Tools – Page 4 – HCSE Blog

22/10/2011

The Three Faces of Improvement Science

There is always more than one way to look at something and each perspective is complementary to the others.

Improvement Science has three faces: the first is the Process Face; the second is the People face and the third is the System face – and is represented in the logo with a different colour for each face.

The process face is the easiest to start with because it is logical, objective and absolute. It describes the process; the what, where, when and how. It is the combination of the hardware and the software; the structure and the function – and it is constrained by the Laws of Physics.

The people face is emotional, subjective and relative. It describes the people and their perceptions and their purposes. Each person interacts both with the process and with each other and their individual beliefs and behaviours drive the web of relationships. This is the world of psychology and politics.

The system face is neither logical nor emotional – it has characteristics that are easy to describe but difficult to define. Characteritics such a self-organisation; emergent behaviour; and complexity. Our brains do not appear to be able to comprehend systems as easily and intuitively and we might like to believe. This is one reason why systems often feel counter-intuitive, unpredictable and mysterious. We discover that we are unable to make intuitive decisions that result in whole system improvement because our intuition tricks us.

Gaining confidence and capability in the practical application of Improvement Science requires starting from our zone of relative strength – our conscious, logical, rational, explanable, teachable, learnable, objective dependency on the physical world. From this solid foundation we can explore our zone of self-control – our internal unconscious, psychological and emotional world; and from there to our zone of relative weakness – the systemic world of multiple interdependencies that, over time, determine our individual and collective fate.

The good news is that the knowledge and skills we need to handle the rational physical process face are easy and quick to learn. It can be done with only a short period of focussed, learning-by-doing. With that foundation in place we can then explore the more difficult areas of people and systems.

15/10/2011

The Devil and the Detail

There are two directions from which we can approach an improvement challenge. From the bottom up – starting with the real details and distilling the principle later; and from the top down – starting with the conceptual principle and doing the detail later. Neither is better than the other – both are needed.

As individuals we have an innate preference for real detail or conceptual principle – and our preference is manifest by the way we think, talk and behave – it is part of our personality. It is useful to have insight into our own personality and to recognise that when other people approach a problem in a different way then we may experience a difference of opinion, a conflict of styles, and possibly arguments.

One very well established model of personality type was proposed by Carl Gustav Jung who was a psychologist and who approached the subject from the perspective of understanding psychological “illness”. Jung’s “Psychological Types” was used as the foundation of the life-work of Isabel Briggs Myers who was not a psychologist and who was looking from the direction of understanding psychological “normality”. In her book Gifts Differing – Understanding Personality Type (ISBN 978-0891-060741) she demonstrates using empirical data that there is not one normal or ideal type that we are all deviate from – rather that there is a set of stable types that each represents a “different gift”. By this she means that different personality types are suited to different tasks and when the type resonantes with the task it results in high-performance and is seen an asset or “strength” and when it does not it results in low performance and is seen as a liability or “weakness”.

One of the multiple dimensions of the Jungian and Myers-Briggs personality type model is the Sensor – iNtuitor dimension the S-N dimension. This dimension represents where we hold our reference model that provides us with data – data that we convert to information – and informationa the we use to derive decisions and actions.

A person who is naturally inclined to the Sensor end of the S-N dimension prefers to use Reality and Actuality as their reference – and they access it via their senses – sight, sound, touch, smell and taste. They are often detail and data focussed; they trust their senses and their conscious awareness; and they are more comfortable with routine and structure.

A person who is naturally inclined to the iNtuitor end of the S-N dimension prefers to use Rhetoric and Possibility as their reference and their internal conceptual model that they access via their intuition. They are often principle and concept focussed and discount what their senses tell them in favour their intuition. Intuitors feel uncomfortable with routine and structure which they see as barriers to improvement.

So when a Sensor and an iNtuitor are working together to solve a problem they are approaching it from two different directions and even when they have a common purpose, common values and a common objective it is very likely that conflict will occur if they are unaware of their different gifts.

Gaining this awareness is a key to success because the synergy of the two approaches is greater than either working alone – the sum is greater than the parts – but only if there is awareness and mutual respect for the different gifts. If there is no awareness and low mutual respect then the sum will be less than the parts and the problem will not be dissolvable.

In her research, Isabel Briggs Myers found that about 60% of high school students have a preference for S and 40% have a preference for N – but when the “academic high flyers” were surveyed the ratio was S=17% and N=83% – and there was no difference between males and females. When she looked at the S-N distribution in different training courses she discovered that there were a higher proportion of S-types in Administrators (59%), Police (80%), and Finance (72%) and a higher proportion of N-types in Liberal Arts (59%), Engineering (65%), Science (83%), Fine Arts (91%), Occupational Therapy (66%), Art Education (87%), Counselor Education (85%), and Law (59%). Her observation suggested that individuals select subjects based on their “different gifts” and this throws an interesting light on why traditional professions may come into conflict and perhaps why large organisations tend to form departments of “like-minded individuals”. Departments with names like Finance, Operations and Governance – or FOG.

This insight also offers an explanation for the conflict between “strategists” who tend to be N-types and who naturally gravitate to the “manager” part of an organisation and the “tacticians” who tend to be S-types and who naturally gravitate to the “worker” part of the same organisation.

It has also been shown that conventional “intelligence tests” favour the N-types over the S-types and suggests why highly intelligent academics my perform very poorly when asked to apply their concepts and principles in the real world. Effective action requires pragmatists – but academics tend to congregate in academic instituitions – often disrespectfully labelled by pragmatists as “Ivory Towers”.

Unfortunately this innate tendency to seek-like-types is counter-productive because it re-inforces the differences, exacerbates the communication barriers, and leads to “tribal” and “disrespectful” and “trust eroding” behaviour, and to the “organisational silos” that are often evident.

Complex real-world problems cannot be solved this way because they require the synergy of the gifts – each part playing to its strength when the time is right.

The first step to know-how is self-awareness.

If you would like to know your Jungian/MBTI® type you can do so by getting the app: HERE

08/10/2011

Flap-Flop-Flip

The world seems to is getting itself into a real flap at the moment.

The global economy is showing signs of faltering – the perfect dream of eternal financial growth seems to be showing cracks and is increasingly looking tarnished.

The doom mongers are surprisingly quiet – perhaps because they do not have any new ideas either.

It feels like the system is heading for a big flop and that is not a great feeling.

Last week I posed the Argument-Free-Problem-Solving challenge – and some were curious enough to have a go. It seems that the challenge needs more explanation of how it works to create enough engagement to climb the skepticism barrier.

At the heart of the AFPS method is The 4N Chart® – a simple, effective and efficient way to get a balanced perspective of the emotional contours of the change terrain. The improvement process boils down to recognising, celebrating, and maintaining the Nuggets, flipping the Niggles into NoNos and reinvesting the currencies that are released into converting NiceIfs into more Nuggets.

The trick is the flip.

To perform a flip we have to make our assumptions explicit – which means we have to use external reality to challenge our internal rhetoric. We need real data – presented in an easily digestible format – as a picture – and in context which converts the data into information that we can then ingest and use to grow our knowledge and broaden our understanding.

To convert knowledge into understanding we must ask a question: “Is our assumption a generalisation from a specific experience?”

For example – it is generally assumed that high utilisation is associated with high productivity – and we want high productivity so we push for high utilisation. And if we look at reality we can easily find evidence to support our assumption. If I have under-utilised fixed-cost resources and I push more work into the process, I see an increase the flow in the stream, and an increase in utilisation, and an increase in revenue, and no increase in cost – higher outcome: higher productivity.

But if we look more carefully we can also find examples that seem to disprove our assumption. I have under-utilised resources and I push more work into the process, and the flow increases initially then falls dramatically, the revenue falls, productivity falls and when I look at all my resources they are still fully utilised. The system has become gridlocked – and when I investigate is discover that the resource I need to unlock the flow is tied up somewhere else in the process with more urgent work. My system does not have an anti-deadlock design.

Our rhetoric of generalisation has been challenged by the reality of specifics – and it only takes one example. One black swan will disprove the generalisation that “all swans are white”.

We now know we need to flip the “general assumption” into “specific evidence” – changing the words “all”, “always”, “none” and “never” into “some” and “sometimes”.

In our example we flip our assumption into “sometimes utilisation and productivity go up together, and sometimes they do not”. This flip reveals a new hidden door in the invisible wall that limits the breadth of our understanding and that unconsciously hinders our progress.

To open that door we must learn how to tell one specific from another and opening that door will lead to a path of discovery, more knowledge, broader understanding, deeper wisdom, better decisions, more effective actions and sustained improvement.

Flap-Flop-Flip.

This week has seen the loss of one of the greatest Improvement Scientists – Steve Jobs – creator of Apple – who put the essence of Improvement Science into words more eloquently than anyone in his 2005 address at Stanford University.

“Your time is limited, so don’t waste it living someone else’s life. Don’t be trapped by dogma – which is living with the results of other people’s thinking. Don’t let the noise of other’s opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.” Steve Jobs (1955-2011).

And with a lifetime of experience of leading an organisation that epitomises quality by design Steve Jobs had the most credibility of any person on the planet when it comes to management of improvement.

01/10/2011

Argument-Free-Problem-Solving

I used to be puzzled when I reflected on the observation that we seem to be able to solve problems as individuals much more quickly and with greater certainty than we could as groups.

I used to believe that having many different perspectives of a problem would be an asset – but in reality it seems to be more of a liability.

Now when I receive an invitation to a meeting to discuss an issue of urgent importance my little heart sinks as I recall the endless hours of my limited life-time wasted in worthless, unproductive discussion.

But, not to be one to wallow in despair I have been busy applying the principles of Improvement Science to this ubiquitous and persistent niggle. And I have discovered something called Argument Free Problem Solving (AFPS) – or rather that is my name for it because it does what it says on the tin – it solves problems without arguments.

The trick was to treat problem-solving as a process; to understand how we solve problems as individuals; what are the worthwhile bits; and how we scupper the process when we add-in more than one person; and then how to design-to-align the problem-solving workflow so that it …. flows. So that it is effective and efficient.

The result is AFPS and I’ve been testing it out. Wow! Does it work or what!

I have also discovered that we do not need to create an artificial set of Rules or a Special Jargon – we can apply the recipe to any situation in a very natural and unobtrusive way. Just this week I have seen it work like magic several times: once in defusing what was looking like a big bust up looming; once t0 resolve a small niggle that had been magnified into a huge monster and a big battle – the smoke of which was obscuring the real win-win-win opportunity; and once in a collaborative process improvement exercise that demonstrated a 2000% improvement in system productivity – yes – two thousand percent!

So AFPS has been added to the Improvement Science treasure chest and (because I like to tease and have fun) I have hidden the key in cyberspace at coordinates http://www.saasoft.com/moodle

Mwah ha ha ha – me hearties!

17/09/2011

The Cost of Distrust

Previously we have explored “costs” associated with processes and systems – costs that could be avoided through the effective application of Improvement Science. The Cost of Errors. The Cost of Queues. The Cost of Variation.

These costs are large, additive and cumulative and yet they pale into insignificance when compared with the most potent source of cost. The Cost of Distrust.

The picture is of Sue Sheridan and the link below is to a video of Sue telling her story of betrayed trust: in a health care system. She describes the tragic consequences of trust-eroding health care system behaviour. Sue is not bitter though – she remains hopeful that her story will bring everyone to the table of Safety Improvement

View the Video

The symptoms of distrust are easy to find. They are written on the faces of the people; broadcast in the way they behave with each other; heard in what they say; and felt in how they say it. The clues are also in what they do not do and what they do not say. What is missing is as important as what is present.

There are also tangible signs of distrust too – checklists, application-for-permission forms, authorisation protocols, exception logs, risk registers, investigation reports, guidelines, policies, directives, contracts and all the other machinery of the Bureaucracy of Distrust.

The intangible symptoms of distrust and the tangible signs of distrust both have an impact on the flow of work. The untrustworthy behaviour creates dissatisfaction, demotivation and conflict; the bureaucracy creates handoffs, delays and queues. All are potent sources of more errors, delays and waste.

The Cost of Distrust is is counted on all three dimensions – emotional, temporal and financial.

It may appear impossible to assign a finanical cost of distrust because of the complex interactions between the three dimensions in a real system; so one way to approach it is to estimate the cost of a high-trust system. A system in which the trustworthy behaviour is explicit and trust eroding behaviour is promptly and respectfully challenged.

Picture such a system and consider these questions:

How would it feel to work in a high-trust system where you know that trust-eroding-behaviour will be challenged with respect?
How would it feel to be the customer of a high-trust system?
What would be the cost of a system that did not need the Bureaucracy of Distrust to deliver safety and quality?

Trust eroding behaviours are not reduced by decree, threat, exhortation, name-shame-blame, or pleading because all these behaviours are based on the assumption of distrust and say “I do not trust you to do this without my external motivation”. These attitudes behaviours give away the “I am OK but You are Not OK” belief.

