“We can’t solve problems by using the same kind of thinking we used when we created them.”
– ALBERT EINSTEIN
Since you have picked up this book, you are probably involved in healthcare. As such, no one needs to tell you that today’s healthcare
environment is extremely complex. It’s also dynamic and, more than anything else, it’s unpredictable. Traditional methods for improvement have a high likelihood of failure. And yet change is not an option: it’s a necessity. For the past eight years, my colleagues and I have been working with hospitals and health systems across the country teaching the principles and practices of Adaptive Design.
I started by first researching disruptive, transformative innovation and then the driving force behind the success of the Toyota Production System (TPS), all the while asking, “Could these innovation and management secrets offer anything to healthcare?” After years of study, testing, learning and improving, one realization surfaced quite naturally: Toyota’s success is not about manufacturing or managing processes. It’s about people — how they work and manage, how they think about their work, how they learn and how together they improve.
These concepts lay the groundwork for Adaptive Design.
The Benefits of Adaptive Design
Adaptive Design works as an enabling technology that continually improves an organization’s ability to deliver exactly what a patient needs while simultaneously lowering the cost of care. Viewing every employee as a valuable knowledge-worker, it revitalizes an organization so that each person becomes a skilled problem-solver. In the bigger picture, healthcare organizations trained in Adaptive Design have seen these great results:
- most improved patient satisfaction in an 17-hospital system,
- highest staff engagement scores for three years in a 12-hospital system,
- increased surgical volume by 16 percent while simultaneously decreasing surgical staff overtime by 14 percent and becoming 95 percent Joint Commission compliant, and
- self-sustaining local systems that increase productivity while simultaneously improving staff retention and recruitment.
Specifically, one Adaptive Design medical/surgical nursing unit showed
a 51 percent decrease in staff turnover within one year while simultaneously
improving financial performance by generating $1,700,000 in savings and
new revenue in a 13-month period.
CEOs who incorporate Adaptive Design build a legacy of excellence. Employees in these transformed hospitals will have their energy and commitment restored, as jobs they previously wanted to escape turn into attractive and rejuvenating opportunities.
And, while quality is being improved, these same results show that healthcare costs are being lowered. There is no tradeoff!
However, while such results are inspiring and empowering, they are not enough reason for a medical facility to incorporate Adaptive Design.
Patient Care — the Primary Focus
The only valid consideration for adopting any innovation into your healthcare organization is this: How will it affect patient care?
Adaptive Design’s primary focus is the patient. In fact, under this process the hospital becomes so patient-centered that adapting to meet patient needs is the natural, balanced, default response of everyone in the organization.
No One Can Stop Innovation, But...
Innovation will happen. For both good and bad, change is inevitable. With Adaptive Design, however, the frontline generates and management coordinates and challenges the innovation, providing structure while lowering the risks of change.
One visionary healthcare CEO confided this: “I know we have great ideas and are planning wonderful new innovations for our system. But what keeps me awake at night are my concerns that our people won’t use them effectively. Will our employees change the ways they work to make use of the innovations? And will these innovations really make a difference?”
Innovation would be easier and less stressful if leaders could be sure that all changes were improvements. And therein lies the rub.
In my research, three factors make the difference between successful innovators and those that try hard, but don’t succeed. Basically, it boils down to management’s ability to:
- make changes,
- maximize the improvements that come from the changes, and
- minimize any change-effects that are not improvements.
With apologies to a great and famous company, I call them the 3-Ms: Make changes. Maximize what works. Minimize what doesn’t.
In one way or another, all great companies find a way to do the 3-Ms. What Toyota discovered is a disciplined, structured, reproducible way to accelerate the rate of change, maximize improvements and minimize the negative effects of change. Think of it as the 3-Ms — turbocharged. Capturing that same capability to optimize improvement is what sets Adaptive Design apart from other healthcare innovations!
Why Adaptive Design Works
For now, just assume that Adaptive Design works. In later chapters I will present the research and case studies. Some folks need “to see it to believe it.” I’m waging that if you believe it, you will see it.
Adaptive Design succeeds because it is:
- a logical, direct extension of what you are currently doing — patient care — rather than some “radical” change,
- steady, progressive, sustainable growth — not a miracle or magic bullet,
- disciplined, structured, testable and verifiable — not a leap of faith,
- a rapid, measurable return on assets — not a big investment with an iffy long-term payoff, and
- “designed to adapt” — not last year’s great idea based on last year’s predictions.
A Commentary on the Future
The story in Chapter Three of patient Bill’s experience with Jane RN at St. Typical American Hospital (St. TAH’s) offers a forecast of the future. But how exaggerated was that picture?
Let’s review the surprises Bill encountered. First, management, physicians and staff were working with a single-minded purpose — Ideal Patient Care — resulting in greater quality at less cost.
Next, Bill’s experience with his reserved parking space was an initial pleasant surprise. His waiting time decreased by being assigned one personal nurse. Furthermore, the Ideal Health Card was efficient and time-saving. Overall, Bill experienced a self-reinforcing culture of effectiveness and safety, which alone diminishes a patient’s stress.
This narrative only portrays what, in fact, people working in real healthcare organizations have been quietly learning and doing for years — under Adaptive Design.
Patients like Bill could not be more pleased!
