Do you need more improvement? Does it seem like you and your team have hit the wall? Consider thinking of improvement as growth. Growth has limiting factors and sometimes more of the same will not create growth, or improvement.

A long time ago in undergrad nutrition the lab assignment was to conduct an experiment about growth in chicks. The experiment involved feeding groups of chicks rations of varying composition. One element of growth involves protein synthesis, which as you know requires amino acids. The test diet on our trial was deficient in one of the amino acids. The experiment showed that despite free access to unlimited feed, the growth rate of the test group was stunted.

The professor used an analogy known as Liebig’s law. While originally conceived to explain soil nutrient composition and the growth of plants, some such analogies are universally helpful. In the chick growth study, the limiting amino acid was the shortest barrel stave; the one that limited the rate of growth. Adding more of the other amino acids or other dietary requirements will not improve growth. You cannot fill the barrel past the limiting stave.

Complex systems exhibit similar dynamic characteristics. The discipline of systems dynamics uses archetypes or generic structures to help explain difficult challenges when concerned with system performance. Liebig’s Law is similar to the limits to success archetype. One key take away lesson from this archetype is that more of the same things you've been doing does not necessarily give you more of what you want.

 

What might be some limits to improvement? Number of people improving quality? Time? Improvement knowledge and skills? Cultural characteristics, such as an aversion to following standards?

You might apply this analogy to a specific improvement or your unit’s improvement work in general. What is your limited amino acid for improvement as growth… and what could you do about it?

 

Liebig's barrel image is in the wikipedia commons here.

While in London on vacation I made a point of seeking out all things Nightingale. Unfortunately, the museum was closed for renovations. There were two striking memorials I did visit: one at St Paul's Cathedral and the other at Waterloo Place, pictured here.

Florence Nightingale's contribution to quality improvement was nothing short of breakthrough. Two facts I learned while in London suggest a persistent Nightingale Challenge to guide improvement.

First was her work improve hygiene practices in military hospitals resulting in a dramatic reduction in the infection-related mortality rate among wounded soldiers - from 40% to 2%!

Second was her interest in making statistics visible and understandable. Apparently in order to advocate for improvement in military procedures she needed to persuade Queen Victoria and felt that a report composed of text and tables of numbers would not be convincing. The coxcomb graph (animated on this page) was an attempt to turn data into a picture that could be easily understood. This graph has not stood the test of time, and a simpler presentation of the same data is probably appropriate. The point is she recognized the need to make data understandable and convincing.

So, the Nightingale challenge is twofold: set out to accomplish dramatic improvement by setting stretch goals, think 40 to 2. And, use meaningful data that answers important questions displayed in a simple manner such as run charts annotated with change; tell a story that anyone can follow.