My mom is a retired public school elementary teacher, so I’ve heard plenty of stories about bad management decisions within a school system and other craziness that runs the risk of crushing souls… but thankfully my mom (and so many other teachers) are strong people and they can put up with it because their work is so important. That reminds me of nurses and others in healthcare who can persevere in bad systems because of their passion for patients.
This opinion piece in the WSJ (“Deborah Kenny: Why Charter Schools Work“) had some interesting thoughts about good organizational culture – ideas that apply, really, in any environment… and it raises questions about the balance to be found in “standardized work” and how it comes to be.
From the piece, Kenny writes that autonomy and freedom (freedom from union rules and other restrictions) lead to success:
Freedom without accountability is irresponsible. Like all professionals, educators need to be accountable for the results of their work. Yet accountability without freedom is unfair: How can teachers or principals be held responsible for results if they don’t control decisions about curriculum or teaching methods? Accountability and freedom do not guarantee that a school will provide an excellent education, but they are prerequisites.
There are parallels to discussions about “standardized work” in healthcare. Physicians are taught to prize their autonomy… but is “freedom without accountability” just as irresponsible in healthcare? If a surgeon wants to do things a certain way, are there measures (such as infection rates and mortality) that indicate if they are doing a good job or not?
“Accountability” is often a loaded phrase (when used by people looking to punish people who deliver bad results), as medicine (like education) is more of a team effort than anything. Can we hold a teacher or a doctor “accountable” in isolation when they are part of a system?
The article talks about how teachers enjoy having the freedom to decide how to teach, as long as goals are being met (measured, though, through standardized tests?). How effective is the measurement system in education? We don’t want teachers to have a lot of freedom in HOW they “teach to the test” since we’d hopefully aim higher than just teaching to the test.
How effective is the measurement system in healthcare? Where do we strike the balance between freedom and autonomy (for employee satisfaction) and the need to education students and treat patients (without harming them)?
From the article, about a charter school environment.
We give our teachers an enormous amount of autonomy, and that ignites their passion. They feel happier because they no longer have to endure the demoralizing impact of working with people who are lazy, who gossip and complain, or who don’t believe in the potential of the children. Autonomy inspires teachers to be more creative and feel more committed. As one of our reading teachers, Michelle Scuillo, put it: “My old school made me tired and depleted. I understood why so many smart people leave teaching. I have to admit that I stopped putting my best effort into my lessons. I was ready to change professions, which was devastating for me, because in my heart I wanted to be a teacher.”
People in healthcare are often already tired and depleted. Just as teachers get worn down by top-down standards and teaching methods (dictated by leaders or outside consultants), we don’t want to wear down people in healthcare with overbearing or inappropriate standards. Standardizing methods can lead to so many great results: better patient safety, better quality, shorter waiting times, lower costs… but we have to work toward more standardized processes in a way that isn’t demotivating or soul crushing.
That’s why Taiichi Ohno’s wisdom is still applicable today – standardized work should be written by the people who do the work. Standardized work should support them in meeting their objectives while ensuring the best possible results for the customer (student or patient).
I’ve seen where having freedom to create standardized work (and to improve it over time) is very energizing for healthcare workers and clinicians. Top-down, dictating standards cause resentment, fatigue, and frustration. A team defining their own standardized work doesn’t mean everybody gets to reinvent the wheel each time – it means they come to agreement about WHAT should be standardized and how standardized it should be… and when it’s reasonable and helpful to use judgment to violate those standards.
From the article, again:
“Here I am given the opportunity to innovate with projects I never could have done in a bureaucracy,” said one of our art teachers, Mary Ann Paredes. “In my old school I had a feeling of stagnation and lost my intellectual rigor. Here I’ve been invited to explore and learn in a way that is making me more effective. Because the trust level is so high here, it’s easy to be open to admit my frustration and ask for help.”
The process of “kaizen” (continuous improvement) means that people get to explore and learn as they improve in a scientific way. That’s highly engaging.
One other piece of the puzzling in the successful charter schools seems to be the leadership style (at least as described in the piece):
Our principal had observed Steve struggling but had also gotten to know him during faculty retreats and meetings, and saw that he embraced our values of accountability and hard work. The principal took Steve out for dinner and offered encouragement and practical pointers. “I’ll remember that conversation for perhaps the rest of my life,” Steve later recalled. He went on to become a top performer. Not only did 100% of his eighth-graders score proficient on the state math test, but 100% of those eighth-graders also passed the Algebra Regents exam, which is usually taken by students in high school.
Instead of just punishing or browbeating the teacher, the principal took time to get to know the teacher… being a coach and an adviser. That seems like great leadership, to me.
What lessons do you draw from the op-ed piece (realizing it might be hidden behind a paywall for many of you)?
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 Executive Guide to Healthcare Kaizen. Mark is also the VP of Customer Success for the technology company KaiNexus. He lives in San Antonio, Texas.