Trust eroding behaviours are most effectively reduced by a collective charter which is when a group of people state what behaviours they do not expect and individually commit to avoiding and challenging. The charter is the tangible sign of the peer support that empowers everyone to challenge with respect because they have collective authority to do so. Authority that is made explicit through the collective charter: “We the undersigned commit to respectfully challenge the following trust eroding behaviours …”.

It requires confidence and competence to open a conversation about distrust with someone else and that confidence comes from insight, instruction and practice. The easiest person to practice with is ourselves – it takes courage to do and it is worth the investment – which is asking and answering two questions:

Q1: What behaviours would erode my trust in someone else?

Make a list and rank on order with the most trust-eroding at the top.

Q2: Do I ever exhibit any of the behaviours I have just listed?

Choose just one from your list that you feel you can commit to – and make a promose to yourself – every time you demonstrate the behaviour make a mental note of:

When it happened?
Where it happened?
Who was present?
What just happened?
How did you feel?

You do not need to actively challange your motives, or to actively change your behaviour – you just need to connect up your own emotional feedback loop. The change will happen as if by magic!

27/08/2011

Focus-on-the-Flow

One of the foundations of Improvement Science is visualisation – presenting data in a visual format that we find easy to assimilate quickly – as pictures.

We derive deeper understanding from observing how things are changing over time – that is the reality of our everyday experience.

And we gain even deeper understanding of how the world behaves by acting on it and observing the effect of our actions. This is how we all learned-by-doing from day-one. Most of what we know about people, processes and systems we learned long before we went to school.

When I was at school the educational diet was dominated by rote learning of historical facts and tried-and-tested recipes for solving tame problems. It was all OK – but it did not teach me anything about how to improve – that was left to me.

More significantly it taught me more about how not to improve – it taught me that the delivered dogma was not to be questioned. Questions that challenged my older-and-better teachers’ understanding of the world were definitely not welcome.

Young children ask “why?” a lot – but as we get older we stop asking that question – not because we have had our questions answered but because we get the unhelpful answer “just because.”

When we stop asking ourselves “why?” then we stop learning, we close the door to improvement of our understanding, and we close the door to new wisdom.

So to open the door again let us leverage our inborn ability to gain understanding from interacting with the world and observing the effect using moving pictures.

Unfortunately our biology limits us to our immediate space-and-time, so to broaden our scope we need to have a way of projecting a bigger space-scale and longer time-scale into the constraints imposed by the caveman wetware between our ears.

Something like a video game that is realistic enough to teach us something about the real world.

If we want to understand better how a health care system behaves so that we can make wiser decisions of what to do (and what not to do) to improve it then a real-time, interactive, healthcare system video game might be a useful tool.

So, with this design specification I have created one.

The goal of the game is to defeat the enemy – and the enemy is intangible – it is the dark cloak of ignorance – literally “not knowing”.

Not knowing how to improve; not knowing how to ask the “why?” question in a respectful way. A way that consolidates what we understand and challenges what we do not.

And there is an example of the Health Care System Flow Game being played here.

13/08/2011

Design-for-Productivity

One tangible output of process or system design exercise is a blueprint.

This is the set of Policies that define how the design is built and how it is operated so that it delivers the specified performance.

These are just like the blueprints for an architectural design, the latter being the tangible structure, the former being the intangible function.

A computer system has the same two interdependent components that must be co-designed at the same time: the hardware and the software.

The functional design of a system is manifest as the Seven Flows and one of these is Cash Flow, because if the cash does not flow to the right place at the right time in the right amount then the whole system can fail to meet its design requirement. That is one reason why we need accountants – to manage the money flow – so a critical component of the system design is the Budget Policy.

We employ accountants to police the Cash Flow Policies because that is what they are trained to do and that is what they are good at doing – they are the Guardians of the Cash.

Providing flow-capacity requires providing resource-capacity, which requires providing resource-time; and because resource-time-costs-money then the flow-capacity design is intimately linked to the budget design.

This raises some important questions:
Q: Who designs the budget policy?
Q: Is the budget design done as part of the system design?
Q: Are our accountants trained in system design?

The challenge for all organisations is to find ways to improve productivity, to provide more for the same in a not-for-profit organisation, or to deliver a healthy return on investment in the for-profit arena (and remember our pensions are dependent on our future collective productivity).

To achieve the maximum cash flow (i.e. revenue) at the minimum cash cost (i.e. expense) then both the flow scheduling policy and the resource capacity policy must be co-designed to deliver the maximum productivity performance.

If we have a single-step process it is relatively easy to estimate both the costs and the budget to generate the required activity and revenue; but how do we scale this up to the more realistic situation when the flow of work crosses many departments – each of which does different work and has different skills, resources and budgets?

Q: Does it matter that these departments and budgets are managed independently?
Q: If we optimise the performance of each department separately will we get the optimum overall system performance?

Our intuition suggests that to maximise the productivity of the whole system we need to maximise the productivity of the parts. Yes – that is clearly necessary – but is it sufficient?

To answer this question we will consider a process where the stream flows though several separate steps – separate in the sense that that they have separate budgets – but not separate in that they are linked by the same flow.

The separate budgets are allocated from the total revenue generated by the outflow of the process. For the purposes of this exercise we will assume the goal is zero profit and we just need to calculate the price that needs to be charged the “customer” for us to break even.

The internal reports produced for each of our departments for each time period are:
1. Activity – the amount of work completed in the period.
2. Expenses – the cost of the resources made available in the period – the budget.
3. Utilisation – the ratio of the time spent using resources to the total time the resources were available.

We know that the theoretical maximum utilisation of resources is 100% and this can only be achieved when there is zero-variation. This is impossible in the real world but we will assume it is achievable for the purpose of this example.

There are three questions we need answers to:
Q1: What is the lowest price we can achieve and meet the required demand?
Q2: Will optimising each step independently step give us this lowest price?
Q3: How do we design our budgets to deliver maximum productivity?

To explore these questions let us play with a real example.

Let us assume we have a single stream of work that crosses six separate departments labelled A-F in that sequence. The department budgets have been allocated based on historical activity and utilisation and our required activity of 50 jobs per time period. We have already worked hard to remove all the errors, variation and “waste” within each department and we have achieved 100% observed utilisation of all our resources. We are very proud of our high effectiveness and our high efficiency.

Our current not-for-profit price is £202,000/50 = £4,040 and because our observed utilisation of resources at each step is 100% we conclude this is the most efficient design and that this is the lowest possible price.

Unfortunately our celebration is short-lived because the market for our product is growing bigger and more competitive and our market research department reports that to retain our market share we need to deliver 20% more activity at 80% of the current price!

A quick calculation shows that our productivity must increase by 50% (New Activity/New Price = 120%/80% = 150%) but as we already have a utilisation of 100% then this challenge looks hopelessly impossible. To increase activity by 20% will require increasing flow-capacity by 20% which will imply a 20% increase in costs so a 20% increase in budget – just to maintain the current price. If we no longer have customers who want to pay our current price then we are in trouble.

Fortunately our conclusion is incorrect – and it is incorrect because we are not using the data available to co-design the system such that cash flow and work flow are aligned. And we do not do that because we have not learned how to design-for-productivity. We are not even aware that this is possible. It is, and it is called Value Stream Accounting.

The blacked out boxes in the table above hid the data that we need to do this – an we do not know what they are. Yet.

But if we apply the theory, techniques and tools of system design, and we use the data that is already available then we get this result …

We can see that the total budget is less, the budget allocations are different, the activity is 20% up and the zero-profit price is 34% less – which is a 83% increase in productivity!

More than enough to stay in business.

Yet the observed resource utilisation is still 100% and that is counter-intuitive and is a very surprising discovery for many. It is however the reality.

And it is important to be reminded that the work itself has not changed – the ONLY change here is the budget policy design – in other words the resource capacity available at each stage. A zero-cost policy change.

The example answers our first two questions:
A1. We now have a price that meets our customers needs, offers worthwhile work, and we stay in business.
A2. We have disproved our assumption that 100% utilisation at each step implies maximum productivity.

Our third question “How to do it?” requires learning the tools, techniques and theory of System Engineering and Design. It is not difficult and it is not intuitively obvious – if it were we would all be doing it.

Want to satisfy your curiosity?
Want to see how this was done?
Want to learn how to do it yourself?

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06/08/2011

Harried to the Rescue!

We are social animals and we need social interaction with others of our kind – it is the way our caveman wetware works.

And we need it as much as we need air, water, food and sleep. Solitary confinement is an effective punishment – you don’t need to physically beat someone to psychologically hurt them – just actively excluding them or omitting to notice them is effective and has the advantage that it leaves no visible marks – and no trail of incriminating evidence.

This is the Dark Art of the Game Player and the act of social omission is called discounting – so once we know what to look for the signature of the Game Player is obvious – and we can choose to play along or not.

Some people have learned how to protect themselves from gamey behaviour – they have learned to maintain a healthy balance of confidence and humility. They ask for feedback, they know their strengths and their weaknesses, and they and strive to maintain and develop their capability through teaching and learning. Sticks and stones may break their bones but names can never hurt them.

Other people have not learned how to spot the signs and to avoid being sucked into games – they react to the discounting by trying harder, working harder, taking on more and more – all to gain morsels of recognition. Their strategy works but it has an unfortunate consequence – it becomes an unconscious habit and they become players of the game called “Harried”. The start is signalled by a big sigh as they are hooked into their preferred Rescuer role – always there to pick up the pieces – always offering to talke on extra work – always on the look out for an opportunity to take on more burden. “Good Ol’ Harried” they hear “S/he works every hour God sends like a Trojan”. The unspoken ulterior motive of the instigator of the game is less admirable “Delegate the job to Harried – or better still – just mess it up a bit do nothing – just wait – Harried will parachute in and save the day – and save me having to do it myself.” The conspirators in the game are adopting different roles – Victim and Persecutor – and it is in their interest to have Rescuers around who will willingly join the game. The Persecutors are not easy to see because their behaviour is passive – discounting is passive aggressive behaviour – they discount others need for a work-life balance. The Victims are easier to spot – they claim not be able to solve their own problems by acting helpless and letting Harried take over. And the whole social construct is designed with one purpose – to create a rich opportunity for social interaction – because even though they are painful, games are better than solitary anonymity.

According to Eric Berne, founder of the school of Transactional Analysis, games are learned behaviour – and they spring from an injunction that we are all taught as children: that each of us is reliant on others for recognition – and those others are our parents. Sure, recognition from influential others is important BUT it is not our only source. We can give ourselves recognition. Each of us can learn to celebrate a job well done; a lesson learned; a challenge overcome – and through that route we can learn to recognise others genuinely, openly and without expectation of a return compliment. But to learn this we have to grasp the nettle and to unlearn our habit of playing the Persecutor-Rescuer-Victim games; and to do that we must first shine a light onto our blindspots.

Gamey behaviour is a potent yet invisible barrier to improvement. So if it is endemic in an organisation that wants to improve then it needs to be diagnosed and managed as an integral part of the improvement process. It is a critical human factor and in Improvement Science the human factors and the process factors progress hand in hand.

Here is an paragraph from Games Nurses Play by Pamela Levin:

“Harried” is a game played when situations are complicated. The aim is to make the situation even more complicated so that a person feels justified in giving up. “Harried Midwife” is so named because I (P.L.) first observed the game on an obstetric floor, but it has its counterpart in other clinical settings. The game is aided by institutional needs, since it is a rare hospital unit that has the staff adequate in numbers these days. In the situation I observed, the harried nurse sent her only nurse’s aide to lunch when three deliveries were pending. Instead of using a methodical approach, she went running about checking a pulse here, a chart there, a dilatation here, and an I.V. there, so she never was caught up with the work. She lost her pen and couldn’t “chart” until she found it. She answered the telephone and lost the message. She was so busy setting up the delivery room, she forgot to notify the doctor of the impending delivery. The baby, which arrived in the labor room, was considered contaminated, and could not be discharged to the newborn nursery. After the chaos had died down, the nurse felt justified in doing almost no work for the rest of the day.

Click for the complete Games Nurses Play article here

16/07/2011

Safety-By-Design

The picture is of Elisha Graves Otis demonstrating, in the mid 19th century, his safe elevator that automatically applies a brake if the lift cable breaks. It is a “simple” fail-safe mechanical design that effectively created the elevator industry and the opportunity of high-rise buildings.

“To err is human” and human factors research into how we err has revealed two parts – the Error of Intention (poor decision) and the Error of Execution (poor delivery) – often referred to as “mistakes” and “slips”.

Most of the time we act unconsciously using well practiced skills that work because most of our tasks are predictable; walking, driving a car etc.

The caveman wetware between our ears has evolved to delegate this uninteresting and predictable work to different parts of the sub-conscious brain and this design frees us to concentrate our conscious attention on other things.

