"People ripped the improvement graphs down!"


I love a run chart: the simple process improvement graph that shows how a particular performance metric is moving over time toward a numerical goal. The values for the single measure on the vertical y-axis, the units of time (day, week, month) ticking by on the horizontal x-axis.  A simple visual story, knowing where we stand relative to a telling number chosen for special attention. It’s exciting. Really, what could be better? *contented sigh*

Well, for many people, pretty much anything could be better. A two-hour staff meeting, bad news from the dentist, not looking at numbers. A lot of people don’t like their group or individual performance analyzed with numbers.

So what’s a leader of improvement to do?

Here’s a little story to illustrate this dilemma, with ideas for solutions to come in a second post.

But here’s the punch line up front, since my list of solutions to this problem will come in a later article: Tell people clearly and repeatedly (and repeatedly) about why you want to track data in this way, and how this is different than the old-style report card of top-down management. And then follow through on the implications of these words for your workplace culture. 

Ok, story time!

I was meeting with the management team of a busy primary care clinic in San Francisco. We were sitting around the lunch table in the clinic’s kitchen/break room – the socio-cultural hub of the place. We were talking about leadership communication for improvement, specifically how this management team shared quality data with the rest of the 20-plus staff who worked in the clinic.

The nurse manager said with pride: “We post the graphs about A1c [a blood sugar test for people with diabetes] and LDL [cholesterol] and so forth in the hallways so that everyone can see what we are working on and how we are improving.” People nodded. I typed a little note.

Then a real zinger from the head clerk: “Yes, we did that, but people ripped the charts down.”

“Ripped them down?” said the nurse manager and the medical director in perfect unison. The medical director cleared his throat, uncomfortably, perhaps unconsciously, but he telescoped a clear message: Let's not talk about this. Everyone looked at me, the outsider.

But the head clerk persisted. “Yes, they did. People tore them down because they didn’t want to look bad and they got angry at putting the charts on the wall.”

“Why would they get angry?” the medical director asked.

“They didn’t like seeing that we were doing worse than other clinics. They thought the managers put the graphs up to make them work harder.”

“But we were the best clinic on some of those measures,” said the nurse manager.

“And we were getting better on most of the other measures. It’s improvement!” said the medical director.

See what happened?

The chart-rippers only understood measurement for judgment and accountability. They were used to a management style that said, explicitly or implicitly, that anything that wasn’t at 100% wasn’t good enough. That everything should be perfect from the get-go. Which of course is impossible and unreasonable and part of the reason the idea of perfect is a real obstacle to improvement. That whole “enemy of the good” thing.

What the management team had not communicated often enough or in the best ways, what some people still needed to understand and believe, is this: that these numbers, these run charts were being displayed as part of a systematic commitment to continually fixing the clinic's processes of care. This is all part of measurement for improvement, versus an indictment, another audit report, a way for managers to push people to feel bad and work harder. Without that key and profound change in how they were supposed to see and use the run charts, the chart-ripper (and likely others) felt burdened, criticized and angry. Ripping down the charts was a way to say "Hey, I'm trying here! Don't bring me down." 

For improvement to happen, and for people to enjoy coming to work, we need creativity, openness, and trust, as well as these data that show us how we are doing and where we are going. The numbers we share with run charts need to spark excitement, discussion, productive conflict, problem-solving and new ideas. When people get offended, defensive and closed off, the improvement process with all its input and experimentation just won’t go.

Leaders of change have to make sure that everyone, every single person who walks the halls of our workplace, understand the distinction between data for improvement and data for judgment. (Both exist and both are necessary. They are different.)

How did this clinic change this accidental and serious rift between the management team and the anonymous chart-ripper? What are some other things to try to make sure everyone knows why performance measurement and run charts are a force for good in the world? Part 2 is here!

Andrew EdwardsComment