An Important Management Principle Can Help Prevent Unnecessary Problems
I was watching a major professional golf tournament a few years back. Many of the golfers were having a very difficult day. In fact, many would hit their shots and get into trouble. What followed for many of them was an attempt to make too much out of an already bad situation, which in turn led to even more problems for many of these golfers. A frequent commentator for many of the major professional golf events is former golf great Johnny Miller, and he was the commentator for the tournament on that day as well. As Miller watched many of these great golfers err by attempting to make heroic shots out of almost impossible situations, what ultimately transpired to Miller's amazement was a number of great golfers with exceptional skills making very stupid mistakes and ultimately taking themselves out of contention for winning the tournament. Yet, this did not need to happen and it could have been easily prevented. It was at that time that Johnny Miller said something quite simple, yet incredibly cogent. After watching the mess that many golfers were unnecessarily making for themselves he stated, "It's like my father said, the first thing you do when you get into trouble is get out of trouble." As I listened to Miller's statement I thought what an economically well stated managerial principle, not just for golf, but for all phases of life in which we need to manage the situation.
How many times have all of us found ourselves in a troubling situation, in which we often attempt to do more with the situation than we really had to do, with the result being even a worse outcome than we could have imagined. Instead of following the dictum that Miller promulgated, and simply attempting to get out of trouble, we attempt to use an overly complex solution to eradicate the issue when all that was needed was a much simpler and more straightforward solution that held a higher probability for achieving success. Why do you need to run as fast as you can over a rough and dangerous terrain, if you have the option to walk over a smoothly paved sidewalk and still get to where you need to be without risk of injury or encountering further problems? This was what Miller was saying. Why are these golfers making it more difficult than it has to be, especially with a game that already has considerable difficulty built into it? This also applies to many managerial situations within healthcare. Why do many individuals make it more difficult for themselves by attempting to implement arcane and impractical solutions that often lead them over rough and dangerous terrain, when they could simply get out of their trouble using much simpler solutions? Probably part of the answer lies in the misconception that most of us hold: If a difficult problem exists, we must always attempt to eradicate the problem with a solution that is equally difficult. This misconception often leads us to myopically only look for complex solutions with higher probabilities for failure, when often the first step is simply to use a straightforward strategy to "get out of trouble."
Even Albert Einstein stated " a theory should be simple but not more so," implying that we need to address the issue at hand in a practical manner and not get involved in unnecessarily convoluted theoretical concepts that can ultimately obfuscate what we are attempting to address and explain.
Think of a few scenarios here that often exist in health care facilities and their management in what often violate what I will refer to as the "Johnny Miller Principle of Management." Remember, we often have to manage the situation, and no single individual can manage the totality of any facility or organization at any single point in time. Yet, what often happens with many administrators, executive directors, chief operating officers, and yes, even the President of the United States? They often attempt to tackle a problem that may be relegated to a particular situation by addressing not just the problem, but even moving beyond the boundaries of the problem. In so doing they will frequently dilute the solution to the problem and even create problems in other areas of the organization that may not have existed before their attempt to reorganize and become too expansive in their problem-solving efforts. What happened? Miller's Principle was violated. When you are in trouble, the first thing you should do is get out of trouble. If X is the problem, simply address X, the problem, and get out of trouble. There is no need to change Q, R, and S if they are 1) not part of the problem, and 2) if doing so increases the probability for further problems.
Think about the issue of what is often referred to as "sunk costs." This is where a cost exists and cannot realize any return on the cost. Yet a common psychological heuristic that exists among individuals is that if any investment has been made, and you suffered a loss, continue to invest since you have already committed yourself. However, this is not rational. If your cost has been incurred it is lost. Yet we often feel compelled to continue to chase an illusory loss that we feel can be resurrected is a Lazarusian manner. If an investment is a bad investment the best managerial strategy is to prevent any future losses and move on. Again, Miller's Principle-when you are in trouble, the first thing you do is get out of trouble, not compound it and make it worse.
