In Pursuit of Elegance | My Own Tiger's Tale
What does Tiger Woods have to do with Lean Thinking and hospitals? Read on…
Our good friend, Matthew May, met Tiger Woods at his health club in California back in 2001. He re-visited that encounter on his blog just recently, I guess given recent salacious events (click here for a cheesy Chinese CGI reenactment, if you must). You should check out Matthew's latest book, also: In Pursuit of Elegance: Why the Best Ideas Have Something Missing
Matthew took advantage of the chance to ask Tiger why he kept re-inventing his swing even though he was already wildly successful.
So I asked him: “What really drives you you to keep breaking what isn't broken?” He said, “The number 18.” I immediately thought: “Aha, that's the number of majors Jack Nicklaus won. So that's the goal.” I said as much. Tiger said, “That's what people think, and I let them. But 18? That's a perfect golf score.”
That says it all right there. The point is this: The pursuit of perfection is not focused on achieving perfection, it's focused on chasing it. Approached as a process, it can drive breakthroughs. Approached as goal, it can actually block innovation. Perfection is unachievable…it'll never happen. Unless you're Buddha I guess. That's what throws people, at least in our Western culture. We've become impatient with mastery. If you can't achieve perfection, why bother pursuing it? Answer: because you have to. Otherwise you'll always be a follower.
One of the key Lean Thinking
Is Toyota perfect? No, of course not, but they strive to be as good as they can possibly be, not just to be better than their competitors.
Many hospitals fall into the benchmarking trap. If you're better than your local peers or if you're in the 90th percentile nationally in some measure, who cares? If there's a bit gap between your current performance and perfection, than you still have work to do.
Tiger's goal is shooting an 18. Impossible? Maybe, but that's the only target worth shooting for if you have the drive and discipline to be as good as Tiger.
If you're a hospital, the only acceptable goal for preventable patient harm is ZERO incidents. Seems impossible? Not always. Paul Levy recently blogged about a hospital that has gone 18 months without a blood stream infection that results from a central venous line. When the goal is perfection, you develop breakthrough processes that get you there. If the bar is set much lower, you can more easily tolerate the mediocre status quo — and patients die.
I've seen far too many hospitals set a non-zero goal for patient falls — there's a difference between what's “expected” given past performance and a “goal” that you often see on a chart or a dashboard. A goal of 3 falls per month isn't very inspirational, is it? Does that drive people to be creative and innovative? I'm not saying you should set a “target” in the sense that people are fearful of punishment for not meeting the goal of zero — targets like that drive dysfunction and probably lead to more people getting hurt, as Dr. Deming taught.
One hospital I previously worked with, one of their leaders said they had previously benchmarked other hospitals and, as a result, they had “delusions of excellence.” The rude expression that sometimes gets used is they were the “cream of the crap.” I don't use that phrase myself, since it's a bit disrespectful, but I've heard it from many hospital leaders who were no longer tolerant of being far from as good as they could be.
The hospital leader I'm thinking of realized, through learning Lean thinking, that if they benchmarked their performance against perfection, they weren't really that good. Actually, if they just benchmarked their performance against what was PRACTICAL by taking waste out of the process, they weren't nearly as good as they became just a year later through the continued study and application of lean management practices and principles.
As Paul Levy also blogged about, John Toussaint gets it. As a patient safety goal:
“Zero is possible, and from a leadership perspective, we should ask for nothing less.”
Let's look at a hypothetical chart that represents productivity, a higher number is better:
Do you feel satisfied that you're better than your competitors? Do you even KNOW the gap between yourself and a practical Lean State? Many leaders and organizations don't even know this gap because they don't know how much waste their is in their process.
To steal a line from a company's advertising slogan, Are You a Tiger? And we're talking professionally… are you chasing perfection even if it seems impossible?
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Benchmarking can be a trap but it can also be a means of dramatic rapid improvement and learning can also take place if done properly. What I mean by that is if there is a process focus to the improvement real learning can take place and be a launch pad to begin to pursue perfection. In my estimation more patients would benefit from following BIDMC's central line approach (yes, a type of benchmarking) than fumbling with pursuit of perfection using a lean approach because many hospitals can do the former and very very few are prepared to do the latter.
I love the "perfect golf score 18" comment – perfection on every hole. It's a great analogy that we can use for the pursuit of perfection (after the Tiger story calms down, of course).