What made the difference at St. TAH? Seven things:
1. Setting a clear direction made the difference!
Everyone on the St. TAH outpatient surgical unit was focused on one thing: Ideal Patient Care. Mission and values were important, but focusing on Ideal Patient Care became the way to achieve that mission and put those values to practice every day in productive, concrete and creative ways.
As you will see later in this book, Ideal Patient Care is an inspiring and aspiring real-time management tool.
Everyone knew where they were going.
2. Immediate, systemic problem solving made the difference!
Bill was concerned about errors and felt hassled by all the system failures he had encountered the previous year. St. TAH made a difference by identifying system failures as problems to be solved now. They made high performance and innovation part of everyone’s daily work, with an operational framework disciplined and structured to solve a particular problem as near to the “snag” as possible.
Everyone became a problem solver, all the time.
3. Developing people — not things — made the difference!
Some folks believe that problem solving is about the problem. Adaptive Design would argue that it’s more about the person working on the problem. Solving problems develops people. Every problem solved by Jane RN and her co-workers and/or managers increased their skills, confidence, trust and optimism.
Adaptive Design emphasizes personal attention. It is people, after all, who make the real difference. In our story Bill was able to connect with a real person, Jane RN, whose redesigned schedule made that connection possible.
In the past 38 years, I have seen administrative duties, information technology and the constant hassle of workarounds, tradeoffs and waiting progressively replace personal connections between patients and caregivers.
St. TAH’s management reversed that trend by relentlessly eliminating administrative work and wasted time. That, in turn, created more time to focus on meeting patient needs — personally and directly.
Since everyone counts, the focus is on developing people through problem solving, to meet patient needs Ideally.
4. Simple “creative” technology made the difference!
In highly adaptive organizations (certainly Toyota is an example), technology is not “the big solution;” it is only part of the solution. It does a job.
Jim Collins, in his best-selling book, Good to Great, reports that almost never is it a big expensive technological product that moves an organization from good to great. Rather, as Collins says, small and cumulative “technological accelerators” are added over time to make a difference. But, again, they are just tools for the people who solve the problems.
For example, at this moment every hospital in America probably has access to all the simple technology needed to create, maintain and improve an Ideal Health Card. Such a card would be a technological accelerator for registration, increased safety and a platform for new business growth.
Technology is not magic; it just does a job. And why buy it when you can make it?
5. All together, problem solving + people + simple technology made the difference!
As Jane explained to Bill, the changes at St. TAH did not happen from a one-time design implementation. Instead, improvements were made and remade daily. A common strategic purpose focused with clarity and consistency empowered the knowledge, creativity and problem solving abilities of people — 7 days a week, 365 days a year.
Every employee in the outpatient surgery unit was accountable to each other for making inquiry and core business execution part of his or her daily work.
6. By relentlessly challenging what employees had already learned and always believed, cycles of increasing returns were created that made the difference!
Everyone at Toyota focuses on the return on assets (ROA), and management is relentless in its efforts to challenge each employee to improve at every opportunity.
St. TAH’s management team taught the value of ROA, demonstrated the benefits of challenging and improving, and provided the rules and support that made it all possible.
Instead of exhorting everyone to “try harder,” St. TAH’s management rekindled the latent energy and desire to improve that lies in the heart of almost everyone in healthcare. The first step down the Adaptive Design path leads to results that make a difference. And the more it’s done, the better it gets, creating cycles of increasing returns. The energy is contagious. Bill recognized it immediately when he walked through the door.
The “waits, delays, unanticipated results, obscure instructions and harried people rushing from place to place” that Bill had previously experienced became problems solved. Ambiguity, assumptions, workarounds and tradeoffs were eliminated, all as a result of Adaptive Design.
The experience of structured problem solving molded staff, physician and management attitudes and enhanced their abilities. And quick results reinforced the learning. Like flushing out small grains of sand grinding away in the wheels and gears of the system for years, patient care and safety were improved, waiting times decreased and outpatient surgery services transformed. Then, by lowering the number of patients waiting, fewer cars remained in the previously overcrowded parking lot.
No surprise, however, since all machine parts run smoother when the gears are progressively cleaned.
Soon the “buzz” spread that St. TAH was different. This led to increased patient volume. More volume — at lower cost — means higher profit and the option to decrease the cost of care.
Higher quality at lower cost and improved patient care — those are the guideposts along the Adaptive Design path and a formula for success that creates hope for patients, nurtures morale among staff, and leaves a legacy of accomplishment and success for leadership.
Management focused on developing people — not processes or things.
7. Acting your way to a new way of thinking makes the difference!
A common saying at Toyota is, “You cannot know until you see. You cannot see until you do.” Current management procedures and methods (based on the traditional industrial model) have people thinking their way to a new way of acting. In highly innovative companies, however, acting your way to a new way of thinking is the norm. Adaptive Design proves acting your way to a new way of thinking makes a difference in healthcare too!
The next chapter describes disruptive innovation — what happens when the inability to adapt to a changing environment disrupts established organizations and institutions. Using a medical metaphor, disruptive innovation is a complex but reliable symptom that signals the need for an organization to adapt and change.
Disruption is happening in healthcare now!
How good is your organization at handling adaptation and change? The path is clear. The time for change is now. You might be the next innovator to become designed to adapt.
