One of the most basic, fundamental and challenging steps any team needs to take in the beginning the improvement process is setting a standard. While this might sound simple it is often a big step for leadership. In my experience most healthcare processes do not have standards. Thus it is impossible to judge what the plan is vs. the actual or if there is a problem. If there is no standard there is no problem nor is there a basis by which any team can improve.
So why is it so difficult to set a standard? Often leadership in a professional environment does not want to declare an expectation for what success looks like. This often has to do with the lack of evidence to show the cause and effect relationship between the process and the outcome; or the focus on perfection as opposed to improvement. Leadership is uncomfortable making anything binary since it may force an uncomfortable conversation.
I always push an aggressive approach in terms of standard setting. I steer my clients to bring science and intuition into the calculus of setting the standard, and I push to bring the voice of the business and customer into the process. Yet, if there is incomplete information I believe the right approach is to still set the standard even if it is not backed by evidence or in other word is might not turn out to be accurate. Why? By setting the standard, even if it is “wrong” it creates the basis for the “right” conversation. Teams are forced to think about what is the right way to define and then achieve the outcome. If this is done in a constructive way the team/organization can begin to put in place the processes that will allow them to be successful. This will create a venue to address variation and talk about best practices. In other words, setting the standard is the right first step, even if the standard must change once we understand more.
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