Practice Guidelines: A Way for Physicians to Manage Work and Life

I’m coming to the end of my “Lean for Healthcare” class and we are discussing standard work.  This is basically a “recipe” for doing something.  Just like any good recipe, it is modified over time to meet the needs of the cook. On principle, I think everyone can agree that a standard approach is a good one.  We can see the advantages - predictability, reliability, hopefully better quality. However, there are multiple reasons why a standard approach to both work and life can be challenging.

At work, I try diligently to apply clinical practice guidelines - the medical equivalent of standard work.  Yet, my patients have specific needs, requests, and limitations that cause me to veer away from the standard and create something which feels like it is entirely new just for that patient.  This is good - after all, medicine is supposed to be personalized. But there is a good reason clinical practice guidelines exist.  It is impossible for me to simultaneously be aware of all the current literature and recommendations for every disease that walks through my office. 

Standard work, or following specific practice guidelines, while sometimes having limited applicability in the care of human beings, can make me more efficient and less stressed. My medical assistant can anticipate what I will need because I do things the same way every time. I don’t have to create a plan of care de novo every time.  I have a general sense that if one medication doesn’t work, I have a reliable Plan B. I can trust myself more when I have standard work because I don’t have to remember to do things the right way - the right way is already built into the process.

Last night with my kids was challenging. They were tired and I was stressed. I had to go into “mean mom” mode and start handing out punishments for poor behavior. I realized, as I was arguing with one of them about whether or not I really meant what I said, that a “standard work” approach, or more accurately, the lack of one, significantly impacts my parenting effectiveness.  If when I say something, I mean it - you will lose a privilege or you will go for a time out - then my kids know exactly what to expect.  When I soften, negotiate, and cajole, it is confusing for everyone and requires far more energy to figure out what type of response I will make. 

I think it is natural to balk a bit at the concept of standard work. It can hinder flexibility, spontaneity, and freedom at times. However, I think in many cases, what you gain in effectiveness and reliability. If you further keep in mind that standard work is made to be adapted over time to meet the needs of whoever is performing it, the benefit more than outweighs any disadvantages.