Insights (Essays)

Insights (Essays) February 2014

A Different Way of Thinking

Ted Ball and Hugh MacLeod

When we listen to the conversations taking place on the “balcony of personal reflection” they are personal and human interest stories. The conversations stem from personal experiences as patients, family members, care providers and managers in healthcare. Our exposure to healthcare, in this capacity, proves a key learning experience for all. Healthcare is a touch business, and care is all about relationships between and among care providers and patients.

Do we fall into a trap of forcing from the top a blueprint, a plan, a process, a tool, without truly allowing for the generation of a new way of thinking and doing business? Were Deming and Juran cognizant of the needs of workers, such as pride and joy in work, breaking down barriers, driving out fear, eliminating slogans, and initiating programs for education and improvement of all? We believe they were, but sometimes it gets neglected when healthcare leaders begin to jump on the TQM/CQI bandwagon.

The Ghost of Healthcare Consciousness appears and states:

“We are ingrained in fragmentation and automatically break off the various pieces from the whole, placing them into isolated and incomplete piles. Instead of examining the experience silo by silo, participants should be asked to address the ‘whole picture,’ rather than the ‘sum of the individual parts.’”

Peter Senge explains that “from a very early age we are taught to break apart problems, to fragment the world. This apparently transforms complex tasks and subjects into more manageable details, but we pay a hidden and enormous price. We become blind to the consequences of our actions; we lose our intrinsic sense of connection to a larger whole.” When we try to “see the big picture,” we try to reassemble the fragments in our minds, to list and organize all the pieces. 

Giving up on the illusion that the world consists of separate and unrelated forces, we are able to build “Learning Organizations,” organizations where “people continually expand their capacity to achieve the results they truly desire; where new and expansive patterns of thinking are nurtured; where collective aspiration is set free; and where people are continually learning how to learn together.”

In such organizations, people no longer compete with one another and the traditional silo wars between departments or factions dissipate. People are working co-operatively and collaboratively in order to fuse the component parts into a coordinated whole. Integration is the opposite of fragmentation. Learning how to think in an integrated, holistic way involves a struggle to overcome our traditional, fragmented ways of thinking. Systems-thinking shows that small, well-focused actions in the right place can produce significant, enduring improvements. By contrast, traditional fragmented thinking focuses on symptomatic fixes – not underlying causes.

To help instigate a change in thinking, we suggest reflecting on these three recommendations:

  1. Your organization has a quality and patient safety accountability framework in place with a set of indicators, and it is credible among and relevant to care providers.
  2. Measuring and reporting on quality and patient safety is a core expectation of all leaders, managers and care providers, and part of their continuing education agenda.
  3. There is an organizational mentorship and professional development program that highlights quality and patient safety improvement theory and practice.

We close with a passage from the essay, “Accountability for Performance”:

“If the healthcare system is to improve its performance over the long term, it must shift from a paradigm where no one – or only a few – are accountable for achieving a particular set of results, to one where a wide range of players is accountable for achieving a broad range of results. To paraphrase Barber, when there is a problem in the system, the answers cannot come only from government, because it has the money, or from provider organization boards and management, because they are ‘in charge.’ Rather, the answers will come when we ask, collectively, how we are going to solve the problem. Accountability for achieving results must go beyond boards and management – and beyond a vague concept of shared responsibility – to include physicians, other healthcare providers, professional associations, regulatory bodies, government, regional networks and the public.”

Join next week’s conversation titled: “The Patient-Oriented Healthcare Model

About the Author(s)

Ted Ball, Patient, Consultant.
Hugh MacLeod, CEO Canadian Patient Safety Institute … Patient, Husband, Father, Brother, Grandfather … Concerned Citizen.


The Canadian Patient Safety Institute (CPSI) exists to raise awareness and facilitate implementation of ideas and best practices to achieve a transformation in patient safety. We envision safe healthcare for all Canadians and are driven to inspire extraordinary improvement in patient safety and quality. To address many of the challenges mentioned in the essay above, the Canadian Patient Safety Institute – with partners – has tools and resources. Please contact


Berwick, D.M., A.B. Godfrey and J. Ruessner. 1990. Curing Healthcare. San Francisco, Jossey-Bass.

Deming, W. 1966. Some Theory of Sampling. Dover Publication.

Juran J.M. 1980. Quality Planning and Analysis. New York – McGraw-Hill.

Senge, P. 2006. The Fifth Discipline. Doubleday, New York.

MacLeod, H. and T. Closson. 2013. “Accountability for Performance.” Longwoods Ghost Busting Essays.

Barber, M. 2007. Instructions to Deliver. Methuen & Co. Ltd. 


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