Monday, 24 March 2008

Warning: "holding the gains" means missing the point

For those well versed in the art of Cockney rhyming slang, then you'll know that the "dog and bone" is how a Cockney Londoner refers to the phone and "apples and pairs" the stairs. They might now say "Would you "Adamn & Eve" (believe) it, but we seem to have a new term."
I keep coming across "spread and sustainability" as though these two remarkably different concepts and dynamics were intertwined. They appear in requests for short presentations, in documents, booklets, advice to project leaders and exhortations for improving results in healthcare.

The quickie defintion usually given after "spread and sustainability" or "sustainability and spread" is "sustainability" means we need to hold our gains and then we need to "spread" the gains / results to others in the organisation.

This looks fine on paper. But let's think about this. What exactly is meant by "holding the gain"? In the majority of improvement projects the gain is valued and assessed against a measurement. For example, the reduction in rate of infections on the ward would be measuring an outcome which is helpful and can keep a team focused on the end result. Some measures focus on a process, such as the number of staff who have adopted the use of a checklist for a certain procedure. Here is my concern.

When it comes to working on what it is that needs to be "held" many teams will focus on the the "what's" they have created. This will be the checklists, the new procedures etc. While helpful, it takes a humble team to be able to keep focused on the outcome and continue to adapt their processes and behaviours to continue to maintain and perhaps improve on their results. In many cases this may mean they have to alter their original soultions (thus, of course, impacting what others may want to spread - but that is another issue for another day...).

How many leaders and improvement teams take the time to work out the qualitative aspects of their results? What really enabled them to deliver the improvement? While the attention is so often on the output, the "thing" that was created, by ignoring or avoiding reviewing the human, social and emotional behavioural processes involved in the development of it, they are at risk of losing what they have gained. I believe that it is in this tacit knowledge that the true gain lies. It is here that the learning resides. The checklist is merely the tangible, and temporary, manifestation of their experience.

The discipline of learning organisations and learning teams is well known, though sadly often disconnected from the conscious experience of many improvement project teams. When the concept of learning gains a hold, then we may hold some gains.

(c) 2008, Sarah Fraser

No comments: