This week, we sat down with David Dibble, creator of the 3D Problem-Solving model which works to transform systems within organizations to improve productivity, safety, and quality of care while reducing burnout, staff shortages, and costs. Come along with us as we learn more about 3D Problem-Solving in this episode of the Caring Support Podcast!
I'm just a guy out there trying to change the world, in this particular case, trying to change the world of health care. We've developed a program that people can introduce primarily with staff to change the systems in which we deliver care, and in so doing reduce burnout rates and staff shortages and increase the quality of care and safety. All those things that, I think, health care has really been looking for recently. So that's sort of me in a nutshell.
It's a bit of a long story, which I'll try to keep somewhat brief. I got out of college and started a company with about $5,000 in the back of an old warehouse. Over time, we built it into about a $10 million business. I had 100 or so employees and I was still relatively young, and I guess you'd say relatively successful. I thought once you have all the stuff, you're supposed to be happy, and I was somewhat dismayed to find out that I wasn't. So, I started looking into some of those bigger questions in life like: who are we and why are we here and what's the purpose of life and those sorts of things. That got me introduced to a guy named W. Edwards Deming. He's probably the number one quality guru in history. He's credited with turning Japan around after World War Two, and he taught Toyota how to do it. I looked at implementing his teachings in my own company, and it took the company from being a good company to being a great company. Then that got me on this whole path to systems-based quality where eventually I got pulled to health care and that brings us to today.
Well, going back to the work with Deming and Prigogine, there was another really amazing individual that I ran into around this time. This is a little bit later, but his name was Don Miguel Ruiz, and he wrote a book called The Four Agreements, which became an international bestseller. I think he’s probably sold 5 million copies by now. I was very fortunate to work with him for about eight years, and he was working in personal transformation. I learned a ton about personal transformation that could also be integrated into this new model, which we ended up calling 3D Problem-Solving. Then it was kind of a mash-up of Don Miguel's work, Prigogine’s work, and Deming's work, which all together became 3D Problem-Solving. The big thing with 3D Problem Solving is we can implement it and sustain it in health care. All these other systems change processes and models, things like Lean and Six Sigma and Lean Sigma and even Toyota. None of them can be sustained in health care and 3D Problem Solving can. So, we get the benefits of a systems-based approach to problem-solving, but also critically importantly, we can sustain it after we implement it. So, I think that's the big differentiator between 3D Problem Solving and some of these other programs that have been out there.
Well, there are a couple of things that are integral to making it so we can implement it in health care. One of them is that it uses a pull strategy rather than a push strategy. You'll see that all these other change programs support, they’re top down. So, someone up in the C-suite says, ‘Oh my gosh, the next shiny object is coming down the road, and we need to do this’. Then it's pushed down through the organization and sort of dumped in the laps of staff and they’re told to do this. We know what happens when you push people, you tend to get pushback. One of the things that we did early on when putting the model together was making sure we were using a pull strategy. We take it to staff, and we say, ‘Hey, it's 100% voluntary. Only people who want to do it can do it.’ We never push anybody. Nobody's ever ordered to do anything. It's all voluntary, it's people who really want to make a difference in health care, who are drawn to it, and they basically come in and they become a part of the process because they want to. Early on, they find it's fun, it's inspiring, and we actually can create the systems change that everybody is really looking for and they get to experience success. The program then grows organically just through word of mouth where successes are spread into other departments.
We have an outcomes report for large and small hospitals. It's a thick document, but there are a few stories that are just remarkable today. I'll share one with you.
I had been on a call with the CEO and with a couple members of the board and they had a couple of members of the C-suite. I'll never forget this, their CEO, John, asked me: “well, how much work have you done in health care?” I said, “None.” He said, “Well, what do you know about health care?” I said, “Well, really, nothing, except I know it's really goofed up. And there's probably a lot of good work that could be done in there if we could fix the systems.” He said, “This might be the worst sales pitch I've ever heard.” I said, “Well, I know, John, but look, systems are systems. It doesn't matter whether it’s health care or anywhere else. I really do know about systems improvement. It might even be a good thing that I don't know anything about health care because I don't have any preconceived notions about it.”
He ended up taking a flier on me, but one of the first things that always happens when you're doing consulting work in health care is they always want to give you their worst problems. One of their worst problems was a wellness centre, that was kind of the stepchild for the hospital. It was a couple of miles away from the main hospital and it had been one of their worst departments for probably close to a decade. The year before, out of 272 similar facilities nationwide, they had been ranked number two seven two by Press Ganey in customer satisfaction or patient satisfaction. Do you know how hard it is to be last out of 272? I mean, it's almost impossible, but they did it.
