For the last several postings I have been writing about two healthcare organizations (one based in St. Louis and one based in Pittsburgh) who have dramatically improved their quality of healthcare. And as I have mentioned, the information presented here is from a book entitled The Nun and the Bureaucrat by Louis M. Savary and Clare Crawford-Mason. In this posting I want to present what their leadership learned and something the authors term as going for the theoretical limit.
Paul O'Neil, a former bureaucrat (Treasury Secretary) and CEO of Alcoa was the CEO of the Pittsburgh based organization, PRHI, and Sister Mary Jean Ryan, a nun, was the CEO of the St. Louis based organization, SSM when these improvements began. As the authors tell us, "It's difficult to think of two people who came from more different backgrounds, yet they both reached exactly the same realization. Each hospital is a system, not merely a collection of departments. To heal a hospital requires three things. First leadership; it is the role of the leader to establish goals that everyone can relate to. Second, the aim of any healthcare system must be continually improving patient care. PRHI called it "perfect patient care." SSM called it "exceptional patient care" aiming for the 99th percentile. Third, a leader - and as many others as possible - needs to be a systems thinker."
The authors go on the list important leadership points to remember that apply to no only healthcare organizations, but to organizations of all types:
- Leaders create the vision.
- Hierarchy in the traditional sense essentially disappear.
- Leaders change from boss to mentor, facilitator and supporter.
- Leaders work alongside other staff primarily as stakeholders and promoters of the corporate vision.
- Leaders become continual learners and involve everyone in the transformation.
- Leaders insure that everyone has the proper tools and training.
So what did they mean by the expression, going for the theoretical limit? Both PRHI and SSM Healthcare chose to set their goals at zero deaths from hospital-acquired infections, zero medication errors, and zero medical mistakes. They both realized that they might not ever reach such lofty goals, but they also concluded that they could not, morally or ethically, set their sights on anything less than perfection. Their goals were dramatically different from the old "zero defects" slogan of manufacturing from the 80's and 90's because they viewed them are merely slogans without methods to achieve them.
While Paul O'Neill was the CEO of Alcoa he developed his theoretical limit for safety as zero accidents and zero safety incidents throughout Alcoa's hundreds of plants and offices around the world. He didn't want to be the "best in the industry" because he felt that wasn't good enough. All around him thought it would be impossible to make safety perfect, but he was undeterred. O'Neill knew he wouldn't achieve perfection, but he never wavered. O'Neill's commitment paid off as during his last year at Alcoa, out of the entire 140,000 Alcoa employees worldwide, there were fewer than 15 safety incidents, To put this achievement into perspective, statistically speaking, on average, it would take 700 years before any incident would be subject to a lost workday because of an accident.
No, they haven't achieved perfection yet at either of the two healthcare organizations, but by the mere fact of striving for the seemingly impossible and having all of the employees focused on it is an absolute necessity if the new level of improvement is to come close to their goals. Both of these healthcare organizations have made amazing progress and will continue to do so because leadership is fully supportive and passionately involved.
The authors point out seven important things to remember on this part of the improvement equation:
- The theoretical limit gives great momentum for improvement.
- The theoretical limit brings the long term goal into focus.
- The theoretical limit is possible only in theory - 100 percent perfection.
- Because of continual change and possibilities for improvement, the vision must be ever-flexible in using new information at that moment.
- Perfect patient care, if or when it can be achieved, will only last until new knowledge, new skills or new goals makes today or yesterday's perfection obsolete.
- Reaching zero errors is an important and necessary step toward the theoretical limit of "safest organization to work for" or perfect patient care," but zero errors and the theoretical limit are not the same thing. The theoretical limit is an idea e.g. "exceptional healthcare," that may change and develop with increasing knowledge and continual improvement.
I think the important lesson here is, set your goals high.....maybe even radically high. Instead of trying to achieve 5 or 10 % improvement, why not shoot for 100 % improvement?
Bob Sproull
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