Could healthcare take a lesson from the rock band Van Halen? Atul Gawande, author of The Checklist Manifesto, describes a simple management tool that Van Halen used to quickly gauge process quality and compliance at their concert venues. By demanding M&M’s with all brown ones removed or face cancellation of the show with full compensation to the band. Evidently, they followed through on the threat once in Colorado after finding brown M&M’s:
“This turned out to be, however, not another example of the insane demands of power-mad celebrities but of an ingenious ruse. As Roth explained in his memoir, Crazy From the Heat, ‘Van Halen was the first band to take huge productions into tertiary, third-level markets. We’d pull up with nine 18-wheeler trucks, full of gear, where the standard was three trucks, max. And there were many, many technical errors—whether it was the girders couldn’t support the weight, or the flooring would sink in, or the doors weren’t big enough to move the gear through. The contract rider read like a version of the Chinese Yellow Pages because there was so much equipment, and so many human beings to make it function.’
So just as a little test, buried somewhere in the middle of the rider, would be Article 126, the no-brown-M&M’s clause. ‘When I would walk backstage, if I saw a brown M&M in that bowl,’ he wrote, ‘well, we’d line-check the entire production. Guaranteed you’d run into a problem.’ The mistakes could be life-threatening, the radio story pointed out. In Colorado, the band found that the local promoters had failed to read the weight requirements and that the staging would have fallen through the arena floor.”
The little things are the best indicator of the bigger ones…
Brown M&M’s in healthcare
Healthcare is also a very complex ‘show’ to pull of successfully time after time. There are many details to be carried out flawlessly or safety is compromised. What’s even tougher on care professionals, reform legislation makes facilities pay for their mistakes, such as patients getting other illnesses and injuries while under care, and preventable readmissions.
Healthcare has an opportunity to take the Van Halen approach. There are events and non-events to correlate and spot problems before they reach crisis stage. Project RED is a great example of specific ways to reduce readmissions by paying attention to the seemingly small details.
This evidence based approach, used by over 250 hospitals, identified 11 key components common in low readmissions discharge processes. It is great to know the factors, but how many facilities have the capacity to manage those points with each and every patient? I would be willing to bet that a facility that can’t manage an 11-point program could be in danger of a host of other challenges.
Transparency
The only approach that makes sense is to be systematic and to manage ‘brown M&M’s’ to the task level for each role in patient care. There needs to be two-way transparency that allows every patient-facing role to know when and why they play an important part, and to be able to see the guidelines and know when and where each component ‘lives’ in the patient journey.
It isn’t difficult to have this level of transparency, but it takes commitment from the healthcare organization to make it detailed and meaningful. As reform plays out, everything will depend on it.
The nine operating models they’ve developed allow for specialization within reasonable boundaries of standardization. Each model has specified ownership that allows for best practices to be ‘built in’, like the way to create a rapid prototype that allows for speed but still aligns with corporate structures like Global Supply Chain for contracting compliance purposes. This capability means that all 134,000 people in the enterprise can have the same understanding of things that should be standard while having the flexibility to be exceptionally good at specialized ways of doing business…the best of both worlds. This kind of flexibility is remarkable in a company this size.
Just this week, 
From my own experience in working with them for the past couple of years, Northrop Grumman has a remarkable level of maturity when it comes to frameworks and process through their adaptation of an APQC-like hierarchy that they call, simply, the Process Architecture. It allows this very large enterprise (over 130,000 employees) to find the common ground for their global supply chain, for example, while enabling fast-moving, innovative work such as the 
Closer to our workplace, cynicism has a numbing effect toward work and success. General Patton is often quoted for saying, “Watch what people are cynical about, and one can often discover what they lack.” He may have been talking about Army soldiers, but he understood that cynicism anywhere comes from an unfulfilled need. People want to feel that the standards they are meeting are genuine and tangible in their everyday work. The places where standards and activities are aligned and managed are the ones that have high energy levels and are consistently known as the best places to work. It’s where I want to work.