So, if something happens that is unexpected we may not be aware of it and we may make a slip without noticing. This is one way that process variation can lead to low quality – and these are the often the most insidious slips because they go unnoticed.

It is these unintended errors that we need to eliminate using safe process design.

There are two ways – by designing processes to reduce the opportunity for mistakes (i.e. improve our decision making); and then to avoid slips by designing the subsequent process to be predictable and therefore suitable for delegation.

Finally, we need to add a mechanism to automatically alert us of any slips and to protect us from their consequences by failing-safe. The sign of good process design is that it becomes invisible – we are not aware of it because it works at the sub-conscious level.

As soon as we become aware of the design we have either made a slip – or the design is poor.

Suppose we walk up to a door and we are faced with a flat metal plate – this “says” to us that we need to “push” the door to open it – it is unambiguous design and we do not need to invoke consciousness to make a push-or-pull decision. The technical term for this is an “affordance”.

In contrast a door handle is an ambiguous design – it may require a push or a pull – and we either need to look for other clues or conduct a suck-it-and-see experiment. Either way we need to switch our conscious attention to the task – which means we have to switch it away from something else. It is those conscious interruptions that cause us irritation and can spawn other, possibly much bigger, slips and mistakes.

Safe systems require safe processes – and safe processes mean fewer mistakes and fewer slips. We can reduce slips through good design and relentless improvement.

A simple and effective tool for this is The 4N Chart® – specifically the “niggle” quadrant.

Whenever we are interrupted by a poorly designed process we experience a niggle – and by recording what, where and when those niggles occur we can quickly focus our consciousness on the opportunity for improvement. One requirement to do this is the expectation and the discipline to record niggles – not necessarily to fix them immediately – but just to record them and to review them later.

In his book “Chasing the Rabbit” Steven Spear describes two examples of world class safety: the US Nuclear Submarine Programme and Alcoa, an aluminium producer. Both are potentially dangerous activities and, in both examples, their world class safety record came from setting the expectation that all niggles are recorded and acted upon – using a simple, effective and efficient niggle-busting process.

In stark and worrying contrast, high-volume high-risk activities such as health care remain unsafe not because there is no incident reporting process – but because the design of the report-and-review process is both ineffective and inefficient and so is not used.

The risk of avoidable death in a modern hospital is quoted at around 1:300 – if our risk of dying in an elevator were that high we would take the stairs! This worrying statistic is to be expected though – because if we lack the organisational capability to design a safe health care delivery process then we will lack the organisational capability to design a safe improvement process too.

Our skill gap is clear – we need to learn how to improve process safety-by-design.

Download Design for Patient Safety report written by the Design Council.

Other good examples are the WHO Safer Surgery Checklist, and the story behind this is told in Dr Atul Gawande’s Checklist Manifesto.

09/07/2011

Passion-Process-Purpose

The wetware between our ears is both amazing and frustrating.

One of the amazing features is how we can condense a whole paradigm into a few words; and one of the frustrating features is how we condense a whole paradigm into a few words. Take the three words – Passion, Process and Purpose – just three seven letter words beginning with P. Together they capture the paradigm of Improvement Science – these are the three interdependent parts.

Passion provides the energy to change and the desire to do something. Purpose is the goal that is sought; the outcome that is desired. Process is the recipe, the plan, the map of the journey. All three are necessary and only together they are sufficient.

The easier bit is Passion – we are all emotional beings – we are not rocks or clocks – we have some irrational components included in our design. Despite what we may think, most of our thinking is outside awareness, unconscious, and we are steered by feelings and signal with feelings. We are not aware of how we use emotions to filter data and to facilitate decisions and we are not aware how we broadcast our unconscious thinking in our body language.

The trickier bit is Process and Purpose – not because they are difficult concepts, but because we confuse the two. There are two different questions that we use to use to try to separate them: the How and the Why questions. “How?” is the question that asks about the Process; “Why?” is the question that asks about the Purpose – and we very often give a How answer to a Why question. We seem to habitually dodge the Purpose question – and that is what makes it tricky. Asking the question “What is my purpose for …” is one that we find difficult to answer. It is difficult because our purpose is unconscious – it is a combination of many things combining in parallel – and such multi-part-interdependent-mental objects are systems; and systems are difficult to capture with a single concept and therefore difficult to bring to consciousness. We feel we have a purpose and we know when others share that purpose but we find it difficult to say what it is – so we say how it works instead. And if we lose our feeling of purpose we become unhappy – we need Purpose.

This trickiness of Process and Purpose is critical to the Science of Improvement because the design method starts with a Purpose – and then works backwards to define a Process; while improvement starts with a Passion and moves forward into deciding a Process. Our normal, intuitive mode of working is to use our irrationality to trigger a sequence of actions – we are instinctively reactive.

The contra-normal, counter-intuitive mode of working is to start with our purpose and use our rationality to assemble a sequence of actions. We pause, consider, think and then act – with purpose. This is why vision and mission are so important to collective improvement – the vision and mission provide a quick reminder of our collective purpose. And that is why investing time in deeply exploring the Purpose question is such an important step – when you get to your purpose and you ask the right question there is a sort of mental “click” as the thinking and the feeling align – the two parts of our wetware working as one system.

02/07/2011

Low-Tech-Toc

Beware the Magicians who wave High Technology Wands and promise Miraculous Improvements if you buy their Black Magic Boxes!

If a Magician is not willing to open the box and show you the inner workings then run away – quickly. Their story may be true, the Miracle may indeed be possible, but if they cannot or will not explain HOW the magic trick is done then you will be caught in their spell and will become their slave forever.

Not all Magicians have honourable intentions – those who have been seduced by the Dark Side will ensnare you and will bleed you dry like greedy leeches!

In the early 1980’s a brilliant innovator called Eli Goldratt created a Black Box called OPT that was the tangible manifestation of his intellectual brainchild called ToC – Theory of Constraints. OPT was a piece of complex computer software that was intended to rescue manufacturing from their ignorance and to miraculously deliver dramatic increases in profit. It didn’t.

Eli Goldratt was a physicist and his Black Box was built on strong foundations of Process Physics – it was not Snake Oil – it did work. The problem was that it did not sell: Not enough people believed his claims and those who did discovered that the Black Box was not as easy to use as the Magician suggested. So Eli Goldratt wrote a book called The Goal in which he explained, in parable form, the Principles of ToC and the theoretical foundations on which his Black Box was built. The book was a big success but his Black Box still did not sell; just an explanation of how his Black Box worked was enough for people to apply the Principles of ToC and to get dramatic results. So, Eli abandoned his plan of making a fortune selling Black Boxes and set up the Goldratt Institute to disseminate the Principles of ToC – which he did with considerably more success. Eli Goldratt died in June 2011 after a short battle with cancer and the World has lost a great innovator and a founding father of Improvement Science. His legacy lives on in the books he wrote that chart his personal journey of discovery.

The Principles of ToC are central both to process improvement and to process design. As Eli unintentionally demonstrated, it is more effective and much quicker to learn the Principles of ToC pragmatically and with low technology – such as a book – than with a complex, expensive, high technology Black Box. As many people have discovered – adding complex technology to a complex problem does not create a simple solution! Many processes are relatively uncomplicated and do not require high technology solutions. An example is the challenge of designing a high productivity schedule when there is variation in both the content and the volume of the work.

If our required goal is to improve productivity (or profit) then we want to improve the throughput and/or to reduce the resources required. That is relatively easy when there is no variation in content and no variation in volume – such as when we are making just one product at a constant rate – like a Model-T Ford in Black! Add some content and volume variation and the challenge becomes a lot trickier! From the 1950’s the move from mass production to mass customisation in the automobile industry created this new challenge and spawned a series of innovative approaches such as the Toyota Production System (Lean), Six Sigma and Theory of Constraints. TPS focussed on small batches, fast changeovers and low technology (kanbans or cards) to keep inventory low and flow high; Six Sigma focussed on scientifically identifying and eliminating all sources of variation so that work flows smoothly and in “statistical control”; ToC focussed on identifying the “constraint steps” in the system and then on scheduling tasks so that the constraints never run out of work.

When applied to a complex system of interlinked and interdependent processes the ToC method requires a complicated Black Box to do the scheduling because we cannot do it in our heads. However, when applied to a simpler system or to a part of a complex system it can be done using a low technology method called “paper and pen”. The technique is called Template Scheduling and there is a real example in the “Three Wins” book where the template schedule design was tested using a computer simulation to measure the resilience of the design to natural variation – and the computer was not used to do the actual scheduling. There was no Black Box doiung the scheduling. The outcome of the design was a piece of paper that defined the designed-and-tested template schedule: and the design testing predicted a 40% increase in throughput using the same resources. This dramatic jump in productivity might be regarded as “miraculous” or even “impossible” but only to someone who was not aware of the template scheduling method. The reality is that that the designed schedule worked just as predicted – there was no miracle, no magic, no Magician and no Black Box.

27/06/2011

What Is The Cost Of Reality?

It is often assumed that “high quality costs more” and there is certainly ample evidence to support this assertion: dinner in a high quality restaurant commands a high price. The usual justifications for the assumption are (a) quality ingredients and quality skills cost more to provide; and (b) if people want a high quality product or service that is in relatively short supply then it commands a higher price – the Law of Supply and Demand. Together this creates a self-regulating system – it costs more to produce and so long as enough customers are prepared to pay the higher price the system works. So what is the problem? The problem is that the model is incorrect. The assumption is incorrect. Higher quality does not always cost more – it usually costs less. Convinced? No. Of course not. To be convinced we need hard, rational evidence that disproves our assumption. OK. Here is the evidence.

Suppose we have a simple process that has been designed to deliver the Perfect Service – 100% quality, on time, first time and every time – 100% dependable and 100% predictable. We choose a Service for our example because the product is intangible and we cannot store it in a warehouse – so it must be produced as it is consumed.

To measure the Cost of Quality we first need to work out the minimum price we would need to charge to stay in business – the sum of all our costs divided by the number we produce: our Minimum Viable Price. When we examine our Perfect Service we find that it has three parts – Part 1 is the administrative work: receiving customers; scheduling the work; arranging for the necessary resources to be available; collecting the payment; having meetings; writing reports and so on. The list of expenses seems endless. It is the necessary work of management – but it is not what adds value for the customer. Part 3 is the work that actually adds the value – it is the part the customer wants – the Service that they are prepared to pay for. So what is Part 2 work? This is where our customers wait for their value – the queue. Each of the three parts will consume resources either directly or indirectly – each has a cost – and we want Part 3 to represent most of the cost; Part 2 the least and Part 1 somewhere in between. That feels realistic and reasonable. And in our Perfect Service there is no delay between the arrival of a customer and starting the value work; so there is no queue; so no work in progress waiting to start, so the cost of Part 2 is zero.

The second step is to work out the cost of our Perfect Service – and we could use algebra and equations to do that but we won’t because the language of abstract mathematics excludes too many people from the conversation – let us just pick some realistic numbers to play with and see what we discover. Let us assume Part 1 requires a total of 30 mins of work that uses resources which cost £12 per hour; and let us assume Part 3 requires 30 mins of work that uses resources which cost £60 per hour; and let us assume Part 2 uses resources that cost £6 per hour (if we were to need them). We can now work out the Minimum Viable Price for our Perfect Service:

Part 1 work: 30 mins @ £12 per hour = £6
Part 2 work: = £0
Part 3 work: 30 mins at £60 per hour = £30
Total: £36 per customer.

Our Perfect Service has been designed to deliver at the rate of demand which is one job every 30 mins and this means that the Part 1 and Part 3 resources are working continuously at 100% utilisation. There is no waste, no waiting, and no wobble. This is our Perfect Service and £36 per job is our Minimum Viable Price.

The third step is to tarnish our Perfect Service to make it more realistic – and then to do whatever is necessary to counter the necessary imperfections so that we still produce 100% quality. To the outside world the quality of the service has not changed but it is no longer perfect – they need to wait a bit longer, and they may need to pay a bit more. Quality costs remember! The question is – how much longer and how much more? If we can work that out and compare it with our Minimim Viable Price we will get a measure of the Cost of Reality.

We know that variation is always present in real systems – so let the first Dose of Reality be the variation in the time it takes to do the value work. What effect does this have? This apparently simple question is surprisingly difficult to answer in our heads – and we have chosen not to use “scarymatics” so let us run an empirical experiment and see what happens. We could do that with the real system, or we could do it on a model of the system. As our Perfect Service is so simple we can use a model. There are lots of ways to do this simulation and the technique used in this example is called discrete event simulation (DES) and I used a process simulation tool called CPS (www.SAASoft.com).

Let us see what happens when we add some random variation to the time it takes to do the Part 3 value work – the flow will not change, the average time will not change, we will just add some random noise – but not too much – something realistic like 10% say.

