All innovative ideas are inevitably associated with new language.
Familiar words used in an unfamiliar context so that the language sounds ‘wacky’ to those in the current paradigm.
Improvement science is no different.
A problem arises when familiar words are used in a new context and therefore with a different meaning. Confusion.
So we try to avoid this cognitive confusion by inventing new words, or by using foreign words that are ‘correct’ but unfamiliar.
This use of novel and foreign language exposes us to another danger: the evolution of a clique of self-appointed experts who speak the new and ‘wacky’ language.
This self-appointed expert clique can actually hinder change because it can result yet another us-and-them division. Another tribe. More discussion. More confusion. Less improvement.
So it is important for an effective facilitator-of-improvement to define any new language using the language of the current paradigm. This can be achieved by sharing examples of new concepts and their language in familiar contexts and with familiar words, because we learn what words mean from their use-in-context.
For example:
The word ‘capacity’ is familiar and we all know what we think it means. So when we link it to another familiar word, ‘demand’, then we feel comfortable that we understand what the phrase ‘demand-and-capacity’ means.
But do we?
The act of recognising a word is a use of memory or knowledge. Understanding what a word means requires more … it requires knowing the context in which the word is used. It means understanding the concept that the word is a label for.
To a practitioner of flow science the word ‘capacity’ is confusing – because it is too fuzzy. There are many different forms of capacity: flow-capacity, space-capacity, time-capacity, and so on. Each has a different unit and they are not interchangeable. So the unqualified term ‘capacity’ will trigger the question:
What sort of capacity are you referring to?
[And if that is not the reaction then you may be talking to someone who has little understanding of flow science].
Then there are the foreign words that are used as new labels for old concepts.
Lean zealots seem particularly fond of peppering their monologues with Japanese words that are meaningless to anyone else but other Lean zealots. Words like muda and muri and mura which are labels for important and useful flow science concepts … but the foreign name gives no clue as to what that essential concept is!
[And for a bit of harmless sport ask a Lean zealot to explain what these three words actually mean but only using language that you understand. If they cannot to your satisfaction then you have exposed the niggle. And if they can then it is worth asking ‘What is the added value of the foreign language?’]
And for those who are curious to know the essential concepts that these four-letter M words refer to:
muda means ‘waste’ and refers to the effects of poor process design in terms of the extra time (and cost) required for the process to achieve its intended purpose. A linked concept is a ‘niggle’ which is the negative emotional effect of a poor process design.
muri means ‘overburdening’ and can be illustrated with an example. Suppose you work in a system where there is always a big backlog of work waiting to be done … a large queue of patients in the waiting room … a big heap of notes on the trolley. That ‘burden’ generates stress and leads to other risky behaviours such as rushing, corner-cutting, deflection and overspill. It is also an outcome of poor process design, so is avoidable.
mura means variation or uncertainty. Again an example helps. Suppose we are running an emergency service then, by definition, a we have no idea what medical problem the next patient that comes through the door will present us with. It could be trivial or life-threatening. That is unplanned and expected variation and is part of the what we need our service to be designed to handle. Suppose when we arrive for our shift that we have no idea how many staff will be available to do the work because people phone in sick at the last minute and there is no resilience on the staffing capacity. Our day could be calm-and-capable (and rewarding) or chaotic-and-incapable (and unrewarding). It is the stress of not knowing that creates the emotional and cultural damage, and is the expected outcome of incompetent process design. And is avoidable.
And finally we come to words that are not foreign but are not very familiar either.
Words like praxis.
This sounds like ‘practice’ but is not spelt the same. So is the the same?
And it sounds like a medical condition called dyspraxia which means: poor coordination of movement.
And when we look up praxis in an English dictionary we discover that one definition is:
the practice and practical side of a profession or field of study, as opposed to theory.
Ah ah! So praxis is a label for the the concept of ‘how to’ … and someone who has this ‘know how’ is called a practitioner. That makes sense.
On deeper reflection we might then describe our poor collective process design capability as dyspraxic or uncoordinated. That feels about right too.
An improvement science practitioner (ISP) is someone who knows the science of improvement; and can demonstrate their know-how in practice; and can explain the principles that underpin their praxis using the language of the learner. Without any wacky language.
So if we want to diagnose and treat our organisational dyspraxia;
… and if we want smooth and efficient services (i.e. elimination of chaos and reduction of cost);
… and if we want to learn this know-how, practice or praxis;
… then we could study the Foundations of Improvement Science in Healthcare (FISH);
… and we could seek the wisdom of the growing Community of Healthcare Improvement Practitioners (CHIPs).
FISH & CHIPs … a new use for a familiar phrase?