Learning to improve: a little less planning, a lot more doing

2012-10-26 Learning to improve

It’s hard to believe it’s been five months since a group of us (from Five Hills Health Region and HQC) did our mistake proofing tour – with stops at Virginia Mason Institute, Virginia Mason Medical Center, Seattle Children’s Hospital, and Autoliv. Each of these organizations has embraced Lean principles and methodology and is unwavering in their commitment to zero defects.

The trip (which I blogged about in an earlier post) was the easy part; it was fun to be part of a group of individuals curious and committed to learning how to make our health organizations safer.  However, when we landed back in Saskatchewan in mid-May, fear quickly replaced the exuberance and hope I felt while I was away.

Each of our teams had to begin applying the ideas and concepts we’d learned, then report out to leadership five months later about the improvements we made since the trip. Could we really achieve any improvements in patient safety in such a short time? We’d never done this before. And what if we did it wrong?

One of the liberating things I’m learning as part of Lean training is that time (or lack thereof) is actually your friend — not your enemy.  Before, we would have built in lots of extra time to ensure our improvement plan was rock solid.  We wouldn’t actually DO anything until we had the perfect plan.

The great thing about having a fixed amount of time to make improvements is that it forces everyone on the team to just “go do it.”: come up with some ideas, try them, collect data on these ideas, then try some more.

Are you going to make mistakes?  Yep. Are you going to wish you had more data? Probably. We’re still hardwired to think ‘just in case’ rather than ‘just enough.’ I’ve come to realize though, that our teachers from John Black and Associates are more focused on helping us change our behaviors than on changing our mindset. Initially, I was kinda ticked off with this. Now I see that we learn a lot more from doing than from thinking.

The project I was assigned to looked at the number of medication defects for patients on the Mental Health Unit at Moose Jaw Union Hospital.  A defect included the wrong drug, wrong dosage, wrong time, wrong person, or medications not given.

In 2011-12 there were 17 instances of one of these defects. During the time we tested some of our improvement ideas, there were just three.  If we keep on this same path, our team estimates we should be able to achieve a 33% reduction in defects over the longer term.

We’re not at zero yet. But my colleagues in Five Hills are committed to hitting that target.

If you were to ask my mistake proofing colleagues, fun is probably not the first word they’d use to describe their experience thus far.  But words like curious, hopeful, and humble just might be.  It’s these words — and the behaviours that come with them — that make me think we’re on the right path with our improvement journey in Saskatchewan.

What did you think of this post? Did it affirm your view on the topic? Change your thinking? Let us know, using the Inspire-o-meter below.

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12 Responses to “Learning to improve: a little less planning, a lot more doing”

  1. Abbas baloch
    December 11, 2012 at 5:37 am #

    I am not a teacher but an awakener

    • Bonnie Brossart
      Bonnie Brossart
      December 11, 2012 at 3:14 pm #

      Fantastic! Awakener is a great term and really pushes us beyond simply teaching to igniting one’s innate desire to improve and learn. Thanks for your comment.

  2. Dennis Kendel
    October 31, 2012 at 8:30 pm #

    The comment about changing our behaviors rather than our mindset is critical to making care safer. We all need to make safer behaior our standard work.

    • Bonnie Brossart
      Bonnie Brossart
      November 1, 2012 at 9:39 am #

      Hi Dennis. Standard work (and the behaviours that go with it) is such a common sense concept; but its far from common place (but not for long)!

  3. Maura Davies
    October 26, 2012 at 2:40 pm #

    Great post Bonnie. The mistake proofing project I am involved in involves eliminating defects associated with unlabeled and mislabeled blood samples drawn and sent by nurses from the NICU to the lab. Sounds simple doesn’t it? Not so, we have learned. Although we are still seeing defects, we are hopeful that through trial and error, we will get there. Change is hard, but the just do it attitude you described and are modeling is a good start.

    • Bonnie Brossart
      Bonnie Brossart
      October 26, 2012 at 3:52 pm #

      Thanks Maura. I am quickly learning – like you – that what appears simple and straightforward is anything but. What feels different and gives me hope is that instead of letting the complexity elephant if you will overwhelm us, we are really embracing a very active “one bite at a time” approach. See you at Saskatoon Health Region’s Mistake Proofing Report Out on November 2.

  4. Betty Collicott
    October 26, 2012 at 10:02 am #

    As the Board Chair for Five Hills, I was invited to attend the Mistake Proofing Report-Out of which Bonnie speaks! The reporting teams are to be commended and congratulated for their progress to date! They ARE making positive changes!
    I am impressed!!! Their commitment, perserverance, stalwart intent, and their passion for making consumer service improvements is visible – they are living examples of improvement initiatives in action.
    Change, in any way, is not easy- and it is even more difficult to make changes from “the way things are done around here”.
    So, as the old saying goes “Keep On A-Truckin!!!”

    • Bonnie Brossart
      Bonnie Brossart
      October 26, 2012 at 10:48 am #

      Hi Betty. Your presence at these Report Outs (and supportive words like these) are great examples of the leadership our health system needs as we continue along our improvement journey. See you soon!

  5. Kyla Avis
    Kyla Avis
    October 26, 2012 at 9:02 am #

    It’s like the joke about PDSAs – Please Do Something, Anything!

    • Bonnie Brossart
      Bonnie Brossart
      October 26, 2012 at 10:44 am #

      When I find myself thinking too much (or being part of discussions where it feels like we’re doing that), I often say with my inside voice: Please Do Something. Anything.

      I think this quote: “Small deeds done are better than great deeds planned” by Peter Marshall nails it.


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