Wednesday, March 30, 2011

Metrics are dangerous - Be careful what you wish for!

Is there a manger out there who would say they operate without metrics?  NOT. 
After all everyone knows that what gets measured gets done, right?  Here is the problem, most managers either use the wrong metrics or only use one dimensional metrics to drive behavior. 

Let’s take a recent example I have seen first hand.  A Materials Manager is being measured on order fulfillment rate.  They have a goal of filling orders 99% of the time; they currently are at 99.4% fulfillment. Is this a good thing?  Does this make the organization more profitable or efficient? 

How about if I told you that over 4,000 individual orders a month are processed. How about if I told you that the number of orders being processed is going up every year but the volume of supplies is relatively flat. How about if I told you that our cost of expediting shipping has risen by 30%?

Here is another prevalent example common in many Hospitals. 

The Hospital employees a physician liaison to build bridges with community MD’s and to produce more referrals. The metric for this person is the number of visits to community MD’s.  Do you think monitoring such a metric will drive the desired results?   Can you come up with some other metrics that might be useful?  Does quantity over quality ring a bell? With this one metric how long will it take you to determine the effectiveness of the program?

I think you get the picture.  Be careful what you measure because it may just get done

Captain Kirk of Star Trek fame is a good role model

For those of you who are Star Trek fans you already know the main characters of the Star Trek series but for those of you who are not let me elaborate (you “Trekies” can skip to the next paragraph).  Star Trek is about the adventures of the star ship U.S.S. Enterprise and their diverse crew who are involved in space exploration.  These future space travelers zoom through the Galaxy at light speed seeking out new life and exploring new worlds. There are three main characters on the Enterprise: Captain Kirk, Commander Spock, and Dr. “Bones” McCoy.  If you watch the series you quickly realize how different these three good friends and crew mates are.  Spock is a Vulcan, born of an alien race that believes in pure logic without emotion.  Dr. McCoy (AKA Bones) is the star ship’s medical doctor and is a study in pure human emotion.  Their leader, Captain Kirk is a man who seems to blend the two other personalities.  He is fairly logical but is often willing to put logic aside when his “gut” tells him to do otherwise. 

These three very good friends face a lot of scary moments together during their many exploratory missions.  When faced with a dilemma where a crucial decision needs to be made Kirk will ask for advice and inevitably Spock gives advice based on logic and “Bones” gives advice based on emotion. As expected Spock and “Bones” often disagree on a solution and there are often many arguments between the two, many of these  involve “Bones” emotionally hurling various insults at Spock (good naturedly of course).  After listening to his crewmates Kirk sometimes chooses the logical path and sometimes the emotional path but more often, he takes a middle ground because he sees the value of utilizing both logic and emotion in his decision-making.  As Operational Excellence leaders we frequently venture into uncharted territory - new projects where we often face hostile “alien” team members.  I have seen all kinds of facilitators from the emotional to the purely logical and everything in between however I think the most effective OE leaders have characteristics similar to Captain Kirk.  They keep their cool even under the most extreme pressure and while they never lose sight of the end game and the need for logic they understand the emotional side of human nature and don’t ignore its power. During the course of a project they are willing to take a few detours in order to satisfy the emotional needs of those hostile “aliens” who tend to mellow as their emotional fervor subsides. At the same time, good OE leaders don’t let emotions get out of hand; they deftly keep the team away from any emotional “death spiral”.  Every team has its characters, the Spocks (usually my engineer or research friends), the “Bones” characters (usually my nursing or marketing friends), and all the in-betweens.  A good leader (and Captain Kirk is one of the best) must carefully utilize the strength of each personality and talent without allowing one to overwhelm the other.  OE leaders need to be an orchestra conductor. One instrument, by itself can make great music, but when a conductor harnesses the power and brings balance to the many instruments of an orchestra the positive effects of the music are multiplied 10 fold.   

For Captain Kirk failure is never an option, the lives of his crew often depend on his decision-making. The crew of the Enterprise is a diverse bunch with many faults but directed by Captain Kirk, they work together and become a powerful and unbeatable force.  At the start of the Star Trek shows Kirk is heard describing their mission:  Space... the Final Frontier. These are the voyages of the starship Enterprise. Its continuing mission: to explore strange new worlds, to seek out new life and new civilizations, to boldly go where no one has gone before.  Doesn’t that sound a lot like your job as an Operational Excellence Leader? 

Thursday, March 24, 2011

Quick process improvement hits can have a BIG impact!