The chart shows the time from start to finish for each customer and to see the impact of adding the variation the first 48 customers are served by our Perfect Service and then we switch to the Realistic Service. See what happens – the time in the process increases then sort of stabilises. This means we must have created a queue (i.e. Part 2 work) and that will require space to store and capacity to clear. When we get the costs in we work out our new minimum viable price it comes out, in this case, to be £43.42 per task. That is an increase of over 20% and it gives us a measure of the Cost of the Variation. If we repeat the exercise many times we get a similar answer, not the same every time because the variation is random, but it is always an extra cost. It is never less that the perfect proce and it does not average out to zero. This may sound counter-intuitive until we understand the reason: when we add variation we need a bit of a queue to ensure there is always work for Part 3 to do; and that queue will form spontaneously when customers take longer than average. If there is no queue and a customer requires less than average time then the Part 3 resource will be idle for some of the time. That idle time cannot be stored and used later: time is not money. So what happens is that a queue forms spontaneously, so long as there is space for it, and it ensures there is always just enough work waiting to be done. It is a self-regulating system – the queue is called a buffer.

Let us see what happens when we take our Perfect Process and add a different form of variation – random errors. To prevent the error leaving the system and affecting our output quality we will repeat the work. If the errors are random and rare then the chance of getting it wrong twice for the same customer will be small so the rework will be a rough measure of the internal process quality. For a fair comparison let us use the same degree of variation as before – 10% of the Part 3 have an error and need to be reworked – which in our example means work going to the back of the queue.

Again, to see the effect of the change, the first 48 tasks are from the Perfect System and after that we introduce a 10% chance of a task failing the quality standard and needing to be reworked: in this example 5 tasks failed, which is the expected rate. The effect on the start to finish time is very different from before – the time for the reworked tasks are clearly longer as we would expect, but the time for the other tasks gets longer too. It implies that a Part 2 queue is building up and after each error we can see that the queue grows – and after a delay. This is counter-intuitive. Why is this happening? It is because in our Perfect Service we had 100% utiliation – there was just enough capacity to do the work when it was done right-first-time, so if we make errors and we create extra demand and extra load, it will exceed our capacity; we have created a bottleneck and the queue will form and it will cointinue to grow as long as errors are made. This queue needs space to store and capacity to clear. How much though? Well, in this example, when we add up all these extra costs we get a new minimum price of £62.81 – that is a massive 74% increase! Wow! It looks like errors create much bigger problem for us than variation. There is another important learning point – random cycle-time variation is self-regulating and inherently stable; random errors are not self-regulating and they create inherently unstable processes.

Our empirical experiment has demonstrated three principles of process design for minimising the Cost of Reality:

1. Eliminate sources of errors by designing error-proofed right-first-time processes that prevent errors happening.
2. Ensure there is enough spare capacity at every stage to allow recovery from the inevitable random errors.
3. Ensure that all the steps can flow uninterrupted by allowing enough buffer space for the critical steps.

With these Three Principles of cost-effective design in mind we can now predict what will happen if we combine a not-for-profit process, with a rising demand, with a rising expectation, with a falling budget, and with an inspect-and-rework process design: we predict everyone will be unhappy. We will all be miserable because the only way to stay in budget is to cut the lower priority value work and reinvest the savings in the rising cost of checking and rework for the higher priority jobs. But we have a problem – our activity will fall, so our revenue will fall, and despite the cost cutting the budget still doesn’t balance because of the increasing cost of inspection and rework – and we enter the death spiral of finanical decline.

The only way to avoid this fatal financial tailspin is to replace the inspection-and-rework habit with a right-first-time design; before it is too late. And to do that we need to learn how to design and deliver right-first-time processes.

Charts created using BaseLine

18/06/2011

The Crime of Metric Abuse

We live in a world that is increasingly intolerant of errors – we want everything to be right all the time – and if it is not then someone must have erred with deliberate intent so they need to be named, blamed and shamed! We set safety standards and tough targets; we measure and check; and we expose and correct anyone who is non-conformant. We accept that is the price we must pay for a Perfect World … Yes? Unfortunately the answer is No. We are deluded. We are all habitual criminals. We are all guilty of committing a crime against humanity – the Crime of Metric Abuse. And we are blissfully ignorant of it so it comes as a big shock when we learn the reality of our unconscious complicity.

You might want to sit down for the next bit.

First we need to set the scene:
1. Sustained improvement requires actions that result in irreversible and beneficial changes to the structure and function of the system.
2. These actions require making wise decisions – effective decisions.
3. These actions require using resources well – efficient processes.
4. Making wise decisions requires that we use our system metrics correctly.
5. Understanding what correct use is means recognising incorrect use – abuse awareness.

When we commit the Crime of Metric Abuse, even unconsciously, we make poor decisions. If we act on those decisions we get an outcome that we do not intend and do not want – we make an error. Unfortunately, more efficiency does not compensate for less effectiveness – if fact it makes it worse. Efficiency amplifies Effectiveness – “Doing the wrong thing right makes it wronger not righter” as Russell Ackoff succinctly puts it. Paradoxically our inefficient and bureaucratic systems may be our only defence against our ineffective and potentially dangerous decision making – so before we strip out the bureaucracy and strive for efficiency we had better be sure we are making effective decisions and that means exposing and treating our nasty habit for Metric Abuse.

Metric Abuse manifests in many forms – and there are two that when combined create a particularly virulent addiction – Abuse of Ratios and Abuse of Targets. First let us talk about the Abuse of Ratios.

A ratio is one number divided by another – which sounds innocent enough – and ratios are very useful so what is the danger? The danger is that by combining two numbers to create one we throw away some information. This is not a good idea when making the best possible decision means squeezing every last drop of understanding our of our information. To unconsciously throw away useful information amounts to incompetence; to consciously throw away useful information is negligence because we could and should know better.

Here is a time-series chart of a process metric presented as a ratio. This is productivity – the ratio of an output to an input – and it shows that our productivity is stable over time. We started OK and we finished OK and we congratulate ourselves for our good management – yes? Well, maybe and maybe not. Suppose we are measuring the Quality of the output and the Cost of the input; then calculating our Value-For-Money productivity from the ratio; and then only share this derived metric. What if quality and cost are changing over time in the same direction and by the same rate? The productivity ratio will not change.

Suppose the raw data we used to calculate our ratio was as shown in the two charts of measured Ouput Quality and measured Input Cost – we can see immediately that, although our ratio is telling us everything is stable, our system is actually changing over time – it is unstable and therefore it is unpredictable. Systems that are unstable have a nasty habit of finding barriers to further change and when they do they have a habit of crashing, suddenly, unpredictably and spectacularly. If you take your eyes of the white line when driving and drift off course you may suddenly discover a barrier – the crash barrier for example, or worse still an on-coming vehicle! The apparent stability indicated by a ratio is an illusion or rather a delusion. We delude ourselves that we are OK – in reality we may be on a collision course with catastrophe.

But increasing quality is what we want surely? Yes – it is what we want – but at what cost? If we use the strategy of quality-by-inspection and add extra checking to detect errors and extra capacity to fix the errors we find then we will incur higher costs. This is the story that these Quality and Cost charts are showing. To stay in business the extra cost must be passed on to our customers in the price we charge: and we have all been brainwashed from birth to expect to pay more for better quality. But what happens when the rising price hits our customers finanical constraint? We are no longer able to afford the better quality so we settle for the lower quality but affordable alternative. What happens then to the company that has invested in quality by inspection? It loses customers which means it loses revenue which is bad for its financial health – and to survive it starts cutting prices, cutting corners, cutting costs, cutting staff and eventually – cutting its own throat! The delusional productivity ratio has hidden the real problem until a sudden and unpredictable drop in revenue and profit provides a reality check – by which time it is too late. Of course if all our competitors are committing the same crime of metric abuse and suffering from the same delusion we may survive a bit longer in the toxic mediocrity swamp – but if a new competitor who is not deluded by ratios and who learns how to provide consistently higher quality at a consistently lower price – then we are in big trouble: our customers leave and our end is swift and without mercy. Competition cannot bring controlled improvement while the Abuse of Ratios remains rife and unchallenged.

Now let us talk about the second Metric Abuse, the Abuse of Targets.

The blue line on the Productivity chart is the Target Productivity. As leaders and managers we have bee brainwashed with the mantra that “you get what you measure” and with this belief we commit the crime of Target Abuse when we set an arbitrary target and use it to decide when to reward and when to punish. We compound our second crime when we connect our arbitrary target to our accounting clock and post periodic praise when we are above target and periodic pain when we are below. We magnify the crime if we have a quality-by-inspection strategy because we create an internal quality-cost tradeoff that generates conflict between our governance goal and our finance goal: the result is a festering and acrimonious stalemate. Our quality-by-inspection strategy paradoxically prevents improvement in productivity and we learn to accept the inevitable oscillation between good and bad and eventually may even convince ourselves that this is the best and the only way. With this life-limiting-belief deeply embedded in our collective unconsciousness, the more enthusiastically this quality-by-inspection design is enforced the more fear, frustration and failures it generates – until trust is eroded to the point that when the system hits a problem – morale collapses, errors increase, checks are overwhelmed, rework capacity is swamped, quality slumps and costs escalate. Productivity nose-dives and both customers and staff jump into the lifeboats to avoid going down with the ship!

The use of delusional ratios and arbitrary targets (DRATs) is a dangerous and addictive behaviour and should be made a criminal offense punishable by Law because it is both destructive and unnecessary.

With painful awareness of the problem a path to a solution starts to form:

1. S hare the numerator, the denominator and the ratio data as time series charts.
2. Only put requirement specifications on the numerator and denominator charts.
3. Outlaw quality-by-inspection and replace with quality-by-design-and-improvement.

Metric Abuse is a Crime. DRATs are a dangerous addiction. DRATs kill Motivation. DRATs Kill Organisations.

Charts created using BaseLine

11/06/2011

The One-Eyed Man in the Land of the Blind.

“There are known knowns; there are things we know we know.
We also know there are known unknowns; that is to say we know there are some things we do not know.
But there are also unknown unknowns – the ones we don’t know we don’t know.” Donald Rumsfeld 2002.

This infamous quotation is a humorously clumsy way of expressing a profound concept. This statement is about our collective ignorance – and it hides a beguiling assumption which is that we are all so similar that we just have to accept the things that we all do not know. It is OK to be collectively and blissfully ignorant. But is this OK? Is this not the self-justifying mantra of those who live in the Land of the Blind?

Our collective blissful ignorance holds the promise of great unknown gains; and harbours the potential of great untold pain.

Our collective knowledge is vast and is growing because we have dissolved many Unknowns. For each there must have been a point in time when the first person become painfully aware of their ignorance and, by some means, discovered some new knowledge. When that happened they had a number of options – to keep it to themselves, to share it with those they knew, or to share it with strangers. The innovators dilemma is that when they share new knowledge they know they will cause emotional pain; because to share knowledge with the blissfully ignorant implies pushing them to the state of painful awareness.

We are social animals and we demonstrate empathy and respect for others, so we do not want to deliberately cause them emotional pain – even the short term pain of awareness that must preceed the long term gain of knowledge, understanding and wisdom. It is the constant challenge that every parent, every teacher, every coach, every mentor, every leader and every healer has to learn to master.

So, how do we deal with the situation when we are painfully aware that others are in the state of blissful ignorance – of not knowing what they do not know – and we know that making them aware will be emotionally painful for them – just as it was for us? We know from experience that that an insensitive, clumsy, blunt, brutal, just-tell-it-as-it is approach can cause pain-but-no-gain; we have all had experience of others who seem to gain a perverse pleasure from the emotional impact they generate by triggering painful awareness. The disrespectful “means-justifies-the-ends” and “cruel-to-be-kind” mindset is the mantra of those who do not walk their own talk – those who do not challenge their own blissful ignorance – those who do not seek to gain an understanding of how to foster effective learning without inflicting emotional pain.

The no-pain-no-gain life limiting belief is an excuse – not a barrier. It is possible to learn without pain – we have all been doing it for our whole lives; each of us can think of people who inspired us to learn and to have fun doing so – rare and memorable role models, bright stars in the darkness of disappointment. Our challenge is to learn how to inspire ourselves.

The first step is to create an emotionally Safe Environment for Learning and Fun (SELF). For the leader/teacher/healer this requires developing an ability to build a culture of trust by actively unlearning their own trust-corroding-behaviours.

The second step is to know what we know – to be sure of our facts and confident that we can explain and support what we know with evidence and insight. To deliberately push someone into painful awareness with no means to guide them out of that dark place is disrespectful and untrustworthy behaviour. Learning how to teach what we know is the most effective means to discover our own depth of understanding and it is an energising exercise in humility development!

The third step is for us to have the courage to raise awareness in a sensitive and respectful way – sometimes this is done by demonstrating the knowledge; sometimes this is done by asking carefully framed questions; and sometimes it is done as a respectful challenge. The three approaches are not mutually exclusive: leading-by-example is effective but leaders need to be teachers and healers too.

