- Traditional Change Models
- Disparate Change Groups
- Uncontained Change
- No Standard Change Approach
- Tools Focus
- Reliance on Benchmarking
- Changes Are Not Based On Data, Good Data, Or The Right Data
- Changes Made Based On Symptoms, Not Causes
- Systems Versus Processes
- Focus On People, Not On Process
- Lack of Context for Solutions
- Adding Versus Subtracting (Patching)
- Poor Implementation
- No Emphasis On Control
- Management Versus Leadership
Reliance on Benchmarking
Very few processes anywhere in healthcare are good from end to end. Admittedly there are pockets of good performance out there, but under scrutiny it’s generally found that the performance is due to the people involved, not the robustness, reliability, and clarity of the process. High performance is related to high-performing teams working extremely hard to maintain it. These teams often exhibit high stress, burnout, and high turnover. Once the team lead goes home or, worse still, leaves the organization, performance quickly returns to typical levels. Let’s face it—we’re working hard, not smart.
And yet, unbelievable as it may seem, healthcare organizations still choose to use the copycat approach as their most important concept ideation tool.
Benchmarking is seen as a solution to problems, and yet the benchmarking undertaken is often without the context of understanding the existing process, its customers, and its suppliers. It is also not often done with the depth of understanding required of the “better” process. This process may in effect be serving a different market, with a different volume and mix of patients, organizational setup, staff, and physicians, and yet it is lifted and copied as is (in a complete unit) to replace an existing process, which sometimes is better.
For some, a full-time role is to benchmark others and find “best practice.” The overlooked flaw here is that what might be best practice for others may not be for us. What is deemed an evidence-based answer is just that, an answer. The problem is that it might not be an answer to our question.
For some, the primary focus is to be a benchmarked organization. In the modern healthcare market it is in fact beneficial to be seen to be successful, which yet further propagates this activity. Whole conferences (very large ones at that) are set up to encourage sharing and testing others’ processes. As one patient I spoke with so succinctly put it, “Fine, but don’t test it out on me!”
For some reason this seems to be a particularly difficult truth to accept. In one prestigious health system I visited, a quality leader threw her hands in the air in exasperation and surprise that benchmarking isn’t the primary solution generator in more advanced change methodologies such as Lean Sigma.
This steadfast belief in the grass being greener on the other side of the street further drives the 1-sigma churn. For every new benchmarking conference, staff members bring back someone else’s process, overwriting again and again their own process without context or control.