An Overly Simplistic View of PI

Process Identification -> Process Improvement -> Performance Improvement -> Performance Excellence -> Operational Excellence

The journey of Continuous Improvement is long, arduous, and best of all, never-ending.  One could say that is the whole nature of the word “continuous”.  This road does, however, have several checkpoints.  With that said, here we’ll provide an overview of the entire journey, but spend more time at the beginning – because that’s where it all starts!

Problem Solving or Thinking Process?

I’ve been spending some time lately working on improving our ability to solve problems, specifically developing a more structured problem solving method, including root cause analysis. Historically we have used problem solving and root cause analysis to, well, solve problems. But one thing we need to realize is that it can also be used to create opportunities. Here’s an example:

Still Missing the Point of Lean

Saw a headline for an article the other day in a local Medical News journal espousing the benefits of Lean Management.  Needless to say, I was excited to see Lean get some press in the local medical community which has been slow to implement the tenants of Lean Thinking.  That is, until I started reading the article…

Titles

Do titles matter?

If they do, then why are so many people with such big titles unable to make decisions in their organizations?  If they don’t, then why does everyone seem to want a bigger and more grandiose title?

The Importance of Proper Definition

The definition of definition is “a statement expressing the essential nature of something.” At least that’s one way Webster defines the word.  But why is a definition so important?  Because definitions enable us to have a common understanding of a word or subject; they allow us to all be on the same page when discussing or reading about an issue.  And while we tend to make sure we properly define our words and phrases so that all understand, how well do we do that with our projects, programs or initiatives?

On Confidence and Arrogance

Watching the UEFA Champions League Semifinal, in which Barcelona needed to net a goal against a 10-man Chelsea unit, I wondered – when does confidence become arrogance?

Understanding Your Value

What value do you really provide?

What value do you really provide to your customers, organization, or whomever you are providing a product or service?  Do you know or do you just think you know?  You may provide a product (or service) that is very unique, or you deliver it in such a unique way that it provides value to those who purchase the product; but do you truly understand why they buy?

Fundamental Assumptions

A rich man wants to build an elaborate house some new property he just purchased on the beach.  He contacts a builder, shows him the design, and wants it done post haste.  The builder agrees, collaborates with the owner over several meetings, and together they develop a timeline to get the job done and meet the owners time demands. 

What is Lean – Minimize or Maximize?

The Continuous Improvement, Six Sigma, and Lean Group on LinkedIn posed the question “What is Lean?” a couple of months ago, requesting responses in just three words. Now, several people who responded would fall into the “does not follow instructions” category, but the answers were very enlightening and wide ranging.  In some ways it is a bit concerning, the fact that members of a group such as this have such varied opinions, but it’s really not surprising.

Sit Down, Shut Up, and Listen

I was asked an interesting question the other day – “Why do new people say dumb things?”  I, of course, provided a litany of answers that I thought quite impressive for a non-psychologist.  And with that, I missed the point.

Design Thinking and The Lean Start Up

I’ve been doing a lot of thinking lately about design.   Not the design of new products, but the design of systems or processes.  A big part of it has to do with my role at Signature HealthCARE, LLC as we work on enhancing the way we implement new initiatives, programs or products.

Process Improvement and Kitchen Nightmares – A recipe for success?

A friend of mine was telling me about a show he thought I would like – Ramsay’s Kitchen Nightmares, which is now being broadcast in the U.S. as Kitchen Nightmares on Fox.  I’m not a big reality show guy but decided to give it a look the other day when I stumbled across it on BBC America while channel surfing.  He was right – I do like the show.  But I think there is something missing – continuous improvement.

Process Improvement – More Than Just a Project

It is a dark day in the Louisville healthcare Process Improvement community.  Once again, senior leaders failed to see process improvement as more than just another way to cut costs or manage projects, and the organizations will suffer.

Perspective and Common Sense

I read an interesting piece on the MIX (link here) about when organizations create change, common sense can often lead them astray because people often act irrationally.  The example used was how people will spend 10 minutes driving around to find the closest parking space when they could have saved half that time by parking in the first open space and walking.  But is this irrational?

