Dr Lee Gruner- Discovering The Carrot Effect 1 The Art of Successful Problem solving Discovering the Carrot Effect

Dr Lee Gruner- Discovering The Carrot Effect 1

The Art of The Art of Successful Successful

Problem solvingProblem solvingDiscovering the Carrot EffectDiscovering the Carrot Effect

2Dr Lee Gruner- Discovering The Carrot

Effect

Format of workshopFormat of workshop

Introduction to problem solvingIntroduction to problem solving Barriers to problem solvingBarriers to problem solving Understanding complex problemsUnderstanding complex problems Real life examples in healthReal life examples in health Reviewing the principles of solving Reviewing the principles of solving

problems successfullyproblems successfully


Effect

Why did I write a book about Why did I write a book about how to solve complex how to solve complex

problems?problems?


Effect

Why did I choose to use Why did I choose to use rabbits as characters rather rabbits as characters rather

than people?than people?


Effect

The tale of a difficult The tale of a difficult rabbitrabbit

Once upon a Once upon a time, there time, there was a rabbit was a rabbit called called Rominy Rominy


Effect

Why was Rominy Why was Rominy considered difficult?considered difficult?

He was always rightHe was always right He always had a problem for others He always had a problem for others

to fixto fix He always had the solutionHe always had the solution He never saw anyone else’s point of He never saw anyone else’s point of

viewview He had no perspectiveHe had no perspective


Effect

The head of the rabbit clan The head of the rabbit clan was Walter Rabbitwas Walter Rabbit

Walter had major concernsWalter had major concerns Rominy always wanted something fixedRominy always wanted something fixed Rominy’s problems were really Rominy’s problems were really

Rominy’s solutionsRominy’s solutions Rominy was very persistentRominy was very persistent Rominy often got his way Rominy often got his way This was causing disharmony in the This was causing disharmony in the

rabbit community as they thought this rabbit community as they thought this was unfairwas unfair


Effect

Walter was a wise and Walter was a wise and consultative leaderconsultative leader

Walter held regular Walter held regular

sessions on the Old sessions on the Old

Tree Stump to assistTree Stump to assist

rabbits to solverabbits to solve

complex problemscomplex problems


Effect

Walter was a wise and Walter was a wise and consultative leaderconsultative leader

But he had no idea of how he But he had no idea of how he could solve the problem could solve the problem presented by Rominypresented by Rominy


Effect

Walter believed in dataWalter believed in data

To find out why Rominy had no To find out why Rominy had no perspective he decided to collect perspective he decided to collect datadata

The one thing that distinguished The one thing that distinguished Rominy from other rabbits was that Rominy from other rabbits was that he was allergic to carrotshe was allergic to carrots

So Walter collected data to see if So Walter collected data to see if this was the issuethis was the issue


Effect

What did Walter find?What did Walter find? Carrots v visual acuityCarrots v visual acuity

No of carrots

Rominy Rabbit

5 carrots


Effect

What did Walter find?What did Walter find? Visual acuity and perception were Visual acuity and perception were

directly relateddirectly related Visual acuity was directly related to Visual acuity was directly related to

number of carrotsnumber of carrots Those who ate less carrots had less Those who ate less carrots had less

perceptive qualitiesperceptive qualities Rominy was at the bottom of the scale Rominy was at the bottom of the scale

for visual acuity and perception as he for visual acuity and perception as he ate no carrotsate no carrots

The problem could not be fixed by The problem could not be fixed by feeding Rominy carrotsfeeding Rominy carrots


Effect

Walter was in a dilemmaWalter was in a dilemma

He took time out to define the He took time out to define the problemproblem

He needed to find something that He needed to find something that would have the same effect as carrots would have the same effect as carrots for non carrot eating rabbitsfor non carrot eating rabbits

He needed to find “The Carrot Effect”He needed to find “The Carrot Effect” But: he didn’t think that he could But: he didn’t think that he could

solve the problem by himselfsolve the problem by himself


Effect

How did Walter define the How did Walter define the problem?problem?

