I’m writing this blog whilst waiting for my daughter to graduate with her next Tang Soo Do red belt stripe. I think she will then have about 3-4 more stripes, before she can try to attain her dark blue belt. This is the first pinnacle, the first master belt: 1st Dan. Amongst other things, quite impressively, you have to break a brick with your bare hands to pass. From my parental perspective, it will be quite an achievement and I, naturally will be very proud.
It has been a long road. She started Tang Soo Do roughly the same time as I started my thesis, 5 years ago, and that at the time felt like forever to me. Then, as now, Tang Soo Do graduation is dominated visually by white, yellow and orange belts, (especially in the car park!) These are the colours of new enthusiastic learner belts maybe 3-6 months in. There are noticeably fewer green, red and dark blue belts, representing higher levels of accreditation. These later levels, like in computer games, take more effort, time, persistence and practice to complete, and perhaps provide fewer adrenalin shots of euphoria to keep you motivated each time, as levelling up becomes less frequent.
It is a lot of time, money, attention, persistence and most importantly, practice to reach real competence in a new skill. Practicing the same moves, routines and forms, over and over and over again. In fact, the practice can be so repetitive, my son, once the most enthusiastic Tang Soo Do attender, as it was so exciting to learn to fight, now refuses to go because it is ‘too boring’… (and Fortnite practice instead calls too much).
I reflect on this because over the last year, I feel that I have really noticed a growth in dialogue in the improvement community about the importance of habits and regular and repeated practice to really ‘get improvement’. To learn the tacit knowledge and mastery over time, that sometimes seems so difficult to grasp.
You may have read some of my blogs about Toyota Kata, a practice which emphasise repeated short bursts of daily practice in improvement experiments and leadership coaching, whilst following, at least at first very prescribed routines. These ‘Starter Kata’ routines are recommended to be followed rigorously for at least 3-6 months through daily practice before any substantive localisation and adaptation. They are also recommended to be learnt through practice, rather than through the classroom.
This approach is in part is aimed at un-learning previous (perhaps bad) habits and to create new neural networks and new habits. The process mimics that of learning a new musical instrument with 30 mins practice a day, and so you might be able to get to Grade 1 within a year or so. It is hard to stick to. Persistence is important here, not just intent, as knowledge of Toyota Kata is most definitely not understanding. Daily work, crises, extra meetings, and many other things (arguably excuses) can all get in the way of daily kata practice. This daily improvement practice too can lose its shine of newness and move into something a little less exciting as it becomes more routine, which is ironically its aim.
Similarly the 6 Sigma (and Lean 6 sigma) approach to improvement uses a karate-like ‘belt’ accreditation system, with white, yellow, green, black and master black belts. 6-12 months to green belt (classroom & a ~six month project with results), with the time taken to reach master black belt being several years. So, I get to my point. Notice the kind of timeline we are talking about here… grade 1 within a year. 6 months to a year for green belt, at least 6 months to practice Starter Kata. These are not short time lines to become reasonably proficient, never mind an expert.
Yet, as noted in recent research often healthcare leaders and teachers have sometimes assumed that improvement knowledge and skills can be: a) predominantly taught in a classroom (or virtual classroom); b) can be taught quickly, say a couple of days worth of content; and c) participants will be able to apply and contextualise this learning with pretty much immediate effect and show results quickly. For me these widespread assumptions are An oversimplification of improvement practice. After, many leaders seem to be disappointed to discover that many learners do not the use their new learning, question its appropriateness and content and, with some exceptions, results don’t often follow. Participants often reflect that ‘it wasn’t as easy we thought‘.
This, for me anyway, suggests that ongoing support, on the job learning and ongoing learning in practice with coaching, apprentice style, is needed if we really want to develop organisational wide improvement capability and learning cultures within health and care. Much like in places lauded like Toyota, and increasingly within healthcare organisations such as Intermountain.
To improve something both as complex and important as health and care, we need to ensure not just the teaching of improvement, but also the ongoing practice in the application of improvement approaches to develop our equivalent of black belts and Grade 8 improvers – mastery. Not just lots of Grade 1s and 2s, white belts and yellow belts, learning a little bit, as important as they are for everyone to participate in improvement and to develop a next generation.
We need this wider recognition of the need for this practice of improvement approaches, if we are really to embed improvement practice and mastery within health and care. Even if practicing is less exciting, more mundane and less new over time and as my son would say, ‘practice is boring’.
But then again, my daughter says, ‘it might be boring, but practice is worth it’.