Bridging The Gap Betwixt Planning Together With Reality
Monday, October 2, 2017
Over 2 years ago, the folks over at the athenahealth kindly invited me to submit columns to their Health Leadership Forum, together with I accept done thence on an occasional footing since them. As I of late reviewed the columns, I realized that my ain thoughts on the topics of leadership together with coaching accept evolved a bit, together with I idea my readers over hither at Not Running A Hospital mightiness savour witnessing the transition. So for several days, I volition endure reprinting the posts from the Forum over here. Comments are welcome at the master copy site together with here. Today's reprint is from a post service dated Dec 17, 2013, "Bridging the Gap Between Planning together with Reality."
A colleague i time said, “Every computer program is excellent, until it’s tested. It’s execution that’s the problem.” And thence it is.
Clay Shirky wrote an excellent article nearly the gulf betwixt planning together with reality. Although the focus was on the misadventures of Healthcare.gov, the the U.S. government’s insurance telephone commutation website, the broader lessons that he presents are worthy of consideration inwards many other settings.
Shirky notes: The administration question, when trying anything new, is “When does reality trump planning?”
In the illustration of Healthcare.gov:
For the officials overseeing Healthcare.gov, the preferred answer was “Never.” Every fourth dimension in that location was a run a jeopardy to do about assort of populace experimentation, or fifty-fifty only about clarity nearly its methods together with goals, the imperative was to deny the opposition anything to criticize.
Failure is ever an option. Engineers operate every bit hard every bit they do because they sympathise the jeopardy of failure. And for anything it mightiness accept meant inwards its screenplay version, hither that sentiment way the opposite; the unnamed executives were maxim “Addressing the possibility of failure is non an option.”
Project advocates locomote into every endeavour amongst a theory of the case, a vision of how things should be. But, every bit my slow colleague Donald Schön noted, reflective practitioners are constantly reviewing the evidence to modify their framework inwards response to reality.
A comment on Shirky’s article summarizes this nicely:
“Any personal persuasion y'all had given actually doesn’t hateful anything.” This is the key regulation behind making anything operate good — from writing an essay to edifice a distich to creating a website. If it doesn’t work, throw out your preconceptions together with re-conceive.
There is a cognitive footing for our failure to endure reflective practitioners. We are all people of habit. The attributes that permitted us every bit cavemen to recognize the saber-toothed tiger the mo fourth dimension nosotros saw it together with to respond inwards the appropriate way (“Run!”) operate good inwards the highly simplistic natural world. In a Darwinian sense, nosotros evolved perfectly for that world. We developed a learning vogue that gave us a competitive evolutionary advantage, a learning vogue based on memory, stubbornness, together with animal force.
But the to a greater extent than hard dry soil of complex organizations — overladen amongst political, organizational, together with cultural forces together with amongst technological challenges — presents an surroundings inwards which those cognitive attributes directly introduce every bit cognitive errors. We grapple amongst this. Indeed, every bit MIT professor Rosalind Picard has outlined, successful learning has 3 phases: interest, distress, together with pleasure.
We experience distress inwards the mo stage because it is during that component subdivision of the bicycle that nosotros must overcome our prejudices together with develop a novel framework inside which to proceed. We resist. Sometimes nosotros recognize that nosotros accept striking a plateau together with take away to adopt a novel approach to proceed. Sometimes nosotros don’t recognize that our framework is flawed together with nosotros uselessly continue apace, until disaster occurs or a competition outruns us.
Learning Organizations & Lean Philosophy
Places that are truthful learning organizations accept built inwards a construction that calls the inquiry early on together with often. One such construction (but non the only) is offered past times the Lean philosophy. By encouraging front-line staff to telephone phone out problems they run into inwards their daily life, managers are given real-time signals every bit to flaws inwards their organization’s processes. The leadership squad thence visits the sites of the flaws together with invents experiments to accomplish incremental improvements inwards operate flow. Using the scientific method, those experiments are tested together with evaluated, amongst redesign beingness a constant role of the process. Lean organizations sympathise that in that location is no grouping of key planners clever plenty to pattern an optimum complex process. Lean leaders do non lack for a potent purpose—indeed audacious goals are favored—but neither do they lack humility.
Lean together with other similarly designed organizations tin exclusively be where the senior leadership is a potent advocate for the proffer that reflective practise is the best way to accomplish outstanding functioning for their customers. The leaders of such organizations embed that modesty together with reflection inwards every facial expression of their lives.
I’ve had the pleasance of visiting a release of hospitals that operate along these lines. The results are palpable — amend service to patients, higher quality, less waste, together with to a greater extent than staff satisfaction. Such results are irrespective of the type of payment regime employed to compensate the doctors together with the hospital. They are irrespective of the societal degree of wellness care, endure it a national populace scheme or a dispersed individual pay system.
Such hospitals rest anomalies inwards their industry, although the release is growing. Adoption tends to centre inwards systems amongst a potent communitarian spirit, where the trustees together with clinical together with administrative leaders see their chore mainly every bit providing a populace service every bit opposed to supporting the personal together with institutional prerogatives of physicians. Thus, acre a few academic medical centers accept gotten on board, many accept not, trapped past times age-old patterns of deference to the doctors. Ironically, inwards those academic medical centers that accept adopted Lean or a like approach, physicians written report tremendous satisfaction from their engagement amongst procedure improvement together with from the enhanced feel of teamwork amongst members of the staff throughout the hospital.
