Sustained Attention

Last Thursday, I listened to a manager describe the range of problems she and her team had found while working to make her medical center “Conversation Ready”.   Her project team aims to increase the number of patients the center asks about health care agents and what matters most.  The project also aims to assure that staff and the record system can steward those patient answers reliably.

While working on their project, the manager and her team uncovered problems like these:

• a unit clerk struggled to record information that required toggling between two applications that had poor interface design.   A quick mitigation:  use a second monitor to allow the clerk to have one application open on one monitor while using the other monitor for all her other tasks.
   
• A central department and a local unit both worked to deliver the same support service to patients, unknown to each other and using different procedures, leading to inconsistent services and wasted effort.   The solution:  use the central department’s more efficient process, which also frees the local unit to concentrate on its primary function.

The team’s experience illustrates a general rule:  Just about any time an inquisitive person starts observing the way work happens in their organization, she will find problems--gaps between what’s expected and what actually happens.

Since problems are everywhere in any organization, why rely only on special projects to bring problems to the surface that can be tackled?

The answer:  build a management system that enables what my friend and colleague Richard Scoville calls “sustained attention” to close gaps between what’s expected and what is.

Management systems that sustain attention increase the odds of frequent discovery and solving of problems for three reasons.  First, problem discovery time is built into the daily and weekly schedule through daily huddles by teams and regular daily and weekly reviews by supervisors and managers of standardized work--the way work should proceed. 

Second, many more people inquire and look for problems compared to the limited team roster of special projects.

With increased effort to discover problems, the odds of discovering any specific problem go up as does the volume of problems uncovered.   To avoid drowning in a sea of problems, the management system needs a way to tackle problems, with a method of escalation when local teams can’t resolve issues themselves.  

Finally, these systems make it easier for special projects to achieve aims more effectively and efficiently.   When project teams uncover problems, unit teams and managers, with problem-solving skills and experience, can support the project; the organization is set up to escalate problems with fewer fits and starts, too.

Scoville, colleagues at the Institute for Healthcare Improvement, and I continue to study and test effective management systems like those described in this post. 

I invite you to join Richard Scoville, Jeff Rakover of IHI and me at the 2017 IHI Forum in Orlando, FL, Sunday 10 December from 1-4:30 pm.  We’ll conduct a Learning Lab session, “Sustaining Improvement in Daily Work.”  More information here.