Phil's Four Principles

As I have worked with physicians on large, complex health care projects these past 20 years, I have come about four principles that have consistently guided successful projects. Let me explain each of them:

1. Every day, every person in health care comes to work planning to do their best for the patients.

People get into health care because they have a passion to make a difference. They study hard, they work hard, and they understand the high stakes of dealing with life and death issues. No one comes to work wanting to commit an error, omit some treatment, or to do less than his/her personal best. Yet each human being is capable of making an error, even on a good day. Fortunately harm rarely occurs from a single person making a single error. Most harm, in my experience, occurs when a cascade of errors occur, processes are lax, and/or procedures are not followed. Health care has made great strides in the past 20 years to create better systems, to simplify processes, and to provide error trapping (e.g. alerts). One thing is clear, people in health care suffer a personal, emotional cost whenever an error occurs, especially if a patient is harmed. The person who does set out to do harm, is a very rare exception to the norm. Two points come out of this issue, 1) don't ever communicate that you are engineering a new process to make it "idiot-proof", and 2) while patient safety
and great outcomes are important to everyone in health care, this principle is often trumped by principle #2 below.

2. Every day, every person in health care comes to work listening to the same radio station, WII-FM.

WII-FM of course is the abbreviation for "What's in it for me?". While everyone in health care is passionate and committed to a good patient outcome, it is important to realize that every new advancement, every new process, must add some personal benefit to the person expected to adopt it. As we adopt new processes and new technologies, it is critical to clearly communicate what the benefit will be to the individual who is asked to change. This might include: a more efficient process, new cues, less effort, or incentives, to name a few. Of course each person in health care comes to work with principle #1. But it's principle #2 that smooths adoption and creates lasting change.

3. Automating broken processes gets you to the wrong place quicker - but then you can fix it.

Many think that new technology is often the solution to things that are no longer working in an organization. Take automating clinical processes as an example. Many clinical processes are inherently inefficient and needlessly complex. Often there is no acknowledgement of this because the process crosses the paths on many different individuals in many different locations or departments. In fact, flowcharting the process often reveals issues that have persisted for years. Often, the person in the midst of the complex process knows what they do, and a little bit about what the persons immediately before and immediately after them in the process. Yet there may be five or more hand-offs before the process is completed. Automation often eliminates several steps and may permit more "transparency" about the process. It is very common that the first result of automation is that it quickly uncovers the flaws. This can be very embarrassing to those who led the effort to automate. The good news is that the broken process is very obvious to all, and needs to be resolved quickly in the new environment. This allows the broken process to get addressed, and an improved solution results.

4. Today's problems were yesterday's solutions. 

I started using this phrase over 30 years ago while in college and it has always kept me humble. (I honestly don't know if I coined it or heard it back then.) It is important to recognize that in one's efforts to fix some obvious issue or problem, a new (not so obvious) problem often results down the road, and a more complex one at that. As Einstein said, "We cannot solve our problems with the same thinking we used when we created them". Always recognize that in the rush to solve problems, one may create unintended consequences which may not even be apparent for some time. Therefore, look for iterative solutions to complex problems. Don't expect solutions to come easy or be simple. And don't expect to have all the answers up front. Do your initial analysis, move forward cautiously, then identify where sequential adaptations and improvements (enhancements) need to occur. Two points of danger occur: analysis paralysis - in which you never move forward until you have everything perfectly figured out; and foolhardy implementation - rushing in with your "perfect" solution, only to find that you are in over your head with an unworkable solution.