Does Your Business Lack Systems Thinking?
By Richard M. Jones, Work Systems Canada Principal
Have you ever noticed the simple changes you tried to implement just don’t seem to work, and sometimes you are surprised at how it really shakes out? Why does A + B no longer = C anyway? Furthermore, as our business grows, the old simplicity gets more and more complicated. So, how do we respond to the complexity that running a modern business involves?
Systems Thinking is designed to enhance your ability to understand, model and resolve complex business issues. It helps us to develop the “mental elasticity” needed to anticipate the intended and unintended consequences of you or your organisation’s decisions and understand how those decisions will lead to tomorrow’s business successes or failures. The concept, based on the work of Peter Senge, author of The Fifth Discipline, and others helps us to:
- Understand the complexities of your organization from a systems’ perspective and design solutions that leverage your strengths
- Anticipate the intended and unintended consequences of today’s decisions
- View your organization as an interrelated and interdependent system rather than a collection of separate entities (i.e. departments, product groups, business units)
Understanding the power of the tools and concepts of Systems Thinking allows you to understand, model and test business assumptions and decisions. This ability can have a tremendous impact on the contribution you can make to your organization. Thinking systemically will give you the knowledge and tools to:
- Improve your “hit-ratio” of good decisions
- Become a more valued member of your team by increasing your ability to understand and manage increasingly complex organizations
- Model and predict the impact that decisions will have throughout the organization before they are implemented
- Avoid short-term thinking that can create long-term problems
- Increase your contribution to shaping the strategic direction of your organization
An example of Unintended Consequences
“Patients won’t be so well cared for” – The Discharge Lounge Syndrome
The Discharge Lounge is an interesting example of the phenomenon of unintended consequences.
First some background. One of our clients was the CEO of a large US tertiary care hospital. One of his many challenges was to free up beds for incoming patients. Hospitals beds get paid for by both insurance companies and Medicare on a midnight bed census. If the bed is occupied it is paid for; if empty the revenue is lost. As the costs of running the beds is roughly the same with, or without, a patient in them this is a good source of revenue that was being lost because people were leaving late. To get a new patient in the bed had to be free by about 2 pm often people were discharged too late in the day for a new patient to be admitted. A review of the bed usage revealed a significant amount of income was being lost because of “empty” beds when the midnight census was taken by the payers.
When we looked at why people were leaving late we discovered:
- This was often because they were elderly and needed collection by their children who were at work till late afternoon.
- Nursing staff were reluctant to call their carers before the Doctor had finally signed of on their discharge as it might get their hopes up falsely
- Nursing staff did not see it as a part of their job.
- The nurses didn’t like to be pushy with the patient’s relations to collect them early because they had a sense that patient care would be compromised.
- Doctors often did rounds first thing in the morning and signed off on patients well before noon.
As a solution the CEO had a Discharge Lounge set up. The lounge was comfortable and created a space for the patients to await pick up. It was staffed by a nurse from 8 am till 7 pm. The patient was still under the hospital care throughout the wait. It was equipped with magazines, newspapers and TV sets.
Though instigated to provide a space for people to await collection on the day of departure it was receiving only a small amount of use. The statistics didn’t add up. About .6 of a patient was using the lounge daily. Yet the statistics showed that patients were departing earlier and the revenues from the beds “freed up” was better than initially forecast. So what was happening?
We were asked to look into this for the CEO. What we learned, unofficially, is that the Nursing staff was extremely reluctant to send people to the discharge lounge. In their view the care would be inferior to that of the Primary Care Unit. As a result they made every effort to get the patient collected earlier. This often involved calling the patient’s primary carer, often an offspring or a sibling, and asking them to pick people up as early as possible. This being the lesser of two evils in their opinion; being pushy was better than compromising their “sense” of care.
In other words, the existence of the Lounge was having the desired effect on staff behaviour but not through the use of the Lounge.
This was a positive consequence. Though the existence of the lounge was actually the spur needed to get the nursing staff to change their behaviour and contact the next of kin earlier so they could pick up their relatives. There is a sad end to this story - over time the lounge costs could not be justified for the small number of users. Not surprisingly, the Lounge was closed after 10 months (over 220 people used it) and the problem of beds not being filled at the midnight started to creep back ………
Need more detail? Read our best practices white paper on helping organizations develop themselves to achieve sustainable breakthrough results:
Breaking the Complexity Barrier
EMAIL Work Systems Canada’s editor andrew@worksystemscanada.com and ask for your copy.