At all stages the challenge for the leader/teacher/healer is to to ensure they maintain an OK-OK mental model of those they influence. This is the most difficult skill to attain and is the most important. The “Leadership and Self-Deception” book that is in the Library of Improvement Science is a parable that decribes this challenge.

So, how do we dissolve the One-Eyed Man in the Land of the Blind problem? How do we raise awareness of a collective blissful ignorance? How do we share something that is going to cause untold pain and misery in the future – a storm that is building over the horizon of awareness.

Ignaz Semmelweis (1818-1865) was the young Hungarian doctor who in 1847 discovered the dramatic live-saving benefit of the doctors cleaning their hands before entering the obstetric ward of the Vienna Hospital. This was before “germs” had been discovered and Semmelweis could not explain how his discovery worked – all he could do was to exhort others to do as he did. He did not learn how the method worked, he did not publish his data, and he demonstrated trust-eroding behaviour when he accused others of “murder” when they did not do as he told them. The fact the he was correct did not justify the means by which he challenged their collective blissful ignorance (see http://www.valuesystemdesign.com for a fuller account). The book that he eventually published in 1861 includes the data that supports our modern understanding of the importance of hand hygiene – but it also includes a passionate diatribe of how he had been wronged by others – a dramatic example of the “I’m OK and The Rest of the World is Not OK” worldview. Semmelweis was committed to a lunatic asylum and died there in 1865.

W Edwards Deming (1900-1993) was the American engineer, mathematician, mathematical physicist, statistician and student of Walter A. Shewhart who learned the importance of quality in design. After WWII he was part of the team who helped to rebuild the Japanese economy and he taught the Japanese what he had learned and practiced during WWII – which was how to create a high-quality, high-speed, high-efficiency process which, ironically, was building ships for the war effort. Later Deming attempted, and failed, to influence the post-war generation of managers that were being churned out by the new business schools to serve the growing global demand for American mass produced consumer goods. Deming returned to relative obscurity in the USA until 1980 when his teachings were rediscovered when Japan started to challenge the USA economically by producing higher-quality-and-lower-cost consumer products such as cars and electronics ( http://en.wikipedia.org/wiki/W._Edwards_Deming). Before he died in 1993 Deming wrote two books – Out of The Crisis and The New Economics in which he outlines his learning and his philosophy and in which he unreservedly and passionately blames the managers and the business schools that trained them for their arrogant attitude and disrespectful behaviour. Like Semmelweis, the fact that his books contain a deep well of wisdom does not justify the means by which he disseminated his criticism of poeple – in particular of senior management. By doing so he probably created resistance and delayed the spread of knowledge.

History is repeating itself: the same story is being played out in the global healthcare system. Neither senior doctors nor senior managers are aware of the opportunity that the learning of Semmelweis and Deming represent – the opportunity of Improvement Science and of the theory, techniques and tools of Operations Management. The global healthcare system is in a state of collective blissful ignorance. Our descendents be the recipients of of decisions and the judges of our behaviour – and time is running out – we do not have the luxury of learning by making the same mistake.

Fortunately, there is an growing group of people who are painfully aware of the problem and are voicing their concerns – such as the Institute of Healthcare Improvement in America. There is a smaller and less well organised network of people who have acquired and applied some of the knowledge and are able to demonstrate how it works – the Know Hows. There appears to be an even smaller group who understand and use the principles but do it intuitively and unconsciously – they dem0nstrate what is possible but find it difficult to teach others how to do what they do. It is the Know How group that is the key to dissolving the problem.

The first collective challenge is to sign-post some safe paths from Collective Blissful Ignorance to Individual Know How. The second collective challenge is to learn an effective and respectful way to raise awareness of the problem – a way to outline the current reality and the future opportunity – and a way that illuminates the paths that link the two.

In the land of the blind the one-eyed man is the person who discovers that everyone is wearing a head-torch by accidentally finding his own and switching it on!

07/05/2011

The Seven Flows

Improvement Science is the knowledge and experience required to improve … but to improve what?

Improve safety, delivery, quality, and productivity?

Yes – ultimately – but they are the outputs. What has to be improved to achieve these improved outputs? That is a much more interesting question.

The simple answer is “flow”. But flow of what? That is an even better question!

Let us consider a real example. Suppose we want to improve the safety, quality, delivery and productivity of our healthcare system – which we do – what “flows” do we need to consider?

The flow of patients is the obvious one – the observable, tangible flow of people with health issues who arrive and leave healthcare facilities such as GP practices, outpatient departments, wards, theatres, accident units, nursing homes, chemists, etc.

What other flows?

Healthcare is a service with an intangible product that is produced and consumed at the same time – and in for those reasons it is very different from manufacturing. The interaction between the patients and the carers is where the value is added and this implies that “flow of carers” is critical too. Carers are people – no one had yet invented a machine that cares.

As soon as we have two flows that interact we have a new consideration – how do we ensure that they are coordinated so that they are able to interact at the same place, same time, in the right way and is the right amount?

The flows are linked – they are interdependent – we have a system of flows and we cannot just focus on one flow or ignore the inter-dependencies. OK, so far so good. What other flows do we need to consider?

Healthcare is a problem-solving process and it is reliant on data – so the flow of data is essential – some of this is clinical data and related to the practice of care, and some of it is operational data and related to the process of care. Data flow supports the patient and carer flows.

What else?

Solving problems has two stages – making decisions and taking actions – in healthcare the decision is called diagnosis and the action is called treatment. Both may involve the use of materials (e.g. consumables, paper, sheets, drugs, dressings, food, etc) and equipment (e.g. beds, CT scanners, instruments, waste bins etc). The provision of materials and equipment are flows that require data and people to support and coordinate as well.

So far we have flows of patients, people, data, materials and equipment and all the flows are interconnected. This is getting complicated!

Anything else?

The work has to be done in a suitable environment so the buildings and estate need to be provided. This may not seem like a flow but it is – it just has a longer time scale and is more jerky than the other flows – planning-building-using a new hospital has a time span of decades.

Are we finished yet? Is anything needed to support the these flows?

Yes – the flow that links them all is money. Money flowing in is called revenue and investment and money flowing out is called costs and dividends and so long as revenue equals or exceeds costs over the long term the system can function. Money is like energy – work only happens when it is flowing – and if the money doesn’t flow to the right part at the right time and in the right amount then the performance of the whole system can suffer – because all the parts and flows are interdependent.

So, we have Seven Flows – Patients, People, Data, Materials, Equipment, Estate and Money – and when considering any process or system improvement we must remain mindful of all Seven because they are interdependent.

And that is a challenge for us because our caveman brains are not designed to solve seven-dimensional time-dependent problems! We are OK with one dimension, struggle with two, really struggle with three and that is about it. We have to face the reality that we cannot do this in our heads – we need assistance – we need tools to help us handle the Seven Flows simultaneously.

Fortunately these tools exist – so we just need to learn how to use them – and that is what Improvement Science is all about.

12/03/2011

Passion, Persistence and Patience.

One goal of Improvement Science is self-sustaining improvement. This does not mean fixing the same problem day-after-day: it means solving new challenges first-time and and for-ever. Patching the same problem over-and-over is called fire-fighting and is an emotionally and financially expensive strategy. We all get a buzz out of solving problems; and that is a good thing because when we free ourselves from the miserable world of the “can’t/won’t do mindset” we gain the confidence to take action, to solve problems and to gain access to an endless supply of feel-good-fuel.

Be warned though: there is a danger lurking here in the form of the unconscious assumption that if we solve all the problems then we will run out of things to do and our supply of feel-good-fuel will dry up too. This misconception and our unconscious fear of ego-starvation conspires to undermine our efforts and we can unintentionally drift into reactive fire-fighting behaviour – which sustains our egos but maintains the mediocre status quo. We may also unconsciously collude with others who supply their egos with feel-good-fuel from the same source – and by doing that condemn us all to perpetual mediocrity.

The root cause of our behaviour is our natural tendancy to see challenges as problems – the negative stuff – the niggles – what we see that is getting the the way and must be removed. We are not as good at seeing challenges as opportunities – the positive stuff – the nice ifs – because we do not see what is not there. The reason for our distorted perception is because the “caveman wetware between our ears” hasn’t evolved to give us a balanced perspective. Fortunately, we have evolved the ability to see with our mind’s eye: to dream, to imagine and to conduct “thought experiments”. When we apply that capability we start to ask “What if?” questions.

What if … I were to see challenges as either niggles (to be lost) or nice-ifs (to be gained)?
What if … there is a limited or manageable number of niggles to be removed?
What if … I believe there is an unlimited supply of nice-ifs?
What if … I do not get the nice-ifs because I spend all my life fighting the same old niggles?
What if … I nailed some niggles once and for all?
What if … I had time and energy to focus on some nice-ifs?

None of us enjoy disappointment. We do not like the feeling that follows from reality failing to meet our expectation – we see it as failure and we often take it personally or accuse others. As children we can dream freely because have not yet been disappointed enough not to; as adults we appear to lower our expectations to avoid the feeling of disappointment. We learn to settle for smaller dreams or no dreams at all. I believe the reason we do this is simply because we are not taught any other way – we are not taught how to deliberately and actively access the inexhaustible supply of feel-good-fuel that is the locked-up in our dreams – our nice-ifs. We are not taught how to nail niggles once and forever and how to re-invest our lifetime into make some of our dreams a reality. To learn those skills we need passion, persistence and patience – and a process. That process is called Improvement Science.

05/03/2011

JIT, WIP, LIP and PIP

It is a fantastic feeling when a piece of the jigsaw falls into place and suddenly an important part of the bigger picture emerges. Feelings of confusion, anxiety and threat dissipate and are replaced by a sense of insight, calm and opportunitity.

Improvement Science is about 80% subjective and 20% objective: more cultural than technical – but the technical parts are necessary. Processes obey the Laws of Physics – and unlike the Laws of People these not open to appeal or repeal. So when an essential piece of process physics is missing the picture is incomplete and confusion reigns.

One piece of the process physics jigsaw is JIT (Just-In-Time) and process improvement zealots rant on about JIT as if it were some sort of Holy Grail of Improvement Science. JIT means what you need arrives just when you need it – which implies that there is no waiting of it-for-you or you-for-it. JIT is an important output of an improved process; it is not an input! The danger of confusing output with input is that we may then try to use delivery time as a mangement metric rather than a performance metric – and if we do that we get ourselves into a lot of trouble. Delivery time targets are often set and enforced and to a large extent fail to achieve their intention because of this confusion. To understand how to achieve JIT requires more pieces of the process physics jigsaw. The piece that goes next to JIT is labelled WIP (Work In Progress) which is the number of jobs that are somewhere between starting and finishing. JIT is achieved when WIP is low enough to provide the process with just the right amount of resilience to absorb inevitable variation; and WIP is a more useful management metric than JIT for many reasons (which for brevity I will not explain here). Monitoring WIP enables a process manager to become more proactive because changes in WIP can signal a future problem with JIT – giving enough warning to do something. However, although JIT and WIP are necessary they are not sufficient – we need a third piece of the jigsaw to allow us to design our process to deliver the JIT performance we want. This third piece is called LIP (Load-In-Progress) and is the parameter needed to plan and schedule the right capacity at the right place and the right time to achieve the required WIP and JIT. Together these three pieces provide the stepping stones on the path to Productivity Improvement Planning (PIP) that is the combination of QI (Quality Improvement) and CI (Cost Improvement).

So if we want our PIP then we need to know our LIP and WIP to get the JIT. Reddit? Geddit?

22/01/2011

Sentenced to Death-by-Meeting!

Do you ever feel a sense of dread when you are summoned to an urgent meeting; or when you get the minutes and agenda the day before your monthly team meeting; or when you see your diary full of meetings for weeks in advance – like a slow and painful punishment?

If so then you may have unwittingly sentenced yourself to Death by Meeting. What? We do it to ourselves? No way! That would be madness!

But think about it. We consciously and deliberately ingest all sorts of other toxins: chemicals like caffeine, alcohol and cigarette smoke – so what is so different about immersing ourselves in the emotional toxic waste that many meetings seem to generate?

Perhaps we have learned to believe that there is no other way and because we have never experienced focussed, fun, and effective meetings where problems are surfaced, shared and solved quickly – problems that thwart us as individuals. Meetings where the problem-solving sum is greater than the problem-accumulating parts.

A meeting is a system that is designed to solve problems. We can improve our system incrementally but it is a slow process; to achieve a breakthrough we need to radically redesign the system. There are three steps to doing this:

1. First decide what sort of problems the meeting is required to solve: strategic, operational or tactical;
2. Second design, test and practice a problem solving process for each category of problem; and
3. Third, select the appropriate tool for the task.

In his illuminating book Death by Meeting, Patrick Lencioni describes three meeting designs and illustrates with a story why meetings don’t work if the wrong tool is used for the wrong task. It is a sobering story.

