Breakthrough Productivity Enhancement

By David M. Williams, DMWAustin consulting

Every December, Harvard Pediatrician and Institute for Healthcare Improvement (IHI) founder, Donald Berwick, MD ignites thousands of high level healthcare executives with passionate speeches that layout ambitious charges to save lives. In December 2006, he proposed that hospitals across the nation strive to protect 5 million patients over the next two years from incidents of medical harm. Berwick estimates that nearly 15 million instances of medical harm occur in the US each year or 40,000 per day. Through twelve changes in care, he believes the goal of saving lives and reducing patient injury for 5 million patients is attainable.

Berwick’s charge seams larger than life. For many who have heard great calls-to-arms before that never materialized, it’s easy to be a skeptic; but as these healthcare heavy weights exited the keynote, they were already making plans and calling colleagues to jump start the initiative. They believed. Six months later, many are well under way or at least know where they are. Using a practical approach, IHI member hospitals will enhance their organizational performance and reach 5 million lives. Let’s look at how they’ll do it.

System of Profound Knowledge. At the heart of the IHI effort is a foundational theory or system of profound knowledge introduced by management and improvement guru W. Edwards Deming. This is the framework taught in IHI’s Improvement Advisor program. Deming is most known for his work in enabling the Japanese auto industry to be the leader it is today. He argues that there are four interrelated parts to understanding a system and enhancing its organizational performance: appreciation for the system, knowledge about variation, a theory of knowledge, and psychology. Let’s look at each:

• Appreciation for the System – Each emergency caregiver and leader has to recognize that we are part of a system (e.g., health care system,). Focus should always be on maximizing the success of the system and not its individual parts. This means appreciating our interdependence and working to cooperate and communicate. It requires that each position, division, or organization work to the optimization of the whole system first and not their individual productivity. And, it entails stakeholders negotiate solutions that work for all and not just one constituent.

• Knowledge About Variation – Nothing we do personally or in our organizations are perfect. Success 100% of the time is not attainable. The goal is to reach a certain comfortable performance benchmark and then reduce variability. Everything we do has variation. Identifying when variation is from a common cause (i.e., normal or expected variation, stable) or a special cause (e.g., isolated or out of the norm variation, unstable) helps leaders to know when it is appropriate to act. Measuring processes, recognizing variation will occur, and only reacting when and where it is special cause variation, empowers leaders for change.

• Measuring data and understanding variation is not enough though. Leaders must also take action to reduce the variability of common cause variation and try to eliminate the frequency of special cause variation. Doing so involves asking yourself, What do I want to accomplish, How will we know the change was an actual improvement, and What changes can we make to create improvement? Only then, you can plan an improvement, implement it, check to see if it worked, and then act on what you discover to improve forward.

• Theory of Knowledge – Leaders need to use data and experience to predict future outcomes. You enter improvement efforts knowing you could be wrong, but by observing outcomes and new data, you modify or adjust to achieve the goal. Information is not knowledge, it’s in how we use that information and apply it forward that we gain knowledge on how to enhance something.

• Psychology – The final piece, involves understanding the organizational behavior within the workplace. Are people intrinsically motivated? Is there a culture of asking “why”? How do teams communicate and manage conflict? Many change practitioners admit that data and control charts show the meat of process issues, but the human interaction, decision-making, and motivation require a bulk of attention to be successful.

Deming’s system of profound knowledge is not complicated. It recognizes that when organizational or process improvement is essential, that leaders must take a holistic and systemic approach. It assumes we have to do more than let our environment impact our service and effectiveness. We need to acutely understand how it is working, how it can improve, and what we can do to improve it. Finally, it puts the responsibility on you to make sure it worked. Aspiring to achieve a system of profound knowledge would be a major leap for most organizations, but the results would be well worth the effort. How many lives could you save?

Re-purposed from an article originally published in Management Focus.