Rinse and repeat." When I think of these words, it's usually related to laundry or running the dishwasher for my family of five. There is comfort and efficiency in doing things the same way every time (though I really never find laundry to be comfortable!). In fact, the desire for consistency to produce the same outcome is why we have clinical pathways. I often hear from students assigned to the orthopaedic unit for clinical that they are seeing a lot of the same types of patients. Aside from house chores, I'm the first in line to adopt the philosophy of "if it's not broke, don't fix it." Change requires us to evolve and that is uncomfortable-we thrive on routine and when things are predictable and consistent.
However, one pitfall with doing things the same way every time is that it can be very hard to recognize when it is time to change. We get caught up in doing the same thing over and over, usually because it seems easier that way, this can make it hard to realize the potential for growth. Even when there is an obvious need for change, a long history of doing things the same way can make it difficult to be creative and think differently.
As I've shared in previous messages, the pandemic catalyzed a lot of changes for our profession, our specialty, and our organization. The firm foundation of past presidents and leaders has given NAON the ability to weather the storm. Our pandemic learnings have made it painfully obvious that we cannot keep doing the same thing. The time is now to think out of the box, to get out of our comfort zone, and reimagine how to survive and to thrive.
Our closing speaker at congress, Courtney Clark, released a book on May 17th called Revisionary Thinking, When You Have to Change Your Plans to Meet Your Goals (Clark, 2022). There is a case study in the book that talks about an interesting and commonly agreed-upon solution to the problem-which everyone thought should be the focus of the future. However, before making the investment into developing the one solution, the group took another look at things and observed the task again. During the last deep dive, they forced themselves to think, "What else?" What else could be the problem?
The same scenario comes to mind when we jump too fast to the intervention, without fully defining the problem. We want to fix the problem and we have a great idea. Perhaps, we think we've seen it before-This is rinse and repeat. However, in reality, sometimes we are applying the wrong solution because we do not fully understand the problem. Does this sound familiar?
We must evolve and do things differently than we did before the pandemic. But what remains a challenge for me is that we cannot simply repeat this next year and the year after. We have to constantly reexamine what is in front of us and ask ourselves "What else could it be?" Another method introduced by Toyota is an exercise called 5 Whys. This method helps to get to the source of the problem by asking "why" five times-Simply state the problem and ask, "Why is that a problem?" Once you answer, then ask, "Why is that?" and so on, repeating at least five times.
As nurses, we have to do the hard and time-intensive work of asking ourselves "What else could it be?" when thinking about our patients, organizations, and other dimensions of healthcare. Why are these things happening? And when we answer this question, we need to break out of the routine of using the same explanations and not testing those explanations further-asking "How do I know this is true?" I want to challenge you to think about problems and issues you face at work and at home with this deeper dive. And, I'd ask you to STOP using the pandemic as the go-to problem. What else could it be? Why was the pandemic such a catalyst for change?
When I hear students' comments that their orthopaedic clinical experience was the same types of patients over and over again, my heart breaks. I often think to myself that the student heard orthopaedics was boring because we have a lot of the same types of patients. However, I know they have not thought about the "What else could it be?" Could it be that weeks of work to optimize the patient made the 24 hours after surgery more predictable? Could it be that years of research went into developing postoperative multimodal pain protocols so that patients are comfortable enough to get out of bed on the day of surgery? What about asking why? Why does this seem so routine? We all know wherever we care for patients it is part of a larger picture. We may only work with patients for a short amount of time. All of the short episodes of care add up to a big picture of helping someone restore their movement.
What problems are you facing that need a deeper dive? What if you looked at the problems with a lens of what else it could be? Can you ask yourself why multiple times and tap into some fresh ways at looking at the issue? We want you to share your ideas with us-the leaders of NAON. We want to thrive and need new and creative ways to see what is happening and to develop new ways to grow. Let's save rinse and repeat for the laundry and the dishes.
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