How the 'Ergonomics of Innovation' mirror the 'Disciplines of Execution'

The McKinsey Quarterly recently featured a case study on a small nonprofit organisation called the Institute for Healthcare Improvement (IHI), which was responsible for a campaign to reduce by 100,000 the number of patients who die each year in US hospitals because of preventable errors.

The lessons that we draw from this single case are tentative, but we are struck by a theme that surfaced again and again in the 100,000 Lives campaign and that receives scant attention in the innovation literature: IHI constantly found ways of making it easier rather than harder for hospitals to innovate. That simple idea, which might be called the ergonomics of innovation, helped save 100,000 lives.

What struck me as I read this story was how closely the ‘ergonomics of innovation’ it references parallel the ‘Disciplines of Execution’ that FranklinCovey has pioneered in our work with organisations around the world. We focus on ‘4 Disciplines’ in particular, which are listed below alongside the way in which they seemed to be applied within the 100,000 lives campaign

Discipline 1 – Focus on the Wildly Important
"For starters, to reduce the number of medical errors, IHI provided six simple, evidence-based practices, many of which empowered the frontline nurses.

Many writings on innovation emphasise the importance of flexibility and of thinking widely and broadly. The case of IHI, along with research on creativity, shows that constraints are also essential for developing and implementing new ideas. For example, peer-reviewed medical journals provide hospitals with thousands of practices they might use to reduce the number of preventable deaths. Yet asking each hospital to review the medical literature and then select its own practices would have been a huge burden for many of the 3,000 participating institutions. By focusing on six basic practices, IHI reduced the burden on hospitals, which were encouraged to devote their energy and creativity to implementation and, once they became expert, to helping other hospitals that joined the campaign."

Discipline 2 – Act on the Lead Measures
"For IHI, the hard count was 400,000: the number of hospital beds the organisation needed to attract to the campaign if it was to save 100,000 lives. In pursuing this target, IHI avoided the distraction of metrics that were less clear stepping-stones to the ultimate goal. It also reduced its intellectual burden by adopting an idea (the hard count) that had already proven effective in other settings."

Discipline 3 – Keep a Compelling Scorecard
"At the campaign kick-off event, IHI’s CEO, Donald Berwick, said, "Here is what I think we should do. I think we should save 100,000 lives. And I think we should do that by June 14, 2006—18 months from today. ‘Some’ is not a number; ‘soon’ is not a time. Here’s the number: 100,000. Here’s the time: June 14, 2006, 9:00 a.m.”

"Hundreds of peer-reviewed studies on setting goals show that measurable, specific, and somewhat (but not absurdly) difficult ones are best for motivating effort. An effective goal doesn’t have to be about anything as important as saving lives. If the goal can grab attention and people believe that it serves a worthy cause, it can move them to action. IHI extended this thinking by giving the problem it was trying to solve a specific name, which further fueled the will to act, and by centering its efforts on a few critical metrics."

Discipline 4 - Create a Cadence of Accountability"IHI focused on small things that had a big impact without placing a big load on hospital staffs (reducing the number of infections, for example, hinged on frequent and thorough hand washing). In this way, the organisation adopted what Karl Weick calls a “small wins” strategy. In Weick’s classic 1984 article, he asserted that big and daunting problems like energy use and pollution often discourage people. They respond to these seemingly insurmountable challenges by doing nothing, because meaningful progress seems impossible. But when such problems are reframed as a series of smaller ones that can be tackled through concrete and manageable steps, Weick shows, the reframing mobilises people to act."

The McKinsey Case Study concludes

In short, the IHI case teaches us that innovations spread quickly when organisations focus relentlessly on selecting and spreading ideas in ways that ease the burden of thought and action for everyone involved. This mind-set differs from the one that burdens most organisations, where innovation is seen as difficult, expensive, and protracted. The IHI staff’s ergonomics-of-innovation mind-set focused on making things easier and cheaper for everyone, including the staff itself.

The lesson for would-be innovators is that they don’t have to invent brand-new ideas or even implement ideas largely unknown in their industries. A great deal of successful innovation happens when ideas that haven’t been widely applied in an industry or a market become dispersed throughout it.

In other words, it’s an organisations ability to engage its staff and execute on new ideas effectively right down to the front line that can be as important – if not more important – than the uniqueness of the idea (or innovation ) in the first place.