It’s no secret, is it? Health care organizations and institutions are struggling, some more than others. However, all are faced with seemingly insurmountable challenges. Demand outstripping resources, failing cultures and disengaged staff, and everywhere blockages and lack of flow are but a few of the common themes.
Big money, large initiatives, and great minds have all been thrown at the problem. The result? Well, if there was an answer we would all have adopted it long ago.
So what can help? Clearly, doing more of the same, or following the same formula that we always have (but trying harder!) isn’t going to work. What’s that famous Einstein quote about madness again?
In this context of highly trained, talented, and committed people following the same established patterns and schedules but without success or ability to change the paradigm, let’s consider the British Cycling team. In 2003, they had been, to put it mildly, seriously unsuccessful for over a century. In the prior 100 years, they had won only one Olympic gold medal and no British cyclist had ever won the 110-year-old Tour de France.
At this point Dave Brailsford, a former professional cyclist and MBA, was put in charge of this mediocre team. However, Brailsford had a different plan to that of his predecessors. His strategy was not to come in with a grand “solution” or to implement bold and revolutionary changes. Instead, Brailsford wanted to concentrate on small change in every facet of team operations in order to “aggregate marginal gains.”
In every aspect of cycling, and the cyclists’ lives, he tried to identify where he could improve things by 1 percent. When added together, he felt that all these incremental improvements would lead to a substantial elevation of performance.
Some of the areas of attention were obvious (tires, gears and other mechanical equipment, more aerodynamic suits); however, others included nutrition, sleep quality, and even the handwashing techniques of the cyclists to reduce the common cold. Every aspect of preparation, training, and performance was examined without an expectation that there would be an astonishing breakthrough or solution, but that there would be a possibility to improve by 1 percent.
The results from this approach spoke for themselves. At the 2008 Olympic Games in Beijing, the British Team won 60 percent of all gold medals in cycling. In 2012, they went even better, setting nine Olympic records and seven world records. In the decade from 2007, a British cyclist won the Tour de France five times.
Is there any relevance of this story to our current health care challenges? Could organizations change from focusing on “fixing” big problems (or even worse, failing to act due to overwhelm) to instead focusing on every aspect of health care and trying to improve by 1 percent? Would this be useful? I think it would.
When considering what the areas of attention would be, there seem to be obvious elements such as optimizing operating theatre time and technical procedures, reducing infection rates, and speeding up the delays in patients being seen in ED. Of course, all of these are already areas of focus in hospitals.
However, there are innumerable other factors in care that are overlooked, unrecognized, or disregarded, which also affect performance. These things can include efficient movement of patients, reducing unnecessary bureaucracy, and effective IT systems. Indeed any aspect of the organization. Further elements that may be considered esoteric by some but which in my experience are essential for a high-functioning organization are communication styles, intra- and inter-team harmony, support of staff, inclusion, creation of belongingness and organizational pride, and the list goes on.
Can each of the above be improved by 1 percent? Of course they can. And will the gains add up to create a better organization with improved clinical outcomes and healthier staff? I think the answer is obvious.
It is important to note Brailsford’s (now Sir David Brailsford’s) prior interest in the Japanese practice of Kaizen or continuous improvement, “Forget about perfection; focus on progression, and compound the improvements.”
Brailsford also noted that when this process was embraced, with a united desire to find continuous small improvements there was a contagious lift in spirits, enthusiasm, and culture within the team.
Perhaps there are lessons here for health care.
Simon Craig is an obstetrician-gynecologist in Australia and author of From Hurting to Healing: Delivering Love to Medicine and Healthcare.
