Practice to be best

We may think we should adopt best practices, but to be really effective and innovative we need to practice to be best.

First, we have to do the hard thinking  about how to do things better. Jay Deragon talks about how important it is to think about what we do and not just emulate others:

Social Doo Doo’s are those that practice and copy, what others do expecting to get the same or better results. Social Doo Doo’s are a dime a dozen and the market seems to think hiring the Doo Doo’s will help their business do something different. Doing something different and getting more than you’ve gotten in the past  requires you to know how to think which isn’t what others are doing.

Gaining  new knowledge or creating new knowledge and knowing what to do with it is more productive than doing what others do. To gain or create new knowledge requires thinking which is a lot deeper than doing.

Another example of advancing practice in a field is provided in The New Yorker’s The Bell Curve: What happens when patients find out how good their doctors really are? In this article, a doctor explains how radically new thinking saved the life of a fire fighter but his mates refused to try something different and they perished.

As Berwick explained, the organization had unravelled. The men had lost their ability to think coherently, to act together, to recognize that a lifesaving idea might be possible. This is what happens to all flawed organizations in a disaster, and, he argued, that’s what is happening in modern health care. To fix medicine, Berwick maintained, we need to do two things: measure ourselves and be more open about what we are doing. This meant routinely comparing the performance of doctors and hospitals, looking at everything from complication rates to how often a drug ordered for a patient is delivered correctly and on time. And, he insisted, hospitals should give patients total access to the information. “ ‘No secrets’ is the new rule in my escape fire,” he said. He argued that openness would drive improvement, if simply through embarrassment. It would make it clear that the well-being and convenience of patients, not doctors, were paramount. It would also serve a fundamental moral good, because people should be able to learn about anything that affects their lives.

Imitating what others do is not the way to make progress, or as Marshall McLuhan said,  “We look at the present through a rear-view mirror. We march backwards into the future.” Individuals and organizations need to chart their own courses but “Best Practice” thinking is still widespread.  I have found that decision-makers in organizations can be too lazy to extrapolate and figure out how to apply practices in their own context. They want easy, clear answers and hence have the tendency to hire cookie-cutter solutions from big name consultancies. But there are no easy answers. As my colleague Jon Husband says of his wirearchy framework, it enables the mass customization of business, and that is what we need to replace best practices. Individuals and organizations continuously practicing to be best, on a large scale.

No technology or process improvement will save an unraveling industry or organization. What is needed is better thinking and learning while practicing to be the best. This starts with transparency in sharing our knowledge and doing our work.

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8 Responses to “Practice to be best”

  1. Ben

    If the medical world is looking for a model of how to put this into practice, they should should check out the CDOI movement in mental health. It’s been happening there for quite a number of years now.

    This kind of transparency and comparison is not really at odds with “best practices,” however. If Hospital A compares itself to Hospital B and discovers that Hospital B is getting better outcomes by doing XYZ process, why in the world WOULDN’T they adopt XYZ process, too?

    Not sure why articles on training blogs always seem so either/or, radical, or dogmatic.

    • Harold Jarche

      Thanks, Ben. I never really considered this a training blog, but I digress ;)

      The point of the New Yorker article, I believe, is that one cannot only look at what others are doing but must push at the envelope of knowledge & practice. I like this definition by David Shaffer; “A professional is anyone who does work that cannot be standardized easily and who continuously welcomes challenges at the cutting edge of his or her expertise.” The same goes for professional organizations, in my opinion. Non-standardized work doesn’t tend to best practices, but there is still a need for high expectations of the results of the work.

      The radical concept is that Best Practices just don’t cut it because they cannot be copied but must be understood and then adapted, if possible, for a different context. Best Practices only translate directly for simple tasks: http://www.jarche.com/2010/07/managing-in-complexity/

      • Harold Jarche

        And I just came across this most interesting article from Fast Company on encouraging positive deviance (best practices?) to effect change. Positive deviance cannot just be copied and applied. It also needs to be done within groups that share attributes and self-identify. Even if positive deviance is effectively disseminated, it will change the goals: “The bell curve of performance keeps moving up, as long as you disseminate the best deviations across the curve and continue to discover new examples of positive deviance among the next group of best performers.”

        http://www.fastcompany.com/magazine/41/sternin.html

  2. Jon Husband

    “The bell curve of performance keeps moving up, as long as you disseminate the best deviations across the curve and continue to discover new examples of positive deviance among the next group of best performers.”

    A fundamental and core assumption underneath the theory that has spawned competency models.

  3. Ben

    Do you consider surgery to be a “simple task”? Hospitals that enforced use of a standardized 19-item safety checklist saw their patient mortality cut in half (no pun intended) and their rate of complications drop from 11% to 7% (NEJM, JAN2009). Talk to any surgeon, and they’ll tell you that surgery is NOT widget-fastening. Every surgery is different. Yet, a simple checklist drastically improves outcomes.

    There are times when it makes sense to re-contextualize, and there are times when it makes more sense to simply adopt someone else’s best practice.

    Pronouncements like “there are no easy answers” and “imitating what others do is not the way to make progress” are dogmatic.

    Sometimes there is an easy answer–like using a checklist that reinforces practices that you probably thought you were doing all along. Sometimes imitating others does help an individual make progress–like when a poor performer slavishly mirros the behaviors of his successful co-worker.

    Admitting this won’t get you an article in Fast Company, and it probably won’t make a great blog entry…but there it is.

    • Harold Jarche

      It’s a blog post, nothing more & nothing less*

      I’m a big fan of checklists and performance support tools. We used them in the hospital where I worked and I helped develop them for helicopter aircrew. Checklists are good for ERP (easily repeatable processes) especially when time is critical. However, more of our work is doing BRP (barely repeatable processes).

      Best practices for simple environments (there are simple aspects of medicine, like following a safety checklist)

      Good practices for complicated environments (rules of thumb, guidelines)

      Emergent Practices for complex environments (constantly evolving through use)

      Novel Practices for chaotic environments (trying something new or from a different field)

      My main concern is that too often we look at successful organizations and just try to copy what they are doing. This is not dogmatic, it’s based on my observations of many organizations over a few decades.

      * No blog post or article is going to address every angle or every consideration of a complex issue. This blog is mostly for me. These are my half-baked thoughts which I make public in order to share and to learn. This post will probably be edited several times and may become part of a longer article or white paper. What you see here is the raw material. Much of the nuance is in the flow of the conversations here for the past six years. Most posts are within the context of previous posts, their comments and the references.

  4. Ben

    You make some good points here, Harold, and I’d like to go further with it, but your little footnote disclaimer has me on the ropes.

    I’m not trying to engage in the “nuance,” but rather engage in a conversation with you about what you wrote in this specific post. If that requires me to understand the context of six years’ worth of previous posts, comments, and references, I can’t really say it’s worth it for me…especially for something that you describe as “half-baked” “raw materials” written mainly for your own benefit.

    Consider me retired from commenting. The entrance fee is too steep.

    • Harold Jarche

      You’re always welcome to comment here again, Ben. It was your comment on being dogmatic that triggered my response to clarify my sense-making process. I don’t see my posts in isolation but neither do I expect anybody to read everything I post. Thanks for engaging, if only for a short while.