There is another dimension to the design of meetings; that is how we solve problems as groups – and how, as a group, we seem to waste a lot of effort and time in unproductive discussion. In his book Six Thinking Hats Edward De Bono provides an explanation for our habitual behaviour and a design for a radically different group problem solving process – one that a group would not arrive at by evolution – but one that has been proven to work.

If we feel sentenced to death-by-meetings then we could buy and read these two small books – a zero-risk, one-off investment of effort, time and money for a guaranteed regular reward of fun, free time and success!

So if I complain to myself and others about pointless meetings and I have not bothered to do something about it myself then I now know that it is I who sentenced myself to Death-by-Meeting. Unintentionally and unconsciously perhaps – but me nevertheless.

08/01/2011

Is a Queue an Asset or a Liability?

Many believe that a queue is a good thing.

To a supplier a queue is tangible evidence that there is demand for their product or service and reassurance that their resources will not sit idle, waiting for work and consuming profit rather than creating it. To a customer a queue is tangible evidence that the product or service is in demand and therefore must be worth having. They may have to wait but the wait will be worth it. Both suppliers and customers unconsciously collude in the Great Deception and even give it a name – “The Law of Supply and Demand”. By doing so they unwittingly open the door for charlatans and tricksters who deliberately create and maintain queues to make themselves appear more worthy or efficient than they really are.

Even though we all know this intuitively we seem unable to do anything about it. “That is just the way it is” we say with a shrug of resignation. But it does not have to be so – there is a path out of this dead end.

Let us look at this problem from a different perspective. Is a product actually any better because we have waited to get it? No. A longer wait does not increase the quality of the product or service and may indeed impair it. So, if a queue does not increase quality does it reduce the cost? The answer again is “No”. A queue always increases the cost and often in many ways. Exactly how much the cost increases by depends on what is on the queue, where the queue is, and how long it is. This may sound counter-intitutive and didactic so I need to explain in a bit more detail the reason this statement is an inevitable consequence of the Laws of Physics.

Suppose the queue comprises perishable goods; goods that require constant maintenance; goods that command a fixed price when they leave the queue; goods that are required to be held in a container of limited capacity with fixed overhead costs (i.e. costs that are fixed irrespective of how full the container is). Patients in a hospital or passengers on an aeroplane are typical examples because the patient/passenger is deprived of their ability to look after themselves; they are totally dependent on others for supplying all their basic needs; and they are perishable in the sense that a patient cannot wait forever for treatment and an aeroplane cannot fly around forever waiting to land. A queue of patients waiting to leave hospital or an aeroplane full of passsengers circling to land at an airport represents an expensive queue – the queue has a cost – and the bigger the queue is and the longer it persists the greater the cost.

So how does a queue form in the first place? The answer is: when the flow in exceeds the flow out. The instant that happens the queue starts to grow bigger. When flow in is less than flow out the queue is getting smaller – but we cannot have a negative queue – so when the flow out exceeds the flow in AND the size of the queue reaches zero the system suddenly changes behaviour – the work dries up and the resources become idle. This creates a different cost – the cost of idle resources consuming money but not producing revenue. So a queue/work costs and no queue/no work costs too. The least cost situation is when the work arrives at exactly the same rate that it can be done: there is no waiting by anyone – no queue and no idle resources. Note however that this does not imply that the work has to arrive at a constant rate – only that rate at which the work arrives matches the rate at which it is done – it is the difference between the two that should be zero at all times. And where we have several steps – the flow must be the same through all steps of the stream at all times. Remember the second condition for minimum cost – the size of the queue must be zero as well – this is the zero inventory goal of the “perfect process”.

So, if any deviation from this perfect balance of flow creates some form of cost, why do we ever tolerate queues? The reason is that the perfect world above implies that it is possible to predict the flow in and the flow out with complete accuracy and reliabilty. We all know from experience that this is impossible: there is always some degree of natural variation which is unpredictable and which we often call “noise” or “chaos”. For that single reason the lowest cost (not zero cost) situation is when there is just enough breathing space for a queue to wax and wane – smoothing out the unpredictable variation between inflow and outflow. This healthy queue is called a buffer.

The less “noise” the less breathing space is needed and the closer you can get to zero queue cost.

So, given this logical explanation it might surprise you to learn that most of the flow variation we observe in real processes is neither natural nor unpredictable – we deliberately and persistently inject predictable flow variation into our processes. This unnatural variation is created by own policies – for example, accumulating DIY jobs until there are enough to justify doing them. The reason we do this is because we have been bamboozled into believing it is a good thing for the financial health of our system. We have been beguiled by the accountants – the Money Magicians. Actually that is not precise enough – the accountants themselves are the innocent messengers – the deception comes from the Accounting Policies. The major niggle is one convention that has become ossified into Accounting Practice – the convention that a queue of work waiting to be finished or sold represents an asset – sort of frozen-for-now-cash that can be thawed out or “liquidated” when the product is sold. This convention is not incorrect it is just incomplete because, as we have demonstrated, every queue incurs a cost. In accountant-speak a cost is called a liability and unfortunately this queue-cost-liability is never included in the accounts and this makes a very, very, big difference to the outcome. To assess the financial health of an organisation at a point in time an accountant will use a balance sheet to subtract the liabilities from the assets and come up with a number that is called equity. If that number is zero or negative then the business is financially dead – the technical name is bankruptcy and no accountant likes to utter the B word. Denial is not a reliable long term buisness strategy and if our Accounting Policies do not include the cost of the queue as a liability on the balance sheet then our finanical reports will be a distortion of reality and will present the business as healthier than it really is. This is an Error of Omission and has grave negative consequences. One of which is that it can create a sense of complacency, a blindness to the early warning signs of financial illness and reactive rather than proactive behaviour. The problem is compounded when a large and complex organisation is split into smaller, simpler mini-businesses that all suffer from the same financial blindspot. It becomes even more difficult to see the problem when everyone is making the same error of omission and when it is easier to blame someone else for the inevitable problems that ensue.

We all know from experience that prevention is better than cure and we also know that the future is not predictable with certainty: so in addition to prevention we need vigilence, prompt action, decisive action and appropriate action at the earliest detectable sign of a significant deterioration. Complacency is not a reliable long term survival strategy.

So what is the way forward? Dispense with the accountants? NO! You need them – they are very good at what they do – it is just that what they are doing is not exactly what we all need them to be doing – and that is because the Accounting Policies that they diligently enforce are incomplete. A safer strategy would be for us to set our accountants the task of learning how to count the cost of a queue and to include that in our internal finanical reporting. The quality of business decisions based on financial data will improve and that is good for everyone – the business, the customers and the reputation of the Accounting Profession. Win-win-win.

The question was “Is a queue and asset or a liability?” The answer is “Both”.

16/12/2010

Inborn Errors of Management

There is a group of diseases called “inborn errors of metabolism” which are caused by a faulty or missing piece of DNA – the blueprint of life that we inherit from our parents. DNA is the chemical memory that stores the string of instructions for how to build every living organism – humans included. If just one DNA instruction becomes damaged or missing then we may lose the ability to make or to remove one specific chemical – and that can lead to a deficiency or an excess of other chemicals – which can then lead to dysfunction – which can then make us feel unwell – and can then limit both our quality and quantity of life. We are a biological system of interdependent parts. If an inborn error of metabolism is lethal it will not be passed on to our offspring because we don’t live long enough – so the ones we see are the ones which and not lethal. We treat the symptoms of an inborn error of metabolism by artificially replacing the missing chemical – but the way to treat the cause is to repair, replace or remove the faulty DNA.

The same metaphor can be applied to any social system. It too has a form of DNA which is called culture – the inherited set of knowledge, beliefs, attitudes and behaviours that the organisation uses to conduct itself in its day-to-day business of survival. These patterns of behaviour are called memes – the social equivalent to genes – and are passed on from generation to generation through language – body language and symbolic language; spoken words – stories, legends, myths, songs, poems and books – the cultural collective memory of the human bio-psycho-social system. All human organisations share a large number of common memes – just as we share a large number of common genes with other animals and plants and even bacteria. Despite this much larger common cultural heritage – it is the differences rather than the similarities that we notice – and it is these differences that spawn the cultural conflict that we observe at all levels of society.

If, by chance alone, an organisation inherits a depleted set of memes it will appear different to all the others and it will tend to defend that difference rather than to change it. If an organisation has a meme defect, a cultural mutation that affects a management process, then we have the organisational condition called an Inborn Error of Management – and so long as the mutation is not lethal to the organisation it will tend to persist and be passed largely unnoticed from one generation of managers to the next!

The NHS was born in 1948 without a professional management arm, and while it survived and grew initally, it became gradually apparent that the omisson of the professional management limb was a problem; so in the 1980’s, following the Griffiths Report, a large dose professional management was grafted on and a dose of new management memes were injected. These included finance, legal and human resource management memes but one important meme was accidentally omitted – process engineering – the ability to design a process to meet a specific quality, time and cost specification. This omission was not noticed initially because the rapid development of new medical technologies and new treatments was delivering improvements that obscured the inborn error of management. The NHS became the envy of many other countries – high quality healthcare available to all and free at the point of delivery. Population longevity improved, public expectation increased, demand for healthcare increased and inevitably the costs increased. In the 1990’s the growing pains of the burgeoning NHS led to a call for more funding, quoting other countries as evidence, and at the turn of the New Millenium a ten year plan to pump billions of pounds per year into the NHS was hatched. Unfortunately, the other healthcare services had inherited the same meme defect – so the NHS grew 40% bigger but no better – and the evidence is now accumulatung that productivity (the ratio of output quality to input cost) has actally fallen by more than 10% – there are more people doing more work but less well. The UK along with many other countries has hit an economic brick wall and the money being sucked into the NHS cannot increase any more – even though we have created a legacy of an increasing proportion of retired and elderly members of society to support.

The meme defect that the NHS inherited in 1948 and that was not corrected in the transplant operation 1980’s is now exerting it’s influence – the NHS has no capability for process engineering – the theory, techniques, tools and training required to design processes are not on the curriculum of either the NHS managers or the clinicians. The effect of this defect is that we can only treat the symptoms rather than the cause – and we only have blunt and ineffective instruments such as a budget restriction – the management equivalent of a straight jacket – and budget cuts – the management equivalent of a jar of leeches. To illustrate the scale of the effect of this inborn error of management we only need to look at other organisations that do not appear to suffer from the same condition – for example the electronics manufacturing industry. The almost unbelieveable increase in the performance, quality and value for money of modern electronics over the last decade (mobile phones, digital cameras, portable music players, laptop computers, etc) is because these industries have invested in developing both their electrical and process engineering capabilities. The Law of the Jungle has weeded out the companies who did not – they have gone out of business or been absorbed – but publically funded service organisations like the NHS do not have this survival pressure – they are protected from it – and trying to simulate competition with an artificial internal market and applying stick-and-carrot top-down target-driven management is not a like-for-like replacement.

The challenge for the NHS is clear – if we want to continue to enjoy high quality health care, free at the point of delivery, and that we can afford then we will need to recognise and correct our inborn error of management. If we ignore the symptoms, deny the diagnosis and refuse to take the medicine then we will suffer a painful and lingering decline – not lethal and not enjoyable – and it is has a name: purgatory.

The good news is that the treatment is neither expensive, nor unpleasant nor dangerous – process engineering is easy to learn, quick to apply, and delivers results almost immediately – and it can be incorporated into the organisational meme-pool quite quickly by using the see-do-teach vector. All we have to do is to own up to the symptoms, consider the evidence, accept the diagnosis, recognise the challenge and take our medicine. The sooner the better!

11/12/2010

The Drama Triangle

Have you ever had the experience of trying to help someone with a problem, not succeeding, and being left with a sense of irritation, disappointment, frustration and even anger?

Was the dialog that led up to this unhappy outcome something along the lines of:

A: I have a problem with …
B: What about trying …
A: Yes, but ….
B: What about trying ….
A: Yes, but …

… and so on until you run out of ideas, patience or both.

If this sounds familiar then it is likely that you have been unwittingly sucked into a Drama Triangle – an unconscious, habitual pattern of behaviour that we all use to some degree.

This endemic behaviour has a hidden purpose: to feed our belonging need for social interaction.

The theory goes something like this – we are social animals and we need social interaction just as much as we need oxygen, water and food. Without it we become psychologically malnourished and this insight explains why prolonged solitary confinement is such an effective punishment – it is the psychological equivalent to starvation.

The emotional sustenance we want most is unconditional love (UCL) – the sort we usually get from our parents, family and close friends. Repeated affirmation that we are ‘OK’ with no strings attached.

The downside of our unconscious desire for UCL is that it offers a way for others to control our behaviour and those who choose to abuse that power are termed ‘manipulative’. This control is done by adding conditions: “I will give you the affirmation you crave IF you do what I want“. This is conditional love (CL).