Current situationCurrent situation A A very myopic rabbitvery myopic rabbit A rabbit that causes A rabbit that causes

disruptiondisruption Rominy’s solutions Rominy’s solutions

upset the communityupset the community A dissatisfied rabbit A dissatisfied rabbit

communitycommunity Walter not making the Walter not making the

right decisionsright decisions Stress dealing with Stress dealing with

the situationthe situation Walter’s leadership Walter’s leadership

being underminedbeing undermined

Desired situationDesired situation Rominy gains Rominy gains

perspectiveperspective Walter makes the Walter makes the

right decisionsright decisions Walter’s stress Walter’s stress

reducedreduced Rominy and other Rominy and other

rabbits live together rabbits live together harmoniouslyharmoniously


Effect

How did Walter define the How did Walter define the problem?problem?

Based on current and desired situation Based on current and desired situation the problem to be solved is:the problem to be solved is:

Rominy’s lack of perspective is Rominy’s lack of perspective is causing disruption in the rabbit causing disruption in the rabbit community and hinders decisions community and hinders decisions being made for the good of allbeing made for the good of all

Issue:Issue: Rominy has no perspective Rominy has no perspective Impact:Impact: poor decisions being made and poor decisions being made and

community harmony disruptedcommunity harmony disrupted


Effect

How did Walter go about How did Walter go about finding the Carrot Effect?finding the Carrot Effect?

To do this he needed the right team To do this he needed the right team with diversity in personality and with diversity in personality and skills skills

He needed persistenceHe needed persistence He needed good dataHe needed good data He needed to adhere to the principle He needed to adhere to the principle

of “no solutions”of “no solutions” He needed to be prepared to take He needed to be prepared to take

risksrisks


Effect

How does this relate to How does this relate to health?health?

Health is populated with Rominy Health is populated with Rominy RabbitsRabbits

Health is constantly in change Health is constantly in change internally and externallyinternally and externally

Health has many complex problems to Health has many complex problems to solve on an ongoing basissolve on an ongoing basis

Health relies on diverse skills and Health relies on diverse skills and knowledge to solve these problems knowledge to solve these problems effectivelyeffectively

Health organisations often go about Health organisations often go about this the wrong waythis the wrong way


Effect

How does this relate to How does this relate to health?health?

Why do we often end up with Why do we often end up with unsustainable solutions to unsustainable solutions to problems?problems?


Effect

Sustainable solutions Sustainable solutions need:need:

Recognition that before we start to Recognition that before we start to solve the problem we need to solve the problem we need to definedefine the problem the problem

Consideration of the impact on the Consideration of the impact on the system of both the problem and the system of both the problem and the solution solution

Recognition that the problem to be Recognition that the problem to be solved is complexsolved is complex


Effect

Because we want Because we want quick solutions:quick solutions:

We don’t take the time We don’t take the time to define the problemto define the problem


Effect

Defining the problemDefining the problem

Example: The growing dilemmaExample: The growing dilemmaPatient numbers

Specialist numbers


Effect

How do you think the How do you think the Rheumatologists defined Rheumatologists defined

the problem?the problem?


Effect

What was their initial What was their initial solution?solution?


Effect

What is the real What is the real problem?problem?

The Rheumatologists defined it as The Rheumatologists defined it as “not enough specialists”“not enough specialists”

The question therefore became “How The question therefore became “How can we increase the number of can we increase the number of specialists?”specialists?”

This was translated into “How can we This was translated into “How can we increase the number of trainees?”increase the number of trainees?”

This resulted in one solutionThis resulted in one solution


Effect

The growing dilemmaThe growing dilemma

Best case scenarioBest case scenarioPatient numbers

Effective Specialist hours today

Effective specialist Hours - future


Effect

What is the question?What is the question?

