"After working with Rule 4, I'm not getting called in to solve frontline problems, yet I understand much more clearly what's happening at the point of care."
- Peter H. Alexander, CEO, St. Vincent Health
Indianapolis, IN

Rule 4 is the sister company and consulting wing to Kenagy & Associates. We work with organizations interested in implementing the ideas Dr. Kenagy puts forth in his book, "Designed to Adapt: Leading Healthcare in Challenging Times." Rule 4 has helped dozens of health care organizations implement Adaptive Design™. We work with your management staff to develop the problem solving ability of your organization from the ground up, giving your organization the ability to stamp out problems at the lowest level of the organization before they become larger crisis. Rapid and focused problem solving also allows your organization to quickly adapt to new challenges whether they be new regulatory requirements, operational challenges, or competitive threats. Learn more about the principles of Adaptive Design™ below:

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 use the Adaptive Design™ methodology and start by engaging people in small, meaningful improvements around issues chosen by staff and physicians. Staff and physicians participate in identifying opportunities to improve how our systems deliver for patients.

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, processes improvement becomes part of the culture of the organization.

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

We often encounter senior leaders who feel they are pulled in to solve problems that would be best solved by people closer to the work.

"After working with Rule 4, I'm not getting called in to solve frontline problems, yet I understand much more clearly what's happening at the point of care." Peter H. Alexander, CEO, Seton Specialty Hospital

It's not enough to "empower" staff and managers. Rule 4 teaches managers, doctors and staff the skills and frameworks of improvement. Thus, senior leaders are able to focus on larger system problems, appropriate to their roles in the organization.

Distinguish Technical from Adaptive Problems--and Treat Accordingly

A technical problem is one for which 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.

An adaptive problem is one that involves changing the habits, behavior, or values of people. Although health care organizations most frequently encounter adaptive problems, they often seek to solve them with technical fixes, which leads to frustration. How often have you heard, "if they would just follow the process; I'll have to have another talk with him about this; they should know by now that it's their job to..."? All of these statements (and many others) demonstrate the gap that occurs when we try to solve human/adaptive problems with technical answers.

At Rule 4, we teach leaders to solve technical problems with technical solutions and adaptive problems with adaptive work. Treating each problem with the right intervention is, in our experience, the key to sustainable improvement.