The Skeptics, The Cynics and The Sphere of Influence

All intentional improvement implies change. Change requires deliberate action – thinking about change is not enough. Action implies control of physical objects and, despite what we might like to believe, the only things that are under our personal control are our beliefs, our attitudes, our behaviours and our actions. Everything else can only be changed through some form of indirect influence.

Our Circle of Control appears to extends only to our skin – beyond that is our Sphere of Influence – and beyond that is our Region of Concern.

Very few of us live a solitary existence as a hermit. The usual context for improvement is social and therefore to achieve improvement outside ourselves we need to influence the beliefs, attitudes, behaviours and actions of others. And we can only do that through our own behaviour and actions. We cannot do telepathy or mind-control.  And remember, we are being influenced by others – it is a two-way street.

So when we receive a push-back to our attempted change-for-the-better action, we have failed to influence in a positive sense and the intended improvement cannot happen.  Those who oppose our innovation usually belong to one of two tribes – the Skeptics and the Cynics – and they have much in common.  They both operate from a position of doubt and a belief that they are being deliberately deceived. They distrust, discount, question, analyse, critique and they challenge. They do not blindly believe our rhetoric.

This is not new. These two tribes are thousands of years old – the Ancient Greeks knew them well and gave them the names Skeptics and Cynics. They were the Lords of the Dark Ages but they survived the Renaissance and the first skeptical hypothesis in modern Western philosophy is attributed to Rene Descartes who wrote “I will suppose … that some evil demon of the utmost power and cunning has employed all his energies to deceive me.”

The two tribes present the Innovator and Improvement Scientist with a dilemma. Before action there is only rhetoric, only an idea, only a belief that better is possible. There is no evidence of improvement yet – so no reality to support the rhetoric. And if the action requires the engagement or permission of either of the two tribes then the change will not happen because it is impossible to influence their belief and behaviour without evidence. We have crashed into the wall of resistance – and the harder we push the harder they push back.  So let us conserve our energy, step back from the wall, reflect for a moment and ask “Does the wall surround us completely – or are there gaps?”

Could we find a region of the Sphere of Influence that has few or no Skeptics and Cynics? Is there a place where they do not like to live because the cultural climate is not to their taste? We have an option – we can explore the Sphere of Influence.

At one pole we discover a land called Apathy. It is a barren place where nothing changes; it is devoid of ideas and innovation; it is passionless, monotonous, stable, predictable, safe and boring.  The Skeptics and Cynics do not like it there because there is none of their favourite food – Innovator Passion – which is where they derive their energy and their sport.

At the other pole we discover a land called Assertion – and we discover that the Skeptics and Cynics do not like it there either but for a different reason. In Assertion there is abundant passion and innovation, but also experimentation and reflection and the ideas are fewer but come packaged with a tough shell of hard evidence. This makes them much less palatable to the Skeptics because  they have to chew hard for little gain. The Cynics shun the place.

At the end of our journey we have learned that the two tribes prefer to live in the temperate zone between Apathy and Assertion where there is an abundant supply of innocent, passionate, innovators with new ideas and no evidence. The Skeptics and Cynics frustrate the inexperienced Innovators who become inflamed with passion which is what the two tribes feed on, and when finally exhausted the Innovators fall easy prey to the Cynics – who convert and enslave them. It is a veritable feeding frenzy – and the ultimate casuality is improvement.

So what is the difference between the Skeptics and the Cynics?

Despite their behaviour the Skeptics do care – they are careful. They are the guardians of stability and their opinion is respected because they help to keep the Sphere safe. They are willing to be convinced – but they want explanation and evidence. Rhetoric is not enough.

The Cynics follow a different creed. Their name derives from the Greek for dog and it is not a term of endearment. They have lost their dreams. They blame others for it and their goal is vengeance. They are remorseless, and shameless. They shun social norms and reasonable behaviour and they are not respected by others. They do not care. They are indifferent.

So the wise Improvement Scientist needs to be able to distinguish the Skeptics from the Cynics – and to learn to value the strengths of the Skeptics and to avoid the Cynics. The deal they negotiate with the Skeptics is: “In return for a steady supply of ideas and enthusiasm we ask only for an explanation of the rejections”. It is a fair trade. The careful and considered feedback of the Skeptics is valuable to the Improvement Scientist because it helps to sharpen the idea and harden the shell of evidence. Once the Innovator, Improvement Scientist and the Skeptic have finished their work any ideas that have survived the digestive process are worthy of investment.  It is a a win-win-win arrangement – everyone gets what they want.

The Cynics scavenge the scraps. And that is OK – it is their choice.


Productivity Improvement Science

Very often there is a requirement to improve the productivity of a process and operational managers are usually measured and rewarded for how well they do that. Their primary focus is neither safety nor quality – it is productivity – because that is their job.

