If The
Tools Exist , How Do We Then Achieve Excellence?
If the tools are now available
for Airway Management Excellence then why do we struggle and how should we proceed in a way that
will provide high quality care that is
reproducible and measurable . The goal
of this work is to provide a guide for system change and method of measuring
the performance of the new process.
The science of change
management must be brought to bear on this. Medical change process started
perhaps with Fredrick Winslow Taylor who introduced the concept that waste and
inefficiency was caused by haphazard unscientific management. The book 1911 book “The Principles of
Scientific Management” was a first attempt to define a science for change. This
proved to be an authoritarian approach suited to a society where workers had
fewer means of education. Later, Peter Drucker in a prodigious effort well
summarized in 2008 , “ The Essential Drucker The Best Of Sixty
Years of Peter Drucker’s Essential Writings on Management ” introduced the
notion of management of “Knowledge Workers” who have substantial core
information that will inform change toward more highly functioning
organizations. The notion that organizations trend toward chaos is perhaps
pessimistic but is widely believed today.
Modern leaders set a
frame work of goals and base rules which allow for distributed leadership of ways
and means to get to change on a local basis. This is demonstrated with the new
organization of the US Army where the strategy and clear objectives are defined
at the center , the Pentagon, and the
assignment of an Expeditionary commander begins a process where the elements
required for success (such as IT Support, Transport, Air ) are defined and
assigned by the unit who is responsible for execution. This devolution of
decision making to those who are answerable for the outcome thus places the HQ in the position of being the
responsible observer monitoring progress
.
The focus for us
professionals should be on the individual unit or work space like the OR, ICU
or ED and begin to seek ways of achieving perfection that is built on the
skills and initiative of the local professionals but is wedded to the IT and
management framework and goals for the organization overall. This local
initiative produces high energy activity that entrains all of the brilliance
available. The trick then for the local change agents must be to have
appropriate goals so that the change does not collapse into petty politics and
divisions. The energy of a fully engaged community with measurements for
results is thus converted into forward action.
The process becomes a
big part of the reason for a great or less than great outcome. As stated
previously there are many capabilities needed for any professional team so the
learning must go on in many directions at the same time. The development of
British style “team leads” can be a useful way to start the process .
Professionals in the organization must be taught to
become agents for change rather than curmudgeons or foot draggers. The new
Systems for quality demand a new set of attitudes geared to embrace real
change.
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