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If The Tools Exist, How Do We Then Achieve Excellence?

An article by Dr John (Jack) Allen Pacey MD FRCSc from the 'Surgeons Guide to Airway Management'.

If the tools are now available for Airway Management Excellence then why do we struggle and how should we proceed in a way that will provide high quality care that is reproducible and measurable . The goal of this work is to provide a guide for system change and method of measuring the performance of the new process.

The science of change management must be brought to bear on this. Medical change process started perhaps with Fredrick Winslow Taylor who introduced the concept that waste and inefficiency was caused by haphazard unscientific management. The book 1911 book “The Principles of Scientific Management” was a first attempt to define a science for change. This proved to be an authoritarian approach suited to a society where workers had fewer means of education. Later, Peter Drucker in a prodigious effort well summarized in 2008, “ The Essential Drucker The Best Of Sixty Years of Peter Drucker’s Essential Writings on Management ” introduced the notion of management of “Knowledge Workers” who have substantial core information that will inform change toward more highly functioning organizations. The notion that organizations trend toward chaos is perhaps pessimistic but is widely believed today.

Modern leaders set a framework of goals and base rules which allow for distributed leadership of ways and means to get to change on a local basis. This is demonstrated with the new organization of the US Army where the strategy and clear objectives are defined at the centre, the Pentagon and the assignment of an Expeditionary commander begins a process where the elements required for success (such as IT Support, Transport, Air ) are defined and assigned by the unit who is responsible for execution. This devolution of decision making to those who are answerable for the outcome thus places the HQ in the position of being the responsible observer monitoring progress .

The focus for us professionals should be on the individual unit or work-space like the OR, ICU or ED and begin to seek ways of achieving perfection that is built on the skills and initiative of the local professionals but is wedded to the IT and management framework and goals for the organization overall. This local initiative produces high energy activity that entrains all of the brilliance available. The trick then for the local change agents must be to have appropriate goals so that the change does not collapse into petty politics and divisions. The energy of a fully engaged community with measurements for results is thus converted into forward action.

The process becomes a big part of the reason for a great or less than great outcome. As stated previously there are many capabilities needed for any professional team so the learning must go on in many directions at the same time. The development of British style “team leads” can be a useful way to start the process.

Professionals in the organization must be taught to become agents for change rather than curmudgeons or foot draggers. The new Systems for quality demand a new set of attitudes geared to embrace real change.

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