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Written by Charmaine Cunningham
Place two fingers on the inside of your wrist, just the below the thumb, and feel your heartbeat. Every 0.8 seconds your cardiovascular system completes a cycle of complex interactions enabling it to pump 60 – 100 times a minute.

The cardiovascular system is highly intricate with centralised and decentralised operating systems synchronising a variety of functions.  Extensive feedback mechanisms provide constant information on performance and fluctuation, in demand.  Via continuous small adjustments, capacity remains within boundaries whilst meeting the demand.  These may include changes to the interval between contractions, the strength of contraction or chemical composition of blood.

The Sinoatrial (SA) node sets the pace for the heart’s mechanical actions by initiating impulses or messages.  The messages are sent at regular intervals, following a predictable path; hence the rhythmic beating.

Normal Sinus rythmThe heart’s normal sinus rhythm.

When chaos erupts…
In the worst case scenario chaos erupts due to complete failure in the communication cascade.  The pacemaker messages are not sent or they are disorganised.  With no coordination of the heart function; muscles pull in their own time and direction. The breakdown in feedback mechanisms cause the muscles to work ferociously, stretching and contracting harder than ever.  Sadly though, the heart rapidly becomes a quivering mass with no output.

ventricular fibrillation
The quivering mass: ventricular fibrillation

Because there is no output, the body’s demand is not met, oxygen starvation occurs, waste accumulates and irreversible cellular damage occurs within minutes.

This state of quivering chaos, with no output, is called ventricular fibrillation. The exact cause is unknown, but it is believed that in most cases warning signs were present.

Buying time
If ventricular fibrillation is not treated death is inevitable, despite prolonged efforts to buy time.

One method of ‘buying time’ is doing CPR.  The main purpose of doing CPR is to restore blood flow to the vital organs until the problem is fixed.  During chest compressions the heart is rapidly squeezed between the sternum and vertebrae, taking over from the quivering pump to create partial output.  For as long as compressions are continued there is hope for survival.

A sacred cow of resuscitation is the administration of medication, usually Adrenaline.  This is resource-intensive on time and people.  According to the American Heart Association, the value and safety of these drugs remains controversial. Retrospective studies suggest that high dosages are associated with worse outcomes.   Yet we continue to use it religiously…because it is what we’ve always done, and everybody has a success story involving Adrenaline!

Treating the root cause
Defibrillation is the administration of a controlled electric shock to the heart. It literally shocks the quivering heart to a standstill for a few seconds until the pacemaker can kick in and restart the functioning of the heart.

So many organisations find themselves quivering!  Each department works away frantically, fighting individual battles, pulling in their own direction with little coordination.  The quivering ripples throughout the organisation produce poor outputs and unhappy customers (internal and external).  Projects to resolve issues are implemented; however, if they do not address the underlying cause, they are only buying time while the organisation remains quivering.

The efficiency lies not in every individual part working as hard as it can, stretched beyond capacity.  Efficiency is created by the perfect harmony of various activities, strengths and functions, making every single beat effective.

A common cause for quivering in organisations is the lack of shared direction due to communication failure or disjointed messages from leadership.  The early warning signs are there, yet ignored.  A firefighting mentality neglects feedback mechanisms, which then leaves organisations stretched beyond safe boundaries of capacity.

Interventions to buy time include external measures rhythmically squeezing every last little bit of output from of the organisation. It may be the implementation of sacred cows which produce limited (sometimes detrimental) results, yet these cows consume resources (time and people).  These include workarounds, over-processing, duplications, inspections and bureaucracies.

In the end people burn out, the organisation falters and nobody wins.

What if the quivering was dramatically forced to stop with a brief interlude, allowing leadership to restart the organisation with clear communication pathways, shared direction and collaborating towards the same outputs?  What if?

Tell me, if we had to analyse your organisation’s rhythm, would defibrillation be advised?

Written by Charmaine Cunningham, a Lean Institute Africa (LIA) Collaborator, currently collaborating with LIA on the Lean Management Development Programme at Groote Schuur Hospital. This post is was also published on Charmaine Cunningham’s blog page at on 13 November 2014.