The dangers of pursuing the “silver bullet”

Occasionally we update and repost a favorite commentary from the past. This post originally appeared in 2012.
In her remarks at the ninth annual World Congress on Health Care, Shari M. Ling, MD, deputy chief medical officer of the Centers for Medicare and Medicaid Services wisely pointed out that there is “no silver bullet” to achieve better value. Dr. Ling emphasized, “When we start to talk about value, that discussion is really formulated on the foundation of quality.”
Given the daunting challenges and demands health care leadership teams face to increase quality while reducing costs, it is easy to see why looking for the “silver bullet” is so tempting. I still get asked by some accomplished, experienced health care leaders, “Isn’t there something simple we can do that will cause our scores to go up?” I see the disheartened look on their faces when I have to reply, “Not if you want real improvement in quality that’s sustainable over time.”
The real danger in pursing silver bullets goes well beyond just implementing simple solutions that produce disappointing, unsustainable results. Organizations that have a culture of only looking for quick, easy solutions undermine the very practices and competencies essential to making real progress in value-creation.
Think about it this way: any object in the path of a bullet is harmed. Sometimes the damage is reparable; often it is not.  When we rely on silver bullets to solve our most important, complex issues in care process improvement and patient experience, we may be damaging — even killing — the very aspects of our culture that we need most to succeed in the future. Following are several primary examples.
Silver bullets kill continuous improvement   The concept of “continual improvement” pioneered by Edward Deming has been embraced by successful companies across industries – including healthcare — as essential to long-term success and achieving higher quality. In silver bullet-dependent organizations, staff and managers stop looking for improvements because they want to believe that they’ve found the “right” answer in a single solution. The idea of an ideal, permanent, silver bullet answer to any question is anathema in cultures that embrace the idea of continuous improvement.
Silver bullets kill innovation and critical thinking   Frontline managers and staff have the critical insights and understanding of core processes that are essential to improving care and making it more efficient. Within organizations that rely on silver bullets to solve problems, staff often simply wait for management to deliver the next solution. This type of culture not only undervalues and under-leverages the potential contributions frontline staff can make to improvement; it also places a tremendous burden on senior leadership to come up with all of the solutions to the organization’s challenges.
Silver bullets stymie effective implementation   Organizations that tend to seek out simple, silver bullet solutions also tend to overly simplify implementation. Poorly implemented hourly rounding initiatives at some hospitals are prime examples demonstrating this weakness.  The idea of checking on patients more regularly to assess their needs and answer questions is a solid way to improve “care responsiveness” as measured in the H-CAHPS survey. Unfortunately, I’ve seen too many organizations simply put a compliance checklist on the wall and tell nurses, “You now have to document that you’re in each patient’s room every hour to check on the four Ps” as their implementation strategy. Conversely, hospitals that achieve the best results in hourly rounding involve staff up-front in understanding the real issue, structuring the new approach, making the improved strategy work across the team, and – perhaps most importantly – in finding ways to make the practice more successful and efficient over time.
While a simple, easy-to-implement answer may seem appealing in the short-term, the long-term impact of silver-bullet thinking in organizations can be debilitating to sustainable improvement efforts. In order to be successful in the new value driven world of healthcare, organizations must invest in developing cultures of continual improvement and collaborative problem-solving to achieve sustainable gains in quality and value over the long haul.