Transforming Healthcare: System of Profound KnowledgeBruce HarriesJuly 23, 2013

 

Improvement Associates Ltd.

The Science of Improvement

Science (from the Latin scientia, meaning knowledge) is defined in Webster’s New Collegiate Dictionary as “knowledge attained through study or practice.” Science refers to a system of acquiring knowledge of the physical world. This system must be based on observable phenomena and capable of being tested through the scientific method for its validity. Acquiring knowledge is essential for improvement activities, whether it is a simple problem to solve, a work process to improve, a design or redesign of a product or service, or improvement to a complex system.

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Objectives

• In this session we will;– Review assumptions, theories and thinking

behind the science and art of improvement.– Learn more about the lens of Profound

Knowledge – appreciation for a system, understanding variation, building knowledge and the human side of change

– Apply it to current challenges to improving healthcare in BC, leaving with a plan to move forward.

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“Useful principles for improvement in complex systems do seem to exist…Some principles that seem to be robust, for example, are (1) knowledge of systems helps people identify smart changes to try; (2) measuring, correctly interpreted, helps guide productive change; (3) some forms of trial-and-error learning help accelerate the growth of knowledge; (4) everyone can help; (5) almost everyone wants to help, and will if given the right opportunity; and (6) entropy wins unless leaders lead. Students of W. Edwards Deming will recognize most of the above as what he called “profound knowledge.”

Donald M. Berwick, MD, MPP, Journal of American Medical Association, May 16, 2012 - Vol 307, No. 19

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Lens of Profound Knowledge

V

alues

Appreciation of a system

Understanding Variation

Theory of Knowledge Psycholog

y

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Some History of the Four Parts of Profound Knowledge

Variation

Systems

Psychology

Knowledge

1900 1920 1940 1950 1960 1970 1980 1990 2000ShewhartControlChart 1924

Design ofExperimentsSir RonaldFisher, 1925

SamplingmethodsDeveloped,H. F. Dodge

Use of statisticalmethods tosupport the wareffort 1941 - 1945

Enumerative vs AnalyticStudies in Statistics, Deming

Shewhart’s 1931 and 1939Books on Quality Control*

Principles of SystemsJay Forrester, 1968 Holistic Management, Stafford Beer, 1959

General Systems TheoryLugwig von Bertalanffy,1949

5th DisciplinePeter Senge1990

Theory of ConstraintsE. Goldratt, 1990

The Goal 1984

F. Taylor, Frank & Lillian Gilbreth, Scientific Management

B - f(p,e)Kurt Lewin1920

AnthropologyExpertsapply theoryto business

OrganizationDevelopmentD. McGregor

Tavistockinstitute 1951Eric TristSocio-technicalSystem

Open SystemsFred Emery

Maslow – Hierarchy of Needs1962

Participatory ManagementMary Parker Follett, 1925

Human Side of EnterpriseD. McGregor, 1960

Motivation TheoryHerzberg,1968

Hawthorne ExperimentsPlant, EltonMayo, 1927

Mind & The World Order, C.I. Lewis1929*

Double LoopLearning in OrganizationsChris Argyris,1977

Lectures atThe USDA,1938, organizedBy Deming*

John DeweyRealism ofPragmatism, 1905

How We ThinkDewey, 1933

Descriptive and Normative Learning Models, Paul Carlile and Clayton Christense

Source: Langley et.al. The Improvement Guide 2nd edition 200923/07/2013 BC Quality Academy 6

Exercise: Build the Components of Profound Knowledge

• Split into groups(8) and go to one flipchart• Add main ideas for that component to your

chart (5 min)– From your own experience– From Chapter Four

• Rotate clockwise • Add to the ideas • Repeat until you’ve written on each flipchart

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8

Once Your Arrive Back at Your First Chart

Review all previous statements if agree if disagree?? If unsure or have questions

about what was written

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Break

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Review of Flipcharts

• Read• Clarify• Summarize (circle top 3)

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Applying the Lens to Current Issues, Methods and Approaches

Run to Space

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A System of Profound KnowledgeAppreciation for a System

Understanding:•existence of a system and their impact on any result•interdependence and interaction of processes and systems

Understanding Variation

Understanding:•Causes of variation (routine & exceptional) and how to respond appropriately•Tampering and how leaders, despite good intentions, can increase variation

Psychology

Understanding:•Difference between intrinsic and extrinsic motivation•The effects of the system on the performance of people•The effects of merit systems, incentive pay, carrots and sticks

Theory of Knowledge

Understanding:•The importance of prediction and theory in the learning process•The interaction between theory and experience•The importance of operational definitions

Source: W. Edwards Deming & Peter Scholtes

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A System of Profound TroubleAppreciation for a System

•Changes introduced here create problems elsewhere•Barriers and distrust created by internal competition and desire for autonomy•Scapegoat and blame people for problems with the system•Silo management•Maximizing the performance of individual departments while degrading performance of the organization as a whole

Understanding Variation

•Seeing trends where there are none, missing trends where there are•No sense of the capability of the system•Superstitious management behaviour•Reliance on targets to achieve performance•Use of budget variance for decisions•Tampering: under or overreacting

Psychology

•Blaming people for problems for which they have no control; rewarding those who are lucky•Cynicism, demoralization, demotivation•Paternalism, offensiveness, indignities•Guilt, anger, resentment•Unrealistic expectations•Turnover and burnout•No joy or pride in work

Theory of Knowledge

•Changes without improvement•Not learning from the past•Problems remain unsolved•Thought without action; action without thought•Not knowing how to improve, how to learn, how to improve improvement, how to improve learning•Not valuing learning or learners

Source: W. Edwards Deming & Peter Scholtes

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What Are Current Issues in Improving Healthcare in BC?

• Issues?

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Questions for Discussion(One-Two-All)

• Look at an issue through the Lens of Profound Knowledge…

• What new insights do you have?

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A New Reference….

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Deming’s System of Profound Knowledge

"One need not be eminent in any part of profound knowledge in order to understand it and to apply it. The various segments of the system of profound knowledge cannot be separated. They interact with each other. For example knowledge about psychology is incomplete without knowledge of variation."

Profound - having intellectual depth and insight (Webster)

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References• Deming, W. Edwards. Out of the Crisis. Massachusetts Institute of

Technology Press. 1986.

• Deming, W. Edwards. The New Economics for Industry. Government, Education. Massachusetts Institute of Technology. Center for Advanced Engineering Study. 1993.

• Langley, G, Nolan, K., Nolan T., Norman C., Provost L. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. Second Edition San Francisco, CA. Jossey-Bass Publishers. 2009.

• System of Profound Knowledge “Lens and Walkabout” courtesy Ron Moen - API

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