On Management and Leadership

Leader or Manager?  Manager or Leader?  Which one are you?  It appears, based on the prevailing conventional wisdom you can only be one.  And there can be little doubt, given the volume of books, articles, etc., published which one the consultants, academics and experts feel you should be: Leader.  But why do you have to be just one?  Why does the conjunction used have to be “or”?  Why can’t it be “and”?

Do Executives “Get It?”

The other day I attended a seminar on the importance of corporate wellness programs, and the positive ROI that can be gained from their implementation.  To get to the seminar from the lobby, there were 2 choices – a flight of about 40 steps, or an elevator.  I took the steps, after all this was a seminar on “wellness”.  While walking up the steps, I noticed an elevator packed with “executives” from various local organizations with a line forming for the next ride.  I thought – “They’re attending a seminar on corporate wellness, and they can’t even walk up a flight of steps… they just don’t get it.”

Changing Managements Focus

The other day I had a conversation about Team Building with the owner of a company that performs team building retreats.  The question I had is how do you maintain the momentum after the team returns to the organization that sucked the life out of them in the first place?

New Thinking in Higher Education

The recession has forced many institutions of higher learning to rethink their business models to not only reduce costs, but also reshape themselves to react to the rapidly changing enrollment patterns.  According to National Center for Education Statistics data, over a ten year period from 1998 to 2008, enrollment at two-year public colleges grew 32 percent, while enrollment at four-year public institutions increased by 19 percent, and by 17 percent at four-year private institutions.  The recession of the past two years has only reinforced this trend as unemployment rates have hovered near 10% and people are seeking economical options to increase their skill set. This creates issues for both two-year and four-year institutions.

Healthcare Radicals Required, But Are They Welcome?

Mark Graban recently posted a piece taken from Tom Peters’ new book The Little Big Things: 163 Ways to Pursue EXCELLENCE about the need for Radicals in healthcare.  Peters is spot on!  But are they welcome?

How can Average be Above Average?

Ah, the word average.  It has become such a negative word in our society today.  Really, who wants to be “average”?  Whenever we respond to surveys, have to rank our direct reports,  or more so, ourselves and our efforts, we almost always say we are “above average.”  How can this be?  How can everyone be “above average”?

Where Should IT Focus?

A recent Information Week article, “Return to Growth” by Chris Murphy discusses a survey performed by IW of 333 IT Executives in May 2010.  It also sets up what could be a potential disaster for IT leaders if they blindly follow the direction espoused.

Do ‘Quick Wins’ Hurt Lean Initiatives?

When an organization decides to pursue an improvement initiative (Lean, Six Sigma, etc.), and let’s be honest, they almost always start out as an ‘initiative’ or ‘program’, the organization needs to determine which areas it will apply this new technique in first.  Some will argue that the starting point should be an area that will provide the most benefit to the organization, regardless of the time to complete the initial project.  However, most times, we are told to “go for the low-hanging fruit” in order to show the benefit of the methodology to management.  How often does this backfire?

How to Handle a Mistake

A colleague of mine recently had to make that most unpleasant phone call.  He had to call a client just before a board meeting and tell them there was an error in a calculation, that the information provided was wrong, and it would take some time to correct.  Needless to say, the client was not happy.  He delayed the presentation to the board until next month.

Consultants Who Give Consultants a Bad Name

I am a consultant.  There.  I said it.  Although admission may be the first step toward recovery, I prefer to think of myself as a facilitator, coach, or business advisor, especially since in some circles being called  a consultant can have the same feeling a being called a snake oil salesman – leaves you feeling a bit….. well… you know.  It’s not that consultants aren’t needed – many organizations lack the expertise that consultants can bring to the table; it’s just that, many consultants simply point out issues management already knows exists and don’t present a viable plan for fixing the problem (unless it involves hiring them to fix it).

Healthcare Reform and Innovation

Over the past several weeks I have attended and participated in several seminars on the Patient Protection and Affordable Care Act (PPACA), or more commonly referred to as the Healthcare Reform Act.  Presentations have included discussions on the tax implications, Justice Department enforcement, and the Insurance industry impact.  There have also been several expert panels comprised of executives from providers and insurers discussing the impact on their organizations and for some, their personal views on the subject.

