Wednesday, November 17, 2010

A New Approach to Healthcare Problem Solving

It is funny how things change our perception. I had a concept in my mind on how we should make changes to improve our healthcare system. My previous blogs ask the question, “We know what works so why can’t we just make it mandatory"?  We also know that mandatory standards fail, but why”?

As I was thinking about this question, I started listening to a WIHI audio conference that day, “The Leaders Needed for the Changes Healthcare Need.” The guests were: 

Marshall Ganz, MPA, PhD, Lecturer in Public Policy, Harvard University
Kate B. Hilton, MTS, JD, Principal in Practice, Leading Change; Leadership Coach, NHS England; Director, Organizing for Health

After this program, I started to think about how to make change in a different light. It is hard to understand the complexity that we have in our healthcare environment to be able to make successful change for improvement. Our current leadership style and culture do not support the “team” method of problem solving.  

This program was about theories of change modeled after community organizing principles that engages citizens to collaboratively work together and move to action. They talked about heuristic problem solving which is based on the things we do not know and must be learned. This is the type of problem solving that needs to occur in healthcare, we do not know the problem. How do we solve these problems as a “community” and not from the top? 

Each of us is problem solving continuously. This is what we do as a significant part of our daily jobs, but in that effort many times we each problem solve independent of one another. When this happens, there is no sharing of information or ideas, which leads to big communication gaps. Poor communication is one of the major problems in healthcare that leads to errors. 

 Marshall Ganz stated that, “Leadership is taking responsibility for enabling others to achieve purpose under uncertain conditions.” This type of leadership is not from the top down and is not defined by position. 

Both Ganz, and Hilton want to know how these principles for leadership problem solving can be applied to healthcare. 

These are the five practices in this framework:

1)    Values – Relationship building that links common values to action that is done with narratives. These narratives ask the questions of team members, what calls them to their profession and why do they care. 

2)      Relationship Values Commitment- Motivation around a shared work.  

3)      Structure- A common purpose, values, and responsibility.

4)   Strategy – How to translate the power to change. Working with teams to achieve     outcomes. 

5)      Move to Action- Measurable and visible. What gets measured gets done.

Teams are the supportive structure needed to make changes within ourselves. Ganz and Hilton suggest one way to bond teams is through stories and emotions. When teams collaborate and share stories, they connect their values and commitments are made together for quality patient care. Cognition does not move how we “ACT”; it is the emotional side and our values that are used for problem solving and decision-making. 

A collaborative team approach is not how we have been taught to interact in our healthcare environment. Training of teams is crucial and leadership is the support needed to change how we approach problems. Leaders take a new role and become learners who then teach and coach other teams. 

This is not about implementing mandates that do not work, or simply standardization or checklists. It is about creative problem solving that incorporates such things as the checklist within a new framework for change.   

To hear the complete audio program go to 

©2010 carol lepper Solutions for Lean Healthcare Inc.