When you start to work on a project don’t forget to look for quick hits that may make an impact without the need for any detailed process improvement methodology.  For example: I’m working on a fairly significant redesign of how our Periop area operates and as we delved into the current process and opportunities we uncovered many small changes that could help the process immediately.  One of those changes involved standardizing how we review the Operating Room (OR) and Ambulatory Surgery Unit (ASU) surgical schedules.  The daily routine is supposed to involve a daily review of the next day’s surgical schedule.  In our situation the two areas are 1700 feet apart yet they both share some limited quantities of very expensive equipment and surgical sets. The daily schedule review is critical because there may be conflicts with surgical set usage, the schedulers may have under or overestimated surgery times, or the Surgeon may have not sent over critical information regarding supplies and sets needed (we often use loaner sets from our vendors).  It is also important that the Surgical Nurse Managers and our Sterile Process Supervisor talk about the schedule together as each has a specialized expertise that is needed.  A typical problem might be:  A surgery scheduled in ASU at 8AM that is using a scope that must be sterilized and sent to the OR for a surgery at 9:30AM; this is a problem because it will take at least 2 hours for the scope to be processed therefore an unrealistic schedule conflict has been created.  

While each Surgical Nurse Manager always reviewed the schedule daily, they did not do it at a consistent time, they did not always do it together, and they did not include Sterile Process in the review (although they occasionally called Sterile Process regarding specific problems assuming they remembered and/or did not get distracted).  We determined that the three key players must meet every day at 11:30AM to review the schedules together and then note issues on a check list to make sure all problems were addressed before the next day’s surgeries.  The results of this simple change have been dramatic: We have eliminated “emergency” scrambles regarding needed surgical sets or equipment (these use to happen at least 3 out of 5 days); the surgeons are noticing that the coordination is cutting their surgical times, and the three departments are developing a camaraderie that was lacking.   There is still a lot of project work needed for us to gain significant efficiency gains but these small victories give a boost and provide greater credibility to the larger project efforts. 

Monday, March 21, 2011

A Process Improvement Lesson from the Libyan Rebels

The recent events in Libya remind me very much about how highly charged emotions always trump logic. At the beginning of the rebellion the Libyan rebels were flush with excitement and had an over-confident sense of invincibility.  I remember watching news clips and listening to the radio about how the rebels refused to be trained in the basics of marching and military tactics by the professional and experienced military pro-rebel leaders. Instead they were screaming “Just give me a weapon, I need to go fight, this training is a waste of time!”  Most grabbed weapons they had never used before and rushed off to the “front”.  It reminds me of the situation we face within process improvement as we try to teach an inexperienced project team to use a DMAIC methodology and the proper process improvement tools in order to solve complex problems.  Many of our trainees are frustrated by the methodology and the perceived slow pace.  They fail to see the value in defining the problem and working out potential solutions on paper and within a small pilot before implementing the improvements throughout the organization.  

Until the recent intervention by NATO the rebels faced almost certain defeat at the hands of the experienced Qaddafi forces. They were being slaughtered by the hundreds and thousands; they were completely unprepared to face a disciplined and well supplied army.  Before reality struck the rebels perceived the world through a very narrow lens – “We had no freedom now we are free so we must be powerful”. There was no thought to past history in their own country or in nearby countries were dozens of rebellions are crushed every year. Organizations, like the rebels, often look at success through a narrow lens that only reflects their small world: “Our costs are down 5% from last year, gosh we are awful smart and successful”; never mind that our main competitor’s costs are down by 15%.    

Many teams we coach are quick to forget the many years they have spun their wheels on the same problem over and over again. Past failures are often marginalized and excused away, blaming any problems and failures on specific individuals or on a “lack of management commitment”. 

I doubt there was even one experienced rebel military leader in Libya who thought the rebel’s impetuous actions had any hope of success and yet, they also knew that trying to stop their illogical initial actions was futile.  A good process improvement leader needs to strike a delicate balance; helping a team exhaust highly charged emotions while also using the right tools and methodology to help them see reality and to open their eyes to a much broader perspective. Unlike the situation in Libya, no lives are in danger (although sometimes it is a close call), but the revelation that the rebels experienced a few weeks ago when they were quickly defeated by Qaddafi’s forces has some relationship.  As process improvement facilitators we must present our team with many unpleasant but irrefutable facts so they are shocked back to reality; sometimes it is the only way that logic can gain a foothold and we can start to bring ego and unrealistic expectations under control. It’s too early to see if the reality of the recent conflicts will changed the way the Libyan rebels approach their future actions but one thing is certain, if they don’t learn to keep emotions in check and apply sound strategy and tactics they will not succeed.  The same goes for the many healthcare organizations that choose to mimic the “Libyan rebel methodology” which can be summed up as a fire, aim, hope methodology. 

