Downloaded from http://qualitysafety.bmj.com/ on November 14, 2015 - Published by group.bmj.com
CORRESPONDENCE
Working smarter, not harder The Hayes, Batalden and Goldmann piece is an important contribution to the debate about what exactly is practice improvement. Most practice improvement thinking is anchored in the ‘innovation’ paradigm, and this paradigm is predominantly ‘gadget thinking’. Others’ solutions are to be adopted here because they produce great outcomes elsewhere. Except now we have to figure out how we can get the gadget to work. Few commentators have been game to shift towards acknowledging that care practices are now too complex for ‘gadget thinking’. Hayes and colleagues are an exception. They propose that frontline professionals themselves need to become smarter at ‘codesigning’ solutions that suit their unique contexts and practices. Here, we are not talking about adopting new gadgets from elsewhere. We are talking about people who will—and who have the skill to—take 288
BMJ Qual Saf April 2015 Vol 24 No 4
Downloaded from http://qualitysafety.bmj.com/ on November 14, 2015 - Published by group.bmj.com
Correspondence inspiration from the smartness that may be invested in whatever gadget or improvement initiative, and apply this smartness to their own work practices. Indeed, these professionals may not even need inspiration to come from elsewhere: they may well be motivated by issues arising in their own work, and decide to redesign their practices. But to date, we have not focused on what this ability to codesign care practices consists in. We expect frontline professionals to somehow know how to codesign practice, and know how to be smart about what they do and what they should do. And yet, their training has not skilled them in practice design. We nevertheless expect them to readily (re)design the organisational dimensions of their work. Usually, such designs fall prey to people’s espoused ideas and preexisting assumptions about how things work and should work. Often there are worrying gaps between what people know and what they (think they) do. Put differently, smartness, in the sense of learning about how to manage complex situations and improve complex practices, is rare. Smartness cannot be expected to exist or arise in situations where there are no resources available for professionals to learn about (or ‘make explicit’) the complexities of their own day-to-day work. Smartness must be nurtured. The way par excellence to achieve this is professionals, just as do top-end athletes, studying their own performances. In sport, video-ing one’s game for transforming good performances into excellent ones is now not just common but also indispensable. This is about capitalising on and building on existing strengths. By analogy, video-ing in situ practice and using the resulting footage to reflect on the work is central to enhancing smartness at work. This is what Katherine Carroll and Jessica Mesman and colleagues have referred to as ‘exnovation’, which involves building on existing strengths and addressing local weaknesses. Of course, many excuses and objections are raised to autoBMJ Qual Saf April 2015 Vol 24 No 4
observation, the most common ones of which are privacy, the Hawthorne effect and subpoenable evidence. But these concerns are overstated, and they trade a real need and opportunity for improvement and smartness off against maintaining the status quo. Without auto-observation, existing habits and routines will go on unquestioned. Work can only become harder, as the only solutions to improvement will remain gadget based. Smartness, by contrast, starts from where we are, and explores where we can go. Rick Iedema Correspondence to Professor Rick Iedema, Faculty of Health, University of Tasmania, Darlinghurst campus, Sydney, Australia; [email protected]
Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed.
To cite Iedema Rck. BMJ Qual Saf 2015;24:288– 289. Accepted 22 January 2015 Published Online First 6 February 2015
▸ http://dx.doi.org/10.1136/bmjqs-2015-004029 BMJ Qual Saf 2015;24:288–289. doi:10.1136/bmjqs-2015-003996
289
Downloaded from http://qualitysafety.bmj.com/ on November 14, 2015 - Published by group.bmj.com
Working smarter, not harder Rick Iedema BMJ Qual Saf 2015 24: 288-289 originally published online February 6, 2015
doi: 10.1136/bmjqs-2015-003996 Updated information and services can be found at: http://qualitysafety.bmj.com/content/24/4/288.2
These include:
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Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
CORRESPONDENCE
Working smarter, not harder The Hayes, Batalden and Goldmann piece is an important contribution to the debate about what exactly is practice improvement. Most practice improvement thinking is anchored in the ‘innovation’ paradigm, and this paradigm is predominantly ‘gadget thinking’. Others’ solutions are to be adopted here because they produce great outcomes elsewhere. Except now we have to figure out how we can get the gadget to work. Few commentators have been game to shift towards acknowledging that care practices are now too complex for ‘gadget thinking’. Hayes and colleagues are an exception. They propose that frontline professionals themselves need to become smarter at ‘codesigning’ solutions that suit their unique contexts and practices. Here, we are not talking about adopting new gadgets from elsewhere. We are talking about people who will—and who have the skill to—take 288
BMJ Qual Saf April 2015 Vol 24 No 4
Downloaded from http://qualitysafety.bmj.com/ on November 14, 2015 - Published by group.bmj.com
Correspondence inspiration from the smartness that may be invested in whatever gadget or improvement initiative, and apply this smartness to their own work practices. Indeed, these professionals may not even need inspiration to come from elsewhere: they may well be motivated by issues arising in their own work, and decide to redesign their practices. But to date, we have not focused on what this ability to codesign care practices consists in. We expect frontline professionals to somehow know how to codesign practice, and know how to be smart about what they do and what they should do. And yet, their training has not skilled them in practice design. We nevertheless expect them to readily (re)design the organisational dimensions of their work. Usually, such designs fall prey to people’s espoused ideas and preexisting assumptions about how things work and should work. Often there are worrying gaps between what people know and what they (think they) do. Put differently, smartness, in the sense of learning about how to manage complex situations and improve complex practices, is rare. Smartness cannot be expected to exist or arise in situations where there are no resources available for professionals to learn about (or ‘make explicit’) the complexities of their own day-to-day work. Smartness must be nurtured. The way par excellence to achieve this is professionals, just as do top-end athletes, studying their own performances. In sport, video-ing one’s game for transforming good performances into excellent ones is now not just common but also indispensable. This is about capitalising on and building on existing strengths. By analogy, video-ing in situ practice and using the resulting footage to reflect on the work is central to enhancing smartness at work. This is what Katherine Carroll and Jessica Mesman and colleagues have referred to as ‘exnovation’, which involves building on existing strengths and addressing local weaknesses. Of course, many excuses and objections are raised to autoBMJ Qual Saf April 2015 Vol 24 No 4
observation, the most common ones of which are privacy, the Hawthorne effect and subpoenable evidence. But these concerns are overstated, and they trade a real need and opportunity for improvement and smartness off against maintaining the status quo. Without auto-observation, existing habits and routines will go on unquestioned. Work can only become harder, as the only solutions to improvement will remain gadget based. Smartness, by contrast, starts from where we are, and explores where we can go. Rick Iedema Correspondence to Professor Rick Iedema, Faculty of Health, University of Tasmania, Darlinghurst campus, Sydney, Australia; [email protected]
Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed.
To cite Iedema Rck. BMJ Qual Saf 2015;24:288– 289. Accepted 22 January 2015 Published Online First 6 February 2015
▸ http://dx.doi.org/10.1136/bmjqs-2015-004029 BMJ Qual Saf 2015;24:288–289. doi:10.1136/bmjqs-2015-003996
289
Downloaded from http://qualitysafety.bmj.com/ on November 14, 2015 - Published by group.bmj.com
Working smarter, not harder Rick Iedema BMJ Qual Saf 2015 24: 288-289 originally published online February 6, 2015
doi: 10.1136/bmjqs-2015-003996 Updated information and services can be found at: http://qualitysafety.bmj.com/content/24/4/288.2
These include:
Email alerting service
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
