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Commentary: Apply Roosevelt’s wisdom to healthcare improvement

Continuous improvement is more than just an approach to process transformation—it’s a way of life, a culture that both permeates and ultimately defines both an organization and its people.

Over the five years I’ve been at Mission Health, watching this culture saturate team after team has been one of the most incredible experiences in my career. Our approach isn’t flashy and it rarely brings on sudden, big-bang results. Instead, Mission’s approach to driving continuous improvement is best captured by paraphrasing the words of President Theodore Roosevelt: Real progress is won by people who take the next step, not those who theorize about the 200th.

Believe it or not, Roosevelt has much to teach healthcare’s leaders about succeeding in our continuous improvement work. Take just the 59th Congress (1905-07), by all accounts one of the most prolific, reform-based congressional sessions in American history. Despite the colossal influence of trusts like Standard Oil, Roosevelt managed to band together coalitions of progressive Republicans and Democrats to drive real progress on both railroad enforcement and campaign finance reform.

He also dramatically improved the quality and safety of the nation’s meat supply and secured passage of both the Antiquities Act (which presidents have since used to protect over 750 million acres of land and sea as national monuments) and the Pure Food and Drug Act. While each victory was imperfect, all moved the nation’s health purposefully forward both economically and socially.

At Mission Health, our Care Process Model, or CPM, teams exemplify the same approach to “take the next step” continuous improvement. By the end of 2018, our teams will have driven clinical continuous improvement work across 80 inpatient and ambulatory conditions. They do so by first defining a best-practice pathway and then integrating it directly into our clinicians’ electronic workflows. Once the CPM is live, the team then measures patient and provider-level metrics in near real time, using their findings to recursively improve the pathway and drive increasingly better adherence and increasingly better outcomes.

The work was slow at first, but two years ago we were able to dramatically accelerate our progress. How? Instead of spending nine months trying to take steps 1 through 200 all at once, we simplified our CPM approach to just “take the next step” over a 90-day sprint. And it worked. Today, the number of patients affected by combining legions of these individual “next steps” matches our local Asheville Tourists’ Minor League Baseball game attendance … for the entire 68-game home season.

To be clear, “taking the next step” isn’t the same as incrementalism. Incrementalists wind up just stepping either clockwise or counterclockwise around in circles. It’s also not the same as blind interventionism, whose acolytes indiscriminately intervene whenever they please and mistake random motion for true progress. Rather, those who purposefully “take the next step” know where they want to go, spend an appropriate but succinct period of time deciding generally how to get there, and then quickly focus their energies on propelling the team forward.

This brand of “take the next step” continuous improvement is rarely sexy, but it works. Roosevelt knew he needed small but purposeful next steps to thread the needle between “the fools who do not want any of the things that ought to be done, and the equally obnoxious fools who insist upon so much that they cannot get anything.” Each victory—even if imperfect—meaningfully improved the lives of Americans, generating the public energy he needed to launch into the next step and the step after that.

So the next time you are faced with a challenge to improve population health outcomes or increase emergency department throughput, I recommend imagining a small, mustachioed and hyperkinetic Theodore Roosevelt perched on your shoulder spurring you to action. Decide where you want to go, point your feet in the right general direction and just take the next step.

Interested in submitting a Guest Expert op-ed? Send drafts to Assistant Managing Editor David May at [email protected]

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