November 10, 2011 1 Comment
By Todd Schneider
Often in improvement work, we rely on Lean tools, Six Sigma methodologies, classic Industrial Engineering methods, etc. However, perhaps we often overlook one of the most valuable skills of a change agent – Asking questions.
Most often, improvement professionals are not the subject matter experts in the clinical or operational area in which they are improving. This provides the perfect excuse to ask questions. Sure, some questions are part of other tools or methodologies. Obviously we ask questions when we apply the 5 Whys. And it’s common to ask “what happens next?” when constructing a flowchart. But do we ask the questions of “what if” or “why not” enough? When done correctly, the questions asked are not so much for your learning, but instead to stimulate the group’s creativity and awareness.
Several years ago, I was working with an organization that had been awarded a grant from the Robert Wood Johnson Foundation. As part of the grant, the organization was provided technical assistance from the Institute for Healthcare Improvement (IHI). One of the project teams was working to improve the care of the Acute Myocardial Infarction (AMI) patients, which typically present to the ER with chest pain. At that time, there were two main goals the team was working to achieve: 1) Obtain an EKG within 5 minutes of arrival, and 2) Go to the Cath Lab and open the vessel within 90 minutes of arrival (commonly referred to as “Door to Balloon”). We were reviewing this project with staff from IHI during a site visit. During the discussion, Don Berwick, then President/CEO of IHI, asked a simple, yet important question. “If I told you that a chest pain patient would arrive to the ER at 5:00 p.m. today, would you be able to meet the goals for Door to EKG and Door to Balloon?” Almost immediately the team leader responded, “Yes, of course.” Berwick responded, “Then go do it. Get ready. And if the patient doesn’t come at 5:00, keep waiting. We know the patient will come.”
The team did just that. They figured out how to get the process right for that next patient. That conversation was a pivotal turning point for this project team. It helped them focus on how they could do it right once, and then figure out how to do that every time for every patient. This organization went on to become an early leader in the care of the cardiac patient and several years later still referred to that moment as an important stimulus for their work. It didn’t change their overall goal or even their general focus. But it did re-frame the project, which allowed the team to look at the project from a different perspective.
By all means, we need to continue to use all the tools we have available, but we must not forget about the power of asking questions. The questions may be simple; they don’t need to be complex or technical. However, the questions should stimulate new ideas and help the team see the potential for new solutions.
Speaking of questions, have you asked a few today?