I’ve been engaged in some healthy conversation with members of our Quality/Safety Department recently about how organizational change occurs at the level of the individual worker. Health care organizations have recently been looking outside ourselves to other industries for performance improvement ideas. The “Toyota model” of performance improvement is based on the teachings of Deming since the 1940s and has transformed auto manufacturing. The same principles have been used in a number of healthcare organizations in the United States to dramatically improve processes, standardizing, becoming more reliable, and reducing waste. Examples include Virginia Mason Medical Center in Seattle, and Bellin Healthcare in Green Bay Wisconsin. Our own efforts in Lean Six Sigma training and process improvement here at SVHC have improved the outcomes for care at end-of-life, with cost savings; reduced “bedsores” at Centers for Living and Rehab, and a number of other hospital processes.
When this team shows up to work on me, I want them to have a flawless execution of their process, and enjoy their work. |
So the debate is: must we change the culture (attitudes, willingness to change, engagement in process improvement, trust, team behavior) before people can participate in performance improvement and change in their work? Or whether the experience of improved work leads to the changing culture. Our health system is currently engaged in accountability training, one component of which teaches that in order to change culture, peoples beliefs need to change. And beliefs are based on experiences. so if you really wants someone to change their beliefs, they must experience something new that tells them that their previous beliefs about the organization are no longer true.
Brent James, MD, teaches that an organizational culture of safety includes an organizational commitment to detecting and analyzing patient injuries and near misses, and is a "just" culture. A "just" culture has also been described as a learning culture. He distinguishes this from cultures that are "pathologic" (shoot the messenger), and those that are" bureaucratic"(write a new rule). A learning culture understands the broader implications of patient injuries or near misses and generalizes. To generalize requires standardizing a process and improving it.
So the dialogue I have been having (and I will upload a couple comments from my colleagues) surrounds where to focus the energy. Can one "teach" a new culture? Or does one experience a new culture because processes and behaviors have changed? I think one has to "teach" that there are behaviors that are more effective (like asking for feedback and really listening), but that in the end it is the experience of the improved process in the workplace and improved behaviors in the workplace that changes the culture. Our health system is on that journey, and has experienced dramatic improvements in infection rates, complicaiton rates, and mortality. Now we need to unleash the energy of every person who works here to be able to help the organization standardize and improve their own work process, just as Toyota has done with cars.
Read No Satisfaction, the complete article on the Toyota method that appeared in Fast Company Magazine.