Accountability and reliable promises, pt. 1

Part 1 in a 3-part series

What do we mean by accountability? In a recent post, I suggested that it’s silly to hold someone responsible for fulfilling a promise when they never actually made a promise. After all, request + acceptance = promise.

Let’s connect this to an insightful take on the same question provided by Mark Graban of Lean Blog. He suggests that it’s unfair to hold accountable someone who isn’t responsible and quotes Deming’s advice to “fix the processes, not the people.”

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Can we hold nurses and other staff accountable for not always following proper hand hygiene procedures when coming in and out of patient rooms?

Let’s say the foam canisters are empty outside a few rooms in a row (something I’ve seen recently). We can’t hold the nurses accountable. This is a system problem. “Writing up” or punishing the nurses would be counterproductive. We need to ask why the canisters are empty? Is there somebody to hold accountable for not restocking the canisters? Maybe not – what if it’s a bad process, where there’s no “standardized work” and no clear cut assignment of who refills the canisters (“everybody?”).

Let’s say the same thing through the language of promises. Having no clear cut assignment means that no specific individual has made a clear promise to restock canisters at a particular time. For there to be a promise, one of the following conversations must occur:

  • A manager (or somebody) else requests that a particular nurse restock the canisters at a particular time, and the nurse accepts. Request + Acceptance = Promise
  • A nurse offers to restock at a particular time, and the manager accepts. Offer + Acceptance = Promise.

To get coverage over the course of a day or week, there would need to be a series of promises, one with each particular nurse for each particular time. I know this is painfully obvious, but if it’s not happening, then the obvious is where we start.

While we are talking about obvious things, what does it take to create an effective request or offer? We’ll examine that question in pt. 2 of this series.