Once you strengthen your data plumbing, what’s the next step?

In an IHI seminar this week, we’re discussing ways to use patient experience data. Two seminar case examples look at the use of tablets in outpatient settings. The organizations seek to capture patient responses to a series of questions, hoping that every patient every day will answer the questions. The organizations each want their clinic managers to get daily information about patient experience, both to mitigate service failures and to monitor the impact of improvement projects.

The seminar discussion includes the Prius Principles I described in a recent post.

The Prius principles outline five conditions for managers to use data to improve a system.

People have to

(1) sense the data: see, hear, smell, touch, taste;

(2) interpret the data: what do the data mean?

(3) connect interpretation to timely actions that can improve performance;

(4) have the power to act based on (3): "be in the driver's seat"

(5) actually act.

These conditions seem necessary but are not sufficient. In addition to the five conditions, there has to be some data plumbing built and maintained to define and capture measurements that comprise the data sensed by managers.

For example, in a Toyota Prius, Toyota engineers designed the sensors and wires to capture and present data on mileage performance in a dashboard display and then the Toyota assembly plant put all the pieces together.

In the two cases in our seminar, the data plumbing is the tablet hardware, the data storage and software to make everything work. Tablet hardware and software gather individual responses and place them into storage; more software aggregates the patient responses and then produces reports and messages sent to managers or accessed on a web page.

Relative to their traditional patient experience surveys, the organizations seek to increase both the volume of patient responses and to drastically reduce the time delays between service event, patient response, and data summary.

The organizations have so far invested the majority of their time and attention on data plumbing and consequently have paid less attention to the other five Prius conditions.

Since I’m convinced of the merit of the five Prius conditions, I tried to understand how this behavior might make sense.

I found at least one theory that explains the focus on data plumbing as rational: If the data plumbing is the weakest link in a data feedback system for clinic managers—data are too sparse and too delayed—then Goldratt’s Theory of Constraints says to focus on that weakest link and make it stronger. That’s the behavior in the two cases.

Goldratt’s theory also makes a prediction: When the data plumbing is no longer the weakest link, another step or resource in the system will then become the weakest link.

In both seminar cases, it looks like the new data plumbing will soon deliver more information than the managers can use productively. Thus, the next weakest link may be how well clinic managers can interpret the patient experience data in order to take timely actions that improve patient experience. Goldratt’s advice? Strengthen the new weakest link.

That’s my advice for these organizations, too.

More on Goldratt’s Theory of Constraints

In the 1980’s, Eliyahu Goldratt codified a management approach, the Theory of Constraints, that focuses improvement activity on the weakest link in a production system. (See the Wikipedia article: https://en.wikipedia.org/wiki/Theory_of_constraints accessed 29 November 2015).

The system might deliver a product or service; Goldratt’s theory certainly applies to the feedback systems in our seminar cases.

Here’s Goldratt’s specific insight: To increase performance of the system, you have to strengthen the weakest link. If you work to improve links other than the weakest, you’ll spend time and effort but not get any better results.

Goldratt outlined a five-step “focusing process” for improvement:

(1) Identify the system’s constraints.

(2) Decide how to exploit the system’s constraints.

(3) Subordinate everything else to the above decisions.

(4) Elevate the system’s constraints.

(5) If in the previous steps a constraint has been broken, go back to step 1, but do not allow inertia to cause a system constraint.

Goldratt’s theory helps me understand why people can focus on different parts of feedback systems and report improvements—different systems will have different weakest links.