Wednesday, February 3, 2016

The Red Sneaker Problem - And how to fix it

Hi fellow Informaticists, chairpersons, and other budding healthcare leaders!

There's no question - Healthcare is currently under tremendous pressure to perform. Quality needs to go up, at the same time that costs go down - And fast. In my own humble opinion, it's currently undergoing change at a pace that's hasn't been seen since the inventions of penicillin and vaccinations. 

Informaticists know that information drives behaviors, and the information doesn't just start-and-stop inside the clinical arena. To really drive down the cost of healthcare, we need to work on efficiency at all levels of healthcare

So there is a quiet little information problem I sometimes see, that I thought I'd share in today's post, to help you spot it and fix it. I call it the "Red Sneaker" problem.

The Red Sneaker problem sometimes happens, quietly, when a well-intentioned committee, with a well-intentioned chairperson, makes a well-informed decision.

Typically, it starts with someone in an organization learning about some new regulation, or evidence of a way to make things better : "The evidence clearly shows that patients like Red Sneakers, and they heal faster when staff wear Red Sneakers - So if we all wear Red Sneakers, costs will go down, quality will go up, and patient satisfaction will improve."

After bringing the idea to a committee who asks for a few presentations and data on the potential benefits of Red Sneakers, the committee finally votes on the question : "Should all staff wear Red Sneakers?". After some deliberation, the committee votes, and the motion is adopted : All staff will wear Red SneakersThe committee celebrates the victory, and the secretary documents the vote in the committee minutesPeople leave the committee meeting, and through emails and word-of-mouth, other people learn that the committee has voted to approve Red Sneakers for all staff.

The quiet problem that sometimes arises is that the committee was not well-positioned for success. The chairperson is new, and might not understand the parliament or committee position in the governance of the organization. The members may not be clear about the mission of the committee. The committee was not made aware of its responsibilities, authorities, or jurisdiction. And so, the vote was overwhelmingly in favor of all staff wearing Red Sneakers, but...
  1. No policy was updated to reflect the new organizational standard of all staff needing to wear Red Sneakers.
  2. No budgets were updated to pay for the ongoing use of Red Sneakers.
  3. No local suppliers were contacted to establish the availability of Red Sneakers.
  4. No employment contracts were updated to require the wearing of Red Sneakers.
  5. No staff education was created for staff to understand the new standard and importance of wearing Red Sneakers.
  6. No onboarding materials were updated to teach new staff about the importance of wearing Red Sneakers.
  7. No workflows were designed to check for Red Sneakers before staff enter the organization
  8. No backup procedures were created for staff who arrive without Red Sneakers.
Without any of this background work, the committee still announces the result of their vote, and record it in the committee minutes. Initially, things look good. With enough cheerleading and word-of-mouth publicity, they start to see some adoption of Red Sneakers

But without planning for these other reinforcements, Red sneakers were not well-budgeted for. Eventually new staff will come into the organization who don't know about this committee vote, and missed the publicity about Red SneakersThe few staff still looking for Red Sneakers might not be able to find them in local stores, and there are no backup procedures for staff who forget them. And with no way to support or enforce the use of Red Sneakers, after a few months, the adoption of Red Sneakers starts to dwindle...

And so the entire discussion of the committee and the vote to adopt the new measure have not been effectively implemented. Six months later, committee members notice almost nobody wears Red Sneakers, gradually get a sense that the committee is powerless, and stop showing up to meetings. Especially in healthcare, this can be an expensive way to generate frustration and apathy.

Fortunately, it's fairly easy to prevent the Red Sneaker problem. The first step is to look out for it. If you think your committee(s) might have the Red Sneaker problem, consider some of the following : 
  1. Make sure you don't have more committees than you need by ensuring that every committee has completed a yearly charter, and that all committee charters are filed in a central location in your organization, so you can look for ways to avoid overlaps and streamline your committee structure. (If you need a committee charter template to start, you can click here to read my old blog post on committee charters.)
  2. Make sure your committee chairpersons have adequate training and orientation before chairing a committee, including some training about parliament, project management, and the quiet-but-problematic red sneaker problem.
  3. Solidify your cost estimates before adopting a new measure, by making sure that committee chairs ask for detailed project plans and cost estimates before bringing a measure to a vote. These project plans should address the various tools and strategies you will use to introduce and reinforce the new workflow.
  4. Consider having a clinical informaticist, workflow expert, or other process expert to consult or help draft the project change plan and cost estimates before adopting the new measure.
I hope this post is helpful to you in developing your own informatics skills, and supporting excellence in your healthcare organization!

Have any thoughts about workflow adoption issues or clinical governance? Want to share your own stories? Leave your comments in the comments section below!

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