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An Improvement Wake-Up Call

A Message from Jonathan Small
NICHQ's Senior Director of Communications

February 2012


It never ceases to amaze me what I learn from my children, especially the youngest ones – my eight-year-old twin daughters. I’ve been working in the quality improvement field for longer than they’ve been alive. But now they’re the ones teaching me about it!

Until two weeks ago, every weekday morning brought the recurring challenge of trying to get these two seemingly responsible third-graders to school on time. How complicated could it be? We set their alarm clock so they would have a whole hour to get dressed, eat breakfast, prepare lunches, wash up, and get out the door and down the block to school. It should have been enough time. But far too often, they arrived late. And the last few rushed minutes of getting them out the door were among the most irritating and stressful times in our relationships.

Their latest progress reports listed 18 “tardies” for each of them – and always just an agonizing two or three minutes late. My wife and I pride ourselves on being prompt. Surely we could get our children to shave a couple of minutes off their morning routine. But we just couldn’t push any harder.

Every system is perfectly designed to get exactly the results it gets, say the improvement experts.

So, we decided to change the system. We did the only logical thing we could think of – we set the alarm clock for fifteen minutes earlier. We reasoned that the extra time would be more than enough to make up for the difference. I had no doubt that this was the right solution. But no! The girls simply lingered in bed longer and were more irritable and less cooperative. Still arriving late. Still stressful. Still “tardy” noted on the progress reports. Our first Plan-Do-Study-Act cycle was a failure – and we had all lost an extra fifteen minutes of sleep to boot.

Now, I’ve been working in quality improvement for more than a decade, and I’ve been a parent even longer. I was determined to find a way to improve our performance here.

Then my wife had a brilliant idea – ask the girls to solve the problem themselves. I began thinking about the quality management principle that the frontline workers (not management) are in the best position to identify possible causes of a problem and find a solution. My wife had empowered our “frontline workers.”

Their recommended solution, however, was preposterous, so counterintuitive that it was almost laughable. The girls suggested that instead of setting their alarm clock earlier by fifteen minutes, they would set it fifteen minutes later. Ridiculous. That would leave them only 45 minutes to get to school. If they couldn’t get there in an hour, how could they possibly think they could get there in 45 minutes?

They reasoned that if the alarm clock went off later instead of earlier, they would pop out of bed and kick it into gear more rapidly and efficiently. Ha. Just an excuse for sleeping 15 minutes longer and getting to school 15 minutes later.

But we decided to try it – just for one day. It was a small test of change with no risk – after all, what was one more “tardy” at this point?

And what do you know: they made it to school on time. So we tried it again the next day. Same result. Since we made that change two weeks ago, the girls have not been late to school even once! No more “tardies.” They are less irritable (probably due, in part, to the extra sleep) and more in control. So far, we are holding the gains.

So, what did my eight-year-old children teach me about quality improvement?

My wife and I never would have thought of this solution ourselves. It was completely counterintuitive to us. Yet, it was as clear as a new day to the people who mattered most in this process. And when they were empowered to solve the problem, they came up with a solution that worked – for them. And now, they own and care about the results more than ever, because it was their idea and they have a stake in seeing that it’s successful – if for no other reason than it allows them to stay in bed an extra fifteen minutes each morning.

We learned that sometimes the best thing a parent (manager) can do is get out of the way and let the child (worker) solve the problem.

Next on the agenda: let them figure out how to keep their room clean. Believe it or not, that’s working too!

Jonathan


You can reach Jonathan at jsmall@nichq.org

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