It is the nature of things to change and become more disordered. Buddhist wisdom tradition is anchored in holding this nature clearly. Our bodies, a miracle of self-repair given sufficient clean water, safe food, supportive social connections, and luck, wear out sooner or later. Nonetheless, we can often keep ourselves and other things going for some time without being too attached to the idea…
In a current project, several community health centers are working to increase the number of patients with diabetes who get timely oral health care. There’s a connection between glucose control and oral health; community health centers that provide dental services as well as medical care are well-placed to leverage this connection to improve the health of their patients. Our project has outlined…
Does the picture of a marked-up math test paper make you anxious? I taught high school math at a suburban Connecticut public school as my first full-time job. I used a red pencil to circle errors on test papers. A recent preprint by a team of researchers led by David Yeager, a psychologist at the University of Texas at Austin, summarizes an experiment that teaches math teachers to embed their…
Last week, I listened to an excellent webinar from Lean Frontiers hosted by Oscar Roche of the TWI Institute. Three managers from Helena Industries in Des Moines, Iowa, described a packaging failure that cost the company time, money, and customer goodwill. To solve the problem, they began by developing work standards in the Kato sequence : build an operational definition of what the customer…
In last month’s post , I reviewed industrial engineer Gerry Nadler’s advice: structure problems as system-design opportunities and start by analyzing the purposes of the new system. While Nadler’s engineering orientation shows through in his body of work, Gerry advocated for engaging the people who would operate or be affected by the new system in the design process. Engaging people to solve…
A problem is the gap between your current state and your desired state. Changing your view of your problem can help you craft a more effective solution. What if you zoom out and consider a larger problem? How would that work? Industrial engineer Gerry Nadler outlined a method to achieve this more than 40 years ago in a monograph, The Planning and Design Approach . Let’s dive in. Problems and…
In 1971, Herbert Simon gave a talk, “Designing Organizations for an Information-Rich World” (M. Greenberger (Ed.) (1971), Computers, Communications, and the Public Interest . Baltimore, MD: The Johns Hopkins Press, pp 38-72). Simon, a 20th-century polymath, was awarded the 1978 Nobel Prize in Economics for his research into organizational decision-making processes. While Simon’s information-rich…
Two years ago, I wrote about psychologist Alison Gropnik’s description of the difference between children and adults. Children are wired to explore, while adults are conditioned to exploit, to “…find resources, make plans, make things happen…”. Gropnik’s perspective prodded me to think about how I coach individuals and teams to learn by doing, using the Plan-Do-Study-Act (PDSA) method embedded in…
The hourly updates in my newsfeed these days describe the Department of Government Efficiency's (DOGE) efforts to change the federal government's structure and performance. These changes may affect the health and welfare of millions of people in the U.S. and abroad. The March 25, 2025, episode of Ezra Klein’s podcast asked what DOGE’s real goal is. Klein points out that efficiency is only a useful…
I discussed Job Instruction in a recent post . I mentioned that JI works best for jobs with few decision points and won’t work well for jobs with many decision points. This means you can’t apply the detailed Job Instruction method to teaching Job Instruction! The Job Instruction job has too many decision nodes, each with multiple branches: A supervisor learning Job Instruction must decide which…
Pocket Card from 1945 to guide Job Instruction Imagine your organization had every supervisor able to teach their people core jobs, improve the work in their area, and lead their people effectively. Such widespread supervisory capability would improve productivity, quality, safety, and morale for almost all organizations. The Bureau of Training, part of World War II’s War Manpower Commission,…
The Three-Part Data Review Method My colleagues at IHI developed a data review method that combines qualitative and quantitative data. This method helps users design and operate better healthcare systems by understanding specific populations' assets and needs. The IHI guide has practical suggestions for wording and tips for summaries of the conversations. Here are the three parts of the review…
I’ve seen and used many different templates to document a Plan-Do-Study-Act (PDSA) cycle. The templates range from those that have just a bit of guidance to those that ask for lots of details. What are the essential ingredients to help build a useful learning cycle? Not every learning experience qualifies as a PDSA cycle I’ve written several posts that quote a definition of a PDSA cycle from my…
In 2011, Perla, Provost and Murray published an article that promotes the use of run charts as an accessible and powerful tool [1] . The body of the article describes simple probability-based rules to identify unusual patterns of runs in time-series plots. Unusual patterns that correspond to intentional actions provide evidence of causal impact. The authors make a compelling case for plotting data…
The psychologist Alison Gropnik has summarized one behavioral difference between human babies and adults. Babies and young children explore their environments while adults exploit their environments: “…you’ve really got these two different creatures. So you’ve got one creature that’s really designed to explore, to learn, to change. That’s the child form. And then you’ve got this other creature…
In 2019 Andrea Jones-Rooy, a data scientist at NYU, reported her response when she is asked a routine question: “What do the data say?”: “Data can’t say anything about an issue any more than a hammer can build a house or almond meal can make a macaron. Data [are] a necessary ingredient in discovery, but you need a human to select it, shape it, and then turn it into an insight….” Following…
Last week Ezra Klein reprised his 4 June 2021 podcast with Brian Christian, “If All Models are Wrong, Why Do we Give them so much power?” Christian used George Box’s aphorism, “All models are wrong, some are useful” in his discussion of machine learning models. He outlined one egregious example, the self-driving Uber that killed a person in 2018. Box rooted his insight based on experience with…
My friends Lilia Pino, Jen Nabong, and Mary Dolansky will share a story this week at the Institute for Healthcare Improvement’s Annual Forum. These friends have embraced the spirit and practice of Plan-Do-Study-Act. I’m grateful for project lessons I’ve learned with them in my role as an Improvement Advisor with the IHI. Lilia and Jen work at MinuteClinic at CVS; Mary is a nursing professor at…
The Biden administration has directed federal agencies to act and promote action to decarbonize the U.S. economy—to radically reduce the emissions of carbon dioxide into the atmosphere. Decarbonizing also includes work to reduce the emissions of other gases that cause heat to be trapped in the atmosphere, like methane and nitrous oxide. The consensus view is that we humans are in a pickle: we have…
The physician started his conversation with a question. “What do you know about your condition?” A family member and I were in the physician’s office to discuss a plan of care for a newly diagnosed condition. We had gotten a lot of information over the previous two weeks. The physician’s initial question invited his new patient to state their understanding. It also invited the patient into…