No more “death by initiative”

We've got what it takes

All the innovation we need is already here:  how do we put it to best use?

We’ve all heard the term: “death by initiative.”  What does this mean?

We work in a gigantic and complex set of systems: financial, research, health care delivery, insurance, compliance, communication, information technology and people. Each of these systems has within it hundreds of sub-systems that create tens of thousands of outcomes.

The organization sets strategy to make best use of these systems.

The implementation of the strategy hits the frontlines as many initiatives, seemingly all at once.  Everyone tries their best to keep up.

Initiative vs. transformation

For the last several years, there has been a transformational movement going on inside Kaiser Permanente. Two factors have come together: the evolution of the labor-management partnership as an operational strategy and the evolution of a holistic approach to outcomes and goals for the organization.

We are working together in the midst of exciting opportunities, especially with the passage of the national health care reform legislation.

To take advantage of these opportunities, we need to create an environment of continuous learning, innovation, and improvement as we find ways to unleash the inherent knowledge and experience of the frontline.

Principles to live by

Some principles that apply to this transformation at KP are drawn from some very different organizational movements including:

• The labor movement
• Social movements
• Improvement strategy
• Experiential learning movements
• The struggle for universal health care

Among those principles that we have been learning from each other and from others:

1. 1. Keep the patient at the center of everything we do
2. Hold onto the commitment that lead us to work in health care in the first place: the wish to make a difference for our fellow human beings
3. Aim high
4. Search outside
5. Compare yourself to others
6. Trust the workforce
7. Trust the patient
8. Test change
9. Constantly ask, “What am I a part of?”
10. Learning is the culture and the path to innovation and performance, not tools and training
11. Learning is a constant journey
12. Use systems charts, not organizational charts
13. Data drives decisions
14. Data is always transparent and available
15. Best practices are driven through the system
16. Create a blame-free environment
17. Reject project-oriented approach
18. Ensure that everyone understands the business and the economics that drive/impact the organization
19. Constantly use PDSA, and allow time for reflection and creativity
20. Continually ask seven questions:

-What is our purpose?

-How do we measure?

-How do we define the gap between today and the best possible future?

-How do we connect our work to the work of everyone else in the organization?

-How do we identify waste and links that do not work?

-How do we prioritize which processes are in need of improvement?

-How do we integrate improvement as a part of everyday work?

We will act our way into a new way of thinking, as opposed to thinking our way into a new way of acting.