PHX Perspectives | February 11th, 2020
My wife and I recently took a leap and bought a house in the ‘burbs. We moved from an urban setting near our work in Boston to a suburban setting 30 miles away. We traded condo fees and “carefree” living for a list of contractors, plumbers, electricians and many others who we can call in a moment’s notice when something goes awry. And trust me, they do. Just like they do in the professional world, problems arise daily. Some larger than others. Having the skills to identify the root cause of a problem and solving it, however, is the difference between chasing ghosts and being able to truly solve the problem for good, not just it’s manifestation. Sometimes, solving one problem leads to another, but with the right set of problem-solving tools and a little bit of patience, nothing is impossible.
Anecdote: One of my wife’s and my favorite things to do together is cook – we cook to be creative, we cook to blow off steam, we cook to learn about one another, and we cook to entertain. Yes, sometimes we even cook because we are hungry. So, when the house we fell in love with was missing a gas stove, we knew we had a problem to solve. This wasn’t one of those HGTV tv shows where there were endless houses to choose from. This was the house we wanted. The fact that there was no gas was a problem and we had, in this case, a relatively straightforward solution. We installed gas.
In the spirit of Lean, we saw an opportunity to take this one step further by eliminating waste and making our new home more efficient. We swapped out our oil boiler and water heater for one we knew would be much more efficient and in doing so, burn much less fuel. All was good in the world. Less fuel, less $$$, less waste. We were living the Lean dream.
But not so fast. Two weeks after we moved in, I walked downstairs to our basement and saw a puddle of water near the boiler. “Oh no!” I exclaimed. I quickly pulled out my phone and looked up Plumber Pete, who just two weeks prior had completed the installation of our super efficient new boiler. Plumber Pete came out and took a quick look – “I know the problem”, he exclaimed, without asking any questions. “One of the valves must be bad”. So, he replaced it. Let’s just say that wasn’t the problem and Plumber Pete paid 4 visits to us in the weeks since to try and tackle this issue.
After visit #3, I paused for a moment and realized his first 3 attempts at fixing the problem didn’t focus on the root cause of the problem at hand, but the manifestation of it. He was trying to stop the water without understanding why it was there. I had water on the floor. That’s a problem. But with lots of pipes coming in and out of this machine, we could be here for a long time replacing tons of parts – a major cost for him in parts and a significant dedication of time for both of us. Or, we could pause and focus on why the problem was occurring.
We were committing one of the major sins that the Lean methodology helps avoid – we weren’t focusing on the root cause of the problem. On his 4th visit, I made sure I was available. Now, I’m no plumber. I know nothing about plumbing, but I do know how to get to the root cause of a problem.
Plumber Pete and I chatted and I asked, “Plumber Pete, our problem is that we have water on the floor. Why might we have water?”
He responded, “It could be a bad pipe. It could be a bad valve. It could be pressure. When do you get the water?”.
I replied, “It comes in occasional bursts. Every few days.”
I watched him trace the system with his eyes. He was moving strategically through the pipes and valves. He eventually looked at the pressure valve and I saw the lightbulb go off. “The pressure!” he stated. This realization allowed him to narrow his problem solving and focus on a specific portion of the set-up, a portion that only had 2 possible parts to replace. His 4th visit was his last and the problem is now solved.
I share this story because like I said, I’m no plumber. I’m a frontline stakeholder whose “must have” in house buying included a gas stove, which got me into this mess in the first place. I like hot showers on the regular and heat on cold nights, meaning I love a working boiler and water heater. I may or may not have the technical information needed (I usually don’t) to help identify and solve the problem. But I have inquiry. Plumber Pete is the subject matter expert who can help us get there, but not without leveraging inquiry and engaging me, the user/frontline stakeholder. I asked him why certain things were happening. He took that information and solved the problem that he previously couldn’t solve.
Organizations, especially healthcare organizations, are complex, made even more so by the human factors that drive them. They are prone to inefficiencies and problems, many of which scream for help. It is so incredibly important that as you tackle problems in your complex organizations, you don’t make the same mistakes that Plumber Pete and I made throughout the case of the mysterious puddle of water. Be inquisitive, ask why and get down to the root cause. Why? Because it’s essential.
The PHX Perspectives blog is a platform that creates an opportunity to share public health stories and viewpoints. Anyone interested in submitting a piece, which should be 600-800 words long, should contact phx@bu.edu. Population Health Exchange reserves the right to reject or edit submissions. The views expressed are solely those of the author and are not intended to represent the views of Population Health Exchange or Boston University School of Public Health.
