The Deceptive Nature of Excellence
One of the most profound insights I've encountered comes from James Clear's work on Atomic Habits: "You don't rise to the level of your goals or expectations. You fall to the level of your systems." This principle resonates deeply in our surgical practices, where consistency matters more than occasional brilliance.
Consider a common scenario in our practices: managing the pre-operative clearance process. When this system works well, it runs smoothly in the background. When it falters, we find ourselves making last-minute calls, rescheduling surgeries, and creating cascading disruptions that affect multiple patients. In those moments of system breakdown, we don't rise to our aspirations of efficiency – we fall to the level of our poorest processes.
The truth is both challenging and liberating: you get the lowest level of performance you're willing to tolerate. Excellence doesn't come from demanding perfection—it comes from systematically eliminating obstacles that prevent consistent quality. By raising the bar on your lowest performance, you achieve more predictable success.
Excellence Through System Design
As management consultant W. Edwards Deming wisely observed, "Every system is perfectly designed to get the results it gets." When we encounter persistent problems in our practices, we must look beyond individual effort to the underlying system design. Are we achieving the outcomes we want? If not, the system is working exactly as designed - just not designed for the results we desire.
The Paradox of Poor SystemsThe Paradox of Poor Systems
One of the most counterintuitive truths about suboptimal systems is that it often takes more effort to sustain a bad system than to create a good one. We become so accustomed to the daily workarounds, the firefighting, and the exceptions that we don't recognize how much energy they consume.
Consider the practice that manually tracks implant inventory across multiple spreadsheets, requiring double-entry and regular physical counts. The workarounds become so routine that we forget to question whether the entire approach needs redesign rather than more diligent execution.
This is why "trying harder" is rarely a viable solution to systemic problems. Teams often say that they could not imagine doing “more.” No amount of effort can overcome a fundamentally flawed process. The real solution lies in reconceiving the system itself.
Breaking Through Inertia: The Path to System Improvement
Many of us recognize the need for system improvement, but find ourselves stuck. This stagnation typically stems from four key barriers.
- Inertia - the gravitational pull of 'we've always done it this way'
- Decision Paralysis - the overwhelming possibilities of where to start
- Politics - The complex web of team interests and concerns
- Firefighting - The tyranny of the urgent crowding out the important
These forces aren't imaginary - they're real constraints that keep us locked in suboptimal patterns. The question becomes: how do we break through?
Start Small: The Power of Minimum Viable Improvement
Drawing inspiration from the concept of a "minimum viable product," I propose focusing on a "minimum viable improvement" – the smallest meaningful change that creates measurable results and builds momentum.
This approach counters our natural tendency to pursue comprehensive, perfect solutions or enact drastic changes. Instead, it embraces the power of starting small, gathering feedback, and iterating rapidly.
The lesson is clear: you can't change everything, but you can change something. Excellence emerges not from grand transformations but from the cumulative impact of focused, iterative improvements.
The Kaizen Approach: Continuous Improvement
The Japanese concept of Kaizen – continuous improvement through small, incremental changes – provides a powerful framework for excellence in our practices. Rather than seeking dramatic breakthroughs, Kaizen focuses on making things marginally better each day.
In practical terms, this might mean:
- Daily Huddles – Brief team meetings to identify one small improvement opportunity
- Process Mapping – Visually documenting key workflows to identify inefficiencies
- PDCA Cycles – Plan-Do-Check-Act cycles for rapid experimentation
- Standardization – Capturing improvements in updated protocols and training
You might recognize this approach as it is the building blocks of our current operating system. These simple practices create a culture where excellence isn't a distant goal but a daily practice. The cumulative effect of these small improvements – what I call "compound excellence" – creates remarkable results over time.
The Courage to Dismantle Legacy Problems Many of the most glaring problems in our practices are actually the legacy of past solutions, improvisations, and workarounds. What once solved an immediate problem has calcified into a permanent constraint.
Recognizing this pattern requires courage – the willingness to question processes that have become so embedded in our operations that they seem immutable. It means acknowledging that what served us well in the past may be precisely what limits us now.
Building Your Excellence System: OMS360 Tools
As your partner in practice excellence, OMS360 has developed several resources to support your system improvement journey:
- 360 Evolve Events – Structured practice optimization sessions focused on specific operational areas
- Process Mapping – Simple tracking for visualizing and improving key practice workflows
- Peer Best Practice Sharing – Documented case studies of successful system improvements across our partner practices
- Management Coaching – Direct support for your improvement initiatives
These resources aren't just about delivering solutions – they're about building your practice's capability to continuously improve systems. Excellence isn't something we achieve once; it's a capability we develop through consistent attention to our systems.
Your Next Action Step
Excellence through systems thinking begins with a simple question: "What small improvement could we make this month that would significantly enhance our patients' experience?"
I challenge each of you to identify one system in your practice that consistently creates frustration – for you, your team, or your patients. Rather than accepting it as an unchangeable reality, approach it as a design challenge. What small, focused improvements could you make?
Share your experience with your peers. Your insights might be precisely what another practice needs to overcome a similar challenge.
Remember, excellence isn't about perfection – it's about creating systems that make the right things easier and the wrong things harder. It's about building processes that naturally guide us toward our best work rather than requiring heroic effort to overcome systemic obstacles.
As you move forward on this journey, I'd love to hear your stories of system improvements – both successes and instructive failures. These collective insights strengthen our entire community and bring us closer to our shared vision of excellence.
Your partner in excellence,
Josh Everts, DDS, MD
Chief Clinical Officer, OMS360