Understanding the root cause of a problem can be one of the toughest jobs leaders face. It takes time, energy and focus. While getting some background information on a small project in our hospital, I asked a couple of leaders how good they and their departments were at root cause problem-solving. The answer I got was, “Well, sorta good…I think.” Don’t get me wrong— I know that was a tough question to answer. Healthcare reform and the competitive business environment will force health systems to solve financial and quality issues faster with less resources and expense.
In his book, Creating a Lean Culture, David Mann developed a few diagnostic questions for leaders to ask:
- How often are workarounds used instead of investigating and resolving underlying causes of problems?
- How often do leaders rely on data and analysis to attack a problem versus gut feel or impression?
- To what degree do leaders proceed with changes even though they expect that changes will expose previously unseen problems that cannot be specifically anticipated?
- How many leaders teach and lead problem-solving efforts?
- How well understood and widely used are structured problem-solving tools such as the five whys and eight-step problem solving?
- How frequently do leaders raise their expectations for process performance and tighten process measures in order to uncover the next level of process interruption or problem?
- In conversation, do employees demonstrate problem-solving, continuous improvement thinking?
As an example, an orthopedic clinic in another region was experiencing long wait times for their patients. Without using any problem solving tools, the manager decided to hire more nurses to help speed up the process. After hiring 3 nurses, the manager noticed patients still waiting for long periods of time. She pulled a team together and finally did a root cause analysis. She discovered the real delay was happening in x-ray. Patients were getting backed up due to low staffing levels at peak times. The x-ray department adjusted their staffing levels to handle the volume and the problem disappeared. The rapid decisions by the orthopedic clinic manager didn’t fix the real issue and also added the unnecessary expense of three nurses.
As leaders, we can create a culture that is efficient at problem-solving. As we have discussed at CMH, the best problem-solvers are the team members closest to the work. We need to give them tools, methods and freedom to tackle issues in the workplace. Here are a few ways to begin developing a culture of problem-solving.
These tools can be used separately and are helpful to develop your A3. Step 2 on the A3, problem analysis, is all about getting to the root cause of the problem. Leaders need to regularly educate their team members about how and when to use the tool. By having teams that are good at problem solving, process improvement becomes faster and easier to achieve.
Leaders hold each other accountable to ask “why” and pursue root causes for problems large and small.
In my past, I had a team member I worked with on many projects. If she noticed I was jumping to a quick fix or an easy answer, she would call me on it and give me one of the tools to use. Accountability is a critical component in the success of problem solving, and we need to help each other improve.
There has been a lot of great improvement work at CMH. You and your team play a crucial role in this transformation. Let me know how we can help!