We Are Struggling
Why then are so many healthcare organizations struggling to make these programs work to anywhere near their full potential? Why is sustainability and ownership of the people who must work in these “optimized” systems proved so illusive? And don’t be fooled by all the nice sounding rhetoric which pours out of most healthcare organizations concerning how well they are doing in key areas such as patient satisfaction, safety, quality of care, employee engagement and cost reduction. Compared to what? To most other healthcare organizations in various states of dysfunction, that’s what!
If you want to know how these healthcare improvement programs are really doing, ask the nurses and care providers closest to the patient what it’s like working in healthcare these days. Remember, nurses are the glue who are holding marginally together this rickety beast we call healthcare. No. Healthcare is a mess from a systems standpoint and the programs chartered to clean up the mess are, in the vast majority of cases, dramatically under-performing or simply failing. Why is it we can’t make these programs work? It appears we have a confluence of contributing factors.
Four Mistakes We Make
1. Programs Mentality: In healthcare organizations, these process improvement initiatives are seen as “programs.” The problem with programs is that they come and go, many times as a flavor of the month. Systems thinking, systems-based leadership and management, and systems-based organizational improvement are not programs. They are a way of being in the workplace. Toyota doesn’t have a quality program. It has a quality, systems-based culture and way of being that creates ever-improving quality naturally.
2. Lack of User Friendly Tools: Although I taught the basic tools for improving systems, I noticed that many people’s eyes glazed over with fear or concern when faced with learning to use these tools. This was especially true of non-technical workers and mangers who didn’t sign up to become systems improvement experts (think care providers). People do not learn well or easily when in fear. In healthcare, we found that in order for people to learn, use, and eventually own the tools, we had to reformat the tools, making them simple, user friendly and even fun. Remember, if your front lines are not using the tools on a daily basis, you’re not systems-based. You are people based and asking for the fires you put out yesterday to be burning brightly sometime in the near future.
3. No Paradigm Shifts: There are two equally important parts of sustainable systems based cultural change: Systems Improvement and Expanding Our Existing Paradigms. Six Sigma and the like focus on tools and process but whiff on the critical nature of paradigm shifts, particularly at the levels of leadership and management. Systems Thinking is a significant paradigm shift, an expanded way of thinking, a more accurate way of thinking and viewing the world. Einstein reminds us that we can’t solve our problems with the same level of consciousness used to create them. It’s the same for improving systems. We have to begin to think differently and expand our mind and skill sets to make systems improvement work sustainable. We found in many cases in healthcare, these paradigm shifts must take place before significant sustainable systems work can be done.
4. Leaders Who Won’t Grow: Systems Thinking is like learning a foreign language. Without knowing this language, leaders have little idea of the source of problems in the organization or how to resolve those issues. In addition, with 90+% of the problems being a function of the systems, not the people who work in those systems, a leader or manager misses the opportunity and responsibility to set up her people to be optimally successful in their jobs, surely a top function of more conscious/skilled leaders or managers. Instead, most non-Systems Thinking leaders and managers use what I call the “more-better-different” strategy. They do what’s no longer working more, better, or differently—expecting a different result. In many ways, leaders in healthcare have been domesticated to think in a “sickcare” box. To make systems improvement work stick, leaders must be willing to grow, too. So far, for most, the comfort of the more-better-different box remains in tact. If we are to be successful in resuscitating healthcare, leadership must change and grow. In fact, we will only go as far as leaders are willing to grow beyond more-better-different.
There are undoubtedly other factors contributing to the critical condition of most quality initiatives in healthcare in America. However, if we begin to address these four issues, it appears we will be well on our way to becoming sustainably better in the most important areas of healthcare delivery.