People First, Then Systems

Many healthcare organizations struggle to implement and sustain improvement programs and as a result become frustrated with the process or attached permanently to consultants. In our view, that's because unless you change the people first the process will always conform to their habits. At Rule 4 we start by engaging people in small, meaningful improvements around issues chosen by staff and physicians.

At first, these improvements tend to be small and self-centered. But as staff and physicians gain experience and skill, they begin to branch out in to areas that impact profoundly the quality, safety and reliability of health care delivery. As a result, process improvement becomes part of the culture of the organization.

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Improvements should be done at the lowest possible level in the organization.

Senior leadership spends too much time solving problems that can be better solved at another level in the organization. This is stressful and fatiguing for the leadership and the organization. Rule 4 teaches leaders to develop the problem solving skills of their staff and direct those resources for maximum benefit to the organization, leaving them free to tackle system problems appropriate to their roles in the organization.

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Recognize different types of problems.

For some problems you can rely on a subject-matter expert. A nurse and a service rep, for example, can figure out the best way to treat a wound, or ensure that diagnostic equipment is functioning properly. As a leader you can also legislate and enforce processes around these types of problems. Most of the problems we face in healthcare, however, are more complex and involve changing the habits, behavior, or values of people.

Attempting to solve these two types of problems with one set of tools leaves an organization frustrated and can create animosity between staff and leadership. At Rule 4 we teach leaders to differentiate between the different types of problems and treat each with the correct intervention.

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Improvements should be made using the scientific method

The scientific method underlies all structured improvement methods: Six sigma, Lean, PDCA, etc. Clinicians are also taught to use the scientific method for diagnosing their patients. Unfortunately, too often while diagnosing and improving what ails their organization, staff and management aren’t using the scientific method. Consequently, improvements aren’t as robust as they could be and failures are seen as a something negative rather than an opportunity to learn and improve further. Organizations that don’t have a robust method for improvement don’t benefit as much as they should from their organizational knowledge and creativity.

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Small is Big

Many organizations ignore what they deem are small problems until these small problems add up to create a big issue. Some of the worst outcomes for patients were the results of many small system issues going bad at the same time. Conversely, small improvements made close to the work are often discouraged in favor of larger, committee-led improvement initiatives. We believe that these are mistakes of the same ilk. Small problems should be addressed before they create bigger issues and small improvements (think $1000 here, 10 minutes of time saved there) add up to big improvements.

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