Lens of Profound Knowledge
What is it?
The Lens of Profound Knowledge (LoPK) (also known as System of Profound knowledge) is a framework introduced by W. Edwards Deming to be used in quality planning. It encourages users to breakdown any variables that may impact on the success of your change ideas. This promotes critical self-reflection, something required for successful and sustainable change.
The LoPK includes four key areas:
Appreciation of the system: this looks at what is happening in the current system. It is important to consider the interaction between different systems, as often a change in one area may result in unintended consequences in another (consider looking at balancing measures to keep track of these unintended consequences). Appreciating your system ties in well with process mapping to really understand how your current system is performing and whether there is any waste/inefficiencies.
Understanding variation: this looks at not only how people vary in their behaviours but also statistical variation. It is often a goal within quality improvement to reduce unnecessary variation. To do so, one must understand the existing variation within the system before changes are made. Variation can be common cause (often from within the system), or special cause (often from outside the system). By understanding the variation, improvement efforts can be focused strategically. Consider looking at your measurement frameworks or statistical process control (SPC) charts to better understand this.
Psychology of people, society and change (human behaviour): this looks at what people do within the system, what people think about the system, what motivates people and how people respond to change. Without properly considering the psychological elements, change ideas and programmes are likely to be unsuccessful. Consider looking at empathy maps or forcefield analyses to help consider these factors.
Theory of knowledge: this relates to the theories around why the system looks like it does, as well as any theories as to why proposed change ideas would work. It is important to understand why these theories are held by people, including those introducing and those affected by change. Theories are just that, they are not always based on the best available evidence. In these occasions, it is important to understand the limitations of theories so that they do not derail a worthy improvement effort. Consider looking at The Model for Improvement and driver diagrams to help with this.
The four components come together to create the lens of profound knowledge.
Robert Lloyd, PhD From the IHI Open School's online course: QI101 Lesson 4 http://courses.ihi.org - Video 1
Why use it?
Using the lens to plan improvement efforts increases the likelihood that teams will consider an appropriately diverse range of concerns in their planning. This should increase the likelihood of success, as key areas have been considered.
It is appropriate to use the lens for large scale concerns or problems. It aims to ensure that improvers do not oversimplify a change.
How to use it?
The LoPK can be used to guide group discussions, particularly when discussing the system as it currently stands. The LoPK can also be a useful framework for planning (see our latest toolkits to see the LoPK in action).
Robert Lloyd, PhD From the IHI Open School's online course: QI101 Lesson 4 http://courses.ihi.org - Video 2
e.g. Want to improve rates of hand washing within the practice
Appreciating the system: Items to consider could include:
Where are the hand wash stations placed?
Are there are professional groups who may find it more difficult to get to a hand wash station?
How are these stations stocked/restocked?
How are these stations presented?
It is likely that increasing hand washing compliance in a practice will increase product usage. This may impact on the ordering system (e.g. is soap ordered every week or is it ordered when there is only one bottle remaining?).
Understanding variation:
Items to consider would include:
What is the variation between different team members, are some staff more compliant than others?
What is the variation within individuals, is someone more compliant at different times of the week?
What is the variation in quality, do most people remember to go to the hand wash station but fail to wash their hands for long enough?
It is likely that there will be variation between groups, individuals and within individuals. Collecting baseline data on this variation can help to target the most appropriate change ideas.
Psychology (human behaviour):
Items to consider would include:
How do staff within the practice respond to change?
What motivates team members and what could be used to motivate them to improve hand washing rates?
Is there someone within the team who is a ‘super-connector’ who could positively influence the success of the improvement work?
It is possible here that the improvement team need to strike a balance between supporting change without being perceived as condescending. The psychology is dependent on the people involved. It can change across time and should not be ‘copied and pasted’ from other contexts.
Theory of knowledge:
Items to consider would include:
What do each professional group think about hand washing, how it works and its importance?
Understanding the theory of knowledge steps beyond the band-aid solution of ‘education’. By understanding the different theories held within the groups, change ideas can be appropriately targeted. ‘Education’ alone often fails to make long lasting change without explaining the ‘why’ of the change. By understanding the theories people hold, the change group are better able to match the right ‘why’ to promote change. (e.g. It is probably unhelpful to say that hand washing needs to be for 20-40 seconds for all staff if an administration team member does not believe they carry enough pathogens to warrant regular hand washing).
By considering the four elements of The LoPK, the planning team have begun to understand their system, refined their aim and generated some new change ideas and ideas for measurement. The LoPK can be applied throughout the improvement effort to see how things have changed.
More information
ELFT - for further perspective on LoPK
NHS England – for another approach