Should we work on insignificant improvements?

Doctors hate their computers. Well, that’s according to Atul Gawande. The influential doctor and writer recently dedicated almost 9,000 words to outline his thoughts on the matter in The New Yorker’s Annals of Medicine.  So many initiatives intended to make things faster and better actually result in the opposite. His main focus of his frustration is on computerised patient record systems. They slow down consultations and increase workload. The vast majority of ‘improvements’ made seem to result in demand for more hours working away from patients.  He goes on to suggest a direct link between software and bureaucracy. As prevalence and complexity of the former grows, so too does the latter.  In addition:

“I began to see the insidious ways that the software changed how people work together. They’d become more disconnected; less likely to see and help one another, and often less able to.”

Impact on patients

Atul Gawande is not alone in throwing the spotlight onto computer systems which are intended to help. To quote Helen Salisbury, writing in The BMJ:

“..if I’m not careful, technology can take over the consultation so that (it takes) more time than the listening and the talking. Worse still is when I try to do both at once—listening a bit but not enough, hands already typing, eyes on the screen. There’s nothing like not listening to encourage not talking.”

It’s so easy to see how, in hindsight, all the little things add up to being something much bigger. Mountains are made up of countless grains of sand – some fused together as solid, impenetrable rock. All the extra little tasks and delays add up to hours of our time. But do we think about all the little things that could help in the same way?

Do we think about improvements in the same way?

If you are reading this, then you are reading the first blog entry on our newly redeveloped website. It’s much, much faster than the old version. Didn’t you notice? No? But then, why should you? We don’t usually notice how quickly or efficiently something works. We just expect it. If we do notice an improvement, it doesn’t take long for us to get used to it and forget the way things were. But we do notice when things are slow and get in the way.

To quote Tom Peters:

“There’s no such thing as an insignificant improvement.”

Such thinking feeds into the concept known as the ‘aggregation of marginal gains’. This principle was utilised by Sir David Brailsford as he coached the British Cycling team and Team Sky to unparalleled success. Yes, all the little inefficiencies add up to major problems. Equally, multiple little improvements add up to something well worth the effort.

Making a worthwhile difference

Our research, published in BMJ Leader, revealed major shortfalls in doctors discussing things that matter. Of over 200 doctors, some 40% said they were not discussing progress toward goals either enough or at all with their colleagues. 37% said they were not involved with discussions about improving processes. Learning how to have such discussions with team members would be one small improvement. Actually having the discussions would create the possibility of many more. Learning how and improving the ability to channel ideas into worthwhile change helps make these little changes real. All too often, we wait for the big idea or the big initiative. Worse still is waiting for someone else to do something. Meanwhile, the problematic little things continue to tighten their grip.

What small yet significant improvements will you make next?

Stephen McGuire – Head of Development