This will be my last blog post as an employee of the ThedaCare Center For Healthcare Value. I am very grateful to have the opportunity to work with some terrific people who are trying to make a difference. I’ll be moving on to other work where I’ll be contributing to the “gang tackle” of healthcare transformation in other capacities. If you are curious about what I’ll be doing, you can follow my exploits at gembawalkabout.com.
A few years ago I had the good fortune to tour a company that is a supplier for Toyota, Honda and other companies. The gentleman that was showing me around would occasionally talk about advice that he was given from his sensei from when he worked at Toyota. Apparently, this Japanese gentleman would try to emphasize important points by making this statement, “this is truth”. I was thinking about this as I was asked to offer some reflections on my time at the Center over the past six years. So, here’s my “top 10” list:
Number 11 – (that’s right “eleven”) Important points don’t always come in handy multiples of 5 or 10. For instance, when we learned about the Shingo Model for Enterprise Excellence, we were told that there were ten important guiding principles. Actually, we discovered two additional principles that we thought were missing: “learn continuously” and “understand and manage variation” so we added them to the model that we teach. You will discover more guiding principles. We do not know it all. This is truth.
Number 10 – What You See Is Not All There is. This is a modification of a key point I learned from Daniel Kahneman from his book Thinking, Fast and Slow. He describes how our minds work and how we can make incorrect decisions by thinking that “what you see is all there is.” He came up with the acronym WYSIATI. It’s a fascinating and important book. What we see is NOT all there is. This is truth.
Number 9 – Healthcare is no longer in an expanding market. My entire career has been involved with healthcare. We’ve been led to believe that the solution to problems was more: more beds, doctors, nurses, technology, computers, etc. I blogged about this here, and for the Deming Institute here. We are no longer in an expanding market. This is truth.
Number 8 – Most people expect miracles. They think they can go to other organizations and copy, but they don’t know what to copy. I’m paraphrasing Dr. W. Edwards Deming from an interview he gave for an NBC television program in 1980. The program was “If Japan Can, Why Can’t We?” and he was asked why the ideas that he brought to Japan starting in the 1950s were not understood and used by Western management. I think he was emphasizing that you can copy the surface practices, but not understand the principles behind them. I see the same thing happening in healthcare. You can copy what you see others doing (huddles, white boards, PICK charts) but if you don’t understand the principles behind these things, there will be no substantial change or improvement. Most people don’t know what to copy. This is truth.
Number 7 – Think for yourself. The really important things require time, and need to be internalized. The people I learned the most from are those who made me figure things out for myself. And I’m still figuring things out. There’s no substitute for knowledge, and no substitute for thinking for yourself. This is truth.
Number 6 – True north measures are not the same as “purpose.” Most people that I know do not come to work every day trying to see how they can move some measures for an organization. They are hoping that their purpose matches up with the purpose of the organization. By purpose I do not mean a mission or vision statement that no one reads or understands. I am referring to a simple statement that explains why we (as a company) exist. By understanding and focusing on this purpose, the results will follow. We need to stop managing by results. Here’s a great video that helps make the point. This is truth.
Number 5 – We spend far too much time and energy focusing on the individual. Although we say we “focus on process” we still seem to spend the majority of our time and energy focusing on the individual. We have not really appreciated the impact of systems on individuals and the interactions between individuals and systems. I am not saying that the focus must never be on the individual, but that should never be our starting point. This is truth.
Number 4 – Systems drive behaviors. We experience this every day. Think about the transportation system. All of the components of that system (traffic signs, traffic lights, laws, equipment, cars, trucks, training, police) are designed to influence the behaviors of people so that people and things can get from one location to another safely and expeditiously. When we see things going wrong (or right) our first question should be “what systems are driving that behavior?” People are a part of the system, and that is where improvement will come. But the systems must be managed and led. This requires management. This is truth.
Number 3 – We all went to the wrong school. What we were taught, how we were taught and how we were treated (at school and at work) turns out to be largely incorrect. We have been led to believe that the world works like a machine, when it actually works like a web. I learned a lot from Sally Goerner’s book After The Clockwork Universe and I think you would too. I blogged about this here, and also made a short video. Thinking that the world works like a machine will not help you when the world works like a web. This is truth.
Number 2 – Transformation requires patience. We must be patient with ourselves and with each other. Even if we realize that an entire new way of thinking is needed, applying this knowledge will not be an easy path. Unlearning what we believe to be true will be difficult and we will make mistakes. I found this video that (I think) illustrates how difficult it will be to change the way we think and act. We must be patient and persevere. This is truth.
Number 1 – Have you made things better for a patient or a caregiver? If not, then keep trying. My mom was a nurse. I’m pretty sure she worked herself to death. She cared deeply about her patients and was very good at workarounds, heroic efforts and fire fighting. That’s not good. My daughter is a physical therapist. I don’t want her to work herself to death. The systems need to make it easier for her to do her work, not make it harder. I blogged about my brother Dave, and I am happy to say he continues to put up a good fight against leukemia and the course of treatment that can be just as hazardous as the disease. But the healthcare system has not made this an easy path. At the end of every day I try to answer this question: “have I made things better for patients?” and “have I made things better for the caregivers?” If not, then I need to adjust my thinking and systems and keep trying. This is truth.
Mike Stoecklein, Network Director
ThedaCare Center for Healthcare Value