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  • Susan Snedaker

Lean Leader #3 - Constancy of Purpose

In this post, we’re exploring the third foundational element of Lean leadership – constancy of purpose.

Continuous change in healthcare IT

In healthcare IT, it often feels like large waves come crashing on shore from unexpected directions on a daily or weekly basis. A surgeon wants to live stream from the OR, a payor’s requirements have changed and charges aren’t being processed, a workflow in the EHR needs to be modified to reflect a change in nursing practice, a new server is needed for a new software program purchased by the business development team….and the list goes on. The needs of the organization shift, a new priority to address patient care pops up, and suddenly the IT department is involved in something new.

The danger of chaos

Our job is to respond and to provide service to the organization, but being responsive can be reactive and dangerous. We know that without proper planning and governance, we end up with what is often referred to as a “spaghetti mess” – systems and capabilities that are loosely meshed together without a coherent strategy or plan.

You may not think this is a big deal at first glance. Yes, it might be distracting or annoying or time-consuming to manage. But there are greater risks looming.

First, this mess adds significant risk to the organization. When things are not clearly planned and managed, they become unclear and unmanaged and that leads to risk of failure and risk of compromise (the system fails or the bad guy gets in and no one notices, for example. Recent examples are numerous, the Equifax breach is one that comes immediately to mind).

Second, this mess is almost certainly chock full of waste – wasted time (doing and re-doing), wasted resources (servers get stood up and never used, software gets deployed and never used or under used, the organization pays for a capability it can’t use or doesn’t know it has, etc.), and wasted processing (reports get generated that no one reads, data is created that is never used, etc.).

Back to constancy of purpose

If we allow all of these crashing waves and spontaneous demands to push and pull us every day, we will certainly end up with the mess described.

Is there a way to do this differently? Many in HIT would argue, no, that is the nature of HIT. It may be the nature of HIT, but that doesn’t mean we need to be held captive by this.

To paraphrase Edwards Deming, constancy of purpose is about long-term thinking and planning and about looking at the organization as a system. It’s about looking ahead and keeping on track every day with systems and decisions that support that long-term vision. Without constancy of purpose, chaos ensues. Though maintaining constancy of purpose can take some commitment and some energy, it's less exhausting (and certainly more productive) than managing chaos.

Constancy of purpose on a physical level

When I think about constancy of purpose, I often think of human fitness because it’s a pretty tangible and understandable framework for most of us. If you become a weekend warrior, if you work out with high intensity once in a while, you will not gain overall fitness and you risk serious injury. On the other hand, if you work out doing some aerobics or strength training 10-15 minutes every day, you will achieve results over time. You will make progress and you will significantly reduce the likelihood of injury. The second path describes constancy of purpose. You achieve results when you keep focused on the plan, you work the plan a bit every day, and you maintain a 'system' level view of your activities.

Those who work in HIT may feel that chaos has indeed taken over your world and yes, sometimes we are battered by the constant and constantly changing demand.

However, constancy of purpose can assist in managing that chaos.

Long-term thinking happens in IT whether you recognize it or not. When you purchase a multi-million dollar SAN or a new enterprise application, the organization is making a long-term commitment. Perhaps the missing piece is the acknowledgement and discussion about the problem you’re solving and the objectives you’re meeting. Though some organizations write the check and don't think about the long-term objectives, most don't have the financial luxury of doing that. So, most organizations directly or indirectly are thinking long-term when they write those big checks for healthcare IT.

But long-term thinking is not exactly the same as constancy of purpose. The latter implies that every day you work toward your objectives and that those objectives are viewed as part of the larger system. It means you don’t quit when the waves come crashing in (though you may need to regroup from time to time). It means you don’t lose site of the long-term objectives and the reasons for undertaking this path in the first place.

Very easy and very hard

In my experience, maintaining constancy of purpose is really foundational to all lasting improvement efforts and it is both simple and maddeningly difficult to achieve. It’s really as simple as making a decision to have constancy of purpose. It’s really as difficult as making that decision every day, over and over, without being swayed off center.

Most people who achieve notable success in their field laugh when the media lauds them as an “overnight success” because almost without exception, they have worked hard day in and day out (constancy of purpose), when no one else was paying attention, to hone their skills (continuous improvement) and achieve their objectives (long-term thinking). Their notoriety and fame may come 'overnight', but success from their achievements is almost always derived from constancy of purpose.

So, how will you achieve constancy of purpose in your IT world? What examples can you point to where constancy of purpose is evident? Where it is lacking? What measures can you put in place to improve your own constancy of purpose to achieve better and more consistent improvements?

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