Learning from the Gulf oil spill to empower the front lines

Huddles, like this one at the Berkeley Regional Lab, can prevent errors

Recently, I wrote about the collective grief that we all share as we watch the disaster pollute our precious Gulf of Mexico and everything in it. Today, I want to share some ideas about how such disasters can and must be prevented. Our important goal in Kaiser Permanente to create a continuous learning organization rests on those strategies for prevention.

Sociotechnical systems

A Sociotechnical system (STS) is a well-respected approach to problem-solving and innovation. Eli Berniker of Pacific Lutheran University defines it this way: “The focus of such design is to enhance the technical problem solving capacities of work teams through autonomy, self-regulation, constant learning, and a competent understanding of the technical system they operate.  One track is to train all team members in all of the required skills including maintenance.”

Berniker, of the Sociotechnical Systems Roundtable, provides insights into the kinds of systems that should have been in place to prevent BP’s oil spill. His fundamental premise is that the people who are closest to the work are the ones, when provided with the opportunity to have a continuous learning environment, who will discover potential danger and make recommendations to prevent disasters. STS systems are in place to protect our nuclear arsenal, nuclear power plants and US Navy nuclear submarines, for example.

Berniker’s following statement could just as easily apply to health care: “Technical system complexity, paradoxically, is a simple concept. If there are a vast number of paths to failure, failure is inevitable. Oil rigs over water have a long history of such failures but few with catastrophic consequences of this magnitude.”

Health care as an STS

The health system in our nation has failed. It has become unaffordable, denying access to tens of millions. Those who do gain access are treated with wide variation, creating unfair and disparate outcomes, tremendous waste and workforce shortages. No one at the front line of health care would have created such a system. No patient or potential patient would have created such a system. Failure was inevitable!

There is no point in assigning blame. Instead, we in the Union Coalition and Kaiser Permanente are trying to create a system that not only will not fail, but will put the delivery of health care and the enhancement of the population’s health on a track for real success.

Our National Agreement is aligned with the Strategic Plan of Kaiser Permanente and the interests of the Coalition of Kaiser Permanente Union members. With the Value Compass as our guide, our National Agreement calls upon us to create that continuous learning environment, which to paraphrase Berniker, is designed to build the problem solving skills of autonomous work groups, and give them an understanding of the big picture in which they operate.

Mixed experience

Our experience to date empowering our front lines at Kaiser Permanente is very mixed. There are competing priorities, hierarchies in decision-making and many work streams to accomplish all at once. Still, we are making progress.

In our tentative, new National Agreement we decided to empower our unit based teams to become high performing teams over the next two years. From my point of view, this does not mean an acceleration of hierarchical direction of frontline teams. No!

What it means is that we need to learn from the thinking and experience of others who have flattened hierarchies and empowered teams with their own problem-solving capabilities. We have got to let go of our fears that the unit-based teams will not succeed, or that the teams will not be aligned with KP-Coalition strategies. All of that stands in the way of our creating an environment which motivates the front lines to see what they see more clearly every day, and turn that knowledge and experience into whole systems success.

Oil in the Gulf is unacceptable and could have been prevented from happening.

We have a new health care reform law which sets forth a mandate to fix the U.S. health care system. We cannot rely on old hierarchies for success. Under our National Agreement we have the best chance to lead the nation in the success everyone wants and needs.

We know what needs to be done.