Seth Godin had an interesting post today talking about delight and mentioning six sigma.  It caught my attention, because some folks I know have been taking six sigma classes who work in health care.

Health care, and all of the caretakers in the system- doctors, nurses, technicians, lab folks, pharmacists- everyone- needs to walk a line between perfection and amazement every day.  Looking for perfection in performing tasks like surgery or making sure medical errors are as minimal as errors in manufacturing on an assembly line is worthwhile, to be sure.  But health care is also filled with individuals needing specialized and bespoke care, taking into account many factors that make them unique, as well as routine.  For example, treating someone for an infection may look routine, until you realize they are allergic to the common medications that are most likely to kill the infection, but instead would kill the patient if given.

I’ve heard stories from our local hospital about weird, one of a kind things happening- like a guy who took hospital transportation between medical centers to visit his girlfriend, and then went to her room and got into a fight, and sought to escape also using Hospital transportation.  While this guy doesn’t win any awards for criminal genius, how much time should the hospital spend on security, or rethinking the transportation system or more, for one guy with a bad temper and bad judgment?  While it certainly deserves notice and something to watch out for, this sort of incident is an anomaly based of dealing with the vast variety of humans, and is not something even six sigma can control.

Perfection and Six Sigma assumes you can control the parameters of a process.  In manufacturing, this is much more likely than in other venues, like social media or health care.  People may be predictably irrational*  but they still can often surprise us with the sheer variety of good and bad decisions they choose to make.

The skills we need as much as perfection are those of improvisation.  We need people to be resilient, to work with what they have on hand and solve problems, rather than search for perfection at the cost of functional.  I get the need for perfection, and pushing to be better than “good enough”- and I hold myself frequently to these standards, but I’ve also learned that there are some areas where good enough is all that matters.

In health care, I worry that if they begin to focus too much on systematization and perfection, a reliance on the “system” will hold people back from questioning and improvising when necessary.  By making too many things fool proof, we forget that fools teach us a lot, and there is always another smarter fool waiting to break the new system anyway.

The persistent problem we all face is that teaching innovation, out of the box thinking and improv is not as easy to systemize as rote learning.  Rote learning  is puzzle pieces, while improv and problem solving is putting the pieces together in more than one “right” way.

Give me the improv folks and the entrepreneurs every day.  The folks who actually like constraints because they make the problem solving more creative.  These are the folks I love to work with and for.  Blue sky thinking is great, but thinking inside and outside the box at the same time is where the magic lies.




*A great book by Dan Ariely, and he even has an app now that I’m eager to give a whirl.