Be agile. Rigid plans and programs are handcuffs. Shorter iterative plans allow us to make decisions based on the most recent data. They allow us to course correct in real time. Know where you are heading and establish checkpoints to make sure you are going in the right direction. But allow flexibility in how you get there. This is coaching. This is patient centered care.
How to Establish an Agile Plan:
It can be very useful to frame any process as a series of short sprints. Think of this as akin to software going from version 1.0 to 1.1 to 1.2. We can focus on making the next small change with the vision of 2.0 in our mind. These sprints need to lead to an imbedded test to allow us to know whether we have truly reached the next version and if we are still on track as originally planned. These short sprints allow us to quickly shift gears as needed. In patient care or coaching, this is a way to quickly calibrate based on response to a stimulus. This can be organized using a tool called a PDCA loop. PDCA stands for Plan, Do, Check, Act. I will break these four components down.
Plan:
Based on my assessment, what is the first step towards the goal. What is the “rate limiting step” in the equation that will allow the rest of the process to continue with less resistance.
“Based on my evaluation, we are going to start with isometric loading to bring some additional blood flow to the tendon, desensitize the area, and gauge tolerance to conservative loads.”
Do:
Carry out the plan. Initiate your first step. Apply the first stimulus.
“Begin with 4x45s single leg heel raise iso holds 3x/day”
Check:
Assess progress towards the desired outcome. Collect the relevant data and identify positives and unanticipated issues.
“Patient reported that isometric holds were 2/10 painful for the first 2 days and then reduced to 0/10 on the 3rd and 4th days”
Act:
Adjust based on feedback from this first loop. The overall process can be revised and updated during this step. Are we still headed in the right direction? Is there a faster route? Do we need more information?
This of course, is followed up with our next planning phase and the loop continues until the desired outcome is met. Rigid plans do not work with human beings. Too many variables change day by day. There is too much information we do not know when creating these plans. We need to respect the emergence of new information that will ultimately allow us to be more accurate tomorrow than I am today. Start with a system that optimizes for this. PDCA.
– Anthony
Dr. Anthony Iannarino 