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This chapter is from the book

Focus On People, Not On Process

Similar to systems thinking, there is also a tendency to think that solutions will be found in the people, not the process. A number of approaches from improvement to communications methods, teaming, leadership, people management, time management, and so on are undertaken with the naïve hope that these will change the fundamental physics of the process. Not surprisingly, without changing the processes, everything from a performance perspective effectively remains the same, barring minor short-lived incremental improvement. With no significant shift in performance, leadership over the process is often replaced (remember, the focus is on people versus the process), and the next installed leader adds his or her patches and tweaks (propagating the 1-sigma churn). This revolving-door practice is very common in the higher-stress areas of hospitals, particularly in surgical services and emergency departments. The churn is broken only when a leader has the insight or foresight to take apart the process.

This is not to say that people aren’t important in process improvement, but as will be described in Chapter 2, the initial focus should be on the physics and engineering of the process: the mechanics, activities, layout, triggers, flow, roles, accountabilities, and metrics. The softer elements of communication, teaming, and leadership will come into play once the fundamentals are in place. In effect, by focusing on the people first, we’re “coming in from the wrong end.”

Let’s imagine taking the people to one side. The process is what remains. If it is missing, disconnected, broken, misaligned, or flawed in any way, when we layer our people back onto it, we frustrate them and they have to become inventive to work around the process. Our most valued asset, our people, is successful despite our processes, not because of them.6

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