When we are born we are completely powerless, and completely dependent on our parents – in particular our mother. As we get older and start to exert our free will we learn that our society has rules – we cannot just follow every selfish desire.

Our parents unconsciously employ CL as a form of behavioural control and it is surprisingly effective: “If you are a good boy/girl then …“. So, as children, we learn the technique from our parents.

This in itself is not a problem; but it can become a problem when CL is the only sort available and when the intention is to further only the interests of the giver. When this happens it becomes … manipulation.

The apparently harmless playground threat of “If you don’t do what I want then I won’t be your friend anymore” is the practice script of a future manipulator – and it feeds on a limiting-belief in the unconscious mind of the child – the belief that there is a limited supply of UCL and that someone else controls it.

And because we make this assumption at the pre-verbal stage of child development, it becomes unconscious, habitual, unspoken and second nature.

Our invalid childhood belief has a knock-on effect; we learn to survive on CL because “No Love” is the worst of all options; it is the psychological equivalent of starvation.

And we learn to put up with second best, and because CL offers inferior emotional nourishment we need a way of generating as much as we want, on-demand.

So we employ the behaviour we were unwittingly taught by our patents – and the Drama Triangle becomes our on-demand-generator-of-second-rate-emotional-sustenance.

The tangible evidence of this “programming” is an observable behaviour that is called “game playing” and was first described by Eric Berne in the famous book “Games People Play“.

Berne described many different Games and they all have a common pattern and a common objective – to generate second-rate emotional food (or ‘transactions’ to use Berne’s language). But our harvest comes at a price – the transactions are unhealthy – not enough to harm us immediately – but enough to leave us feeling dissatisfied and unhappy.

But what choice do we believe we have?

If we were given the options of breathing stale air or suffocating what would we do?

If we assume our options are to die of thirst or drink stagnant pond-water what would we do?

If we believe our only options are to starve or eat rubbish what would we do?

Our survival instinct is much stronger than our belonging need, so we choose unhealthy over deadly and eventually we become so habituated to game-playing that we do not notice it any more.

Excessive and prolonged exposure to the Drama Triangle is the psychological equivalent of alcoholic liver cirrhosis. Permanent and irreversible psychological scarring called cynicism.

It is important to remember that this is learned behaviour – and therefore it can be unlearned – or rather overwritten with a healthier habit.

Just by becoming aware of the problem, and understanding the root cause of the Drama Triangle, an alternative pathway appears.

We can challenge our untested assumption that UCL is limited and that someone else controls the supply. We can consider the alternative hypothesis: that the supply of UCL is unlimited and that we control the supply.

Q: How easy is it for us to offer someone else UCL?

Easy – we see it all the time. How do you feel when someone gives a genuine “Thank You”, cheers you on, celebrates your success, seeks your opinion, and recommends you to others – with no strings attached. These are all forms of UCL that anyone can practice; by making a conscious choice to give with no expectation of a return.

For many people it feels uncomfortable at first because the game-playing behaviour is so deeply ingrained – and game-playing is particularly prevalent in the corridors of power where it is called “politics”.

Game-free behaviour gets easier with practice because UCL benefits both the giver and the receiver – it feels healthier – there is no need for a payback, there is no score to be kept, no emotional account to balance. It feels like a breath of fresh air.

So, next time you feel that brief flash of irritation at the start of a conversation or are left with a negative feeling after a conversation just stop and ask yourself “Was I just sucked into a Drama Triangle?”

Anyone who is able to “press your button” is hooking you into a game, and it takes two to play.

Now consider the question “And to what extent was I unconsciously colluding?“

The tactic to avoid the Drama Triangle is to learn to sense the emotional “hook” that signals the invitation to play the Game; and to consciously deflect it before it embeds into your unconscious mind and triggers an unconscious, habitual, reflex, emotional reaction.

One of the most potent barriers to change is when we unconsciously compute that our previously reliable sources of CL are threatened by the change. We have no choice but to oppose the change – and that choice is made unconsciously. So, we unwittingly undermine the plan.

The symptoms of this unconscious behaviour are obvious when you know what to look for … and the commonest reaction is:

“Yes … but …”

and the more intelligent and invested the person the more cogent and rational the argument will sound.

The most effective response is to provide evidence that disproves the defensive assertion – not the person’s opinion – and before taking on this challenge we need to prepare the evidence.

By demonstrating that their game-playing behaviour no longer leads to the expected payoff, and at the same time demonstrating that game-free behaviour is both possible and better – we demonstrate that the underlying, unconscious, limiting belief is invalid.

And by that route we develop our capability for game-free social interactions.

Simple enough in theory, and it does works in practice, though it can be difficult to learn because game-playing is such an ingrained behaviour. It does get easier with practice and the ultimate reward is worth the investment – a healthier emotional environment. And that is transformational.

05/12/2010

Lies, Damned Lies and Statistics!

Most people are confused by statistics and because of this experts often regard them as ignorant, stupid or both. However, those who claim to be experts in statistics need to proceed with caution – and here is why.

The people who are confused by statistics are confused for a reason – the statistics they see presented do not make sense to them in their world. They are not stupid – many are graduates and have high IQ’s – so this means they must be ignorant and the obvious solution is to tell them to go and learn statistics. This is the strategy adopted in medicine: Trainees are expected to invest some time doing research and in the process they are expected to learn how to use statistics in order to develop their critical thinking and decision making. So far so good, so what is the outcome?

Well, we have been running this experiment for decades now – there are millions of peer reviewed papers published – each one having passed the scrutiny of a statistical expert – and yet we still have a health care system that is not delivering what we need at a cost we can afford. So, there must be someone else at fault – maybe the managers! They are not expected to learn or use statistics so that statistically-ignorant rabble must be the problem -so the next plan is “Beat up the managers” and “Put statistically trained doctors in charge”.

Hang on a minute! Before we nail the managers and restructure the system let us step back and consider another more radical hypothesis. What if there is something not right about the statistics we are using? The medical statistics experts will rise immediately and state “Research statistics is a rigorous science derived from first principles and is mathematically robust!” They are correct. It is. But all mathematical derivations are based on some initial fundamental assumptions so when the output does not seem to work in all cases then it is always worth re-examining the initial assumptions. That is the tried-and-tested path to new breakthroughs and new understanding.

The basic assumption that underlies research statistics is that all measurements are independent of each other which also implies that order and time can be ignored. This is the reason that so much effort, time and money is invested in the design of a research trial – to ensure that the statistical analysis will be correct and the conclusions will be valid. In other words the research trial is designed around the statistical analysis method and its founding assumption. And that is OK when we are doing research.

However, when we come to apply the output of our research trials to the Real World we have a problem.

How do we demonstrate that implementing the research recommendation has resulted in an improvement? We are outside the controlled environment of research now and we cannot distort the Real World to suit our statistical paradigm. Are the statistical tools we used for the research still OK? Is the founding assumption still valid? Can we still ignore time? Our answer is clearly “NO” because we are looking for a change over time! So can we assume the measurements are independent – again our answer is “NO” because for a process the measurement we make now is influenced by the system before, and the same system will also influence the next measurement. The measurements are NOT independent of each other.

Our statistical paradigm suddenly falls apart because the founding assumption on which it is built is no longer valid. We cannot use the statistics that we used in the research when we attempt to apply the output of the research to the Real World. We need a new and complementary statistical approach.

Fortunately for us it already exists and it is called improvement statistics and we use it all the time – unconsciously. No doctor would manage the blood pressure of a patient on Ward A based on the average blood pressure of the patients on Ward B – it does not make sense and would not be safe. This single flash of insight is enough to explain our confusion. There is more than one type of statistics!

New insights also offer new options and new actions. One action would be that the Academics learn improvement statistics so that they can understand better the world outside research; another action would be that the Pragmatists learn improvement statistics so that they can apply the output of well-conducted research in the Real World in a rational, robust and safe way. When both groups have a common language the opportunities for systemic improvment increase.

13/11/2010

How Do We Measure the Cost of Waste?

There is a saying in Yorkshire “Where there’s muck there’s brass” which means that muck or waste is expensive to create and to clean up.

Improvement science provides the theory, techniques and tools to reduce the cost of waste and to re-invest the savings in further improvement. But how much does waste cost us? How much can we expect to release to re-invest? The answer is deceptively simple to work out and decidedly alarming when we do.

We start with the conventional measurement of cost – the expenses – be they materials, direct labour, indirect labour, whatever. We just add up all the costs for a period of time to give the total spend – let us call that the stage cost. The next step requires some new thinking – it requires looking from the perspective of the job or customer – and following the path backwards from the intended outcome, recording what was done, how much resource-time and material it required and how much that required work actually cost. This is what one satisfied customer is prepared to pay for; so let us call this the required stream cost. We now just multiply the output or activity for the period of time by the required stream cost and we will call that the total stream cost. We now just compare the stage cost and the stream cost – the difference is the cost of waste – the cost of all the resources consumed that did not contribute to the intended outcome. The difference is usually large; the stream cost is typically only 20%-50% of the stage cost!

This may sound unbelieveable but it is true – and the only way to prove it to go and observe the process and do the calculation – just looking at our conventional finanical reports will not give us the answer. Once we do this simple experiment we will see the opportunity that Improvement Science offers – to reduce the cost of waste in a planned and predictable manner.

But if we are not prepared to challenge our assumptions by testing them against reality then we will deny ourselves that opportunity. The choice is ours.

One of the commonest assumptions we make is called the Flaw of Averages: the assumption that it is always valid to use averages when developing business cases. This assumption is incorrect. But it is not immediately obvious why it is incorrect and the explanation sounds counter-intuitive. So, one way to illustrate is with a real example and here is one that has been created using a process simulation tool – virtual reality:

06/11/2010

When Is Seeing Believing?

One of the problems with our caveman brains is that they are a bit slow. It may not feel that way but they are – and if you don’t believe me try this experiment: Stand up, get a book, hold it in your left hand open it at any page, hold a coin in your right hand between finger and thumb so that it will land on the floor when you drop it. Then close your eyes and count to three. Open your eyes, drop the coin, and immediately start reading the book. How long is it before you are consciously aware of the meaning of the words. My guess is that the coin hits the floor about the same time that you start to making sense of what is on the page. That means it takes about half a second to start perceiving what you are seeing. That long delay is a problem because the world around us is often changing much faster than that and, to survive, we need to keep up. So what we do is fill in the gaps – what we perceive is a combination of what we actually see and what we expect to see – the process is seamless, automatic and unconscious. And that is OK so long as expectation and reality stay in tune – but what happens when they don’t? We experience the “Eh?” effect which signals that we are temporarily confused – an uncomfortable and scary feeling which resolves when we re-align our perception with reality. Over time we all learn to avoid that uncomfortable confusion feeling with a simple mind trick – we just filter out the things we see that do not fit our expectation. Psychologists call this “perceptual distortion” and the effect is even greater when we look with our minds-eye rather than our real eyes – then we only perceive what we expect to see and we avoid the uncomfortable “Eh?” effect completely. This unconscious behaviour we all demonstrate is called self-delusion and it is a powerful barrier to improvement – because to improve we have to first accept that what we have is not good enough and that reality does not match our expectation.

To become a master of improvement it is necessary to learn to be comfortable with the “eh?” feeling – to disconnect it from the negative emotion of fear that drives the denial reaction and self-justifying behaviour – and instead to reconnect it to the positive emotion of excitement that drives the curiosity action and exploratory behaviour. One ewasy way to generate the “eh?” effect is to perform reality checks – to consciously compare what we actually see with what we expect to see. That is not easy because our perception is very slippery – we are all very,very good at perceptual distortion. A way around this is to present ourselves with a picture of realilty over time, using the past as a baseline, and our understanding of the system, we can predict what we believe will happen in the near future. We then compare what actually happens with our expectation. Any significant deviations are “eh?” effects that we can use to focus our curiosity – for there hide the nuggets of new knowledge. But how do we know what is a “signifcant” deviation? To answer that we must avoid using our slippery self-delusional perception system – we need a tool that is designed to do this interpretation safely, easily, and quickly. Click here for an example of such a tool.

23/10/2010

Will the Cuts Cure the Problem or Kill the Patient?

Times are hard. Severe austerity measures are being imposed to plug the hole in the national finances. Cuts are being made. But will these cuts cure the problem or kill the patient? How would we know before it is too late? Is there an alternative to sticking the fiscal knife in and hoping we don’t damage a vital part of the system? Is a single bold slash or a series of planned incisions a better strategy? How deep, how far and how fast is it safe to cut? The answer to these questions is “we don’t know” – or rather that we find it very hard to predict with confidence what will happen. The reason for this is that we are dealing with a complex system of interdependent parts that connect to each other through causal links; some links are accelerators, some are brakes, some work faster and some slower. Our caveman brains were not designed to solve this sort of predicting-the-future-behaviour-of-a-complex-system problem: our brains evolved to spot potential danger quickly and to manage a network of social relationships. So to our caveman way of thinking complex systems behave in counter-intuitive ways. However, all physical systems are constrained by the Laws of Nature – so if we don’t understand how they behave then the limitation is with the caveman wetware between our ears.

