On his blog, John Toussaint shared this letter from ThedaCare CEO Dean Gruner to all employees. Toussaint said the letter is inspired by Paul O’Neill and his thoughts on patient safety (you can hear my podcast with O’Neill here, as well as a podcast with Dr. Gruner).
Can download the Word document from the Center blog and I’ll share some highlights below.
Dean starts the letter with:
For about a year now, several members of our team have been having conversations about what is possible, what is likely, and how we use the words “goal” and “target.” Much of this started when we had a conversation with Paul O’Neill, U.S. Treasury Secretary from 2001-2002 and former Alcoa CEO. Paul was insistent to the point of almost being annoying! He kept saying, “The goal must be zero.”
Gruner explains the difference between their “target” (50% reduction in infections) and their “goal” — zero.
Setting goals or targets does nothing to create improvement, in and of themselves. Goals can be inspiring – who wants to see a patient suffer through a painful infection? Targets, used in the wrong environment, can be incredibly dysfunctional.
If people have a target and they fear being punished or fired for not meeting that target, all sorts of dysfunctional things can happen. Dr. Deming famously told a story about a factory that was offering a prize for workers if there were zero injuries (or some such target). What happened was simple and understandable – people just stopped reporting injuries. That’s not real improvement. And we have to be careful for the same thing in healthcare. Read about what happened in the British NHS when fear of targets led people to game the system.
From my visits to ThedaCare, my hunch is that their use of targets and goals will not be punitive. It’s more likely to drive improvement than fear because they also have a METHOD for improvement – Lean and the ThedaCare Improvement System. Dr. Deming used to ask, “By what method?” ThedaCare has a method and I think they have the right culture for improvement, a culture they are tirelessly working to improve.
Dean ends his letter with the following:
To me, this goal of zero is very motivating because it reminds all of us of what we would want for ourselves, our families and friends. Yes, it is very daunting and we will not get there as quickly as we might like. In fact, for some of our work we might never get to zero. But by choosing the right goal we will work like heck to improve our performance year over year and achieve progress that we otherwise might never dream of. So to be clear and unambiguous, the goal is zero defects and the target is improvement. Let’s use these words properly as we go forward so we know what each other is talking about.
It’s not just the words – it’s the culture and the mindset that creates improvement instead of fear.
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