Accuracy – Deliver What You Aim For

Hit your customer’s expectations, he will love you.  Miss them, and you have a LOT of work to do to make that up.

Let’s say you go to the emergency room. Let’s figure out how accurate the staff needs to be in the top that in order for you to feel like they have done a good job. Let’s use a baseline of 90%.  90% is great for a lot of things. If you shoot if you make free throws added 90% rate that is phenomenal. If you have your kids ready for the bus in plenty of time on 90% of school days, there is not a word that enough to describe that. If you get 890 percent on a test, that is generally an A.

A 90% rate of getting the diagnosis and treatment correct is an arbitrary number and probably lower than any emergency room out there.  I have worked with these people and they are good at what they do. And the other 10% just means something went wrong, not anything major.

Let’s look at the steps of the visit to the emergency room. First you register and describe your problem. Then you talk to the triage nurse, who gets more detail on the issue. Then you are assigned to a bed or room. Another nurse comes in and gives you a more detailed examination. Then a doctor examines you.  You might have blood drawn or have an x-ray taken.  Your problem is diagnosed and treated. At the end, you get some instructions, either written or verbal, and you get discharged. At some point in the future you get a bill, but we won’t focus on that today.

Now, we have posited that the 90% success rate for your emergency room visits is good. How about 90% success rate in each of the steps?

  • Let’s say the registrar gets some piece of information wrong,. No big deal, you can always fix it later.
  • The triage nurse evaluates you and puts you in the wrong place in the queue to be treated. Again, usually not a big deal.
  • The bed that your to be assigned to is not ready.
  • The nurse does not adequately prepare you to talk to the doctor.
  • The Dr. misdiagnoses your issue.
  • There is some kind of printer error or problem with the discharge instructions.

But as long as any of these mistakes happen only 10% of the time, that is still OK, right?  This is where the math comes in. If there are six steps in this process and the probability of success at each step is 90%, then the probability that you will get through this visit and everything goes right is only 53% (.9 x. .9 x. 9 x .9 x .9 x .9).  That is the magic, or the curse, of compounding.  Increase the success rate of each step to  95% or 19 out of 20. The odds of you having a completely good experience in emergency room are still only 74%.  To get to 90% each person who you deal with has to be right almost 99% percent of the time.

This is a very simple example and it shows how insidious small numbers of errors in multiple steps in a process can add up to make a very inefficient process. In real life, there is usually one step that is the worst offender  or causes the worst problems.  Finding and fixing that step will get you a long way to a more efficient process.


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