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Garavaglia’s The One Thing

Published June 9, 2015 10:54 AM by Brian Garavaglia
Businesses are being bombarded with techniques to provide continuous improvement in their everyday operations.  Healthcare facilities are no different.  In fact, Total Quality Improvement, Six Sigma techniques, various forms of root cause analysis just to mention a few have become common terms and methods that are used within healthcare, and at growing rates, long-term care.  However, although we often opt for many more sophisticated forms of intervention retroactively employed, we often lose sight of the more simple proactive techniques that once habitually instilled, lead to considerable quality enhancement in our daily operations.  Furthermore, one does not have to matriculate or formally complete an MBA training program to understand a simple method for enhancing quality.  The simple method is often used when we do many things in life.  We can only address so many issues and often, just addressing one issue each day leads to great success.        

Given this, here is an idea, which I will call “Garavaglia’s The One Thing."  With such things as Parkinson’s Law and the Peter Principle, why not add another name to what I think is even a more useful principle than the previous two I have mentioned.  Yes, I am going to give it my name. However, I am providing it with my name not because it has some grandiose, arcane and previously undiscovered methodology or principle only able to be ascertained and discovered by me. I wish I could claim such brilliance. However, providing my name to it just works to create and eponymous distinction. If we institute into all the concept of "The One Thing" that we can use to improve our healthcare facilities, we can focus them toward something that needs to be achieved each day.  In fact, here is an idea for management.  Have managers keep track of The One Thing they have implemented each and every day, as well as within each department. If they are held accountable to maintaining The One Thing, you will unequivocally start to see improvements in all areas of operations. 
Stop always attempting to focus on the grand issue. Many of the most common problems are simple and right in front of you. However, they have been continuously ignored and continue to be key problems in a larger process. The One Thing could be something as simple as "today we are going to get 3 quotes on those restroom locks." It could also be something such as today, our “The One Thing” will be one person being scheduled to clean the walls in one of the restrooms. The One Thing could be today we are going to plant some flowers to enhance our outside entrance.  Or maybe, The One Thing that we are going to do today is have a fresh coat of paint applied to one of the walls in our activity room. 
When you think about it, if you commit to achieving one significant improvement each day, being mindful of "The One Thing," how many things can you find to change and continuously improve your environment — each day — for 365 days each year?  This is an important method for TQI — total quality improvement.  
Thinking about The One Thing makes you focus on change in a manageable and organized way.  It also keeps you sensitized toward looking for something each day to improve, no matter how big or small.  Eventually, all these things add up and they will also pay large dividends.    
Furthermore, if you keep this mindset — "The One Thing" — at the forefront, after a few months you are probably already looking to improve things that have already been improved. You are now building on an already improved foundation to further enhance the superstructure of the organizational environment.  How does that sound! Now you are improving on the improvements instead of having to constantly dig yourself and your business out of holes. Healthcare, as well as any other form of business, is plagued with holes, most of which are self-created. Holes are endemic to the business environment. However, often many these potential sinkholes can be prevented with the proper managerial mindset. Moreover, even though some are endemic, one can prevent them from getting larger and unmanageable. That is the essence of proper management. However, we often become complacent and ignore many of these various obvious problems, and subsequently, we are never in front of an issue, but always behind due to having to dig ourselves out of the holes that we have created. Introduce The One Thing and you now establish a culture of PROACTIVITY, not reactivity. 
It is amazing at how much money, efficiency and overall productivity is lost due to one constantly ignoring the infinitesimal issues that many think because they are small, they can wait. However, a single or a few cancerous isolates, if not addressed or eradicated in some way, can continue to grow and within a very short time one has possibly a disease that is no longer tractable. Although this is a biological scenario, it applies to organizational environments as well that often can be viewed on an organic level.  Frequently in healthcare organizations, whether they are hospital, long-term care environments, or for that matter any form of business environment, many individuals are too dismissive of the small issues that end up festering and becoming intractable and destructive over time. Again, internalize into all your workers The One Thing and this can be overcome.   
Once we have a habitually and culturally established goal that directs us toward incremental improvement, the smaller single daily improvement will lead to a magnitude of change over a few months that will often make you look back and say WOW! However, we often miss out on these WOW factors since they are too often associated with large-scale projects. However, many never are able to address large-scale problems since they become plagued in an environment of complacency, with multiple sink holes developing and that we have to constantly dig ourselves out of or fill.  An attitude of The One Thing will help to prevent such a scenario from transpiring.        

As I have already briefly mentioned, managers get sidetracked by attempting to take on monumental projects that have high levels of complexity.  At times this is quite necessary.  However, what tends to happen is that many managers get bogged down attempting to figure out how they should get started with a complex, multifaceted project. Furthermore, many managers mistakenly assume that important quality enhancements have to always be large-scale. Yet, they often overlook that often more important is the small, incremental issues that we can target each day. They often are influenced by what I refer to as the “project grandiosity delusion,” where the bigger project is viewed as the important project and they minimize the smaller steps that need to be developed before one can move to that level. It is typically these small, incremental issues, which often are not targeted, exacerbate and become large and expensive problems which, if they would have been addressed on a smaller-scale, would never had reached the magnitude that they are now at on the problem management level. Often these simple issues, following Garavaglia ‘s The One Thing rule, targeting something as straightforward as addressing a daily preventative maintenance issue, can save your healthcare facility large amounts of money. In an era in which healthcare funding and reimbursement is so crucial, attempting to save money for resident care and capital improvements is essential. As mentioned, this simple rule is important in all areas of management, not just healthcare. Managing even one’s car, and providing regular preventative intervention such as oil changes, often adds years to your car use and saves on mechanical expenses.
However, what I fear is that the admonition of following The One Thing will not be taken seriously. Why?  It is too simple.  Most individuals look at simple things and say something like, “it can’t be that simple,” leading often to sound advice being disregarded. Again, the delusion of project grandiosity is playing an important, albeit misleading role. However, often simple things, if followed, are very beneficial. It can’t be that simple that walking 30 minutes to one hour each day is healthy. Therefore people disregard it and opt for cardiovascular disease, medication and surgery. It can’t be that simple that getting regular oil changes increases the car’s life, so we opt to disregard this advice and spend money on cars before we need them. It can’t be that simple that putting a small amount of your income away each paycheck will lead to a very formidable nest egg in retirement.  So we become dependent on our hopes and aspirations for Social Security’s survival. It can’t be that simple that regularly checking the fitting around our pipes will do any good. So we end up having water leaks and large amounts of monetary resources being diverted to fixing issues related to water damage.   
Garavaglia’s The One Thing is not a panacea.  Nor will it forestall every expensive issue. There are some things, regardless of how vigilant one is, that will still break, will still need repair and will still incur large expenses. There are some healthcare issues, again, no matter how vigilant one is in their care, will still have unexpected complications and will experience negative results. However, giving heed to The One Thing will often provide a culture of continuous improvement in the quality of one’s healthcare facility and the organizational environment of the institutions.  
posted by Brian Garavaglia


I love the simplicity of the concept.  An added benefit of this concept is the idea that  a little reflective practice on the "one thing" should assist to keep us motivated every day knowing we are achieving something of value.   This often gets lost in the busyness and sometimes chaos that exists in our workplaces and sometimes spirals people into a negative mindset.  

Carolyn, Spectrum care Solutions June 11, 2015 9:35 PM

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About this Blog

    Brian Garavaglia, PhD
    Occupation: Long-term care administrator
    Setting: Sterling Heights, Mich.
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