There is an inconvenient truth about our brain. It is not into reality. It is into plausibility.

Rather than spend all its time and energy to gather all the possible data, the brain gathers just enough to form a likely explanation of what is happening. It then fills in the missing pieces enough so that it can make a decision you can act upon.

To concoct this story, the brain interprets the data its senses take in by applying what I call its sorting criteria- what it is most concerned about at that time, what it fears the most, the consequence if it is not successful - and then chooses a course of action that appears the most likely to lead to success.

The sorting criteria help make sense of what you ‘see,’ but what you see depends on what you are looking for. Since you don’t ‘see’ everything, it is likely your story is missing something. That story your brain concocts is not based on a full accounting of the observed circumstances. Expand the sorting criteria to include the full array of risks, and the story and resulting choice will likely be different.

Individuals at different levels in any organization have different concerns and different sorting criteria. They 'see' things differently. Their stories differ and the result is conflict and resistance. In the chaos of this confusion, is it any wonder organizations stumble from one thing to the next, unable to discover the right next step to take to achieve their goals?

Although one’s working brain participates in forming the story, much of this processing occurs outside one's awareness, in what researchers call the Hidden Brain, processing and functions we can’t consciously control and have little to no insight into. This system uses pattern recognition and standard responses to direct our actions. It is often a mystery why the brain connects things the way it does. Nevertheless, it works amazingly well to factor in one’s beliefs, preferences, and values. But when you try to force a response to a pattern that doesn’t exactly match, you just might make a choice that is not the best option available.

The prefrontal cortex not only participates in the story forming, but also monitors these hidden brain choices on the lookout for these mismatches. This is tough work for the prefrontal cortex because it is quite fragile and easily overwhelmed. Researchers believe the working prefrontal cortex in our awareness has very limited bandwidth and is only able to handle 4-9 variables at a time. This is why multitasking is a myth. Your brain can really only do one thing well at a time.

What happens when the organization keeps layering on tasks, expects people to be available 24 hours a day, and asks them to get their work done despite often ambiguous and conflicting expectations? How well does your prefrontal cortex function when you are hungry, thirsty, and tired? Your brain is likely not at its best, making it a challenge to effectively decide what to do next.

Enter Hoshin Kanri- a mechanism for the organization to be clear about the sorting criteria. This provides the opportunity to match the realities of getting work done with the challenges created by the chosen goals and parameters for success. The ensuing catchball enables the organization to establish common sorting criteria, to 'see' together and find ways to achieve those goals that work and are workable. Then a person can make choices and prioritize their work in a way that not only enables the organization to be successful, but also enables them to be successful in their individual work responsibilities.

Uncluttering the collective prefrontal cortex of the organization is really about uncluttering the prefrontal cortex of each person there. This is where change really happens - in the interactions of one person with another, reconciling the various stories and finding the next step to take together. That just doesn't happen so well when we occupy everyone's prefrontal cortex with data that don’t accurately portray what is truly happening, metrics that don’t accurately represent the desired outcomes, and expectations that are ambiguous and conflicting. 

And as it turns out, an uncluttered and well-functioning prefrontal cortex is not just about making the best possible decision. It is also just what the brain needs to tap into creativity.

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About the Author:

Mark Jaben is a residency trained, board certified Emergency Physician with over 25 years of clinical experience.

After 20 years in a single hospital group, he has been doing independent emergency medicine practice for the past 7 years in the community setting in emergency departments ranging from 5000- 75,000 annual visits and has experience in hospitals, Indian Health Service facilities, office practices, and EMS services.

Although thinking 'lean' for many years, it was in New Zealand that he became acquainted with the concepts and language of Lean. It was there he began to learn first hand about the potential benefit the Lean approach might bring to healthcare systems struggling to meet the needs of their patients.

In addition to supporting hospitals in their efforts to improve their delivery of quality patient care, his particular interests include the application of Lean principles to medical decision making and to individual work. He was included in A Factory of One, by Dan Markovitz, the 2012 Shingo prize winning book on this topic. He has written extensively about what it really takes to engage people in change efforts and has presented internationally on these topics. His experience includes EMR development and implementation, facility design, regional health delivery, and the interface between different hospital departments as well as between different organizations.