Just Do It? Don’t Forget to Then Just Study It and Just Adjust It

I had a great conversation with my fellow Lean healthcare blogger, Brian Buck, the other day. We talk about once a month or so… Brian claims I am mentoring him, but it's a great two-way exchange and discussion that I always learn from.

How Many “Just Do Its” Are There, Really?

Brian asked a really interesting question:

“How many ‘just do its' are there really in an organization?”

It's common to refer to small, simple Kaizen improvements as “just do its” because they don't require the detailed planning and time commitment you'd see in a “Rapid Improvement Event” (or whatever term you use for a weeklong event).

But “just do it” shouldn't imply that there's zero Plan.

“Just Do It” Doesn't Mean Zero Plan

There's always some Plan involved in a Kaizen, as part of a full Plan-Do-Study-Adjust (PDSA) cycle, no matter how simple the change is.

Let's pick a super simple change. Let's move the cup on a hospital lab bench that holds the disposable pipettes. There's at least a slight bit of Plan here — identifying a problem (the cup is a long reach) and thinking about what could be done about it.

I've always advocated for minimizing the amount of Plan when we have a simple change that can be tested, where the Do can be easily followed by an Undo. If it's a simple, low-cost, low-risk change that can be easily reversed, then we'd err on the side of “just do it.”

When a Change Needs More Plan

For more complicated changes, such as changing a clinical protocol, or for changes that are less easily undone, such as knocking down a wall in a nurse's station, we need more Plan.

Not too much Plan, not too little. Just the right amount for each change.

Don't Skip Study and Adjust

Even with a small amount of Plan and a quick, easy Do, we cannot forget Study and Adjust.

To repeat: do not blow through Study and Adjust.

So my modification to the famous Nike logo and slogan would be this: just PDSA it. Do it, study it, adjust it.

Even for a simple change, we still study the effects. Moving that small cup that holds the pipettes — what do employees and the team think about it? Did it improve ergonomics? Did it make work easier? Did it create any problems we didn't anticipate?

We don't necessarily need to collect lots of data for a small change. Sometimes we just know the small change was really an improvement, unless we later discover otherwise.

So, my modification to the famous Nike logo and slogan would be this:

How Do You Know a Change Is Really an Improvement?

Here's the short version of my thinking on that:

1. Can we measure something to see if the change is really an improvement? Does it benefit safety, quality, flow, or cost in a meaningful way?
2. If we can't measure it precisely, is there consensus among the employees that the change makes their work easier, or makes things better for the customer in some way?

For changes where you do have data over time, a Process Behavior Chart helps you separate signal from noise, so you can tell a real improvement from normal variation.

Adopt, Adapt, or Abandon

After we Study, we can Adjust if needed. Our next step might be to:

• Adopt the change as is.
• Adapt it, tweaking it in some way based on what we've learned.
• Abandon it, going back to try something different.

Even if we “just do it,” the Kaizen cycle does not end with Do.

Frequently Asked Questions