Bioethics Blogs

Learning to Love Improvement Work: The Key is in the Relationships

By David C. Leach and Paul B. Batalden

Thomas Merton once asked his novices: “What was Adam’s sin?”  He then answered his own question by saying: “It was that he wanted to do good.”  The knowledge obtained from eating the fruit of the tree of the knowledge of good and evil, coupled with the serpent’s seductive approach announcing that now he could be really good and show God his abilities introduced Adam to pride.  Instead of being nurtured by his relationship with God he settled for self-sufficiency and we all know the result…

We also know the litany of flaws in the healthcare system and that many feel compelled to improve the situation.  Like Adam we want to do good. We may have even devoted time to “learning” how to improve, yet the results are mixed at best.  Many good people have put in lots of effort, but the system is still dangerous and expensive; somehow true improvement has eluded us. Learning from Adam, we feel that more attention should be given to the relationships in healthcare. At its base, a healthcare service is composed of relationships and actions.  They are held together by knowledge, skill, habit and vulnerability.  Yet, often our approaches to improvement have focused on “tools” or “analytic techniques” or recognition—even “belts” of different colors!  These externalities fight with the humility that comes when we seriously engage the hard work of helping smart people change their behaviors, which effectively hold relationships and actions together.  It has often seemed easier to assume that “relationship” takes care of itself.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.