I have witnessed individuals attempt to remedy health care deficiencies that surveyors have found to exist. Here is another issue that is frequently found to violate Miller's Principle. In addressing the problem, what often entails is the thinking that more words and more remedies often implies more solution(s) to the problems that they are attempting to correct and have been found in violation of federal and/or state regulations. Often this same type of poor logic not only exists among the managerial and administrative staff of a health care facility, but also among the regulatory personnel as well. "If you get into trouble, the first thing you do is get out of trouble." If A is the problem, then address A. If A and B are the problem, then address each one. No more or no less is needed. Too little and you are not solving the problem and getting out of trouble. However, often the problem is with too much. If you do too much you are frequently diluting your solution toward the problem at hand, and furthermore, you often are mathematically increasing the probability of more problems that will ultimately 1) fail to solve the original issue, and 2) make for a refractory issue in which the solutions add further problems, which in turn can lead you to even greater problems. To use a golfing analogy that Miller would probably agree with, if you are in the rough, do not think about aiming for a green surrounded by water and sand. Get out of the rough first (the current trouble you face) and get into the fairway. Then you can plan your next shot, or managerially speaking, you next plan of action. "When you are in trouble, the first thing you do is get out of trouble."
Health care facilities will often attempt to increase their income by taking residents with higher acuity to enhance reimbursement, especially rehabilitative reimbursement through Medicare. However, what if you extend your services beyond the resources you have available to serve the clients within your health care facility? Again, it would be extremely idealistic to say that money is not a concern. Money is a concern regarding whether you are a for-profit or not-for-profit organization. However, attempting to increase the patient or resident-base beyond your resources available to further enhance your net income will not only be counter-productive to the clients you are servicing, but to your organization as well. How do you solve the problem? You could get the resources you need to appropriately service your clientele. If this is not tenable, reduce the type and kind of clients you service that will allow you to safely and effectively address the situation. "When you are in trouble, the first thing you do is get out of trouble."
Let me provide one last example. Many individuals often want and need to mathematically quantify problems in management. However, often their attempt to find and quantify problems can lead to more problems. For sure, one needs to look at their income statement for the month and see if a problem exists. Furthermore, using a T-test to examine the statistical effectiveness of one group to another may be very important for addressing and quantitatively analyzing a problem as well. However, often individuals will think if one measurement is good, then each additional measurement that I add will further help to solve a problem. In today's world management is often based on the many quantitative tools that are available. They think quantity leads to quality. Many also think these tools aid magically in addressing the problem. They still need to be interpreted and used correctly. Furthermore, frequently there is the problem with over-management by overuse of these tools. Often if one tool does show a problem it is often common to use another tool to help triangulate the issue and provide greater validity. However, to continue to use one measurement tool after another, all showing a problem exists is redundant, and you are then left with attempting to correct the results of each tool, which does not necessarily correct the problem and is an incredible waste of time, not to mention an inappropriate use of needed resources. The measuring devices, whether it is a cash flow statement, and correlational measurement, or a forecasted regression analysis, which are means that should be used judicious to find and correct the desired end or goal have now become the goal in themselves. Here again, if a tool or even a few tools have found and confirmed an problem, address the problem and get out of trouble. There is no need to compound your tool usage and continue to waste time, money and valuable resources just to advance the pursuit of an intellectual counting exercise. "When you are in trouble [and trouble has been identified], the first thing you do is get out of trouble." If the managerial analogy of your trouble is that you are just off the green and are terrible pitching up safely unto the green, use your putter and safely get it on the green. Then plan your next shot if you need to at that point.
Using golf as a strategic analogy for thinking about managerial problems is highly beneficial. Good golfers are always managing the situation over the entire course. As Bobby Jones stated, the success of any golfer exists within a space of about six inches between both ears. That is because golf is strategic and is based on sound management of the course. They do not plan to manage the entire course all at once. Their management is situationally based, predicated on each shot that they take over the 18 holes. Jones' statement however can also apply to all management. Furthermore, successful management of the course often means that you avoid foolish errors and employ Miller's Principle-The first thing you do when you get into trouble is get out of trouble. The course however does not just have to be a golf course, but the business, facility or organization can also be viewed as a competitive course environment as well.
Management in general and managing health care facilities in particular are quite similar to managing the golf course. Attempting to manage an entire facility or organization at a single point in time will lead to failure. Each management decision is based on the situation that one finds oneself in and all decisions that have been made up to that point in time. Therefore, next time you encounter a problem think about the Johnny Miller Principle: "The first thing you do when you get into trouble is get out of trouble." It is simple, clear and apparently obvious. However, how often does one violate the principle in attempting to manage their health care organization? Thank you Johnny Miller for giving impetus to the introduction of a principle that can have an important managerial impact for so many if they adhere to just a few simple words.