For-profit organisations see improved productivity as a path to increased profit. Not-for-profit organisations see improved productivity as a path to being able to grow through re-investment of savings.  The goal may be different but the path is the same – productivity improvement.

First we need to define what we mean by productivity: it is the ratio of a system output to a system input. There are many input and output metrics to choose from and a convenient one to use is the ratio of revenue to expenses for a defined period of time.  Any change that increases this ratio represents an improvement in productivity on this purely financial dimension and we know that this financial data is measured. We just need to look at the bank statement.

There are two ways to approach productivity improvement: by considering the forces that help productivity and the forces that hinder it. This force-field metaphor was described by the psychologist Kurt Lewin (1890-1947) and has been developed and applied extensively and successfully in many organisations and many scenarios in the context of change management.

Improvement results from either strengthening helpers or weakening hinderers or both – and experience shows that it is often quicker and easier to focus attention on the hinderers because that leads to both more improvement and to less stress in the system. Usually it is just a matter of alignment. Two strong forces in opposition results in high stress and low motion; but in alignment creates low stress and high acceleration.

So what hinders productivity?

Well, anything that reduces or delays workflow will reduce or delay revenue and therefore hinder productivity. Anything that increases resource requirement will increase cost and therefore hinder productivity. So looking for something that causes both and either removing or realigning it will have a Win-Win impact on productivity!

A common factor that reduces and delays workflow is the design of the process – in particular a design that has a lot of sequential steps performed by different people in different departments. The handoffs between the steps are a rich source of time-traps and bottlenecks and these both delay and limit the flow.  A common factor that increases resource requirement is making mistakes because errors generate extra work – to detect and to correct.  And there is a link between fragmentation and errors: in a multi-step process there are more opportunities for errors – particularly at the handoffs between steps.

So the most useful way to improve the productivity of a process is to simplify it by combining several, small, separate steps into single large ones.

A good example of this can be found in healthcare – and specifically in the outpatient department.

Traditionally visits to outpatients are defined as “new” – which implies the first visit for a particular problem – and “review” which implies the second and subsequent visits.  The first phase is the diagnostic work and this often requires special tests or investigations to be performed (such as blood tests, imaging, etc) which are usually done by different departments using specialised equipment and skills. The design of departmental work schedules requires a patient to visit on a separate occasion to a different department for each test. Each of these separate visits incurs a delay and a risk of a number of errors – the commonest of which is a failure to attend for the test on the appointed day and time. Such did-not-attend or DNA rates are surprisingly high – and values of 10% are typical in the NHS.

The cumulative productivity hindering effect of this multi-visit diagnostic process design is large.  Suppose there are three steps: New-Test-Review and each step has a 10% DNA rate and a 4 week wait. The quickest that a patient could complete the process is 12 weeks and the chance of getting through right first time (the yield) is about 90% x 90% x 90% = 73% which implies that 27% extra resource is needed to correct the failures.  Most attempts to improve productivity focus on forcing down the DNA rate – usually with limited success. A more effective approach is to redesign process by combining the three New-Test-Review steps into one visit.  Exactly the same resources are needed to do the work as before but now the minimum time would be 4 weeks, the right-first-time yield would increase to 90% and the extra resources required to manage the two handoffs, the two queues, and the two sources of DNAs would be unnecessary.  The result is a significant improvement in productivity at no cost.  It is also an improvement in the quality of the patient experience but that is a unintended bonus.

So if the solution is that obvious and that beneficial then why are we not doing this everywhere? The answer is that we do in some areas – in particular where quality and urgency is important such as fast-track one-stop clinics for suspected cancer. However – we are not doing it as widely as we could and one reason for that is a hidden hinderer: the way that the productivity is estimated in the business case and measured in the the day-to-day business.

Typically process productivity is estimated using the calculated unit price of the product or service. The unit price is arrived at by adding up the unit costs of the steps and adding an allocation of the overhead costs (how overhead is allocated is subject to a lot of heated debate by accountants!). The unit price is then multiplied by expected activity to get expected revenue and divided by the total cost (or budget) to get the productivity measure.  This approach is widely taught and used and is certainly better than guessing but it has a number of drawbacks. Firstly, it does not take into account the effects of the handoffs and the queues between the steps and secondly it drives step-optimisation behaviour. A departmental operational manager who is responsible and accountable for one step in the process will focus their attention on driving down costs and pushing up utilisation of their step because that is what they are performance managed on. This in itself is not wrong – but it can become counter-productive when it is done in isolation and independently of the other steps in the process.  Unfortunately our traditional management accounting methods do not prevent this unintentional productivity hindering behaviour – and very often they actually promote it – literally!

