The Insidious Nature of Variation

The most difficult lessons to learn come on the heals of great success.  We implemented a big project across a large healthcare setting.  It involved the support of thousands of physicians, nurses and administrators.  It took years to complete and when the final analysis was performed, it demonstrated great results.  We significantly improved patient care and made the work environment safer, not to mention the millions of dollars in cost avoidance.  By any standard this was a great success.  The problem…a couple of years later we noticed the old problem was beginning to slowly return.  How could this be you might ask?  It wasn’t obvious at first, but it can only be described as the insidious nature of variation.  It doesn’t hit the shore like a tsunami, it is more like soft gentle waves hitting the beach slowly and persistently over time.  On any given day the changes are imperceptible.  It is only with the passage of time that the effect becomes apparent.

What we didn’t realize was that staff turnover can be a new source of variation.  If you are not on boarding and orienting new staff to any new process, then there will be a steady influx of personnel who will be doing that new process a little differently.  The assumption was that older staff would teach the newer staff the new process.  Unless there is a standardized process for that education, then this just becomes another source of variation.  With each new addition in personnel, variation creeps into the process.  In time, it becomes a very different process compared to the new standardized process that led to the great outcomes.  Unfortunately, it creates new outcomes that may not be so great.  So if you want to continue to get great outcomes with any process change, make sure to create a process to sustain the new process and perform regular checks to make sure it truly is sustained.

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