Twin-peaks?

I have just been reading Matthew Syed’s Black Box Thinking.

Much of it was a revision of the work around patient safety and quality improvement that I have been reading for the past couple of years.

One thing that stood-out for me was the relationship between incremental improvement and innovation.

Matthew explains this using the following diagram:

So long as you are improving day by day – or if you imagine a mountain, with each step you take being higher than the previous, you will reach the top. Applying this heuristic, no matter what you do, you will get there:

Step, step, up – you’re going up – proceed – step

Step, step, down, you’re going down – don’t proceed – step

Using these principles, it doesn’t matter if you are in the dark, blind-folded or lacking a GPS, you’ll get to the top.

This is daily, incremental quality improvement – in the clinical environment, so long as each action I take is in the direction of ‘better care’ – fewer falls, better nutrition, hydration or length-of-stay, I won’t go wrong; onwards and upwards.

Bruce Lee hacked-away the unessential; this is the same logic.

Eventually, you well get to the top of peak A – the Local Maximum. You will get as good as you possibly can, using that heuristic, the same rules, perceptions or interpretations.

You will only reach the Innovative Change (peak B) through a modification in your world-view, seeing the problem differently, perhaps upside down, inside out or taking some other approach that you have never considered.

This is innovation – radical change. The second peak cannot be achieved through rational calculus, through sequential, logical analysis – the creative spark must apply.

And, this is the essence of Improving Quality meaningfully – changing the paradigm, shifting the model into a new reality.

We need process and we need leaps into the unknown.

Process is supported by order, organisation, and, management – great leaps forward can however only be achieved through accessing innovation – imagination or, creativity, which in turn is only accessible to those who feel safe, loved, and, secure.

We need order and, we need love.

Otherwise we won’t evolve.