Improvement Science is about solving problems – so looking at how we solve problems is a useful exercise – and there is a continuous spectrum from 100% reactive to 100% proactive.
The reactive paradigm implies waiting until the problem is real and urgent and then acting quickly and decisively – hence the picture of the fire-fighter. Observe the equipment that the fire-fighter needs: a hat and suit to keep him safe and a big axe! It is basically a destructive and unsafe job based on the “our purpose is to stop the problem getting worse”.
The proactive paradigm implies looking for the earliest signs of the problem and planning the minimum action required to prevent the problem – hence the picture of the clinician. Observe the equipment that the clinician needs: a clean white coat to keep her patients safe and a stethoscope – a tool designed to increase her sensitivity so that subtle diagnostic sounds can be detected.
If we never do the proactive we will only ever do the reactive – and that is destructive and unsafe. If we never do the reactive we run the risk of losing everything – and that is destructive and unsafe too.
To practice safe and effective Improvement Science we must be able to do both in any combination and know which and when: we need to be impatient, decisive and reactive when a system is unstable, and we need to be patient, reflective and proactive when the system is stable. To choose our paradigm we must listen to the voice of the process. It will speak to us if we are prepared to listen and if we are prepared to learn it’s language.