One of the themes I have observed from these panelists has been, with a few exceptions, a prevailing attitude of, “How am I going to fit the new requirements of the Healthcare Reform Act into my existing system?”  I’m not so sure this is the right question to ask.

Electronic Medical Records and Higher Costs

Virtually every Electronic Medical Record (EMR) vendor claims their system will increase efficiencies.  However, a recent study by professors at Arizona State University’s W. P. Carey School of Business will “cast doubt on some of the savings” of these systems says Assistant Professor Michael Furukawa, one of the study’s authors.

“There’s a disconnect in the policy world that assumed that with all of the records moved into the computer system, nurses and other hospital personnel could spend less time running around looking for charts and that they would have more time to spend with patients,” says Associate Professor Raghu Santanam, another of the study’s authors. “While some documentation time was reduced, a lot of time at computers may have been added, especially at organizations just learning to implement the new technology in a likely transition period. Higher levels of nurse staffing were really needed.”

Work Life Balance – Has Technology Helped or Hurt?

I happened upon an article on FastCompany.com which stated “30% of U.S. workers who employ technology as part of their jobs feel the need to maintain a digital link to their employer at all times.”  The article also stated, “Technology is supposed to facilitate one’s work experience, making tasks smoother and more efficient, not push work so far beyond a traditional 9-5 office-based lifestyle.”  In the end, the author concluded, ”Isn’t it time to tell your company that your life is your life, and work-based tech should be kept at work?”  So, has technology helped or hurt work life balance?

The Myth of Productivity Cost Savings

We’re well into the NCAA’s March Madness and according to the outplacement firm Challenger Gray & Christmas, the first week of this year’s tournament will cost firms $1.8 BILLION in “unproductive wages.”  Really? Call me a non-believer, but I don’t buy it.  CEO John Challenger refutes my disbelief by saying, “Those who insist there will be no impact are kidding themselves. It might be a slight drop in output or it could be slow Internet connections as bandwidth is sapped by employees watching streaming feeds of the games.”

I have not looked at the details of the study, for instance to see if they factored in the increases in productivity at the local watering holes, and I’m not saying there is no impact, but to make such a claim is akin to fear mongering.  Do we really think that companies lost $1.8 billion in revenue last weekend solely due to the NCAA tournament?  This is where the great myth of productivity cost savings lies.

The Continuous Non-Continuous Improvement Cycle

Introduction

Continuous Improvement is something virtually every organization wants to achieve. Whether it’s called continuous improvement, process improvement, performance improvement, re-engineering, Lean, Six Sigma, Lean Sigma, or some other name, the objective remains the same – develop a program or system of ongoing improvement.

Organizations approach this objective in many different ways. Initially,most start with external consultants using Continuous Improvement tools in isolated areas on specific problems. Impressed with the results and wanting those results to cascade throughout the organization, many decide to bring the expertise in-house. The importance of understanding what this means and the impact this has on the organization cannot be underestimated – unless senior management truly understands the principles of Continuous Improvement, the organization risks falling into “The Continuous Non-Continuous Improvement Cycle.”

The Politics of Continuous Improvement

The other day I came across a post on LinkedIn that stated, “Lean Crushing Six Sigma as the New Dominant Force in Corporate Continuous Improvement.”  It pointed to a survey done by the Avery Point Group which found that Lean talent demand was outpacing Six Sigma talent demand.  I was also enlightened about the animosity that appears to exist between the systems thinking advocates of John Seddon and the lean advocates of the Lean Enterprise Institute.

All of this has me thinking – when did we start the competition about which improvement methodology is the best?  Why do we want to waste our time arguing over which methodology is the best (sometimes to an all too personal level)?  Isn’t the purpose of these approaches to establish an on-going system of Continuous Improvement?  Whether it’s Lean, Six Sigma, Systems Thinking, Theory of Constraints, or something else – if the organization can establish a continuous improvement mindset, does the methodology used really matter?

Do People Really Resist Change?

People always resist change.

