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Perfection in healthcare – why not?

15 May 2017

Perfection in healthcare – why not?

The printed notice was taped to the cistern in a prominent position. It said: 'For your safety be aware that the toilet seat may be a little loose'. Indeed, it was and the tap on the washbasin was loose too – although it didn't apparently warrant a safety warning. I was in a healthcare establishment and several thoughts occurred. The building was new as were, presumably, the fittings. The notice appeared to have been there a while. To me, this suggested a design fault with the loo seat. It seems we (actually, they) can put a man on the moon but not design a toilet seat that won't work loose. Maybe it was an installation error – screws not tightened sufficiently. If so, how did it pass the quality check or maybe there wasn't one? Perhaps it was a maintenance issue – toilet seat fixings needing regular checking for some reason. Again, if they can put a man on the moon why can't toilet seat fixings be made not to come loose or at least the maintenance periods be designated to occur before they come loose?

Lifting the lid

I have to assume this was not the only toilet seat of this design in the building or other similar buildings across the country. Are they all inclined to be a little loose? If so, why were they purchased in the first place? Were they not tested and the manufacturer's quality certifications not inspected? Maybe it was a cost issue. Hang on, how much more expensive can toilets with seats that don't come loose really cost? More than the cost of the paper, ink, tape and time involved in generating and affixing the notice (or many notices)? How many people were involved in the process? How long did it take to agree the wording of the notice? Did it require an executive decision? How is the cleaning of the cistern(s) affected by the affixation of the notice(s)?

Chain reaction

The toilet was designed for use by people with disabilities and situated in an area used to treat people with eyesight problems. Can we be sure a person in, say, a wheelchair would transfer to the toilet seat in such a way that they would see the notice? Would someone with poor sight manage to read it?

And what would happen if the loose seat caused someone to have an accident despite them exercising care after reading the notice? At the least it could be embarrassing. It might also involve actual injury.

Perfectly possible

Okay, I know I've banged on about this and you may be questioning my motivation (or sanity). As a change management consultant working primarily in healthcare, I'm often challenged when I raise the topic of pursuing perfection. Doubters suggest such a level of excellence is not achievable. They are wrong. The Pursuing Perfection initiative in the US, with technical assistance from the Institute for Healthcare Improvement (IHI), found that: '…dramatic improvement in health care organizations is achievable, but it requires more than simply expanding current, even excellent, improvement initiatives.' Read more here:

For examples of the successful pursuit of perfection in the NHS go to:

In summary, some of the key points from these case studies were:

  • involve and engage patients in the design of care
  • allow staff to use their initiative
  • segmenting patients into groups according to the severity of their condition and their ability and motivation to manage it themselves enabled resources to be targeted more effectively
  • break down barriers among providers
  • be truly innovative in the pursuit of perfection

And what has this to do with the loose toilet seat? Years ago, I read a quote from the CEO of an American airline. It went something like this: 'If we don't clean the food trays properly, passengers think we also fall down on our maintenance program'.

About the author

Amanda Atkin is a change management consultant focusing on the healthcare sector in which she has considerable expertise and experience. Amanda's skills range across contractual management, performance management, operational delivery and leadership development to strategic planning as well as governance and regulatory compliance.



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