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Continuous improvement through critical reflection

One of the mantras I have adopted in my life is: "there is no such thing as failure, only feedback."

Corollary: Back in my days at a high tech startup, my colleagues and I would regularly try to raise money from venture capitalists. We would come back to the office after making our pitch and employees would ask, "Well, did you get the money?" Our CEO would say, "No, but we learned a lot." So the expression was born in our office: "Learning is what you get what you don't get a check."

I do like to extract maximum learning from failure or feedback or not getting a check or whatever you want to call it. I have evolved a short template for reflecting critically on my performance. After any experience (e.g. giving a talk, putting on a training workshop, writing a grant, etc), I write down my answers to the following questions:

1. Current goals? What was I trying to accomplish? (These are usually carried over from a previous attempt, see last item below.)

2. Achievements? It's important to note and celebrate the ways in which I did accomplish or contribute to my goals. As my daughter's first-grade teacher says: give yourself a pat on the back.

3. Failures? What did not go well or according to plans, hopes, desires?

4. Success factors? What did I or other people say or do, or what was happening in the environment, that contributed to the achievements above?

5. Barriers? What did I or other people say or do, or what was happening in the environment, that contributed to the failures (or inhibited the achievements) listed above?

6. Next goals? What am I going to work on next time? I carry those over to the next performance.

Just as an example, here is my reflection after conducting a workshop that I give periodically on decision making:

Goals? – experiential; shorter (6 hours); same content. Focused only on skills.

Achievements? Individual, realistic practice (e.g. with computers), focused (not distracted by sharing  a computer). Finished on-time. Students were all engaged, even at the end of a long week. Students did arrive at skills they will need (confident).

Failures? Half-trained (not a lot of process training); Not ready to initiate a phone call; Did not present the service delivery lifecycle very well; (in SF Margot took us through the clinic before, recording of Margot initiating a phone call). The context. This was presented week before.

Success Factors? Computers available: kept away until they needed them (no checking emails). Experiential worked (practice, role playing). Undergrads had very fresh perspectives. No model clash.

Barriers? Limited time availability (of medical students – almost sporadic availability).

Goals for next time? Integrate the skills and process training? Immediate follow up and practice? Pipeline of patients waiting to be served? Process training would include scripts, practice calling, etc. Add time and split between two days? Video clip of process (project for student). Course for undergrads (intense), weave in medical students. 

In addition to using this framework to reflect episodically, I use it every week with my team. Each of us responds to those six questions with reference to the week we just completed.

Here are some excerpts of my reflections from last week (redacted for privacy):

LAST TIME GOALS  -  Finalize performance reviews; Film SCOPED promo; Fix budget for Mendocino in CMS Innovation; SSU affiliate agreement; BCT paper – check calculations; SV/O2O/MAP manuscripts; Reimbursements.

ACHIEVEMENTS - Performance reviews; SCOPED promo v1; CMS Innovation grant submitted; BCT paper moving along; PANCAN; Shanti; QL WCRC; IHPS adv bd meetings - leadership summit idea; CERC idea well received. Some progress on SSU.

FAILURES - Did not get to O2O/MAP manuscripts; reimbursements; CS video and marketing materials; 

BARRIERS - Grant collaborator canceled meeting, did not complete draft on time.

SUCCESS FACTORS - Grant collaborator put more resources on project and team rallied to submit a promising proposal.

UPCOMING GOALS - Mtg with John and Jill; SV/O2O/MAP manuscripts; SSU; CHQI Feb privacy mtg; reimbursements; Feedback; BMB syllabus; Promo video to Trina

Each week I share my reflections with my team, and they share theirs with me, and we discuss all the elements. It's a powerful way of going beyond setting/reporting on goals... to reflecting on the dynamics surrounding our productivity.

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