As we struggle to understand how we can transform the health system to meet the six criteria advocated by the IOM report, Crossing the Quality Chasm, we are challenged by the need to gain an increased understanding of how to reduce variation, standardize where appropriate, and engage our patients as well as our providers in participating in the changes which seem to be essential.

While there is value in guidelines, checklists, rules, protocols, and policies, they have not succeeded in moving to the outcomes desired. In fact, we often see evidence of the increasing dissatisfaction of physicians and other health care professionals with their jobs, and more specifically a loss of “joy” in the work they do.

While I’ve read many books, in attempting to gain a better understanding of human behavior and motivation, Practical Wisdom by Barry Schwartz has addressed a concept which I believe can be critical for us to consider in our transformation efforts.

What is practical wisdom? It begins with the work of Aristotle, who described what he called phronesis. He describes a system which is based on practical actions, not theoretical beliefs. It is not enough to just “know” the right rules (often times delineated in checklists, forms, procedures) but knowing it is the right thing to do, at the right time, in the right circumstances, with the right person. That sounds very similar to our patient centered principles.

In his book, Schwartz outlines the concerns that in an effort to ensure reliability, we are often moving to the creation of more rules, with the intent of reducing variability and increasing performance outcomes. However, this may have the unintended consequence of causing the individual involved to disengage, focus only on the rules and not use the “practical wisdom” which is the result of experience, intellect, training, and context which is critical in many areas of health care.

The book spends much time addressing the issues of incentives, motivation, and building on other books which I’ve reviewed, extends our understanding of the complexity of human behavior, and a need to consider both the intended and unintended consequences of our actions. Learn more about the importance of framing a topic, and the impact on the discussion which ensue. Begin to question many of our assumptions about how we can incentivize and engage patients in their health care.

While some may criticize this book as being a bit simplistic, for most of us not well versed in the science of human behavior, neuroscience or behavioral economics, it is a thought provoking and valuable resource. Practically speaking, it added wisdom to my actions, or so I’d like to think.