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Improvement Cycle 3 – Taking Action BL015

The third stage in the improvement cycle is taking action. The nature of the actions will of course depend on the improvement area. The following is true of any type of improvement, but more would have to be added for larger or more complex initiatives. 

In selecting improvement actions, here are some criteria that can be applied to prioritize:
  • having the highest proven probability of achieving the desired result
  • proportionate to the nature and degree of the problem
  • well-understood benefits, costs, trade-offs, possible side effects within the detailed understanding of the situation developed in the previous step
  • clearly defined — SMART (specific, measurable, agreed-upon, realistic, time-bound)
  • that everyone understands, accepts, can commit to, and follow through on
  • may have been tried before
  • independent, or dependence well-known — can be done sequentially or in meaningful groups — if we make multiple changes we’ll never know what made the difference
One of the alternatives that should be included in any analysis is the option of doing nothing. Very often, a great deal of cost and effort is expended doing something, when in fact the best use of resources is stopping this particular train, and shifting to another one. Or postponing. Or doing things in sequence rather than simultaneously. These are all considerations of program management and project management, so I will just mention them in passing.
Before implementing you’ll have to consider how you have to update your measurement system for this action. At minimum you will have to add some tracking of whether the action is performed for each relevant time period. If you have to change your measurement system, take time to collect a new baseline for the changed measures. 
Now (finally!) we’re ready to start: perform the action, track when and what we do, and measure performance. [For a more complex situation, a reminder that all of this is wrapped in project management, process improvement, and change management.]
Note the difference between the approach we’ve taken and simply jumping in and trying something based on current knowledge. We’re now armed with structure, knowledge, understanding, and buy-in to take actions, measure results, and learn from our actions.

Example
Let’s apply these to the sleep example. Reminder that I’m not a sleep therapist.

Suppose my research has come up with some possible factors that could affect my sleep (I have gathered a list of over 40 ideas and I’ve chosen a few that are easy to work with):
  • temperature
  • screen time (blue light)
  • sleep medication
  • sleep apnea
  • alcohol
  • exercise
And now I’ll apply the criteria
  • having the highest proven probability of achieving the desired result — this is very hard to judge without better definition of the specific situation. Depending on the severity of the underlying issues and the nature of the sleep problem, any of these could be sufficient to make the difference I have in mind.

    For this example I’m going to consider them as equally probable at the outset.

  • proportionate to the nature and degree of the problem — I defined the problem as being not too severe, so I’ll be willing to try personal interventions before pursuing medical relief.

    I’ll rule out sleep apnea and sleep medication as early actions.

  • well-understood benefits, costs, trade-offs, possible side effects within the detailed understanding of the situation developed in the previous step — adjusting things that affect the temperature, changing my screen time and using a blue light filter, reducing or changing the time of alcohol consumption, and getting more exercise, are all easily understood with just a bit of thinking through. They could have effects on other people, and could take time.

    For this example I’ll suppose I have a consistent morning exercise program so I feel that I’m getting the known benefit of exercise for sleep, and not doing it in the evening when it could be a stimulant. I’m now left with three factors.

  • that everyone understands, accepts, can commit to, and follow through on — for a non-severe personal example, this may be the critical decision factor for early actions: what am I willing to do, what do I feel like doing, what do I believe will make a difference, etc. Nothing wrong with that. When the risks are higher, this criterion can lead us astray, choosing what’s easy instead of what’s necessary, and that’s the reason it’s placed after the previous criteria.

    In this case I’m going to choose what I can follow through on, something that’s easy to try: temperature. I’m not dismissing the other factors, just choosing one to try first. My research has shown that it’s a valid and reasonable thing to try.

  • clearly defined — SMART (specific, measurable, agreed-upon, realistic, time-bound) — this criterion and the previous one are a back-and-forth process: what I can commit to depends on what is defined

    How will I define the action? I think it’s okay in this case to actually do a few different things that affect the temperature because I’m really just interested in whether adjusting temperature will work for me, so that if I’m having trouble sleeping I’ll know that I should look at this factor. If I wanted to be more precise, I could change one temperature factor at a time, but that seems like overkill for this example.

