best, I view myself as the fifth blind man, extending the Indian folklore, who jostles between the one feeling the trunk and the one holding the leg,touches the eyes of the elephant , knows it is only part of the elephant, but becomes curious if the elephant can see! I guess he is different from his four blind friends. The difference is in the question. In my case three primary questions:

A. Is improvement a science? If so, what kind of science?

B. How to increase the ‘cognitive resonance’ between Clinical and Improvement Thinking?

C. Why Improvement Science isn’t common practice in Developing Countries?

I am aware , that half of what I write in this blog, may turn out to be wrong. But as the cliche goes, I have no way of knowing which half. The ‘essays’ are term papers in search of a professor.So please read them with a skeptical mind.


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