There are two parts to respect, the respect that happens within an organization—how employees feel about and treat one another. And respect that happens outside of the organization—how employees treat patients, partners, and other members of the communities we live and work in. The Shingo Model focuses on respect as a way of helping individuals achieve their maximum potential. People give their all when they know they are respected. They are respected when they are treated as equal human beings.

Examples

• Hospitals and Clinics annual assessment framework, especially the professional development section.

• The people doing the work, improve the work. 

• Organizational development, like skills coaching.

Our culture does not always value humility. But intellectual humility, on the part of the leader and the employee, is foundational to improvement work. Like Brene Brown says, leadership requires a certain level of vulnerability so that we can discard the preconceived beliefs that prevent us from exploring unlikely solutions. 

Examples

• Leaders who stay engaged throughout the length of the project (not just at the beginning or end).

• Psychological safety—employees don’t expect retribution when they share concerns. 

Perfection may be an impossible goal. However, the pursuit of perfection drives us toward continuous improvement. Seeking perfection is a state of mind that refuses to be limited by the status quo.

Examples

• Seek long-term solutions not temporary fixes.
• Constantly work toward simplifying work.

Medicine is particularly suited to the principle of scientific thinking. Through rigorous experimentation, direct observation, and the reporting of results, medicine and the practice of medicine advance. This applies not only to successful endeavors, but to failures as well. Good scientific thinking learns just as much from the losses as the wins.

Examples

• Follow a structured approach to solving problems.

• Encourage people to learn from their failures. 

The Shingo Model always focuses on processes over people. This can be tricky because our natural instinct is often to blame people when something goes wrong. But even top performers suffer in an environment with confusing or sloppy processes. Bad outcomes can almost always be traced back to faulty processes. 

Examples

• Separate people from processes, like Sarah Sherer does. 

• Make sure you have all the information by nailing down your process.

You know the line about a few bad apples? It is a bit misunderstood. The point is that even one bad apple can ruin the entire barrel. The same holds true for our improvement efforts. An error at the source will contaminate the rest of the process.

Examples

• Organize places of work so potential problems become immediately visible.

• Stop work to fix errors before continuing.

At its core, this principle has two elements. First, only have as many products (procedures, etc.) as the patient demands. Anything outside of that is potentially wasteful to the organization and the patient. Second, ensure you have sufficient resources to deliver the service without interruption. A lack of resources is a source of waste.

Examples

• Avoid creating or having more product or services than are necessary to serve demand.

• Ensure the resources that are needed are available when required.

The improver should focus on their end goal, and not necessarily how to get there. Often we talk about this in terms of vision. If given a clear vision, teams will naturally do what it takes to get there—often in ways that are surprisingly more efficient or innovative than previously thought.

Examples

• Clearly communicate the direction and purpose of the organization to all.

• Set goals that are connected to the organization’s overall goals.

Alignment has become something of a buzzword over the last few years. At its heart, it refers to removing barriers within an organization to ensure the free flow of ideas and decisions across the system. 

Examples

• Eliminate any barrier that prevents the flow of ideas, information, decisions, product, etc.

• Ensure the goals and issues for each day are understood by those who are affected.

Patients are our true north. Every improvement we make should be looked at through the lens of creating value for our patients (giving them a better experience, improving their safety and outcomes, and lowering their costs). 

Examples

• The Patient Design Studio helps employees understand the needs and expectations of our patients.

• We embrace a team of teams improvement framework.