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Davis Balestracci

Innovation

The Vasa: A Cautionary Tale for Covid-19 Vaccine Development...

...and the current state of improvement​?

Published: Monday, June 8, 2020 - 12:03

What is the Vasa? It was a Swedish warship built in 1628. It was supposed to be the grandest, largest, and most powerful warship of its time. King Gustavus Adolphus himself took a keen personal interest and insisted on an entire extra deck above the waterline to add to the majesty and comfort of the ship, and to make room for the 64 guns he wanted it to carry.

This innovation went beyond the shipbuilder knowledge of the time... and would make it unstable. No one dared tell him. On its maiden voyage, the Vasa sailed less than a mile and sank to the bottom of Stockholm harbor in full view of a horrified public, assembled to see off its navy’s—and Europe’s—most ambitious warship to date.

What reminded me of the Vasa? The time has been ripe for visible motivational speakers to weigh in on Covid-19 and “inspire the troops.” From a speech using the Vasa as a backdrop:

“I want to see healthcare become world-class. I want us to promise things to our patients and their families that we have never before been able to promise them.... I am not satisfied with what we give them today.... And as much respect as I have for the stresses and demoralizing erosion of trust in our industry, I am getting tired of excuses....

“To get there we must become bold. We are never going to get there if timidity guides our aims.... Marginal aims can be achieved with marginal change, but bold aims require bold changes. The managerial systems and culture that support progress at the world-class level... don’t look like business as usual:
1. Bold aims with tight deadlines
2. “Improvement” as the strategy
3. Signals and monitors—providing evidence of commitment to aim, giving visible evidence of strategy via managing monitors
4. Idealized designs
5. Insatiable curiosity and incessant search
6. Total relationships with customers
7. Redefining productivity and throughput
8. Understanding waste
9. Cooperation
10. Extreme levels of trust

“The lesson about the Vasa is not about the risk of ambition. It is about the risk of ambition without change, ambition without method.”

Oops! Wrong speech. These words are from... 1997!

The above is extracted from a plenary speech given by Donald Berwick (link to video at end of article), an acknowledged leading expert in healthcare improvement.

Look at his 10 challenges. What’s changed in the 23 years since that speech? Here’s the long version of my answer (short answer: not much), and I wonder: Did improvement become an industry that ironically just got better at building various versions of a Vasa?

Berwick published yet another inspiring article the other day—somewhat of an update of his words from 1997 transplanted to a “bigger... better... faster... now!” world. As I read it, noting how shocked… shocked! he was at how long it takes improvements to become accepted and inculcated, it begged the question: Are ongoing organizational improvement efforts a waste of time unless there’s a violent “whack on the side of the head” to upset the status quo?

Even then: Are highly visible leaders who shout from an armchair, “C’mon, people—the time is now!” going to make such things magically appear in today’s unprecedentedly stressful environment? (And I’m also getting tired of high-profile people “getting tired of excuses.”)

Joining this chorus are the consultants with their own distracting chants of “Tsk-tsk,” “Tut-tut,” “Applying lean principles...” “Dr. Deming says...” “Most problems are due to bad processes,” and, “Leaders: Help your employees take joy! in their work.”

Want to know what the front-line folks, once again feeling patronized, hear? “Blah, blah, blah.”

As President Eisenhower said in 1956: “You know, farming looks mighty easy when your plow is a pencil, and you’re a thousand miles from the corn field.”

Back to the Vasa

To refresh my memory a bit, I looked up the Vasa and found a paper (please read!) that gave a chilling account of its chaotic design and development process as well as a sober analysis of 10 lessons to be learned.

Is this where we could be headed in a Covid-19 vaccine development... especially when very visible, big-ego people get involved?

Is it also time to reevaluate our efforts at improvement and blow up some of the Vasas that have been unwittingly built... and continue to be encumbered with more decks and cannons? Start here.

Link to Berwick’s 1997 Vasa speech (you will have to register with the IHI site, but it is very reputable). Actually, I think Berwick’s speeches from 1993 and 1995 (links to videos) are just as inspiring (especially 1995), if not more so, and well worth your time. Note that my recommendations end there (here’s why), and come to your own conclusions.

Discuss

About The Author

Davis Balestracci’s picture

Davis Balestracci

Davis Balestracci is a past chair of ASQ’s statistics division. He has synthesized W. Edwards Deming’s philosophy as Deming intended—as an approach to leadership—in the second edition of Data Sanity (Medical Group Management Association, 2015), with a foreword by Donald Berwick, M.D. Shipped free or as an ebook, Data Sanity offers a new way of thinking using a common organizational language based in process and understanding variation (data sanity), applied to everyday data and management. It also integrates Balestracci’s 20 years of studying organizational psychology into an “improvement as built in” approach as opposed to most current “quality as bolt-on” programs. Balestracci would love to wake up your conferences with his dynamic style and entertaining insights into the places where process, statistics, organizational culture, and quality meet.

