This topic takes me back to one of my early posts in March 2008 when I worried about how we know whether what is being spread is a good idea in the first place. My experience of the last few weeks leaves me even more perplexed as the reality of large scale change (spread of good practice) initiatives across different continents seems to experience similar, dis-spiriting, effects. On the one hand there is a group, mostly senior leaders, who speak of success in the programs, and on the other hand, there are others, mostly those involved in the direct implementation of the changes, who want to speak of success yet talk quietly of the hurdles and challenges they face.
When I step back and look at many of these large scale initiatives they are all using similar frameworks, tools and techniques, and they are all experiencing the same sorts of problems in their implementation. Roughly, they get around a third of teams involved delivering some improvement, another third demonstrating engagement to some or another extent and the final third inactive despite a variety of tactics. These are very rough figures but the pattern is fairly consistent in a number of large programs.
So the question I ask myself is why do we accept this level of performance? There seems to be a quality improvement / spread of good practice "virus" which goes round and infects all groups to the extent everyone does copy each other with little investigation to seek out new and alternative large scale change methods. The dynamic reminds me of "groupthink" so I checked out what characterises groupthink; according to McCauley we'll see it when we have directive leadership and homogenous groups that are isolated from outside sources of information and analysis. That sounds like many of the healthcare teams and organisations I encounter along with their quality improvement consultancies they work with.
So I've started challenging the groupthink and speaking up a bit more than I usually do. In a small way this means providing information, directing teams and organisations to look outside their usual frames of reference, suggesting alternative sources of challenge (even other than myself). It also means saying no thank you to requests for support where it feels it is encouraging groupthink.
So my challenge now is to think about topics like patient safety. There's a proliferation of programs and initiatives either underway or planned around the western world. The more I think about them and talk with others who are working on the programs, the more groupthink appears to be at work. I am not convinced on the progress so far that the current large scale initiatives are sufficiently breaking free of the mindsets that got us in the mess in the first place. It feels like we're implementing workarounds. Many colleagues agree though few are ready to speak out.
If you are willing to rethink your strategy and tactics on large scale patient safety intiatives, and do so in an innovative and challenging way, involving people from different disciplines, industries and countries, then let me know. There has to be a better way.
2008 Sarah Fraser, Creative Commons: Attribution-Non-Commerical-No Derivative