10 September 2009 • 7:00 am

Best Practice in Best Practice?

U.S. President Barack Obama delivers his speech on healthcare. REUTERS/Jason Reed

U.S. President Barack Obama delivers his speech on healthcare. REUTERS/Jason Reed

U.S. President Barack Obama gave his highly-anticipated speech on health care reform to a joint session of the U.S. Congress and a national TV audience yesterday evening. For those outside of the U.S., speeches to both houses of Congress are relatively rare (except for an annual ‘state of the union’ address), and this speech marked a crucial point in the intense health care reform debate that has been raging here for the past several months. I am sure that several other bloggers have already or will shortly provide their take on the speech itself, so I will spare you my own interpretation. But Obama used the ‘best practice’ term to describe a couple of U.S. regions in which per-capita health care costs are both significantly lower than average, while quality of care and outcomes are better than average (a theme in a New Yorker article I reviewed over the summer), in his desire to improve the cost and quality of health care across the country.

It was interesting to hear Obama cite the concept of ‘best practices’ that is often used in business settings, but rarely presented to the public at large. The idea of capturing and sharing of best practices across an industry or an organization is both pervasive and elusive. I’ve yet to see or hear of an organization that claims to have a best practice for capturing and sharing best practices, and as such, I am a bit skeptical of the term in general.

My reflexive check of the Wikipedia entry on best practices yielded the following tasty morsel:

“As the term (best practices) has become more popular, some organizations have begun using the term “best practices” to refer to what are in fact merely ‘rules’, causing a linguistic drift in which a new term such as “good ideas” is needed to refer to what would previously have been called “best practices.”

Amen to that. I think that comment captures much of my skepticism. It seems to me that implicit in the idea of best practices is that an organization has evolved to a point where it is doing the same thing in more than one way, and that it can be objectively determined that one way is better than the other. Best practice sharing sounds good when discussed in an executive setting, but reconciling different approaches to an esoteric task requires the participation of the very people who are using the different approaches. While sometimes it may be obvious that one practice needs to be abandoned, it is far more likely that no clear winner will be determined.

Anyone who has ever gotten or renewed a drivers’ license at their state’s motor vehicle division (DMV) knows that the process can be slow and bureaucratic. I’ve often imagined how useful it would be for an independent organization to benchmark the efficiency, effectiveness, and consumer satisfaction of each of the 50 DMVs across the U.S. and to use the results to identify and ultimately implement best practices across all of them (some overseas readers of the Tenacious Blog may wonder why the U.S. doesn’t simply have one national process – that would be a whole other topic). But it is easy to see the flaw in my idea. Each of the 50 bureaucracies would incur a high risk of having its flaws objectively quantified and compared, while the chance of being found to have a best practice would be quite low. Even if politicians agreed to the benchmark, they’d encounter considerable resistance to actually implementing any changes to the status quo.

Such is also the case in organizations. The challenge of best practices lies not in the identification of the candidate practices, but with the choice and implementation of a particular practice. Risks are high, benefits are low, subversion of the concept is easily and often accomplished.

Or perhaps I am too cynical. Does anyone reading this want to offer a description of a best practice in best practice sharing? Please comment below.

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