This insight is not new – it has been recognised by some for a long time – so we might ask ourselves why this is still the case? This is a very good question that opens another “can of worms” which for the sake of brevity will be deferred to a later conversation.

So, when applying Improvement Science in the domain of financial productivity improvement then the design of both the process and of the productivity modelling-and-monitoring method may need addressing at the same time.  Unfortunately this does not seem to be common knowledge and this insight may explain why productivity improvements do not happen more often – especially in publically funded not-for-profit service organisations such as the NHS.

Pruning the Niggle Tree

Sometimes our daily existence feels like a perpetual struggle between two opposing forces: the positive force of innovation, learning, progress and success; and the opposing force of cynicism, complacency, stagnation and failure.  Often the balance-of-opposing-forces is so close that even small differences of opinion can derail us – especially if they are persistent. And we want to stay on course to improvement.

Niggles are the irritating things that happen every day. Day after day. Niggles are persistent. So when we are in our “ying-yang” equilibrium and “balanced on the edge” then just one extra niggle can push us off our emotional tight-rope. And we know it. The final straw!

So to keep ourselves on track to success we need to “nail” niggles.  But which ones? There seem to be so many! Where do we start?

If we recorded just one day and from that we listed all the positive things that happened on green PostIt® notes and all the negatives things on red ones – then we would be left with a random-looking pile of red and green notes. Good days would have more green, and bad days would have more red – and all days would have both. And that is just the way it is. Yes? But are they actually random? Is there a deeper connection?

Experience teaches us that when we Investigate-a-Niggle we find it is connected to other niggles. The “cannot find a parking place” niggle is because of the “car park is full” niggle which also causes the “someone arrived late for my important meeting” niggle. The red leaf is attached to a red twig which in turn sprouts other red leaves. The red leaves connect to other red leaves; not to green ones.

If we tug on a green leaf – a Nugget – we find that it too is connected to other nuggets. The “congratulations on a job well done” nugget is connected to the the “feedback is important” nugget from which sprouts the “opportunities for learning” nugget. Our green leaf is attached, indirectly, to many other green leaves; not to red ones.

It seems that our red leaves (niggles) and our green leaves (nuggets) are connected – but not directly to each other. It is as if we have two separate but tightly intertwined plants competing with each other for space and light. So if we want a tree that is more green than red and if we want to progress steadily in the direction of sustained improvement – then we need to prune the niggle tree (red leaves) and leave the nugget tree (green leaves) unscathed.

The problem is that if we just cut off one or two red leaves new ones sprout quickly from the red twigs to replace them. We quickly learn that this apprach is futile. We suspect that if we were able to cut all the red leaves off at once then the niggle tree might shrivel and die – but that looks impossible. We need to be creative and we need to search deeper. With the  knowledge that the red-leaves are part of one tree and we can remove multiple red leaves in one snip by working our way back from the leaves, up the red twigs and to the red branches. If we prune far enough back then we can expect a large number of interconnected red leaves to wither and fall off – leaving the healthy green leaves more space and more light to grow on that part of the tree.

Improvement Science is about pruning the Niggle tree to make space for the Nugget tree to grow. It is about creating an environment for the Green shoots of innovation to sprout.  Most resistance comes from those who feed on the Red leaves – the Cynics – and if we remove enough red branches then they will go hungry. And now the Cynics have a choice: learn to taste and appreciate the Green leaves or “find another tree”.

We want a Greener tree- with fewer poisonous Red leaves on it.

All Aboard for the Ride of Our Lives!

In 1825 the world changed when the Age of Rail was born with the opening of the Darlington-to-Stockton line and the demonstration that a self-powered mobile steam engine could pull more trucks of coal than a team of horses.

This launched the industrial revolution into a new phase by improving the capability to transport heavy loads over long distances more conveniently, reliably, quickly, and cheaply than could canals or roads.

Within 25 years the country was criss-crossed by thousands of miles of railway track and thousands more miles were rapidly spreading across the world. We take it for granted now but this almost overnight success was the result of over 100 years of painful innovation and improvement. Iron rail tracks had been in use for a long time – particularly in quarries and ports. Newcomen’s atmospheric steam engine had been pumping water out of mines since 1712; James Watt and Matthew Boulton had patented their improved separate condenser static steam engine in 1775; and Richard Trevethick had built a self-propelled high pressure steam engine called “Puffing Devil” in 1801. So why did it take so long for the idea to take off? The answer was quite simple – it needed the lure of big profits to attract the entrepreneurs who had the necessary influence and cash to make it happen at scale and pace.  The replacement of windmills and watermills by static steam engines had already allowed factories to be built anywhere – rather than limiting them to the tops of windy hills and the sides of fast flowing rivers. But it was not until the industrial revolution had achieved sufficient momentum that road and canal transport became a serious constraint to further growth of industry, wealth and the British Empire.

