A common challenge is the need to balance the twin constraints of safety and cost.
Very often we see that making a system safer will increase its cost; and cutting costs leads to increased risk of harm.
So when budgets are limited and allowing harm to happen is a career limiting event then we feel stuck between a Rock and a Hard Place.
One root cause of this problem is the incorrect belief that ‘utilisation of capacity’ is a measure of ‘efficiency’ and the association of high efficiency with low cost. This then leads to another invalid belief that if we drive up utilisation then we will get a lower cost solution.
Let us first disprove the invalid belief with a simple thought experiment.
Suppose I have a surgical department with 100 beds and I want to run it at 100% utilisation but I also need to be able to admit urgent surgical patients without delay. How would I do that?
Simple … just delay the discharge of all the patients who are ready for discharge until a new admission needs a bed … then do a ‘hot swap’.
This is a tried and tested tactic that surgeons have used for decades to ensure their wards are full with their patients and to prevent ‘outliers’ spilling over from other wards. It is called bed blocking.
The effect is that the length of stay of patients is artifically expanded which means that more bed days are used to achieve the same outcome. So it is a less efficient design.
It also disproves the belief that utilisation is a measure of efficiency … in the example above utilisation went up while efficiency went down and without also causing a safety problem.
So what is the problem here?
The problem is that we are confusing two different sorts of ‘capacity’ … space-capacity and flow-capacity.
And when we do that we invent and implement plausible sounding plans that are doomed to fail as soon as they hit the reality test.
So why do we continue to confuse these different sorts of capacity?
Because (a) we do not know any better and (b) we copy others who do not know any better and (c) we collectively fail to learn from the observable fact that our plausible plans do not seem to work in practice.
Is there a way out of this blind-leading-the-blind mess?
For sure there is.
But it requires a willingness to unlearn our invalid assumptions and replace them with valid (i.e. tested) ones. And it is the unlearning that is the most uncomfortable bit.
Lack of humility is what prevents us from unlearning … our egos get in the way … they quite literally blind us to what is plain to see.
We also fear loss of face … and so we avoid threats to our reputations … we simply ignore the evidence of our ineptitude. The problem of ‘hubris’ that Atul Gawande eloquently pointed out in the 2014 Reith Lectures.
And by so doing we achieve the very outcome we are so desperately trying to avoid … we fail.
Which is sad really because with just a pinch of humility we can so easily succeed.