The immature cadre of rise wellness attention leaders I consider when I address clinical together with administrative grooming programs, together with when I verbalise at conferences together with inwards infirmary settings, sympathise that the futurity is brightest for learning organizations. They thirst for experience inwards trying out these approaches, together with they intend to Pb inwards the way of reflective practitioners. I tell to electrical current wellness attention leaders, when y'all uncovering i of these rise stars, select handle of him or her for your place. They are going to learn y'all something special.
A colleague i time said, “Every computer program is excellent, until it’s tested. It’s execution that’s the problem.” And thence it is.
Clay Shirky wrote an excellent article nearly the gulf betwixt planning together with reality. Although the focus was on the misadventures of Healthcare.gov, the the U.S. government’s insurance telephone commutation website, the broader lessons that he presents are worthy of consideration inwards many other settings.
Shirky notes: The administration question, when trying anything new, is “When does reality trump planning?”
In the illustration of Healthcare.gov:
For the officials overseeing Healthcare.gov, the preferred answer was “Never.” Every fourth dimension in that location was a run a jeopardy to do about assort of populace experimentation, or fifty-fifty only about clarity nearly its methods together with goals, the imperative was to deny the opposition anything to criticize.
Failure is ever an option. Engineers operate every bit hard every bit they do because they sympathise the jeopardy of failure. And for anything it mightiness accept meant inwards its screenplay version, hither that sentiment way the opposite; the unnamed executives were maxim “Addressing the possibility of failure is non an option.”
Project advocates locomote into every endeavour amongst a theory of the case, a vision of how things should be. But, every bit my slow colleague Donald Schön noted, reflective practitioners are constantly reviewing the evidence to modify their framework inwards response to reality.
A comment on Shirky’s article summarizes this nicely:
“Any personal persuasion y'all had given actually doesn’t hateful anything.” This is the key regulation behind making anything operate good — from writing an essay to edifice a distich to creating a website. If it doesn’t work, throw out your preconceptions together with re-conceive.
There is a cognitive footing for our failure to endure reflective practitioners. We are all people of habit. The attributes that permitted us every bit cavemen to recognize the saber-toothed tiger the mo fourth dimension nosotros saw it together with to respond inwards the appropriate way (“Run!”) operate good inwards the highly simplistic natural world. In a Darwinian sense, nosotros evolved perfectly for that world. We developed a learning vogue that gave us a competitive evolutionary advantage, a learning vogue based on memory, stubbornness, together with animal force.
But the to a greater extent than hard dry soil of complex organizations — overladen amongst political, organizational, together with cultural forces together with amongst technological challenges — presents an surroundings inwards which those cognitive attributes directly introduce every bit cognitive errors. We grapple amongst this. Indeed, every bit MIT professor Rosalind Picard has outlined, successful learning has 3 phases: interest, distress, together with pleasure.
We experience distress inwards the mo stage because it is during that component subdivision of the bicycle that nosotros must overcome our prejudices together with develop a novel framework inside which to proceed. We resist. Sometimes nosotros recognize that nosotros accept striking a plateau together with take away to adopt a novel approach to proceed. Sometimes nosotros don’t recognize that our framework is flawed together with nosotros uselessly continue apace, until disaster occurs or a competition outruns us.
Learning Organizations & Lean Philosophy
Places that are truthful learning organizations accept built inwards a construction that calls the inquiry early on together with often. One such construction (but non the only) is offered past times the Lean philosophy. By encouraging front-line staff to telephone phone out problems they run into inwards their daily life, managers are given real-time signals every bit to flaws inwards their organization’s processes. The leadership squad thence visits the sites of the flaws together with invents experiments to accomplish incremental improvements inwards operate flow. Using the scientific method, those experiments are tested together with evaluated, amongst redesign beingness a constant role of the process. Lean organizations sympathise that in that location is no grouping of key planners clever plenty to pattern an optimum complex process. Lean leaders do non lack for a potent purpose—indeed audacious goals are favored—but neither do they lack humility.
Lean together with other similarly designed organizations tin exclusively be where the senior leadership is a potent advocate for the proffer that reflective practise is the best way to accomplish outstanding functioning for their customers. The leaders of such organizations embed that modesty together with reflection inwards every facial expression of their lives.
I’ve had the pleasance of visiting a release of hospitals that operate along these lines. The results are palpable — amend service to patients, higher quality, less waste, together with to a greater extent than staff satisfaction. Such results are irrespective of the type of payment regime employed to compensate the doctors together with the hospital. They are irrespective of the societal degree of wellness care, endure it a national populace scheme or a dispersed individual pay system.
Such hospitals rest anomalies inwards their industry, although the release is growing. Adoption tends to centre inwards systems amongst a potent communitarian spirit, where the trustees together with clinical together with administrative leaders see their chore mainly every bit providing a populace service every bit opposed to supporting the personal together with institutional prerogatives of physicians. Thus, acre a few academic medical centers accept gotten on board, many accept not, trapped past times age-old patterns of deference to the doctors. Ironically, inwards those academic medical centers that accept adopted Lean or a like approach, physicians written report tremendous satisfaction from their engagement amongst procedure improvement together with from the enhanced feel of teamwork amongst members of the staff throughout the hospital.
The immature cadre of rise wellness attention leaders I consider when I address clinical together with administrative grooming programs, together with when I verbalise at conferences together with inwards infirmary settings, sympathise that the futurity is brightest for learning organizations. They thirst for experience inwards trying out these approaches, together with they intend to Pb inwards the way of reflective practitioners. I tell to electrical current wellness attention leaders, when y'all uncovering i of these rise stars, select handle of him or her for your place. They are going to learn y'all something special.