Pursue Progress at Your Medical Practice, Not Perfection

"Dilbert," by Scott Adams, is my favorite comic strip. It consistently captures the essence of the ridiculous conversations that are all too common in modern offices, and I applaud his keen insights. Last Sunday, June 9, I felt skewered when looking at the comic strip.

In the second frame, a manger says: "Don't let perfect be the enemy of good." Since that is one of my guiding principles, I feel a need to defend myself - to a cartoon! Here's how I apply the aphorism.

Define perfect for a particular environment, situation, or solution. Without a definition of the goal, there is no way to figure out how to achieve it, place a value on complete success, evaluate options, and know when success has been achieved. "Perfect" has its place.

Plot a path toward perfection. Knowing where you want to go makes it possible to plot a route. In describing a cross-country driving trip, it is sufficient to know where you want to spend each night. Changes in a medical practice require much more detail to keep the project on track and moving forward, with lots of interim deadlines and milestones.

Take small steps, and deliberately build in early wins. When perfection is the only acceptable goal, you must go from the status quo to a perfect execution of the ultimate solution in one giant leap. The bigger the change, however the more likely it is your practice will experience disruptions and difficulty, and nothing is as paralyzing to progress as an insistence on the ideal.

For that reason, it's smart to break any large-scale project, such as an EHR implementation, into small steps. This has five benefits:

1. It minimizes operational risk. Any changes and training are gradual and easily manageable. The size of the change minimizes adverse consequences, makes them easier to deal with, and avoids disasters all together.

2. It ensures the concept is sound. Small steps keep options open much longer. Some of the hard dollar outlays may be delayed, and the soft costs of training and lost productivity are certainly avoided until the practice is convinced they are necessary.
For example, a full-blown bar coding system can be expensive to buy and implement. A single bar code reader, however, can cost less than $50, and give the practice a realistic view of the benefits it might gain from bar coding inventory and documents.

3. It builds credibility. Success is much more likely with small steps. Experiencing positive outcomes builds trust among providers and staff, and that is invaluable.

4. It increases capacity. Theoretically, all process and system changes in a medical practice are to improve patient care and/or increase productivity. Initial milestones often yield significant gains in productivity, which can then be used to counteract the efforts associated with subsequent changes.

5. It refines the ultimate goal. A staged implementation gives the practice a chance to learn, in time to make adjustments to the ultimate solution. No matter how much time is spent trying to understand all the implications of a system or process change, something is always lost in translation. It is much better to find out about the miscommunication before everything is written in stone. In addition, the practice may decide that perfect is not worth the cost and effort and stop at an interim milestone. Remember Pareto's Law: 80 percent of the benefit of a project comes from 20 percent of the effort. That last 20 percent of benefit comes at a high price.

Know what your idea of perfection is and keep your practice moving toward it. Just don't let it be the enemy of real, achievable improvements.