Health Systems by William “Ike” Eisenhauer

ISE Magazine –Volume: 49, Number: 08

Raiders of the lost arts

My favorite movie of all time is the adventure pulp classic Raiders of the Lost Ark. The dual personality of Dr. Jones, professor of archeology, and Indiana, whip-wielding obtainer of rare antiquities, resonates with the roles played in healthcare improvement. Harrison Ford, however, plays the dual role much better than most of us in one major regard – Indiana actually listens and remembers what Dr. Jones has taught.

During this last term (my Dr. Jones phase), an unexpected retirement gave me the unique opportunity to teach in the statistics department – the experimental design theory class sequence, to be specific – instead of engineering. After all, I am the primary instructor for the engineering department’s experimental design methods class. I eagerly accepted, even though I had to leave behind my fedora and whip covered with dust from adventures with field experimentation challenges of sampling bias and latent effects. A three-piece suit and spectacles were more appropriate for the nuances of optimality determination and Hesse diagrams.

I received a shock about halfway through the second term of the sequence. As it turns out, the practical experimenting adventurer I had become was leaving a lot on the table. I rediscovered possibilities and treasures of remarkable usefulness that, when I first learned them, I had dismissed as academic exercises of no practical value.

I was wrong.

One exceptionally rare antiquity was George Box’s evolutionary operations (EVOPS). Originally described in 1957 (antediluvian in terms of improvement science), his was the exact methodology I had been trying and failing to establish in clinical operations. Of course it was being done under terms like huddle boards or continuous improvement. It theoretically describes a simple method of small but constantly progressing improvements that adjust as the system deviates from the optimal. The power of the theory, as described by Box, was that the process could be done by those in the system, not an outside observer, and the experimentation would be part of the work, not in addition or external to the work. Just like Dr. Jones and Indiana, I had found the location of Tanis.

The classic EVOPS is a specified sequencing and ordering of experimental designs such that people can quickly see the improvements and decide if modifications are needed. No shipping the data off to the statistical consultant or extracting big data into a mysterious black hole of the Six Sigma department to wait for a report. Just see and make the changes right where information is collected and then continue with no disruption to processes. Deming PDSA cycles on high speed.

Back in my Dr. Jones role I dug deeper into the source documentation and papers. What I found most interesting is that there seemed to be a big move on this activity until about 1970. Then, just like Tanis, a sandstorm of forgetfulness wiped it from the map of the practicing experimenter’s tool box. Well, it is time to pull that one out of the Well of the Souls and bring it back to the modern world.

My short foray back to the more theoretical academic Dr. Jones side has given my Indiana side a glimpse back to what had been forgotten, along with many other practical possibilities to rediscover. I am positive that instead of reinventing, we can rediscover many more lost arts.

It might do everyone good to step back from the practical side, lay down the whip for a bit and give another look at things we previously dismissed. The worst that can happen to those great theoretical ideas is they get hand-carted into a huge warehouse of history to be forgotten forever.