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It seems everyone is talking about "Best Practice" these days. But lets ask a tough and perhaps controversial question... Is Best Practice what is best for your Practice?
Say what? Heresy are you thinking? Let's dig a little deeper...
If every Practice was just like every other Practice (think clone) - same training and skill set, same service offering, same space and equipment, same patient mix, same community, same location, same competitors, same business performance, same ...well you get the picture; then Best Practice might be just the answer.
Even then one must always ask, "Best for whom?"
The fact is that every Practice has certain uniquenesses that set it apart from the rest - for better or for worse. It is just those differences that make Best Practice problematic. There is of course no competitive advantage in sameness - competitive advantage comes from the exploitation of differences and innovation. If everyone adopted Best Practice then by definition everyone would be average - again, there's no competitive advantage in average.
If all were average, then who would discover Better Practices? How adaptable and sustainable would our Practices be in an ever changing world if there were little to no diversity in our gene pool? Evolution and genetics teach us that the ability to survive and thrive is found in diversity, options, and alternatives.
Could standardized Best Practice keep up with the pace of our ever evolving, rapidly changing, and increasingly more complex world? Where would innovation come from in such a Practice environment? Can conformity withstand obsolescene?
Success in Practice is similar in many ways to success in financial investment, where the first principle is risk management. A key strategy in reducing financial risk while retaining a favorable return on investment is a diversified portfolio. If one were to apply that principle to Practice management, one might be more interested in a portfolio of diversified "Better Practices" than an undiversified supposedly Best Practice.
Performance sustainability over time is more about innovation, agility, resiliency, and adaptability to a rapidly changing environment than it is about the exploitation of yesterday's Best Practice.
Those Practices that are satisfied with being average will be satisfied with Best Practice. However those Practices that aspire to lead, serve well, and earn exceptional reward will be better served by collecting emerging Better Practices and customizing for their Practice.
Best Practice is ultimately a joyless box of conformity. Better Practices represent an endless journey toward new challenges, opportunity, performance, and reward.
Will it be conformance or performance for your Practice?
In which environment will you practice?
Is your Practice plugged into innovation? Is it wired for innovation? Will it power your future?
Bob
Copyright 2008
Performance Builders
Wednesday, January 2, 2008
2 comments:
Bob - Just read your Best Practice post and as always I find your comments soothingly provocative!! Thanks for the tweak!!!
I'll start with the question - Is it possible that in order for Better Practice to exist at the collective level, Best Practice MUST be present at the individual patient level?
"Standardized best practice", as I see it is an oxymoron. Standardized practice is not the best and Best Practice is not standardize-able. Best Practice exists only on an individual basis, as in what is Best for THIS patient - so by definition Best Practice can't be equated with sameness.
Sackett, in describing Evidence-Based Practice (EBP) states that EBP consists of Data (often over-rated and over-weighted, but essential), Clinical Expertise (difficult to measure, but obvious when present), and Patient Values. (often under-rated and under-weighted). The most important part of EBP, Sackett says, is patient values (i.e., the uniqueness or samelessness).
I also find it interesting that while average is in one sense an adjective, the mathematical truth of averages (as one form of description of a group) is that the number that represents the "average" rarely exists as a real number in the set from which the average was derived - in other words, the average is rarely, if ever, real.
Finally, EBP (or maybe more accurately, Better Best Practice?) is derived from data collected from individuals, analyzed as groups, and the results of which are applied to individuals - hopefully with expertise and with respect for the individual patient. This sounds to me like a process by which we can use Best Practice to drive Better Practice and in turn practice Best Practice. As I like to say - Evidence-Based Practice must necessarily be based on "Practice-Based Evidence" or else our practice won't and can't be evidence-based. That would make our Best Practice Better or "Better Best Practice"
Could it be that Better Practice is simply a journey consisting of infinite destinations called Best Practice??
Thanks and take good care.
Bob - your thoughts are included here.
"Standardized best practice", as I see it is an oxymoron. Standardized practice is not the best and Best Practice is not standardize-able. Best Practice exists only on an individual basis, as in what is Best for THIS patient - so by definition Best Practice can't be equated with sameness.[BW] Best is always relative to the environment, conditions, participants. That distinction is too often overlooked in discussions about best practice and evidence based practice – one size does not fit all. And yet, especially third party payers would have us think that. The Plimsoll Line defines the safe loading level on ships to assure they are not over loaded. The Plimsoll line is in fact not a single line but a group of lines that distinguish between the appropriate floatation level in different seas around the world - each varies according to salt concentration and temperature affecting water density and thus floatation. Practice too floats in “different seas”.
Sackett, in describing Evidence-Based Practice (EBP) states that EBP consists of Data (often over-rated and over-weighted, but essential), Clinical Expertise (difficult to measure, but obvious when present), and Patient Values. (often under-rated and under-weighted). The most important part of EBP, Sackett says, is patient values (i.e., the uniqueness or samelessness).[BW] Yes! I really like how that critical understanding is phrased – unfortunately too often not understood. It brings us back to the portfolio concept – it is not the one silver bullet that we should be pursuing but rather a portfolio or repertoire that is being gathered and honed for intelligent and discriminating application.
I also find it interesting that while average is in one sense an adjective, the mathematical truth of averages (as one form of description of a group) is that the number that represents the "average" rarely exists as a real number in the set from which the average was derived - in other words, the average is rarely, if ever, real.[BW] What concerns me are all of those practices that are used that result in performance that is at or below the statistical average that is calculated – i.e. 50% of providers! Those represent worst practices which need to be rapidly abandoned. To improve group performance a strategy to simply eliminate worst practices can be powerful. Over time the average should steadily increase and the variance decrease (i.e. standard deviation) if our efforts toward better practices are being successful. Then too its important to remember there is never only one metric that needs to be considered when outcomes are considered. The real test is how one’s portfolio of outcome metrics is perforating individually and in combination. Easy answers are seldom the right answers. That is evident in the amount of performance data that is expressed as averages rather than rankings and distributions.
Finally, EBP (or maybe more accurately, Better Best Practice?) is derived from data collected from individuals, analyzed as groups, and the results of which are applied to individuals - hopefully with expertise and with respect for the individual patient. This sounds to me like a process by which we can use Best Practice to drive Better Practice and in turn practice Best Practice. As I like to say - Evidence-Based Practice must necessarily be based on "Practice-Based Evidence" or else our practice won't and can't be evidence-based. That would make our Best Practice Better or "Better Best Practice"[BW] Understanding the essential importance of robust “practice-based evidence” is too often overlooked in professional discussions. So many conclusions get drawn from so few data points. Too seldom are the right things measured. The bandwidth and timeline of traditional research models severely constrain the professions capacity to gather essential evidence. Better tools are needed – benchmarking is certainly one such tool that can use outcome data to point the way toward better practices. What is desperately needed is a widely used an efficient documentation / outcome system to aggregate industry wide performance data (clinical and business). Only then will real progress be made and will the profession be in control of its own destiny.
Could it be that Better Practice is simply a journey consisting of infinite destinations called Best Practice??[BW] I think you are close… Better practice is certainly a journey but also an attitude of continuous improvement and innovation along with a commitment and an investment to make things happen. The way-points reached on the journey provide accountability and encouragement. We need more travelers!
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