Stupid Stuff:  Waste by another name

Stupid Stuff: Waste by another name

Last week in The New England Journal of Medicine, Dr Melinda Ashton described her organization’s work to rid their EMR of ‘stupid stuff’, here.

Since October 2017, her physician and nurse colleagues have identified almost 200 instances of inappropriate documentation, documentation that can be done more efficiently with new tools or understanding, and misunderstanding of requirements that caused confusion.

Ashton reports the Stupid Stuff program has now moved beyond the EMR documentation issues. 

“It appears there is stupid stuff all around us, and although many of the nominations [for stupid stuff] we receive aren’t for big changes, the small wins that come from acknowledging and improving our daily work do matter.” 

That’s a succinct description of continuous improvement derived from a focus on reducing wasted effort.

Dr. Ashton points out an additional benefit of the Stupid Stuff program:   it demonstrates the commitment of her organization to understand and act to reduce daily frustrations. 

Link to Management for Quality Control

Stupid stuff identification and elimination should be a core management function and competence.

How could an organization tackle this responsibility?

Ashton does not describe the way her organization manages the Stupid Stuff program.

One way to reduce stupid stuff:  encourage individuals or teams to submit nominations when they have a chance or as part of a specific department meeting; create a special committee that reviews items for feasibility and action.  

A second way to reduce stupid stuff:  use daily and weekly huddles by point of care and management teams as part of the organization’s system of quality control.   

The quality control approach starts and ends with the daily huddle.   

1.      Ask a question in the care team’s daily huddle to get nominations:  “Did anyone experience stupid stuff in documentation yesterday?”  

2.      Communicate the nomination to next tier manager if the stupid stuff can’t be handled by the team.

3.      Carry out stupid stuff review and assignment for action in next-tier managers’ daily or weekly huddle. 

4.      Close the loop back to the care team’s daily huddle with action and resolution; the best way to continue to get nominations is to act to eliminate or mitigate stupid stuff.

Moving from a care team’s daily huddle to leaders and back again to the care team is the essence of escalation; this diagram of a management system for quality control translates the words into a picture.


Source:  Scoville R, Little K, Rakover J, Luther K, Mate K. Sustaining Improvement. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2016. (Available at

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