If you ask the wrong question, you If you ask the wrong question, you will get the wrong answerwill get the wrong answer

You need to take time to decide what You need to take time to decide what the right question isthe right question is


Effect

Defining the problemDefining the problem

What is the real problem?What is the real problem? Think about what the major symptoms Think about what the major symptoms

of this situation are (current situation)of this situation are (current situation) Think about what you would like to Think about what you would like to

see as satisfactory outcomes (desired see as satisfactory outcomes (desired situation)situation)

What is the impact on patients of this What is the impact on patients of this situation?situation?


Effect

Defining the real Defining the real problemproblem

Problem needs redefining to enable a sustainable Problem needs redefining to enable a sustainable solutionsolution Current situation: not enough (specialist) hours Current situation: not enough (specialist) hours

allocated to meet patient needsallocated to meet patient needs Desired situation: patients with rheumatology Desired situation: patients with rheumatology

needs appropriately managedneeds appropriately managed Problem: GAP BETWEEN CURRENT AND DESIREDProblem: GAP BETWEEN CURRENT AND DESIRED PATIENTS WITH RHEUMATOLOGICAL PATIENTS WITH RHEUMATOLOGICAL

CONDITIONS DO NOT HAVE ACCESS TO CONDITIONS DO NOT HAVE ACCESS TO APPROPRIATE MANAGEMENT APPROPRIATE MANAGEMENT

Major impact of the problem: Major impact of the problem: suboptimal patient suboptimal patient

carecare

THE SOLUTION IS ALL ABOUT HAVING THE THE SOLUTION IS ALL ABOUT HAVING THE RIGHT PERSPECTIVERIGHT PERSPECTIVE


Effect

Defining the real Defining the real problemproblem

Analysis:Analysis: Not enough specialists= not enough timeNot enough specialists= not enough time Not enough time= not enough appropriate Not enough time= not enough appropriate

timetime Appropriate time = deciding whose time is Appropriate time = deciding whose time is

neededneeded Too many patients= patients who perceive Too many patients= patients who perceive

they need a rheumatologistthey need a rheumatologist Perception = they need some care but not Perception = they need some care but not

necessarily specialist rheumatologist carenecessarily specialist rheumatologist care Decision needed on how this care can be Decision needed on how this care can be

providedprovided


Effect

Gaining Gaining

perspectiveperspective


Effect

What is the real What is the real problem?problem?

HOW DO WE PROVIDE HOW DO WE PROVIDE APPROPRIATE MANAGEMENT TO APPROPRIATE MANAGEMENT TO RHEUMATOLOGY PATIENTS?RHEUMATOLOGY PATIENTS? Increase the effective workforceIncrease the effective workforce Decrease the effective workload (less Decrease the effective workload (less

patients)patients)


Effect

Finding the solutionsFinding the solutions

Decrease effective workload

Increase effective workforce


Effect

Using the 5 P structure Using the 5 P structure

Policies and proceduresPolicies and procedures People- staff who use the service and People- staff who use the service and

supply itsupply it Patrons- external users of the Patrons- external users of the

service- patients/ relativesservice- patients/ relatives Place- facilities and equipment Place- facilities and equipment Provisions- supplies/ consumablesProvisions- supplies/ consumables


Effect

Addressing the issuesAddressing the issuesForce field analysisForce field analysis

Increase effective Increase effective workforceworkforce

Decrease effective Decrease effective workloadworkload


Effect

Addressing the issuesAddressing the issuesForce field analysisForce field analysis

Increasing Increasing effective workforceeffective workforce

More traineesMore trainees Make use of other Make use of other

health professionalshealth professionals Better use of admin Better use of admin

staffstaff Better systems to Better systems to

improve efficiencyimprove efficiency Work more hoursWork more hours

Decreasing Decreasing effective workloadeffective workload

Limit reviewsLimit reviews Educate GPs betterEducate GPs better Preventative strategiesPreventative strategies Educate patients on Educate patients on

self-careself-care Patient triage systemsPatient triage systems Group practiceGroup practice


Effect

Where do the solutions lie?


This was a complex This was a complex problem? problem?

What does this What does this mean?mean?


Effect

What is a complex What is a complex problem?problem?

