I continue to be amazed at the creativity some people have. I’ve even heard some staff boast that they were “The Kings and Queens of Workarounds” because they knew how to get things done through back channels, crisis management, and personal connections that were never listed in any procedure manual. They are too busy to follow the established procedure, which “may look good in some book but doesn’t work in real life!”

I believe that one reason for this is that people lose sight of the reason they are providing the care. In handling patient issues on adaily basis, the issues become “routine” for the healthcare providers, and patients become “workload.” That’s why you may hear staff complaining that a certain patient pushes the call light too frequently, for example. Most people will seek the “least effort method” – whatever causes them the least effort is their own most efficient process – and they don’t stop to think about the impact of their personal changes on the rest of the process flow.

I was involved in a Rapid Improvement Event recently where we queried the Human Resources folks about the customer of their nurse hiring process. The voting tallied pretty evenly at 50% for nurse candidates; and 50% for nurse managers. We had to dig a little deeper to get the “aha” moment of the true customer: our patients, who need nurses to provide appropriate clinical care; and the faster we fill vacancies, the better staffed our hospital units are, and presumably the better care we can provide to our patients.

Why did this take 15 minutes of discussion? Because the group was focused on the workload of hiring a nurse, and not the outcome. The re-focusing exercise helped the group to break some log-jams during the RIE when we looked at a few sacred cows.

Part of our work, as J P Spencer wrote in his August 25 blog, is to be change agents as well as statisticians. Helping our improvement teams to remember the difference between their calling and their workload is an essential part of that job.

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