DOCTORS’ LOUNGE
(continued from page 27)
actually did the jobs were supposed to have
a loud, clear, vital and authoritative voice in
changing those processes (i.e. the opposite
of the Kremlin dictatorial Five Year Plan).
When carried out in manufacturing, quality-circle methods worked great (just look
at the success of Japanese cars in America).
In health care here, what survived after Mr.
Petersdorf ’s untimely death in 1987 was the
notion of managing a whole system at once.
Since patients are not widgets, however,
managing the variances and the outliers is
a tremendous challenge. Office staff, nurses
and doctors, and ancillary staff work with
people, not with machines – and therefore
they have to make a whole lot of independent decisions. Teaching, not blaming, still
helps, but human beings have to be in a
receptive mood to learn.
Since then, the adoption of IT has made
data management and time management
even more difficult, especially in medicine
where bad things happen to good people
fast. The latest entry in “managing health
care delivery systems” is called Design
Thinking. David Kelley out of Stanford, in
partnership with companies out of London
and San Francisco, invented the phrase in
1991 and applied his concepts to business
clients. His merged company, IDEO, is now
the industry leader in “human-centered
management,” and in the past few years
more and more health care companies have
adopted this approach.
What’s different about it is that its inventors recognized that empathy comes first:
talking to everyone involved about his or
her experience of a process is the first commandment. “How did it feel?” is the question. The emotional IQ of the experience is
what counts. Patients, staff and doctors have
been exhaustively interviewed at the Mayo
Clinic resulting in new exam room design
and flow. After getting comprehensive “experiential” input, each specific problem is
redefined; then people brainstorm ideas for
solutions. Then – the other central feature
of design thinking – prototypes are invented, to be tinkered with by all (for instance:
flow charts, making actual gadgets, writing
dialogue for encounters, role-modeling for
the workers involved in the task, workspace
changes, etc.). Initial failures are expected.
Failing over and over until the right match
is made between idea and prototype is part
and parcel of the design (an “expected variance” as Deming would say). Failing is not
grounds for reprimand or demotion or dismissal. People whose feelings are considered
carefully are far more likely to learn how to
do something differently for the good of all;