Avoiding predators, improving work systems

Avoiding predators, improving work systems


Last week on a project review call, I listened to a physician leader describe the skillful way she invited the medical assistants at her clinic to redesign the way staff entered lab results and tests into the medical record.  Through multiple Plan-Do-Study-Act cycles, the MAs reduced churn and wasted effort by the care team.

The MAs observed their messy situation, tried ideas to neaten the mess and adapted their actions based on experience.  Natural improvement: it’s what our brains can do; we’ve evolved to learn from our environment to survive and thrive.

“...[the mind is] not in the business of gathering data for its own sake:  the original point of perceiving the world was to help a creature survive in it.  For the purpose of survival, what was needed was not a complete picture of the world but a useful one—one that guided action.”  


On the call, my physician colleague Neil Baker asked me to comment about the role of prediction in sharpening Plan-Do-Study-Act practice. 

Prediction appears to be a deep part of how we learn, in a forest or in a clinic.

 “A brain needed to know whether something was normal or strange, helpful or dangerous.  The brain had to infer all that, and it had to do it very quickly, or its body would die—fall into a hole, walk into a fire, be eaten….Instead of taking in a whole scene afresh each moment…the brain focused on the news:  what was different, what had changed, what it didn’t expect.   The brain predicted that everything would remain as it was, or would change in foreseeable ways, and when that didn’t happen error signals resulted…As long as the predictions were correct [actual events match forecast], there was no news.  But if the signals appeared to contradict the predictions—there is a large dog on your sofa (you do not own a dog)—prediction-error signals arose, and the brain did its best to figure out, as quickly as possible, what was going on.”

If you make an explicit prediction before running a test—e.g. ”we will be able to get the lab results documented in 15 minutes”—you call attention to part of the test environment embodied by the prediction.  An explicit prediction prepares you to look for a potential surprise, a mismatch between prediction and actual events.

Now factor in a wonderful consequence of evolution:  when we see a mismatch between actual events and predictions, we are primed to figure out what’s going on, primed to improve performance.

Writing Out our Plan-Do-Study-Act cycles:  The case for documentation

“How is it that human thought is so deeply different from that of other animals, even though our brains can be quite similar?  The difference is due…to our heightened ability to incorporate props and tools into our thinking, to use them to think thoughts we could never have otherwise.”

A Plan-Do-Study-Act form (here’s an example) works as a checklist to prevent missing key steps.  You can share written plans to align a team.  A form encourages you to record predictions.  Finally, a completed form provides a record for reference and a foundation for subsequent cycles, especially useful to capture what you learned (STUDY) and what you will do next (ACT).

A PDSA form is a way to extend our PDSA thinking.  While there is a cost to use—we must slow down for a minute or more and work to put our intentions into words and numbers—writing out the PDSA steps is conscious practice that strengthens our testing skills.

Notes on quotes

The quoted sentences come from “Annals of Thought:  Mind Expander” by Larissa MacFarqhuhar, The New Yorker, 2 April 2018, a summary of the work of Andy Clark, philosopher and cognitive scientist at the University of Edinburgh (https://www.newyorker.com/magazine/2018/04/02/the-mind-expanding-ideas-of-andy-clark, accessed 2 April 2018).



PDSA forms and PDSA practice

PDSA forms and PDSA practice

Plot Dots, Add Notes, Look at Multiple Instances

Plot Dots, Add Notes, Look at Multiple Instances