Bad Systems Beat Good People

W. Edwards Deming said, "A bad system will beat a good person every time."  He was right.  Three executive leaders from the Institute for Healthcare Improvement (IHI) (Kedar Mate, Josh Clark, and Jeff Salvon-Harman) recently wrote a digital article for the Harvard Business Review ("To Improve Health Care, Focus on Fixing Systems - Not People") that emphasizes this exact point.  While a number of health care organizations have adopted management strategies such as the Toyota Production System, Lean/Six Sigma, and High Reliability Organization principles, most of these efforts have unfortunately met with either limited or temporary success.  Mate, Clark, and Salvon-Harman studied a number of industries outside of health care, including not only the prototypical High Reliability Organizations in the nuclear power industry, commercial aviation, and U.S. Navy, but also highly performing organizations such as Amazon, Ritz Carlton, and the Cheesecake Factory.  They found that all of these organizations have "focused less on trying to get more from their workforce and more on trying to maximize what they can get from the system."  Importantly, improvement work is considered part of everyone's daily work.  

Maureen Bisognano, a senior fellow at IHI said, "Everyone in health care has two jobs: the job that they were hired to do and the job of making it better."  Mate, Clark, and Salvon-Harman argue that these are the same job as part of a culture of continuous learning and improvement.  A critical component of this kind of culture, however, is having leaders within the organization working to eliminate roadblocks and overcoming organizational inertia.

Leaders in these highly performing organizations spend time on the front lines seeking feedback on how they can redesign daily operations to make their workers' jobs easier and more efficient, which invariably also leads to improved output from the system.  While leaders within these organizations have customized what Mate, Clark, and Salvon-Harman refer to as the operating system to the needs of their customers and workforce, all of these organizations share a few key features.  First, they deeply value both the commitment and passion of their workforce to achieving the mission of the organization.  Second, they understand that organizations can be highly complex and that complex organizations require a system that supports its workforce.  Third, they recognize that efforts to improve culture are meaningless unless there are strong systems that enable the kind of culture that they are trying to build.  As Mate, Clark, and Salvon-Harman suggest, "Seeking a transformed culture without building the systems that enable it is like trying to create music without instruments."  Fourth, and this is particularly important in my mind, they recognize that a "silo mentality" is not conducive to a highly performing organization.  For health care organizations in particular (which were the focus of the article), safety, quality, equity, efficiency, and experience are viewed as important components of a single, integrated, and highly coordinated operating system.  Lastly, the leaders of these organizations believe in true transparency, reporting their outcomes not only internally but also externally as well.