The tip of the iceberg

During an interview in the post season, the franchise quarterback explained his success.

“I love to play the game. I work really hard. And I have some talent. But, you know, that describes plenty of athletes who don’t make it. The thing is, I didn’t succeed. We succeeded. I’m just the tip of an iceberg. I can do what I do out there on the field with everyone watching because of this terrific group of people who are all making their contribution. And it only works because every one of us sees our job as making the team succeed. The guy who sells tickets, the trainers and staff in the weight room, the equipment managers, everyone. Everything they do is to make the team better.”

This is a tremendous insight that is too often missing in large organizations. What’s best for a weight room or a security detail may not be what’s best for the team. Uniforms that are easy to clean and never need repair may not be the best for the players. Hours that are convenient for the stadium crew may not be ideal for game scheduling. Every individual and group needs to do their best - but best must be evaluated in terms of the overall team goals, not local needs.

In a health care system, the ‘team goal’ is high-quality, safe patient-centered care that is accessible and efficient, and delivered at the lowest cost possible. Every individual and every department within the organization needs to use this rather than just local targets to plan their initiatives and evaluate their performance. What’s best for network administrators may not be best for patient care. What’s best for material services or pharmacy or the billing department or clinicians may not be what’s best for patients. One of the big dangers of management based on goals and targets is that it is an approach that tends to reinforce myopia and create an unhealthy emphasis on arbitrary, local targets without regard for the impact on systemic performance or the impact on patients. This is how a pharmacy decides it is appropriate to remove alcohol swabs from exam rooms to prevent overdoses. It is how an IT department decides to block internet access to collaborative sites. It is how a policy emphasizing in-house referrals come to be. It is how filling slots in a schedule replaces continuity of care as a priority. It is how a quality committee decides that there is only one acceptable way to document a piece of clinical information. In the end, it is how each individual or group maximizes their own performance in order to appear to be a center of excellence, without regard to the fact that they are hurting the care patients receive.



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