Sunday’s Dilbert was a brilliant (if not harsh and mean) indictment of the idea that an organization and its leaders can have 25 “focus areas” in a given year. The pointy-haired boss, of course, proclaims 25 focus areas for the year… as with many Dilbert strips, it’s funny because it’s true (as Homer Simpson says).
How common is this thinking in our organizations, including healthcare?
It’s not uncommon for a healthcare organization to have 25 (or more!) objectives for a year. Even calling them something like “focus objectives” does nothing but create a bit of a joke. If we focus on everything, we’re not really focused on anything.
It’s a point that John Toussaint, MD makes in his first book, his blog, and in the DVD “Thinking Lean at ThedaCare: Strategy Deployment.”
Sometimes, when it comes to goals and objectives, less is more. By focusing on a small number of high-level objectives and by focusing on key projects (the large ones at the systemic and organizational level), we can actually accomplish some things and move on to the next. It’s better to get something done than to get nothing done, which is often the case when our focus is spread too thin.
When we first started on this journey our consultants initially challenged us to get our core measurements to the two or three things that really mattered. We argued about this for three days. How could we possibly distill the complexity of the business to only three things? We were quite proud of our first attempt. We decided there were three things that were really important on our journey to transform ourselves. The three things were meeting budget, achieving 95% performance in the country on all quality indicators and having all our staff members on Kaizen events (Kaizen is defined at ThedaCare as 5-day activities during which staff are taken off of their daily work to study their work and make suggestions as to how to improve and then these improvements are rapidly implemented over the next week).
As the years went by and we better understood our business we were subsequently embarrassed by our first attempt at True North. Meeting budget for example, had nothing to do with year-over-year improvement because the budget was re-set every year with higher expense levels than the year before. 95% performance on quality indicators left our patients still receiving many defects as the entire industry was poorly performing on medication errors, infection rates, and other defects. Having people on improvement events was a good idea but were we instilling the culture of continuous improvement by only doing events?
Toussaint and the leadership refined their “True North” to high level goals that could better inspire change and improvement.
As you look into 2012, do you have 5 goals or 25 goals? What’s your reflection on those goals, the number, and their achievability? Has your organization scaled back to a smaller number of objectives?
About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the Chief Improvement Officer for the technology company KaiNexus.