Comments

Healthcare Has Been Admiring the Problem

At IHI in 2006, Dr. Berwick asked attendees to "Pledge allegiance to science and evidence," by which he meant control charts, histograms, Pareto charts and other quality tools.

Ten years later, in 2016 in his closing keynote, Dr. Berwick again emplored attendees to "Pledge allegiance to science and evidence." His tone of voice told us he was not happy with the progress made.

Many key indicators, such as patient harm, have not changed in the last decade. The IHI estimates that one in every two patients suffers some sort of preventable harm.

Hospitals have a window of opportunity during the summer lull to implement changes to make healthcare faster, better and cheaper with better patient outcomes and less patient harm.

The IHI also estimates that healthcare wastes a Trillion dollars every year. They announced a goal to cut waste by 50% ($500B/year) by 2025. This will require dedication and focused improvement across every aspect of healthcare delivery.

Will this pandemic usher in an age of transformation? Only time will tell.

I'm not happy either!

Just like Berwick was "tired of excuses" in 1997.  Sigh...

It's become a tired, predictable, patronizing, scolding parent "schtick" (always complete with a sound bite)...and a very profitable one.  He should look in the mirror and give himself a scolding.  Why hasn't he taken personal accountability for the disappointing lack of results caused by his, for lack of a better term, "improvement malpractice"?  I'm tired of his public statements of how tired he is of excuses...meanwhile "crying all the way to the bank."

Given his fame and influential contacts, why hasn't he been held accountable for his role in silently tolerating executive behaviors propogating longheld barriers and cultural handcuffs? In my article, look at the link to his 1993 speech -- things he wanted solved IN TWO YEARS...that continue today (maybe token progress on two).

  • "Many key indicators, such as patient harm, have not changed in the last decade. The IHI estimates that one in every two patients suffers some sort of preventable harm..."

I am shocked...SHOCKED! (not really)

  • "The IHI also estimates that healthcare wastes a Trillion dollars every year. They announced a goal to cut waste by 50% ($500B/year) by 2025."

[Standing ovation]

Who's against this?  I can just see Deming's dreaded glare and growl:  "A goal without a method is nonsense! BY WHAT METHOD?" Juran even said, "There is no such thing as 'improvement in general'."

Starting with IHI's 100K lives campaign (December 2004), "politics" crept into improvement, and it's since become an ongoing tired game of justification via a series of vague solutions to vague problems yielding vague results. Method? -- "Vasa du jour," churning out "qualicrats" by the thousands imposing improvement KoolAid on people who, God bless them, think working HARD and doing their best is "quality." 

Deming said, "If everyone did their best, 95 percent of problems would remain."  He also said, "It is not enough to do your best; you must know what to do and then do your best."

Put focused attention on ANYthing and it will improve.  And "stopped clocks" always tell the right time twice a day -- as Bob Emiliani says (from his 7 laws of lean disillusionment): "Results that live up to expectations are an accident."  There will always seem to be just enough vague results to justify calling it "successful." And then out comes a Ouija board to massage the "vague data" and allegedly prove it (like the 100K lives...).  Then it's...

..."NEXT!"

You are right:  they do admire how much they admire the problem.

I always appreciate your comments, Jay.

The Solution Is Not That Complex

Most IHI improvement posters use Line and Bar charts with useless trendlines--the dumb and dumber of charts.

I have suggested that if the IHI wants control charts, Pareto charts, Histograms, fishbones and the other tools of quality that they should require them in all improvement posters. No tools? No proof? No poster.

Can you and I just stop pretending to keep being surprised?

Jay, what you describe is a perfect example of another of Emiliani's other Laws of Lean Disillusionment:

  • Dilution widens acceptance. Acceptance widens dilution.

If they did what you suggest, the poster room would be pretty empty...and "the customer" wouldn't like it one bit!

Another excellent article!

Hey, Davis,

Last year I was thrilled (at first) to get involved with a major hospital system's initiative to become a Highly Reliable Organization (HRO). One of the five principles of HRO is "reluctance to simplify." What this means is that you have fo consider the whole cause system when studying a problem, and essentially use good science to drive past the surface symptoms to the actual causes of the issue. Of course, the doctor who was running the whole initiative decided almost immediately that they could get there using "Lean 9-block A3" projects, and said that statistics just "never caught on" in that organization, so he didn't want anyone getting confused.  A few weeks later, he decided that "reluctance to simplify" was too hard to explain and too hard to remember, so he changed it to "get to the root causes." I never did get to ask him if he saw the irony in simplifying "reluctance to simplify." 

So, not much hope there...

Always good to hear from you

Thanks for the kind feedback, Rip, and for sharing another frustrating story that once again proves we could never even begin to make up the things we encounter.

To adapt the amusing quip attributed to either Sam Goldwyn or former President Gerald Ford, "If Dr. Deming were alive today, he'd be spinning in his grave."

Improvement continues in its thriving "Vasa du jour" efforts...and ongoing avoidance of the needed rudder of data sanity.