Finding the right place to start a healthcare improvement initiative can be like trying to find the end of a ball of string. The best place to start is not immediately obvious until you start looking.

It is not always about a new initiative either. Sometimes it is about re-starting a stalled one or re-gaining improvements that were lost or didn’t stick.

At Metrixcare we look for certain characteristics or conditions that help to guide us and our clients in finding the best places to start.

Pain Points

One of the best ways to find a place to start is to focus on a major pain point. It will be easier to get organisational support and buy-in from others if there is a recognised problem with no effective solution. Another technique is to find a recent disaster. Sometimes they are obvious but often they are hidden or just disasters in the making. Senior leaders will tend to be more receptive to embracing improvements shortly after something has gone seriously wrong.

Start Lean

Lean start-up techniques can be applied in healthcare to start small, fail fast and bootstrap an idea with no money. An early place to start will often involve some sort of prototype product or service. Don’t over-engineer things but rather only build just what you need to move forward which represents a minimum viable solution.

Plan for Early Success

Sometimes there are many places where you could begin. Be careful not to pick the wrong place to start as this can be fatal and dissipate early energy that will take time to rebuild. For early initiatives we always plan for early success by not picking the hardest problem but one that may demonstrate the approach and provide validation and evidence for tackling the really hard ones. Avoid big bang approaches. They rarely succeed and can be a big waste of time, energy and money. Instead aim for incremental improvements that require a series of short sprints.

Formulate a Stepping Stone Strategy

The best place to start can often involve establishing some foundation capabilities. This may include foundational people, processes or technology that provide building blocks for future progress. There is usually a logical sequence to things and obvious gaps that need to be filled before more mature options can come into play. Foundation technology capabilities get incrementally cheaper the more that they are re-used as a foundation for other tools and initiatives.

Prove the Model and Build a Cookie Cutter

Aim for a cookie cutter approach where an early initiative can be re-applied into another adjacent problem. This could also include looking for verticals (or laterals) that demonstrate a pattern for a solution to an end-to-end problem. With some early success, adjacent groups or services can easily become intrigued or envious of possibilities for themselves and be naturally attracted to your idea.

Inner Circle of Believers

Many organisations are inherently conservative or resistant to change so some slightly unconventional techniques can be effective in getting an initiative started. A good place to start can be to create an inner circle of believers in an informal way. If others say “it’s not my problem” think creatively. There can be many ways to make it their problem.

Create a Transformation Team

With the constant daily demands of business as usual it can be tough for team members to find enough time to spend on a new initiative. At first you may have no option other than to borrow time from people to get things started but after some early success the team will have learnt a lot. Try not to let all that new knowledge and experience be lost. To repeat successful projects a dedicated transformation team is a proven way to apply your cookie cutter in other areas and people will be more receptive to extra help rather than just greater demands on already scarce resources.

Seek Forgiveness Rather Than Permission

Don’t ask for permission – you will probably never get it. Instead, just gather people together who want to make a difference in a way that is not generally visible to the rest of the organisation. Try not to give your initiative a name, at least not an obvious one, this makes it harder for others to attack it. Treat it like a covert-operation in the early stages when ideas are most vulnerable. An inner circle of innovators will likely be inspired by this idea and it can create a strong bond and sense of purpose between early believers. We tell a story of the gorilla versus the guerrilla. Only present gorillas with the smallest possible target. When attackers try to shoot down an idea the guerrilla is already gone before they pull the trigger. Just melt back into the shadows and they may be distracted, go about their business as usual and leave you alone.

Using a Soft Sell

When a new idea is being presented to someone they may naturally become wary and try to push back or reject it. In these cases a soft-sell approach can be effective. After initial socialisation of an idea it can be useful to pull back a little. If the other party sees some benefit to themselves or is intrigued they may take a step towards you. When attempting to take it off the table by saying “it’s ok, this is not for you” they may become very interested and chase you down to be involved.

This Stuff is Hard

Healthcare environments are complex dynamic socio-technical systems with emergent properties. If change was so easy someone would have done it already and you wouldn’t have a problem to solve. Looking back things will have rarely gone the way you might have thought at the beginning. It can be hard to connect the dots looking forward but stay open and light on your feet and use your kit bag of innovation techniques to make progress. Stay positive though – you just might get your improvement initiative off the ground and make a real difference by finding that end to a ball of string which is the right place to start.


Steve Govis
CEO Metrixcare