While working out this morning, I watched with interest as a man looking about 70 years old started adding massive weights to an Olympic bar. He didn’t look like someone who could move 100 pounds let alone 400. I scanned the room for the nearest defibrillator and kept an eye on him hoping I would not have to perform CPR.

The man stretched his legs, moved his arms, touched his toes and took a few deep breaths. And then he walked up to the bar with confidence, gripped it at about shoulder width and lifted 400 pounds…about 3 inches. A shoulder shrug. Ten times. Then sat down. He did two more sets.

Impressive. Unexpected. Superhero-like. But why?

• First, I clearly underestimated his ability based on appearance and I should have known better.
• Second, to see him load eight 45 pound plates one at a time was like a slow build to the climax of a movie scene.
• Last, I couldn’t help but think that my shoulders would have been ripped out of their sockets.

Then, after I realized that CPR and an AED were not needed, I wondered how I could relate these observations to quality improvement. See if this works.

• We hear or read about mammoth transformation projects with laudable intentions (i.e., lower costs, reduce burnout, improve quality). [Lift 400 pounds]
• The results of these efforts are sometimes impressive [heroic] but often disappoint because they are marginally effective. [Move three inches]

Competitive body builders will sometimes use heavy weight with low repetitions and short-range of motion to achieve specific, often impressive results. But is that the right model for health care? To continue the analogy, perhaps a better model would be:

• To lift lighter weights [smaller, focused projects]
• Through the full range of motion [from start to completion]
• Establish muscle endurance with more repetition [anchor the changes in the culture].

What do you think?