Posted in Healthcare

When Best Practices Become Too Much of a Good Thing

What do you feel when you hear the words “best practice”? It probably depends where you sit. For those in the C-suite, a best practice may seem like a no-brainer. If something works well in one area, why not multiply its effects by mandating its use elsewhere? But for those whose job falls within the elsewhere category, just hearing the words “best practice” may conjure up a long list of negative memories about mandatory policies gone wrong. I’ve seen it countless times throughout my personal journey from the bureaucratic behemoth of the federal government to the business of healthcare: a best practice can turn into a nightmare when handled inappropriately.

The journey is a common one. One team develops an ingenious solution to a problem — and it works incredibly well. Kudos and accolades follow. All good so far! A few management layers up from the team, somebody makes the logical leap (a reasonable one) that this creative solution should work elsewhere. Motivational emails and conversations follow. Still good! The new solution is suggested to everybody else, and a few managers see potential and follow suit.  

But here comes the twist. Frequently, the best practice morphs into a mandatory process, possibly disseminated from what many businesses are optimistically starting to call “Centers of Excellence”. What was once an innovative solution to a unique problem set becomes just another process that adds to everybody’s workload. In some cases, the mandated change does indeed improve results. But in too many cases, the mandatory change, despite being well-intentioned, proves either unnecessary or ineffective given its blanket one-size-fits-all implementation.

In my military experience, it was checklists. My unit–which did mission planning support for fighter aircraft–developed a few key checklists that kept us all from avoiding serious mistakes. After this idea became a best practice, we were ordered to create checklists for virtually every work function we carried out. These good intentions ended up bogging us down when our real world needs shifted so fast that we spent way too many hours tweaking checklists instead of thinking through new solutions.

In hospitals, I’ve heard countless stories about the missing voice of nurses in the development of new technology. Nurses get frustrated when new software and protocols get pushed on them from above–especially when the capabilities or “solutions” don’t really apply to their unit. One nurse recently relayed to me his frustration at new, time-consuming charting requirements that had been identified elsewhere as a best practice. After fitting these new requirements into already overloaded shifts, this nurse was surprised and disappointed to find out that doctors didn’t even know where to locate these new electronic charts. A good idea had become just another routine process divorced from the core mission.

Unfortunately, there is too often a gap between decision and practice in these cases. Those who mandate a best practice don’t actually have to carry it out; they are insensitive to the increased time and effort many of these best practices might require, and they may not be sensitive to the nuances that made the best practice work in the first place.

So how to fix this? One idea is to focus on the creation of best practices, not the spread of them. Creating a culture of innovation, where the best ideas and innovations bubble up from the lowest levels, is one way of ensuring new processes fill a specific need. Best practices can be incredible suggestions, and many times another department can benefit by adopting one. But a best practice is not guaranteed to be effective somewhere else simply due to its being called a best practice; it’s the innovative spirit from which it developed that organizations should nurture and encourage. Give your employees the freedom to make and suggest changes, focus on freeing up their time by eliminating unnecessary processes, and trust their opinion when they find new technology that appeals to them. Getting your employees’ input at the beginning will lead to better buy-in, adoption, and results in the end.

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