Best practices don’t matter. Here’s what does.

High-reliability organizations don’t implement best practices. They continually make new best practices.
Healthcare is an industry obsessed with best practices. And for good reason. Our costs are growing almost uncontrollably, and quality is highly variable from hospital to hospital, department to department and physician to physician. It makes sense, then, that organizations seeking to improve a measure would look to those who are top performers and emulate their processes.
However, instituting best practices isn’t the approach taken by the highest-performing organizations.
What is?
To answer this, let’s examine Toyota, the company whose efficient and adaptive practices have led to millions (if not billions) of consulting dollars spent by others who want to learn just how they do it.
Toyota doesn’t worry about implementing best practices. Instead, it worries about adjusting and improving current practices in real-time — and doing so continually.
“The focus at Toyota is not to implement standard best practices across the organization,” John Kenagy, MD, who studied Toyota in the 1990s while at Harvard Business School, recently told me. “Unpredictable changes in local environments between production facilities and even micro environments inside the same facility create opportunities to continually improve the current ‘best practice.’ Therefore, Toyota has standard ways to continually create new best practices.”
He recounted how one of his Toyota teachers explained the approach to him:
“We know we cannot implement perfect processes because, first of all, we are human and humans aren’t perfect. Secondly we know that, even if we design a perfect process, the environment will change around that process in unknown and unknowable ways. Therefore, although we work hard to design the best process possible, it is much more important for us to know when our processes fail and then improve them or the environment around them as quickly, simply and easily at the lowest-cost possible.” (emphasis mine)
Ensuring high-reliability and, moving beyond that, innovation, is not implementing best practices. It’s the ability to continually make new best practices.  But, says Dr. Kenagy, 95 percent of established organizations are unable to 1) identify process failures or opportunities for improvement and 2) adjust and improve on the front-line, in real time.
What distinguishes those who can from those that can’t?