    I’ve already set the time frame at 2 months. My package of actions will be, without getting into the exact details: turning down the heat one degree; keeping a window open at night; switching to a lighter blanket; lighter night clothing; preventing my bedroom from getting hot during the day by using a window shade

  • may have been tried before — people will often say “I’ve tried that” but very rarely would they have made a change in a structured way, and so they may not actually know whether that action was implemented consistently, long enough, or what other factors may have been at play

    Maybe I have the observation that I sleep well in winter when it’s a bit cooler. But it’s also darker, and I have heavier blankets, and my activity levels are different, and…

    So it’s hard to know which one of those things actually made a difference.

  • independent, or dependence well-known — can be done sequentially or in meaningful groups — if we make multiple changes we’ll never know what made the difference.

    I think that I can make the changes to temperature independently of other factors. They shouldn’t change anything else in my long factors list. If changes to temperature were going to affect a sleep partner negatively, for example, the impact of any conflict would mean that the temperature factor wouldn’t be independent.

    I do want to know at the end of my trial whether the change in temperature actually made a difference. If the case were true that there were several changes that I could make as a package, and I was willing to make and continue all of them, then if they worked, I would be “stuck” with continuing all of them, not knowing whether some of them could be eliminated with no effect. I could try experimenting then, of course, or I can just do it now and build up a set of factors that I am confident works consistently and by itself, for me. I’m not going to achieve scientific rigour, but I’ll at least not be flying by the seat of the pants.

The measures I will add to my measurement system are:
  • thermostat heat setting
  • window state — closed, ajar, open wide
  • blankets used
  • clothing worn
  • day shade state — closed, partially or part of the time, open
  • the temperature at bedtime as reported in the same weather app at the same time each night
  • an open-ended notes measure to capture any other impressions, factors or changes that might affect the data. We’ll talk about where we have to be careful in interpretation later.
And I can stick to my idea of capturing daily and reviewing weekly.

This may all feel like overkill for the example I’ve given, but a) if I had more serious sleep problems that were affecting my work, relationships, mental health, etc. or b) I was considering a more complex situation, the same method could be used and its structure and usefulness would be more obvious and necessary.

I personally do sometimes use a scaled down version of this approach for fairly basic issues, and I have had success using essentially what I’ve described to address more significant personal health/lifestyle issues. There are also scaled up versions used for larger organizations and issues. Since our Better Life scope is very broad, you’ll have to decide what the right scale of approach is.
I recommend that you get professional assistance, whether it’s medical, psychological, or other, for anything that is having serious disruptive effects, to complement/supplement personal efforts, to provide access to additional knowledge and resources, to rule out serious problems, and to prevent serious mistakes or errors of judgment. 
Exercise
For your own improvement area:
1. Gather a list of possible actions based on your research in the previous step
2. Review the criteria and make sure you understand them.
3. Are there any criteria you would add to the list? Why?
4. Apply the criteria above to evaluate the actions and to select one action to implement
5. Update your measurement system
6. Implement and track the action and performance using your measurement system
About Learning
Powerful thinking and learning depends on being able to direct and focus attention. Our ability to multi-task is generally poor for tasks that require a lot of brain power. There is an efficiency and effectiveness cost to switching between different activities. Emotional and intellectual work requires getting deep into the feelings and the ideas, and each time we’re distracted we can lose momentum and possibly progress.
It shouldn’t be news that most of our modern activities and entertainment encourage distraction and multi-tasking, where we are drawn into multiple unrelated streams of thought and feeling. We listen to music while we do other things. Social media is based on small bites. Exercise is increasingly packaged into short and changing routines. Television, film, video games, and online entertainment all foster cognitive passivity and rapid switching. Advertising and marketing are pervasive, trying to influence our thoughts and feelings in ways that we are not aware of.
All of this might be fine. And. But. One of my themes is having multiple tools in the toolkit. Can we choose how we are thinking and feeling and responding? If we have practice and skill with different modes, we can actively choose an appropriate way of being for different situations.
So how can we practice less common modes. Mindfulness is a trendy word for doing one thing at a time and being fully aware of what you’re doing. Some of my thoughts for developing attention skills if pursued actively (not as a spectator) for a significant chunk of time without distraction and in near-silence: 
  • Reading longer articles and books
  • Lectures or documentaries
  • Structured creative or non-fiction writing
  • Playing music or creating art
  • Formal study
  • Playing a sport, yoga, martial arts
  • Strategy games
  • Meditation, prayer, contemplation, reflection
  • Nature-based activity: bird-watching, star-gazing

What could you do to build attention?