Friday, March 11, 2011

Considerations BEFORE you install the next Great Technology

In today's highly competitive business environment executives often settle for shortcuts.   CEOs are under constant pressure from the Board of Directors to tell them what is changing in the organization – “give us examples of change” is a common request. Of course most of these changes are relayed via a very polished once-a-month PowerPoint presentation. These presentations are highly scripted and of course, manipulated to present the best picture of the organization and the CEOs accomplishments. It is a rare day when bad news is presented in the boardroom.

Executives often become obsessed with checking the box versus doing what's right. One major waste in every organization but especially Hospitals is the tendency to install the latest and greatest software that will “solve all our problems and put us in the forefront of medicine”.  The exercise usually goes like this:
 One of the senior managers or executives keeps hearing about process issues; maybe the lack of good cost accounting or the shortfalls in our patient management system.  They discover several vendors who can offer solutions and they bring them in for demonstrations.  These vendors wow the group with the software capabilities and everyone buys-in because this system seems to be able to eliminate the headaches caused by the current process and/or current software. IT is pulled into the mix to asses the technology needs and Purchasing sends out an RFP and beats up the vendors on price.  Soon the capital is approved and a rough plan is assembled with emphasis on launch dates, hardware upgrades, and a few slides about the business benefits.

And the problem begins….most of the effort upfront is about what software to pick based on the best technology and little if any time is spent developing a detailed analysis of the current process, user needs (voice of the customer), and the desired future process.  Sure, everyone knows the current process is broken but few really understand why, they just think they know why.  Users are so bogged down in the day-to-day process that when they sit in on a vendor demonstration everything looks better than what they have and of course, the vendors paint a picture of seamless software that is so easy to use a child can operate it.  Studies have shown that best-practice organizations spend at least 30% - 40% of their effort on defining the business needs of the organization before purchasing and installing software solutions yet, on average, most organizations spend only 10% of their efforts in this area.  I have seen multi-million dollar software installs with ill defined user needs, poor or no metrics, and little upfront involvement of the user community.   The result is predictable; due dates and budgets are hit because that is where the focus was concentrated but there is a complete failure to deliver on the business needs.

Installing state-of-the-art software makes a great slide for the Board Room and probably creates a certain sense of accomplishment but business results are what matters and sooner or later the piper comes calling.  As these bad technology decisions accumulate they have a way creating tremendous process inefficiency and hidden (but real) costs,  users start creating more and more work-arounds and  side-systems in their efforts to get around the business road blocks created by a poorly executed software or new technology launch.  It’s not long before everyone is back in the conference room looking at another software/technology demonstration and living the fantasy one more time. 

May the "Force" be with you

Are you a fan of star wars? Ever think that you might be living the movie?  The other day I thought about how life as a process improvement guru is a lot like being Obi-Wan Kenobi.  Everyone thinks you have all the answers and possess special powers.  On many days you can feel the power of “The Force” helping you achieve great things but sometimes you feel weak and depleted and you find that you must find a quite place to rejuvenate.  Everyday you face at least one, if not three, Darth Vader “like” opponents. They know how to use “The Force” and they are powerful but they use the Force for evil and they would not hesitate to destroy you.

You must hone your alliances and you need an ally like Yoda to help you stay focused on the path of good and you rely on him or her to protect you from any tendency on your part to move to the “Dark Side” as a means of gaining power or status. Yoda also alerts you to any surprise attacks from the your opponents.  Sometimes you are held captive by Jaba the Hutt that enormous blob of greed created by your COO or CFO  who cry  “Find me more savings, more savings!”. You deal with a CEO who’s personality alternates between Chief Chirrpa of the Ewoks and that of the Emperor (aka: The Dark Lord).

Every once and awhile you find a Princess Leia - A kind and fearless soul who shares the same passion for improvement that you do and is willing to follow you into battle no matter what the odds.  You probably have a young apprentice, your Luke Skywalker; eager and smart but sometimes a bit to impetuous and head strong so you sometimes find yourself in "damage-control mode" fixing some relationship problem that Luke created.  And of course you may run into Hans Solo that untouchable rogue that everyone seems to love even though he really gets nothing done. And as you work late into the night trying to complete a past due project it’s often just you and R2D2 pounding out financial models, spreadsheets, and stats.   In good times and bad but especially in your most desperate moments, remember one thing: "The Force will always be with you".

Thursday, March 3, 2011

OE career move: Making the transition to a healthcare environment

 Because more and more process improvement professionals will start to move from non-healthcare roles (i.e. manufacturing and service) I thought I would give you my perspective on what it’s like on “the other side”. 

As you might suspect healthcare is a much more people centric environment. How could it be otherwise?  Although there are a fair share of selfish SOB’s in healthcare most of the folks are not here for the stock options (they don’t exist in non-profits) they are here because they want to help people and serve the community. That attitude is a double edge sword. On one hand it’s great to work with caring folks but on the other it’s the excuse many give to avoid change – “I’m here for the patient; you can’t standardize what I do”.     

