The more fundamental the improvement the more people are affected. The more people involved the greater the psychological inertia. The greater the resistance the longer it takes to show tangible effects.
The advantage of deep-level improvement is that the cumulative benefit is greater – the risk is that the impatient Improvementologist may give up too early – sometimes just before the benefit becomes obvious to all.
The seeds of change need time to germinate and to grow – and not all good ideas will germinate. The green shoots of innovation do not emerge immediately – there is often a long lag and little tangible evidence for a long time.
This inevitable delay is a source of frustration, and the impatient innovator can unwittingly undo their good work. By pushing too hard they can drag a failure from the jaws of success.
Q: So how do we avoid this trap?
The trick is to understand the effect of the change on the system. This means knowing where it falls on our Influence Map that is marked with the Circles of Control, Influence and Concern.
Our Circle of Concern includes all those things that we are aware of that present a threat to our future survival – such as a chunk of high-velocity space rock smashing into the Earth and wiping us all out in a matter of milliseconds. Gulp! Very unlikely but not impossible.
Some concerns are less dramatic – such as global warming – and collectively we may have more influence over changing that. But not individually.
Our Circle of Influence lies between the limit of our individual control and the limit of our collective control. This a broad scope because “collective” can mean two, twenty, two hundred, two thousand, two million, two billion and so on.
Making significant improvements is usually a Circle of Influence challenge and only collectively can we make a difference. But to deliver improvement at this level we have to influence others to change their knowledge, understanding, attitudes, beliefs and behaviour. That is not easy and that is not quick. It is possible though – with passion, plausibility, persistence, patience – and an effective process.
It is here that we can become impatient and frustrated and are at risk of giving up too soon – and our temperaments influence the risk. Idealists are impatient for fundamental change. Rationals, Guardians and Artisans do not feel the same pain – and it is a rich source of conflict.
So if we need to see tangible results quickly then we have to focus closer to home. We have to work inside our Circle of Individual Influence and inside our Circle of Control. The scope of individual influence varies from person-to-person but our Circle of Control is the same for all of us: the outer limit is our skin. We all choose our behaviour and it is that which influences others: for better or for worse. It is not what we think it is what we do. We cannot read or control each others minds. We can all choose our attitudes and our actions.
So if we want to see tangible improvement quickly then we must limit the scope of our action to our Circle of Individual Influence and get started. We do what we can and as soon as we can.
Choosing what to do and what not do requires wisdom. That takes time to develop too.
Making an impact outside the limit of our Circle of Individual Influence is more difficult because it requires influencing many other people.
So it is especially rewarding for to see examples of how individual passion, persistence and patience have led to profound collective improvement. It proves that it is still possible. It provides inspiration and encouragement for others.
One example is the recently published Health Foundation Quality, Cost and Flow Report.
This was a three-year experiment to test if the theory, techniques and tools of Improvement Science work in healthcare: specifically in two large UK acute hospitals – Sheffield and Warwick.
The results showed that Improvement Science does indeed work in healthcare and it worked for tough problems that were believed to be very difficult if not impossible to solve. That is very good news for everyone – patients and practitioners.
But the results have taken some time to appear in published form – so it is really good news to report that the green shoots of improvement are now there for all to see.
The case studies provide hard evidence that win-win-win outcomes are possible and achievable in the NHS.
The Impossibility Hypothesis has been disproved. The cynics can step off the bus. The skeptics have their evidence and can now become adopters.
And the report offers a lot of detail on how to do it including two references that are available here:
- A Recipe for Improvement PIE
- A Study of Productivity Improvement Tactics using a Two-Stream Production System Model
These references both describe the fundamentals of how to align financial improvement with quality and delivery improvement to achieve the elusive win-win-win outcome.
A previously invisible door has opened to reveal a new Land of Opportunity. A land inhabited by Improvementologists who mark the path to learning and applying this new knowledge and understanding.
There are many who do not know what to do to solve the current crisis in healthcare – they now have a new vista to explore.
Do not give up too soon – there is a light at the end of the dark tunnel.
And to get there safely and quickly we just need to learn and apply the Foundations of Improvement Science in Healthcare – and we first learn to FISH in our own ponds first.