Fuller’s model is helpful to the completion of a successful project because it provides the necessary framework to thoughtfully proceed through each process. This model provides a very succinct method that seems to be very easy to understand and visualize. Fuller begins with the right leadership which is extremely important because the role of the executive leadership is to direct the corporation and provide the authority and credibility needed for a change to be successful. Shared vision is the responsibility of leadership to translate the innovations and possibilities of the future state and enlist the support and buy-in of the participants; an easy analogy is to picture a row boat, perhaps a really big one and you are fortunate enough to have a leader that can see ahead and can elicit the rowers to row in one direction because they believe they will arrive at a worthy destination. The culture describes in a day to day way how an organization or group within an organization think, feel and act. If a given organization is overly authoritarian there becomes the possibility of the Abilene Paradox. Governance sets the structure of authority, communication, and process. Steve Spear and Kent Bowen in the 1999 Harvard Business Review article ‘Decoding the DNA of the Toyota Production System’ articulated the basics of the Toyota system and came up with four rules:
1. RULE #1: All work must be specified according to content, sequence, timing and outcome.
2. RULE #2: Explains how the people involved in a work process should connect with one another. Simply put, Rule #2 states that every connection in the process must be direct (yes/no responses)
3. RULE #3: This rule specifies that every service process must flow along a simple, specified path.
4. RULE #4: Stipulates that process improvement must be done based on the scientific method, under the guidance of a coach and by those doing the work closest to the problem. This implies that ‘frontline’ workers are empowered (and expected) to make improvements to their own jobs. Their supervisors are responsible to provide both direction and assistance to this effort as coaches. (Krebs, 2008)
When you think of governance, many will think who is the boss and how do I delegate. Spear’s Four Laws serve to empower the process improvement and serve to strengthen shared vision through active engagement and ownership. Physicians, nurses and key stakeholders are engaged early and accountable to lead the clinical transformation which is essentially the byproduct of the Spears. Consider that clinical people will be most using the proposed system so it would make the most sense that they steward the process and help define the work. Resources speak to