Video Transcript: Applying the Lens of Profound Knowledge Bob Lloyd, PhD, IHI Director of Performance Improvement
So let’s take this idea and now apply it to our concept of hand-washing. Every time you bring a team together, they’re going to start coming up with ideas; the question is, how are you going to be able to actually put them through a process to break down that complexity and make sense so you can move forward and make tests of change?
So let’s think about the system aspects of hand hygiene. We know that different systems in the hospital have different complexity and different need for infection control. So the neonatal intensive care unit (NICU), the surgery areas, physical therapy, administration, all of those have different requirements in terms of the necessity for hand hygiene. It’s more likely that you’re going to get an infection in surgery or the NICU than it is in physical therapy or admissions, or even administration. So we start to break down the process and realize that there is a system and those systems have smaller subsystems and it’s the interaction of all these systems that drive the outcome.
We then have to think about variation. And that variation is not only conceptually how people vary in their behavior, but also statistically. Can we gather data and look at the percent of compliance with hand hygiene, get the average compliance, and then be able to stratify that into the different systems.
Then we’d like to know what theories people have about hand hygiene. And these are quite varied; everyone seems to have different theories. Some people don’t seem to think that germs really matter anymore, that because they have good intentions, in fact, they’re not going to have to worry about hand hygiene.
Everybody has different theories, what Deming called ‘views of the world,’ that you need to explore and understand why those theories are in place because those theories ultimately drive human behavior. This is why people act as they do.
So every time we’re thinking about trying to get people to wash their hands in a consistent way, we need to think about how the system is interacting, the variation, the theories that we have, and finally the human behavior. These four components then create this lens of profound knowledge that Deming talked about. And if we take this lens and apply it through these four components, we’ll be able to understand the dependent variable, or our topic of interest, and be able to break it down into its constituent parts and have a better chance of success.