The Simple Truth about Complexity

I joke around with my family by telling them that I have “themed weeks”. A “themed week” is a week when a particular subject tends to come up all the time, no matter where you go. And since I did some serious traveling last week, I thought it particularly interesting that everywhere I went, the word simple kept coming up.

While in the security line at the airport, the man in front of me kicked off my themed week by asking, “remember when going to the airport used to be simple?” as he was attempting to balance on his right foot in order to take the shoe off his left.

I smiled and said, “sure, but better to be safe than sorry, right?”

He didn’t answer.

And when I arrived in San Antonio for the American Organization of Nurse Executives (AONE) conference, it was pouring rain and I couldn’t seem to find an umbrella in all the airport stores. I thought, “It’s such a simple thing, how can no one have an umbrella to sell?”

DISCLAIMER: I am not a nurse – only the daughter, niece, cousin, friend, and employee of nurses. Nurses are the greatest people on earth.

Anyway, while at the conference, I took a class that focused around the healthcare industry’s desire to simplify. And the speaker talked about how important it is that before we try and simplify, we must acknowledge the complexity of the environment in which we work. I couldn’t help but think about Malcolm Gladwell’s The Tipping Point, and how his main theory is that changes in simple things can make an enormous impact.

I leave San Antonio and I’m flying across the country to meet with a hospital client. It is a six-month milestone meeting and the team goes line-by-line through what we call the “action register”. The action register is a tool we use to organize all the activity that each team member is responsible for accomplishing. It’s absolutely grueling to have to walk through EVERY activity, but one simple activity that isn’t acknowledged can throw off the entire project - the project looses momentum and the rest is history. But here is the kicker - once we went through the activities, we spent the rest of the meeting focused on the incredible impact that ONE accomplishment had on the rest of the project. The one project was the implementation of multi-disciplinary rounds.

The facilitation of multi-disciplinary rounds had the most positive impact on the entire project. The rounds were able to streamline the workflow in ways that enabled the teams to work more efficiently and with a safer level of care. It is so exciting. They are doing incredible work.

I’m off to the airport and I realize that I haven’t talked to my mom (the nurse) in a while. I call to check in and she says, “Claire, I was trying to explain what you do for work to a friend and I need you to explain it to me in simple terms.”

“Okay mom, lets say when you come into work in the morning, one of your responsibilities is to review patient Joe’s chart to find out what medications he is taking, and if he has any allergies, etc. After you talk to Joe, you learn that he can only take his medicine with apple sauce. So, you check the refrigerator and there is no applesauce. You try and call support services to restock the fridge and you can’t find the number. You waste 30 minutes of your morning trying to get more applesauce. Joe is waiting on his applesauce and won’t take his medication without it. Now his meds are not on time. And since you are 30 minutes behind schedule, you decide to wait until later to document when you gave him his meds. And since you are so exhausted by the end of the day, you forget to write in his chart that he needs applesauce with his meds. And the next nursing shift goes through the same thing.”

“Umm…okay…” she says.

“Well, we make sure that the applesauce is in the refrigerator. We uncover and help eliminate the system/process failures that waste your time,” I explain.

“But, that’s so simple!” she says.

“Very simple mom! But add hundreds of those types of simple things and you get a complex mix of inefficiencies! Imagine now that Joe is 2 years old. And he has Cystic Fibrosis.”

“Poor little guy,” she says.

“Yep, poor little guy with angry parents. He didn’t think he’d have to wait 30 minutes for his applesauce. And neither did his parents, and now they are irate. Get it now?” I ask.

“Yep. I get it,” She answers.

Something as simple as stocking the applesauce can make a huge difference in the patient experience and the caregiver’s availability to work efficiently.

This, of course, is a VERY simple way of talking about waste, inefficiency and the patient experience. But, these types of simple things make a huge difference in our healthcare systems all over the country. Sometimes these inefficiencies can result in complex medical errors. Sometimes fatal.

I’m happy to be back home with my kids. My ten-month-old still has that baby smell. And my two-year-old is playing air guitar now and it makes me laugh so hard. Those are the things I miss when I’m away. Because at the end of the day, it’s the simple things that make all the difference.

I believe in my work.

Claire