In healthcare much of the work done regarding process improvement is openly shared.  The sources of this information vary, coming from organizations dedicated to process improvement like the Institute of Healthcare Improvement (IHI) but it is also readily available on healthcare websites and journals.  I have found that most of the authors are very willing to talk about their projects and give advice. This is a great source of knowledge that you must tap before you start a project as there are plenty of lessons learned and you can get a head start on most of your projects.  On the downside you will find a strong “we are unique” syndrome within the workforce and some groups will resist improvements even when there is proven success at a similar healthcare institutions.  I have found that emphasizing the similarities and making a few unique (often low impact) tweaks tends to satisfy the doubters.

You will not find an executive management group seeped in decades of process improvement experience.  While the landscape is slowly changing, it is not unusual to find that most of the executives have spent their entire careers with one healthcare institution and thus they need a lot of instruction about process improvement and they tend to oversimplify the effort.  You will likely find that they are either an eager sponge and absorb process improvement advice readily or they simply can’t get the concepts. Hopefully for your sake they exhibit traits of the former. 

Like in all new process improvement situations you need to start with the low hanging fruit.  In my opinion you should  start with parts of the organization that readily lend themselves to lean principals such as sterile processing (it’s very much an assembly line), or some of the administrative tasks such as billing where there are likely opportunities to reduce time and defects (such as under charging). 

I’m glad I made the transition as I think the health care industry is about 5-10 years behind other industries so the opportunities are more than abundant. Expect slow evolution versus revolution, you must have patience. Remember, this is one of the oldest professions and tradition has a strong hold.

Tuesday, March 1, 2011

Building a culture of improvement is a lot like riding a bike

Leading process improvement projects is both frustrating and rewarding. As many of my colleagues can attest, this is no easy job. You need to get things done, sometimes very big things, even though you are “not in charge”.

If we didn’t have a passion for process improvement most of us would probably have quit long ago and tried to find a less strenuous job.  Whenever I’m faced with a challenging project or resistant team member I think of raising kids. It can be the most difficult and trying time of your life, dealing with temper tantrums, poor friend choices, sibling rivalry, etc… but as the kids get older and show confidence in who they are you start letting go because you can see the growth and they can make you proud.   

Facilitating and coaching projects sometimes feels a lot like raising kids. You deal with teaching them how to “play together nicely”, how to accept “rules” aka standardization, and how think of others needs not just their own needs. There is nothing like that satisfying moment during a project when you see the light bulb go on for team members. When you notice that the group of individuals who at first, wouldn’t even look at each other, are now true teammates working together to achieve their mutual objectives – It can be the best part of your day.   

I was recently involved in a project with our Hospitals surgical department which included our sterile process group (the folks who assemble, sterilize, and deliver medical instruments).  We have been collecting loads of data and doing a lot of work to map the process and to understand some of the defects. One quick idea we came up with was to start using a root cause analysis (RCA) form. Previous to the RCA form problems were not documented, we just resolved them and moved on and of course the inevitable happened, the same problem keep reoccurring.

A few days after we started using the form it was put to good use because we had several big problems that cropped up. I ran into the Sterile Process supervisor in the hallway and she explained to me, that when she received the RCA form she immediately took the form to the assemblers since they needed to determine root cause of that particular issue. I was a bit surprised because in the past she or the manager would solve the issue and smooth over any ruffled feathers with the nurses and surgeons; hardly mentioning the problem to the assembly team.  However, she inherently knew that that was part of the problem and with this new process she needed to get her assembly team directly involved. and get them to solve the problem - She wasn’t going to give them the answer.  Her team was a bit put-off because in the past they didn’t have to get involved; the supervisor solved the problem and smoothed over the ruffled feathers with the operating room personnel. All of a sudden this simple form was creating a different attitude and developing important accountability. Thank goodness the supervisor was sharp enough to realize the appropriate approach; of course, I like to think my coaching influenced her actions. She pushed the team and they worked on a permanent solution so the problem was unlikely to repeat.

After she told me about the RCA and related team work I had a good feeling about the work I had been doing with this team.  I guess it’s like teaching your kids to ride a bike.. At first you steadied them, yelled encouragement, and explained the balance thing and comforted them when they fell. But in the end they needed to take the initiative and go for the “big ride”. Before you knew what happened they gained confidence and started riding faster and further, gaining independence in the process even if it sometimes gave you anxiety pangs. They were growing up and making more of their own decisions.

Helping an organization develop a culture of continuous improvement is sometimes discouraging and stressful but when the kids start maturing you sure do feel proud.