Spinning Coins Debrief
Rebecca Steinfield, MA; Improvement Advisor, IHI
Ninon Lewis, MS; Vice President, IHI
Rebecca Steinfield, MA: What are some of the attributes of teams that are able to successfully spin their coins? What does it take to learn how to spin a coin, really?
Ninon Lewis, MS: Sure. When we ask teams, "What got you to that longest spin?" Oftentimes, they're very creative. So they define surface in lots of different ways. They try lifting a tablecloth over the table and trying it on just the bare table surface. They'll run out of the room and try a brushed concrete floor. They'll put a book down or a purse down and try it on lots of different surfaces. So they get as creative as they can possibly be about what that definition is of surface. Additionally, they try to run a lot of tests and just, you have 15 minutes to spin and you can actually get a lot of spins in that time. So they try as many different things as they possibly can.
Ninon Lewis, MS: Additionally, they start to create a theory. Sometimes they don't even know that they've created a theory. So sometimes the theory is around who at this table could be the best spinner? Because not everybody's going to be a spinner. So they'll run tests and they'll rule out who are the not so great spinners, then they'll go get to the best spinner and then they'll move on to their next theory, which is perhaps the quarter or the nickel or one point or another is going to be a better spinning coin. So they'll test out the theory and try to rule out the coins that are not great spinning coins.
Rebecca Steinfield, MA: How much data do they collect? What's enough data for them to decide to rule out one surface or one spinner or another?
Ninon Lewis, MS: Well first, not everybody ends up collecting the data. Some teams get so into the doing part of the PDSA cycle that they just do, do, do, do, do, and they're tracking so many spins at the same time that they're not going back and actually creating a prediction and actually tracking their data over time. If we were to ask them, "What was the thing that worked?" they probably can't tell us because it wasn't documented. So those are the teams that sort of come up short of like, "Actually, I don't know what worked."
Ninon Lewis, MS: But those that actually did document, oftentimes, they'll do one run of all the coins or one run of all the spinners, and then they get a hunch of which spinners or which coins are the best and then they try it multiple times to try and get it reliable. Those teams that have the longest spinning coins tried one service multiple times to get the longest spin. So it might be 10 seconds and then they try it again, and it's 11. They tried again and it's 12, and then they feel really good about the fact that, "Hey, we're consistently at a really high number of seconds. That's the one that's going to be the longest."
Rebecca Steinfield, MA: Excellent. So it sounds like teams that are successful collect a little bit of data, just enough-
Ninon Lewis, MS: Yeah.
Rebecca Steinfield, MA: ... and enough to build our confidence. We talk about that a lot in improvement we want, and just enough data to get a higher degree of confidence that our change is going to result in improvement.
Ninon Lewis, MS: Exactly.
Rebecca Steinfield, MA: And it just made me think about the importance of asking questions, right? That's what helps us be creative and helps us build good theories, is we're able to formulate questions. Who is the best spinner? Which surface is going to be best for us? Which coin is going to offer the longest spin?
Ninon Lewis, MS: And it allows us to explore an assumption without judgment against that assumption.
Rebecca Steinfield, MA: Yeah.
Ninon Lewis, MS: So with one of our teams, somebody was adamant that all those over the age of 50 were going to be the best spinners because they had a chance to spend coins in their childhood. Whereas they thought that younger people at the table weren't going to have such great spinning skills. People could have easily looked at him and said, "Well, that's just a joke," but they actually said, "Hey, let's test that out," and it actually turned out that those over the age of 50 at the table were the best spinners. So rather than just ruling out somebody's assumption as that's just an idea, everything's on the table to try out. Suddenly, people felt like they belong, they felt like their ideas were contributing, and it's because it was in the form of, "Hey, it's a question. Let's learn about it."
Rebecca Steinfield, MA: So I know that when you set up the game, when you give people instructions, you give them that PDSA tracker that you want them to fill out. How much do people actually do that? [inaudible 00:04:11].
Ninon Lewis, MS: I would probably say about 50% of the time.
Rebecca Steinfield, MA: That's pretty good.
Ninon Lewis, MS: I know. I know, and we're asking people to do it very quickly. So in 15 minutes, you can run 20 different spins. That's an intense amount of tests for a small amount of time. So to ask people to also be writing down what their prediction is, and like I said, they get so into the game and the doing that they don't stop to make the prediction or don't stop to actually see, did this work or did it not work? And then how are we going to iterate on it? However, when we debrief with them and we talk to them about, what about in the real world? What if you were to have been running a project and this is really about improving patients' lives, and then you actually move the dial and your local government or a reporter or your leadership team comes to you and says, "What was the secret sauce? What was the deciding factor?" and you can't give them that answer? There's real implications from that.
Rebecca Steinfield, MA: So you're asking folks to collect a lot of data in a very short period of time. How to folks manage that? What do they do?
Ninon Lewis, MS: So they are continually surprised at how easy it is that we gave them a blank run chart and you're just asking them, with a pen and pencil, to plot on a run chart. There's nothing that's stopping you from taking that same idea and going home and you don't have to have Excel or any other type of program to produce a run chart for you. You could start on a piece of paper and people have that realization a lot of, "Wow, this is way easier. I have no excuses of why I'm not measuring."
Rebecca Steinfield, MA: So in your experience now, what's the longest spinning coin?
Ninon Lewis, MS: That's an interesting point. In the situations where we've tested this, which has been in the US, so remember it's a quarter, a dime, a nickel, a penny, generally the spinning coin has been about 13 to 15 seconds. I don't know that I've seen something that went higher than 15 seconds, which is interesting because then that's the bounds of the system. That's the limit of how far we can go. So if we were to think about we want a system that's going to get us higher than 15 seconds, we would have to look at completely redesigning that system; changing the surface, maybe changing the coins, putting different spinners in place. Probably changing the coins I bet was probably the biggest redesign piece we would need in that system in order to get it to perform different results. How often are we trying to get a current system to perform at results higher than it can because we're not actually looking at how do we redesign the system. So, yeah.