Involves many people or groupsInvolves many people or groups Solution will impact significantly on the Solution will impact significantly on the

systemsystem Will have a variety of options for solutionWill have a variety of options for solution Will be able to work on many of the Will be able to work on many of the

options in a multi- pronged approachoptions in a multi- pronged approach Will need teamwork and good leadership Will need teamwork and good leadership

to solve appropriatelyto solve appropriately


The The Dysfunctional Dysfunctional

outpatient outpatient serviceservice


Effect

The dysfunctional The dysfunctional outpatient serviceoutpatient service

Current situationCurrent situation Clinics go 3 hours over Clinics go 3 hours over

timetime Too many new patients Too many new patients Patients wait 2 hours to Patients wait 2 hours to

be seen and get upsetbe seen and get upset Waiting room doesn’t Waiting room doesn’t

have enough chairs have enough chairs Patients’ cars bookedPatients’ cars booked Pharmacy makes up Pharmacy makes up

chemo without scripts chemo without scripts and may need to redoand may need to redo

Day ward overcrowdedDay ward overcrowded

Desired situationDesired situation Appropriate numbers of Appropriate numbers of

new patients bookednew patients booked Clinics finish on timeClinics finish on time All chemo made All chemo made

according to scriptsaccording to scripts No chemo wastageNo chemo wastage Day ward used more Day ward used more

efficiently so no efficiently so no overcrowdingovercrowding

Patients happy with the Patients happy with the serviceservice


Effect

The dysfunctional The dysfunctional outpatient serviceoutpatient service

What is the problem?What is the problem? Gap between current and desired Gap between current and desired

situationsituation ImpactImpact


Effect

Definition of a problem- Definition of a problem- exampleexample

What is the gap between current What is the gap between current situation and desired situation?situation and desired situation?

The overbooking of oncology The overbooking of oncology clinics has a major impact on staff clinics has a major impact on staff and patients and is compromising and patients and is compromising patient safety and quality patient safety and quality

Major impact:Major impact: patient care is patient care is compromisedcompromised


Effect

The dysfunctional outpatient The dysfunctional outpatient serviceservice

How do we solve this How do we solve this problem?problem?

Decrease the factors leading to the Decrease the factors leading to the current situationcurrent situation

Increase the factors leading the Increase the factors leading the desired situationdesired situation


Effect

How do we decide How do we decide which options are which options are

best?best?


Effect

Deciding on the best Deciding on the best optionsoptions

Develop a set of criteria and rate Develop a set of criteria and rate according to these as a teamaccording to these as a team

Examples of criteria:Examples of criteria: FeasibilityFeasibility Time to implementTime to implement CostCost Effect on the systemEffect on the system Sustainability Sustainability


Effect

What did Walter learn What did Walter learn about solving complex about solving complex

problems?problems? You need to take time to understand You need to take time to understand

what the problem iswhat the problem is This means you need to analyse the This means you need to analyse the

current situation and be clear on current situation and be clear on what you want the desired situation what you want the desired situation to be to be


Effect


problems?problems?

You need to decide what data you You need to decide what data you need and not try to solve the need and not try to solve the problem until you have collected and problem until you have collected and analysed all the relevant data analysed all the relevant data


Effect


problems?problems? Don’t be fooled into thinking there is Don’t be fooled into thinking there is

only one solution and this is “the” only one solution and this is “the” solutionsolution

Don’t be fooled into thinking you can Don’t be fooled into thinking you can use only one option at a timeuse only one option at a time

There are many ways of addressing There are many ways of addressing complex problems from many anglescomplex problems from many angles


Effect


problems?problems?

Solving complex problems takes Solving complex problems takes time if you are after a sustainable time if you are after a sustainable solutionsolution

Even then it might not be Even then it might not be sustainable in the longer term and sustainable in the longer term and constant evaluation is neededconstant evaluation is needed


Effect


problems?problems?

You need the You need the right teamright team

Documents

Dr Lee Gruner- Discovering The Carrot Effect 1 The Art of Successful Problem solving Discovering the Carrot Effect