Several people have asked me for more specific stories about the points I discuss here. Here is an interesting experience that highlights the importance of simplicity and prioritizing in effective change efforts.
A hospital had just engaged me that in recent months had seen an increase in patient falls. Hospital leadership was highly stressed. Middle managers were trapped between competing and conflicting executive demands and a tired and somewhat demoralized staff.
Leadership wanted me to look into the situation as a communicator to try to understand what was happening and how the message of “never let a patient move unattended” was getting lost.
Multiple conversations later, patterns emerged. In the past year the hospital had initiated several committees with accountabilities for different areas of focus. There were, for example, distinct committees for quality of care, patient satisfaction, and safety.
Each committee was given clear instructions to improve the metrics associated with their area. As time went by, each committee predictably did its work. Their findings led to several new initiatives at the hospital. Some examples:
The patient satisfaction committee developed a campaign to respond within 2 minutes to any patient call light. As noise on the floor was a main source of patient dissatisfaction, they also set a clear expectation for hospital staff to respond immediately to any beeping hospital devices.
The committee for safety picked a number of items for focus, too, including the need for staff to clean up any spills immediately.
The quality committee had multiple initiatives, many of which pertained to very technical protocols of care, but two general initiatives also came forward: to renew the never leave a patient unattended campaign and to re-ignite hand washing initiatives.
Taken individually, there’s nothing to disagree with there. Each area of focus is important, even essential, to the proper functioning of a good hospital. But three subcommittees each had their own priorities and no incentive to consider their activity relative to others.
My interviews with the chief safety officer and patient-facing staff began to make the consequences of this complexity clear. In the past several months, the majority of fall incidents happened when hospital mandates came into conflict:
- “There was a machine beeping loudly on the floor. I went to turn it off, just for a second, but in that moment, the patient I was with fell down.”
- “I saw a call light go on. I knew I wasn’t supposed to leave a patient in transit, but there was no one else around. I was gone for less than a minute. When I returned, the patient had fallen.”
- “I was walking a patient, and we almost stepped in a spill. Everyone else was busy and the patient seemed steady on her feet, so I went to the nurse’s station just a few feet away to get cleanser and deal with it…”
Well-intentioned people in moments of stress were wrestling with conflicting priorities. They usually made the right decision in the moment, but multiply hundreds of care workers with thousands of patient interactions. Even the slightest ambiguity and hesitation will start to emerge as measurable incidents.
It takes a particular rigor and discipline to ingrain best-practices around the simplest of hospital protocols and make them habitual. Atul Gawande is particularly amazing on this topic. I highly recommend his book, Better.
Of course, the hospital can’t stop doing everything except preventing patient falls. Hand washing must continue to prevent hospital-born infections, faster response times to patient call lights is greatly desirable. But they can’t all be a priority for behavior change at the same time. It’s overwhelming, and when people get overwhelmed, they make more mistakes, feel more frustration, and may start to lessen their commitment to organizational priorities, and the organization itself.
When we talk about the courage of simplicity, here is a great case in point. You can imagine some of the debates that might arise were we to tell the quality committee that their well-conceived hand-washing campaign would need to wait a few months — that the hospital would tolerate status quo performance on that front while the organization worked with singular focus on improving behaviors connected to patient falls.
You may say, how can you make that choice? We can’t progress fast enough if we agree to only improve in one area at a time. What I have observed in multiple organizations is that putting focus in too many areas at the same time only creates the illusion of progress and activity. It hides accountability and makes random what any one individual chooses to prioritize in their moment-to-moment behaviors.
When you have one area of focus and a clear goal to accomplish, progress and accountability become starkly clear. With clarity comes very definable messages about success or the need to improve. Champions arise and feelings of success and accomplishment follow.
The goal is to focus on behaviors and achieve success quickly to celebrate and create positive emotional resonance. With focus and the emotional reinforcement of success, you can anchor the new behaviors into habits. The great thing about people is that once behaviors become habits, it clears room for the next priority, the next new area for unwavering focus.
Over time, you can use a “focus – reinforce – success – habit formation” formula to address every initiative as you prioritize them. Specific to the hospital, you might phase in initiatives to improve specific behaviors tied to hand-washing, spills, staff response times to call lights, and more. But to improve any one of them requires a level of courage to simplify, prioritize, create measurable accountability, and celebrate progress.