They sent me down to work with the director down there and try and straighten this place out. I was talking to the director, and I said, “Look, I have no doubt we can straighten this place out. The opportunity for you is not really in straightening the place out. If you want to, I'll train you in 3D Problem Solving and you will become an excellent leader and manager and problem solver. Then, you can move up in the organization if you want to.” So, he said, Yeah, you'd like to do that. He was an incredible student who later became the CEO of the hospital. The long and the short of the wellness centre story is that in a little less than one year, they moved from number 272, dead last, to the 96 percentiles with Press Ganey in patient satisfaction in one year and it's remarkable.
We just went in and did the systems work. People don't really understand that everything in health care is systems and subsystems all the way from the C-suite to the person sweeping the floors at night. 94% of the outcomes that we get good and bad are a function of those systems and subsystems. When we look at turnover rates for nurses, those turnover rates, good or bad, are a function of these systems which are invisible to the people that work in them. They don't even know they exist. Sadly, most of them think they do, which of course they don't, because no one can know what the systems look like unless you make them visible. The only way you can make them visible is to take the people that work in the system and pull that information out of them and put it up on the wall, where you can see it, and that's what 3D Problem Solving does. It takes that information from the people that actually work in the systems, and we get it up where we can see it, and then we condense it down into the critical 20% of the systems that are producing 80% of the problems we want to solve.
Going back for a minute to nurse turnover, the vast majority of turnover, whether it's health care or any other workplace, are for two primary reasons. One is bad management and bad supervision. The interesting thing about bad management and bad supervision, most of that is caused by bad systems. Managers are bad managers when they're working in bad systems. The second one is in bad recruitment and retention systems, including bad care delivery systems. When those systems are bad, you're not going to feel good working there and you're not going to be successful. What is that going to do? It’s going to drive you out of that job, just like it's doing in health care in general right now.
We went in and we were working in fixing systems in nursing. Suddenly people are getting happier because they're providing better care, they're feeling better about their jobs and that sort of thing. At the same time, I was working with the CNO on their retention systems for their nurses and in their recruitment system. We fixed those and improved those and the next thing you know, we were getting, 66% more recruits, and new recruits coming from the nursing school in the community. They had a 27% rate of turnover in their nurses, but now the nurses are becoming happier and they're recruiting better, then the rates start to go down. Over three years, it went from 27% to under 5%. This hospital was competing against larger hospitals that could pay bigger bonuses and that sort of thing. It turns out that if we fix the systems, those things don't matter nearly as much.
Health care is very much attuned to evidence-based processes, evidence-based care, that sort of thing. They also are very much attuned to peer-reviewed evidence-based information, particularly new information. The idea that these two peer-reviewed papers coming out of a really good academic health care system, going to major journals, I think will open up mainstream health care both in the U.S. and internationally to 3D Problem-Solving.
One of the papers is going to be how UAB used 3D Problem-Solving for looking at the wellness of staff and improving turnover rates and burnout rates. The second one is on how they used it to improve quality of care and safety. If there are any bigger issues in health care right now, I really don't know what they are.
Probably the best way is you can go to our website. It's TheNewAgreements.com. Also, you can go to DavidDibble.com and there's all kinds of information on there both on 3D Problem Solving and also you can contact me through the website. I'm also available at David@DavidDibble.com and then I am very active on LinkedIn.
I seem to be very fortunate in creating kind of a tribe of kindred spirits working in health care who really do want to make a difference in health care. We've got some graduates out of our 3D Problem-Solving facilitator certification program, which my hope is we can scale that program into health care in a way where we really can turn health care around and start solving some of these problems, particularly coming out of the pandemic.
I would like to say that I believe that we are entering interesting times. Being a bit of an expert on both systems-based improvement, based on Deming and the law of dissipated structures, and based on Prigogine’s work, those principles are hard at work in health care. They're invisible. People don't know about them. I think we're coming up on a time where we're going to have to start making some difficult choices, new choices to go different directions in health care, particularly at the leadership and management level, because everything that has been going on in health care over the last 30 years plus have been taking us down essentially the wrong road. That wrong road has stressed the systems to the point of breaking. And we're already seeing what Prigogine calls reorder. That's the breakdown of these systems that unless we get in there and repair these systems, which can only be done by staff, particularly at the care delivery level, these systems are going to come apart and they're going to take staff and patients down with them. We're at this critical juncture where we're either going to be proactive in making these changes, which are going to be made one way or the other, because the law of dissipative structures, there's no choice in where that's going to take these things if we do nothing. I think we're reaching a tipping point where we need to get busy doing our real work in the world, which is changing these systems and setting ourselves up and staff and patients for success.
Four years ago, David had a powerful dream that sat him straight up in bed and scared him wide awake. He was told quite clearly that he was to take 3DPS into healthcare and the world in a meaningful way and it would be a catalyst for making a real difference in the world. It’s taken him almost four years to get everything ready to follow the instructions of what he calls Inner Wisdom.
David Dibble is a husband of 50 years, father to three grown children and a grandfather.
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