This must be true if you listen to the “experts” when it comes to organizations implementing new ideas, approaches, programs, etc..  And these organizations can be anything from the place you work to your local rotary club and all things in-between.

It seems that whenever a new program is attempted to be implemented, and it falls short of expectations, that the leaders who were charged with the implementation write off the failure to the conventional wisdom that people just resist change.

But is that really true? 

Physician Practice Consolidation, Patients, and Process

Healthcare systems appear to be on a late night binge lately, gobbling up Physician practices as fast as they can.  It all seems to be part of their “Physician Growth Strategy” – otherwise known as “rather than entice physicians to practice at my system by providing exceptional service and patient care, I’ll just buy them out, make them employees, and structure their contracts so it is to their benefit to send the patients to me.”  Well, whatever the reason it’s happening a lot.

Mark Carter recently wrote about his experience with his newly acquired physician on his Healthcare Strategy blog.  His physician stated the usual reasons for being bought out – increased back office efficiency, electronic medical records, help with contracting, etc.  Not mentioned, but probably a major driving factor was income stability – a salary not dependent upon patient mix (that was now the Healthcare Systems problem).  [Click here for the entire article]

While this was all good for the physician, what about for the patient?

Beyond Lean – To Where?

I recently came across a seminar advertised as “Beyond Lean – Optimizing Factory Performance.”  The synopsis mentions learning about “Lean-Plus” and moving “…beyond conventional Lean Manufacturing.” Huh?

EHR Meaningful Use Criteria

Late last year (2009), CMS released the proposed Stage 1 criteria for Meaningful Use of Electronic Health Records (EHR) for Eligible Professionals and Hospitals.  (A nice summary of the criteria prepared by my colleague, Jason Miller, is available here, as well as some other useful links)  A quick look at the criteria shows that many providers are probably already performing parts of many of the criteria.  This could be dangerous.

Remember the Other Perspective

One thing that never ceases to amaze me is our (society’s) ability to insulate ourselves from activities occurring beyond our own area of expertise or interest.  I lead a seminar the other day to present some of the fundamentals of Process Improvement to attorneys and how these fundamentals could be applied to their firms.  When I asked how many had heard of “Lean”, a couple raised their hands; “Six Sigma” grabbed a few more, but “Theory of Constraints” – nada.

EHR & The Ghost of Technologies Past

“It’s like déjà-vu all over again” Yogi Berra famously once said, and yes, it is. We’ve been here before.  The promise of a new technology the will create so many efficiencies – too many to count.  It will make everyone’s life so much ‘easier’ and allow the organization to make unprecedented gains.

The Importance of Error-Proofing

Error-Proofing, Mistake-Proofing, Poka-Yoke.  Whatever name we want to give them, they all are methods that help operators avoid mistakes in their work.  Devices and tools based on this premise have been utilized in virtually every industry to minimize / eliminate the ability of an operator to make a mistake and pass that mistake to the next step in the process – the elimination of human error.  But, just how far should we take this?

Before Process – Define Purpose and Value

When pursuing an improvement activity, it is absolutely critical to that one defines the process of the activity to be improved.  Whether this is an effort to reduce cycle time in an operation or the installation of a new IT system, understanding the process is essential to ensuring the improvement is successful.

However, before diving into process definition, it is even more important to take a step back from the process and first ask, “What it the purpose of this activity, and what value does it provide the customer?”

Lean, Six Sigma, Value Streams – Podcast with Business901

A couple of days ago I talked with Joe Dager at Business 901 about a variety of topics around Process and Performance Improvement.  Topics included Lean, Six Sigma, Value Stream Analysis and many others.

Here is the link to the Podcast :  Podcast with Business901

Hope you enjoy!

Glenn

Value People Process

People Process Technology.  Few can dispute the importance of each of these three words in an organization.  There may be disagreement on the order of the words – my argument being that for years organizations have focused on the technology, glanced at the process, and ignored the people – thus one of the reasons for many IT failures organizations experience.  To break this trend, the approach I’ve espoused is to Focus on the Process while Engaging and Involving the People to Prepare for Technology.  I’m convinced this is the right approach when addressing these three words.  But, are they the right three words we should be focusing on?