But not everyone was happy with the impact that mechanisation brought – the Luddites were the skilled craftsmen who opposed the use of mechanised looms that could be operated by lower-skilled and therefore cheaper labour.  They were crushed in 1812 by political forces more powerful than they were – and the term “luddite” is now used for anyone who blindly opposes change from a position self-protection.

Only 140 years later it was all over for the birthplace of the Rail Age – the steam locomotive was relegated to the museums when Dr Richard Beeching , the efficiency-focussed Technical Director of ICI, published his reports that led to the cost-improvement-programme (CIP) that reorganised the railways and led to the loss of 70,000 jobs, hundreds of small “unprofitable” stations and 1000’s of miles of track.  And the reason for the collapse of the railways was that roads had leap-frogged both canals and railways because the “internal combustion engine” proved a smaller, lighter, more powerful, cheaper and more flexible alternative to steam or horses.

It is of historical interest that Henry Ford developed the production line to mass produce automobiles at a price that a factory worker could afford – and Toyoda invented a self-stopping mechanised loom that improved productivity dramatically by preventing damaged cloth being produced if a thread broke by accident. The historical links come together because Toyoda sold the patents to his self-stopping loom to fund the creation of the Toyota Motor Company which used Henry Ford’s production-line design and integrated the Toyoda self-monitoring, stopping and continuous improvement philosophy.

It was not until twenty years after British Rail was created that Japan emerged as an industrial superpower by demonstrating that it had learned how to improve both quality and reduce cost much more effectively than the “complacent” Europe and America. The tables were turned and this time it was the West that had to learn – and quickly.  Unfortunately not quickly enough. Other developing countries seized the opportunity that mass mechanisation, customisation and a large, low-expectation, low-cost workforce offered. They now produce manufactured goods at prices that European and American companies cannot compete with. Made in Britain has become Made in China.

The lesson of history has been repeated many times – innovations are like seeds that germinate but do not disseminate until the context is just right – then they grow, flower, seed and spread – and are themselves eventually relegated to museums by the innovations that they spawned.

Improvement Science has been in existence for a long time in various forms, and it is now finding more favourable soil to grow as traditional reactive and incremental improvement methods run out of steam when confronted with complex system problems. Wicked problems such as a world population that is growing larger and older at the same time as our reserves of non-renewable natural resources are dwindling.

The promise that Improvement Science offers is the ability to avoid the boom-to-bust economic roller-coaster that devastates communities twice – on the rise and again on the fall. Improvement Science offers an approach that allows sensible and sustainable changes to be planned, implemented and then progressively improved.

So what do we want to do? Watch from the sidelines and hope, or leap aboard and help?

And remember what happened to the Luddites!

Negotiate, Negotiate, Negotiate.

One of the most important skills that an Improvement Scientist needs is the ability to negotiate.  We are all familiar with one form of negotiaton which is called distributive negotiation which is where the parties carve up the pie in a low trust compromise. That is not the form we need – what we need is called integrative negotiation. The goal of integrative negotiation is to join several parts into a greater whole and it implies a higher level of trust and a greater degree of collaboration.

Organisations of more than about 90 people are usually split into departments – and for good reasons. The complex organisation requires specialist aptitudes, skills, and know-how and it is easier to group people together who share the specialist skills needed to deliver that service to the organisation – such as financial services in the accounts department.  The problem is that this division also creates barriers and as the organisation increases in size these barriers have a cumulative effect that can severely limit the capability of the organisation.  The mantra that is often associated with this problem is “communication, communication, communication” … which is too non-specific and therefore usually ineffective.

The products and services that an organisation is designed to deliver are rarely the output of one department – so the parts need to align and to integrate to create an effective and efficient delivery system. This requires more than just communication – it requires integrative negotiation – and it is not a natural skill or one that is easy to develop. It requires investment of effort and time.

To facilitate the process we need to provide three things: a common goal, a common language and a common ground.  The common goal is what all parts of the system are aligned to; the common language is how the dialog is communicated; and the common ground is our launch pad.

Integrative negotiation starts with finding the common ground – the areas of agreement. Very often these are taken for granted because we are psychologically tuned to notice differences rather than similarities. We have to make the “assumed” and “obvious” explicit before we turn our attention on our differences.

Integrative negoation proceeds with defining the common niggles and nice-ifs that could be resolved by a single change; the win-win-win opportunities.

Integrative negotiation concludes with identifying changes that are wholly within the circle of influence of the parties involved – the changes that they have the power to make individually and collectively.

After negotiation comes decision and after decision comes action and that is when improvement happens.