Daily Bulletin 2016

A Strategy for Success is Critical to Avoiding Failure

Wednesday, Nov. 30, 2016

On the road to becoming a successful practitioner and leader, anticipating — and learning to avoid — obstacles that could derail performance is key, according to a Tuesday presenter.

David B. Larson, MD, MBA

David B. Larson, MD, MBA

Pitfalls and problems commonly encountered in performance improvement and strategies to avoid them was discussed by David B. Larson, MD, MBA, associate professor of Pediatric Radiology, associate chairman for Performance Improvement in the Department of Radiology at Stanford University, during a Tuesday session.

Improvement projects can create uncertainty among team members who may know the current and desired performance level, but often don't know how to achieve their goal, Dr. Larson said. In other words: They know where they are and where they want to be, but they don't know how they are going to get there, Dr. Larson said.

"Like with most worthwhile endeavors, there are probably more ways for an improvement project to go wrong than for it to go right," said Dr. Larson, a 2014 RSNA Honored Educator Award recipient. "But different types of missteps often result in similar types of undesired outcomes, similar to the human body in which different types of causes of diseases can result in similar symptoms, so it can be hard to understand what caused things to go wrong."

Dr. Larson focused on the factors he uses to predict the likely success of an improvement project: leadership, method, resources, culture and execution. These five factors should be familiar to every QI (Quality Improvement) leader, he said.

Leaders should strive to set the vision for improvement, model desired behavior, empower the right people, address skeptics and mobilize resources, Dr. Larson said. "When leadership support fails in any of these areas, the project is likely to fail," he said.

Performance improvement has a well-developed methodology, Dr. Larson said. While there are different flavors, they all follow a similar pattern. These methods are closer to the engineering design process than to the scientific method; it is fairly straightforward but not always intuitive, Dr. Larson said.

"Project teams can flail — and fail — if they do not have at least some training in improvement methods," he said.

Additionally, dedicated improvement projects tend to attack problems that are not easily solved with intuition alone, Dr. Larson said. This means they require investments in thought, discussion, expertise, and often investment in new tools, infrastructure and roles, he said.

"This requires protected time and resources," Dr. Larson said. "Expecting to tackle a difficult problem without the corresponding investment is likely to result in failure."

Anticipating Pitfalls Helps Avoid Them

An organizational culture can be defined as having shared beliefs, values and assumptions that drive behavior on a daily basis. Since most performance improvement requires the individual to change in some way, if individuals in the organization do not have a history of collaboratively solving problems, then an improvement project may fail because it meets predictable resistance, or "antibodies," he said. Teams that do not have a change management strategy tend to fail, Dr. Larson said.

There is an entire field of study and practice devoted to project management, Dr. Larson said. While its tenets are relatively straightforward (define the tasks to be done, designate those responsible and plan, carry out, and follow through on these tasks), doing it effectively is difficult, he said. "It has been said that success is 10 percent idea and 90 percent execution," Dr. Larson said.

Most pitfalls fall into one of these categories, Dr. Larson said. Those who have thought these factors through and have anticipated pitfalls are much less likely to be caught off guard and more likely to be successful, he said.

In 'The Art of War,' Sun Tzu said that the general who wins a battle makes many calculations before the battle is fought and the general who loses a battle makes but few calculations beforehand, Dr. Larson said. "In this way, the likely winner can be foreseen. So it is with improvement projects."

Question of the Day:

The NRC dose limit for radiation workers is 50 mSv/yr. How much radiation do flight crews and astronauts get?

Tip of the day:

Typically, mammography units have an HVL of 1cm. This means that a woman with a 6cm thick compressed breast needs at least four times as much radiation as a woman with a 4cm thick compressed breast.

The RSNA 2016 Daily Bulletin is owned and published by the Radiological Society of North America, Inc., 820 Jorie Blvd., Oak Brook, IL 60523.