Getting Rid of Stupid Stuff

In January 2019, the ABIM Foundation launched its Trust Practice Challenge, an initiative to address the “trust gap” in health care by identifying practices that foster trust and trustworthiness in various aspects of the health care system. The Foundation would later launch Building Trust to build on this open call.

In its program “Getting Rid of Stupid Stuff,” Hawai’i Pacific Health (HPH), a not-for-profit health care system of medical centers, clinics, physician and specialty groups and other care providers, invites clinical staff who use its electronic health record system to identify documentation and other practice requirements that should be eliminated, changed or modified. The program named signaled and emphasized that leadership sincerely wanted to engage staff in rooting out items at work that would cause an individual to think “why do I bother?” as they have to completed the task.

Hawai’i Pacific Health asked frontline staff to help identify EHR areas that should be changed, using a nominations process. Nominations are submitted through a dedicated intranet email site, and the inbox is monitored by a small team. Nominations are sorted for either immediate action or evaluation and action by subject area workgroups. The staff member who made the nomination receives a “thank you” acknowledgment, and then a follow-up email about the outcome of the suggestion.

Since the program began in October 2017, more than 350 nominations have been received from clinicians of all types. Nurses and physicians have submitted the bulk of the topics, but pharmacists, therapists and others who use the EHR have participated.

Skills/Competencies:

  •  Critical thinking and analysis
  •  Knowledge of electronic health record system
  •  IT support to identify technical improvements

Proof of Concept:

There has been very positive response to this program across the clinical staff. It was first announced in a Managers and Directors meetings (at each of HPH’s four hospitals, and shared services meeting) by the chief quality officer and endorsed by leadership. There was initially a lot of sheepish laughter about a program called “Getting Rid of Stupid Stuff,” but then enthusiastic support as it was presented. As nominations have come in and been addressed, HPH has received a lot of appreciation for being willing to listen and to make changes.

Several nominations for stupid stuff beyond the EHR documentation topics have been received. Across the organization, there is a recognition that they have changed the way they think about clinical protocols, and are willing to stop and consider current practices. “Our CEO takes every opportunity to encourage us to keep working to identify and eliminate stupid stuff, and almost 18 months after we started it is clearly part of our approach to doing business,” said Melinda Ashton.

The positive reaction to HPH’s Perspective column in the November 8, 2018 issue of NEJM suggests that this approach has trust-building value. HPH has been approached by a number of organizations and heard from CMOs, CIOs and others around the country that there is something unique here. Their willingness to label well-intended, required work as stupid has seemingly struck a nerve.

Replicability/Scalability:

This trust practice is a very simple to implement; no fancy tools are needed. A dedicated email inbox and a few knowledgeable staff can get a program started.

Some important components for success, however, include:

  •  Executive sponsorship and willingness to publicly acknowledge that stupid things may exist in the organization they lead
  •  IT support and participation, even if they don’t lead
  •  Ability to efficiently evaluation nominations from multiple perspectives so that implemented changes are not themselves viewed a stupid
  •  Effective prioritization so that additional work can be scheduled