Lessons learnt on an oil rig….how to improve health care

I’m regularly asked whether my experience working on an oil rig triggered my interest in improvement and system strengthening. Absolutely and this is how:

I was on an offshore site where it took more than a year for medical supplies to arrive. Being an inquisitive person (also referred to as a pain that asks too many questions) I arrived on-board and started asking why. The standard reply was that this is how it is, we’ve have tried everything and the situation cannot be remedied.  I stubbornly insisted that there must be a better way…until I was giving carte blanche to find that better way.  Great…I did not need another invite.

I started by mapping the process. Only at the time I did not know it’s a map or a process.  I thought that what I’m doing is a mind map to make me think about the problem better.

The map demonstrated additional steps in the process including drawn out approvals between the on-board medic, contracting company, pharmaceutical supplier and the client. Every change regarding pack size, dosage or alternative medication had to be approved by everyone every time.  From the initial supplier the packaged pharmaceuticals were shipped to another supplier in another country, where when released from customs, the supplies was unpacked and relabelled to meet local legislative requirements.  It was again packed, and shipped.  On arrival in Africa, it remained in customs for a minimum of six months.  When released it would go to the client’s warehouse.  The warehouse was managed by a contracting agency; supplies had to go through a verification process taking up to six weeks. Finally it was dispatched offshore.

On arrival the boxes was open, seals broken, the boxes contained rodent droppings and expired medication. We could not trust that cold chain was maintained during transit, making the use of fridge items such as tetanus toxoid unreliable.

The process was lengthy and the map was met with disbelief. An important lesson learnt:  facts especially when presented as a picture, map or graph is a better way of pushing for change than emotive complaints.

Until confronted with the facts we were placing band aids on the real problem. Actually not even, we were ignorant of the problem.  Our attempt to “solve” the problem by placing more orders was not solving anything. It was just the “easiest” solution and aggravated the costs such as running costs of the clinic, cost to client and increasing the amount of expired stock on-board.

A related problem was that we were not ordering according to need. This resulted in “relative” shortages on certain medications and oversupply of others.  It’s like shopping without a shopping list, you always buy stuff that you don’t need and forget the things that are needed.

To make a long story short, by mapping the process, we were confronted by the facts and it was clear that we had to address supply chain issues. We could now make a plan and address it and to make a long story short:  within six months we had implemented actions and time from ordering until arrival on-board (intact and in-date) was four weeks.  I could now focus on the medication shopping list and established average monthly usage to forecast future use and set minimum, maximum and reorder levels;  thus addressing the “relative” shortages and oversupply.

Why it was successful

“To learn anything other than the stuff you find in books, you need to be able to experiment, to make mistakes, to accept feedback and to try again. It doesn’t matter whether you are learning to ride a bike or starting a new career, the cycle of experiment, feedback and new experiment is always there.”  Charles B. Handy

A crucial success factor to this experience was that I had a manager that created an enabling environment where I felt safe enough to experiment. And perhaps I was lucky because it was seen as so hopeless that anything would’ve been an improvement.

What did the enabling environment look like?

  1. Trust. There was a mutual trust relationship.  Steven Covey has written two books about trust (the Speed of Trust and Smart Trust) and he states that managers that trust their employees build capacity and confidence in their people.
  2. Listen.  The people on the floor knows what needs to improve in their workspace and if their manager would just shut up and listen instead of offering solutions and quick fixes; problems could be solved in a sustainable way.
  3. Delegate and let it go.  Once it was decided that I could work on the problem, there was little interference and I was forced to take responsibility. Manager’s struggle to delegate and sometimes people on the floor struggle to take ownership.  A really clever manager will not take the ownership back; they will guide the person through a tough patch.
  4. Make it ok to experiment.  Yes there will be some not-so successful experiments…that are part of the process.  One of our not so successful experiments was an attempt to hand carry vital supplies, it resulted in me being detained at the airport for a few hours.
  5. Set boundaries, communicate it and renegotiate the boundaries when needed. It gives freedom to experiment, within a certain frame.  (This was only done after me being detained)
  6. Acknowledge and reward people.  I received a special recognition award from the client.  This propelled me to do more, read more and learn more. I think acknowledgement is so valuable and yet so easily forgotten.  There needs to be a concerted effort to notice contributions.

So was this LEAN, IHI, SIX SIGMA or whatever else? Define it now!

I have reached disillusionment that there are quacks in the improvement sphere.  The quacks love the big words, the theories, and the tools.   They love making the concepts foreign to the people that they are supposed to be guiding.  They don’t seem to understand that the crux is not to define every action, step or prescribe solutions and tools for everything. Change and improvement is not about theorizing which methodology is best.  I agree with Shakespeare on this one: What’s in a name? That which we call a rose by any other name would smell as sweet;”

The big words and theories are not the essence. Complexity is failed simplicity (Edward Bono).  The bigger the words people use, the less they understand the essence (My opinion).

Unfortunately improvements is at times adopted as a program or tool and forced upon people without realizing that there needs to be a certain amount of intuition, flexibility, an enabling environment and good management. It’s not just posters against a wall, it is a shift in culture.

Bringing it back to health care

Working on an oilrig triggered my interest in improvement and system strengthening. And yes a great manager was instrumental to this.

Managers are products of their industry and their environment. So the culture of the oil and gas industry co- created the enabling environment. Culture is protected by the habits in the industry in other words hospitals and oilrigs (health care and the oil and gas industry) do not have a culture, it is a culture.

I don’t think that at the time I would’ve been able to experiment in health care and learn the lessons that I learnt. The structure definitely did not exist in any of the health facilities I’ve worked in and in many instances health care still need to reframe the culture to one where people feel empowered to identify, explore and experiment on fixing problems in a way that it can remained fixed. This implies a huge shift in how health care are managed.

The good news is that recently the health care industry has woken up and there are various recent examples of improvement, innovative health care administration and leadership that can serve as examples. Let’s hope that it will continue diffusing.

Note: Please note that I purposefully used the word manager and not leader.

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One thought on “Lessons learnt on an oil rig….how to improve health care

  1. I think this is a very insightful piece of writing. I find it interesting that the much criticised “Oil and Gas industry” is so much more open to THE CHALLENGE than traditional health care institutes are. Please keep posting …. this is important stuff!!

    Liked by 1 person

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