We do have an amazing skill though – we have the ability to develop tools that extend our limited biological capabilites. We have mastered technology – in particular the technology of data and information. We have learned how to recode and record our expereince and our understanding so that each generation can build on the knowledge of the previous ones. The tricky problems we are facing are ones that we have never encountered before so we have to learn as we go.

So our current problem of understanding the dynamics of our economic and social system is this: we cannot do this unconsciously and intuitively in our heads. Instead we have developed tools that can extend our predictive capability. Our challenge is to learn how to use these tools – how to wield the fiscal scalpel so that it is quick, safe and effective. We need to excise the cancer of waste while preserving our vital social and economic structures and processes. We need the best tools available – diagnostic tools, decision tools, treatment planning tools, and progress monitoring tools. These tools exist – we just need to learn to use them.

A perfect example of this is the reining in of public spending and the impact of cutting social service budgets. One thing that these budgets provide are services that some people need to maintain independent living in the community. Very often elderly people are only just coping and even a minor illness can be enough to tip them over the edge and into hospital – where they can get stuck because to discharge them safely requires extra social support – support that if provided earlier might have prevented a hospital admission. So boldly slashing the social care budget will not magically excise the waste – it means that there will be less social support capacity and patients will get stuck in the hospital part of the health and social care system. This is not good for them – or anyone else. Hospitals are not hotels and getting stuck in one is not a holiday! Hospitals are for people who are very ill – and if the hospital is full of not-so-ill people who are stuck then we have an even bigger problem – because the very ill people get even more ill – and then they need even more resources to get them well again. Some do not make it. A bold slash in just one part of the health and social care system can, unintentionally, bring the whole health and social care system crashing down.

Fortunately there is a way to avoid this – and it is counter-intuitive – otherwise we would have done it already. And because it is counter-intuitive I cannot just explain it – the only way to understand it is to discover and demonstrate it to ourselves. And in the process of learning to master the tools we need we will make a lot of errors. Clearly, we do not want to impose those errors on the real system – so we need something to practice with that is not the real system yet behaves realistically enough to allow us to develop our skills. That something is a system simulation. To experience an example of a healthcare system simulation and to play the game please follow the link: click here to play the game

25/09/2010

The Plague of Niggles

Historians tell us that in the Middle Ages about 25 million people, one third of the population of Europe, were wiped out by a series of Plagues! We now know that the cause was probably a bacteria called Yersinia Pestis that was spread by fleas when they bite their human hosts to get a meal of blood. The fleas were carried by rats and ships carried the rats from one country to another. The unsanitary living conditions of the ports and towns at the time provided the ideal conditions for rats and fleas and, with a superstitious belief that cats were evil, without their natural predator the population of rats increased, so the population of fleas increased, so the likehood of transmission of the lethal bacteria increased, and the number of people decreased. A classic example of a chance combination of factors that together created an unstable and deadly system.

The Black Death was not eliminated by modern hi-tech medicine; it just went away when some of the factors that fuelled the instability were reduced. A tangible one being the enforced rebuilding of London after the Great Fire in Sept 1666 which gutted the medieval city and which followed the year after the last Great Plague in 1665 that killed 20% of the population.

The story is an ideal illustration of how apparently trivial, albeit annoying, repeated occurences can ultimately combine and lead to a catastrophic outcome. I have a name for these apparently trivial, annoying and repeated occurences – I call them Niggles – and we are plagued by them. Every day we are plagued by junk mail, unpredictable deliveries, peak time traffic jams, car parking, email storms, surly staff, always-engaged call centres, bad news, bureaucracy, queues, confusion, stress, disappointment, depression. Need I go on? The Plague of Niggles saps our spirit just as the Plague of Fleas sucked our ancestors blood. And the Plague of Niggles infect us with a life-limiting disease – not a rapidly fatal one like the Black Death – instead we are infected with a slow, progressive, wasting disease that affects our attitude and behaviour and which manifests itself as criticism, apathy and cynicism. A disease that seems as terifying, mysterious and incurable to us today as the Plague was to our ancestors.

History repeats itself and we now know that complex systems behave in characteristic ways – so our best strategy may the same – prevention. If we use the lesson of history as our guide we should be proactive and focus our attention on the Niggles. We should actively seek them out; see them for what they really are; exercise our amazing ability to understand and solve them; and then share the nuggets of new knowledge that we generate.

Seek-See-Solve-Share.

18/09/2010

How to Kill an Organisation with a Budget.

The primary goal of an organisation is to survive – and to do that it must be financially viable. The income must meet or exceed the expenses; the bottom line must be zero or greater; your financial assets much equal or exceed your financial liabilities. So, organisations have to make financial plans to ensure finanical survival and as large organisations are usually sub-divided into smaller functional parts the common finanical planning tool is the departmental budget. We all know from experience that the future is not precisely predictable and that costs tend to creep up; and the budget is also commonly used as an expense containment tool. A perfectly reasonable strategy to help ensure survival. But by combining the two reasonable requirements intoi one tool have we unintentionally created a potentially lethal combination? The answer is “yes” – and this is why ….

The usual policy for a budget is to set the future budget based on the past performance. Perfectly reasonable. And to contain costs we say “if our expenses were less than our budget then we didn’t need the extra money and we can remove it from our budget for next year.” Very plausible. And was also say “if our expenses were more than our budget then we are suffering from cost-creep and the deficit is carried over to next year and our budget is not increased.” What do we observe? We observe pain! The first behaviour is that departments on track to underspend will try to spend the remainder of the budget by the end of the period to ensure the next budget is not reduced … they spend their reserves. The departments on track to overspend cut all the soft costs they can – such as not recruiting when people leave, buying cheap low quality supplies, cancelling training etc. The result is that teh departments that impose internal cuts will perform less well – because they do not have the capacity to do their work – and that has a knock on effect on other departments because the revenue generating work is usually crosses several departments. A constraint in just one will affect the flow through all of them. The combined result is a fall in throughput, a fall in revenue, more severe budget restrictions, and a self-reinforcing spiral of decline to organisational death! Precisely the opposite intention of the budget design.

If that is the disease then what is the root cause? What is the patholgy?

The problem here is the mismatch between the financial specification (budget available) and the financial capability (cost required). The solution is to recognise the importance of the difference. The first step is to set the budget specification to match the cost capability at each step along the process in order to stabilise the flow; the second step is to redesign the process to improve the cost capability and only reduce the budget when the process has been shown to be capable of working at a lower cost. This requires two skills: first to be able to work out the cost capability of every step in the process; and second to design-for-cost. Budgets do neither of these and without these skills a budget transforms from a useful management asset to lethal organisational liability!

11/09/2010

Do We have a Wealth of Data and a Dearth of Information?

Sustained improvement only follows from effective actions; which follow from well-informed decisions – not from blind guessing. A well-informed decision imples good information – and good information is not just good data. Good information implies that good data is presented in a format that is both undistorted and meaningful to the recipient. How we present data is, in my experience, one of the weakest links in the improvement process. We rarely see data presented in a clear, undistorted, and informative way and commonly we see it presented in a way that obscures or distorts our perception of reality. We are presented with partial facts quoted without context – so we unconsciously fill in the gaps with our own assumptions and prejudices and in so doing distort our perception further. And the more emotive the subject the more durable the memory that we create – which means it continues to distort our future perception even more.

The primary purpose of the news media is survival – by selling news – so the more emotive and memorable the news the better it sells. Accuracy and completeness can render news less attractive: by generating the “that’s obvious, it is not news” response. Catchy headlines sell news and to do that they need to generate a specific emotional reaction quickly – and that emotion is curiosity! Once alerted, they must hold the readers attention by quickly creating a sense of drama and suspense – like a good joke – by being just ambiguous enough to resonate with many different pepole – playing on their prejudices to build the emotional intensity.

The purpose of politicians is survival – to stay in power long enough to achieve their goals – so the less negative press they attract the better – but Politicians and the Press need each other because their purpose is the same – to survive by selling an idea to the masses – and to do that they must distort reality and create ambiguity. This has the unfortunate side effect of also generating less-than-wise decisions.

So if our goal is to cut through the emotive fog and get to a good decision quickly so that we can act effectively we need just the right data presented in context and in an unambiguous format that we, the decision-maker, can interpret quickly. The most accessible format is as a picture that tells a story – the past, the present and the likely future – a future that is shaped by the actions that come from the decisions we make in the present that we make using information from the past. The skill is to convert data into a story … and one simple and effective tool for doing that is a process behaviour chart.

29/08/2010

Now is When Infinity Becomes One

Time is an intangible – we can’t touch it, taste it, smell it, hear it or see it – yet we do sense it – and we know it is valuable. A precious commodity we call lifetime. We often treat lifetime as it if were tangible – something that we can see, hear, smell, taste and touch – something like money. We often hear the phrase “time is money” and we say things like “spending time” and “wasting time” – as if it were money. But time is not money; we cannot save time, we cannot buy time, and we all get the same amount of time per day to use.

Another odd thing about time is that we sense that it moves in one direction – from past to future with now as the transition. This creates an interesting discontinuity: if we look forward from now into the future we perceive an infinite number of possibilities; yet if we look backwards from now into the past we see only one actuality. That is really odd – Now is when Infinity becomes One.

So, how does that insight help us make a choice? Well, suppose we have decided what we want in the future and are now trying to make a choice of what to do next; to plan our route to our future desired goal. Looking from now forwards presents us with a very large number of paths to choose from, none of which we can be sure will lead us safely to where we want to get to. So what happens? We may become paralysed by indecision; we may debate and argue about which path to take; we may boldly step out on a plausible path with hope and courage; or we may just guess and stumble on with blind faith. Which we choose seems more a reflection of our personality than a rational strategy. So let us try something else – let us project ourselves into the future to the place where we want to be; and then let us look backwards in time from the future to the present. Now we see a single path that led to where we are; and by unpicking that path we can see that each step of it had a set of necessary and sufficient pre-conditions which, with the addition of time, moved us forward along the path. Hindsight is much clearer than foresight and each of us has a lifetime’s worth of hindsight to reflect on; and the cumulative hindsight of history to draw on. This is not an exercise in fantasy; we already have what we need.

To make our choice we start with the outcome we want and ask the question “What are the immediately preceeding necessary and sufficient conditions?” Then for each condition we ask the question “Does that condition already exist?” If so then we stop – we need go no further on this side branch; and if not then we repeat the Two Questions and we keep going until we have linked our goal back to pre-conditions that exist. All the pre-conditions in the map we have drawn are necessary but we do not yet have all of them. Some are only dependent on pre-conditions that exist – these are the important ones because they tell us exactly what to focus on doing next. Our choice is now obvious and simple – though the action may not be easy. No one said the journey would be easy!

31/07/2010

Can Chance make Us a Killer?

Imagine you are a hospital doctor. Some patients die. But how many is too many before you or your hospital are labelled killers? If you check out the BBC page

25/07/2010

What Happens if We Cut the Red Tape?

Later in his career, the famous artist William Heath-Robinson (1872-1944) created works of great ingenuity that showed complex inventions that were created to solve real everyday problems. The genius of his work was that his held-together-with-string contraptions looked comically plausible. This genre of harmless mad-inventorism has endured, for example as the eccentric Wallace and Grommet characters.

The problem arises when this seat-of-the-pants incremental invent-patch-and-fix approach is applied to real systems – in particular a healthcare system. We end up with the same result – a Heath-Robinson contraption that is held together with Red Tape.

The complex bureaucracy both holds the system together and clogs up the working – and everyone knows it. It is not harmless though – it is expensive, slow and lethal. How then do we remove the Red Tape to allow the machine to work more quickly, more safely and more affordably – without the whole contraption falling apart?

A good first step would be to stop adding yet more Red Tape. A sensible next step would be to learn how to make the Red Tap redundant before removing it. However, if we knew how to do that already we would not have let the Red Tapeworms infest our healthcare system in the first place! This uncomfortable conclusion raises some questions …

What insight, knowledge and skill are we missing?
Where do we need to look to find the skills we lack?
Who knows how to safely eliminate the Red Tapeworms?
Can they teach the rest of us?
How long will it take us to learn and apply the knowledge?
Why might we justify continuing as we are?
Why might we want to maintain the status quo?
Why might we ignore the symptoms and not seek advice?
What are we scared of? Having to accept some humility?

That doesn’t sound like a large price to pay for improvement!

17/07/2010

Is this just a Clash of Personality?

Have you ever have the experience of trying to work on a common challenge with a team member and it just feels like you are on different planets? You are using the same language yet are not communicating – they go off at apparently random tangents while you are trying to get a decision; they deluge you with detail when you ask about the big picture; you get upset when their cold logic threatens to damage team unity. The list is endless. If you experience this sort of confusion and frustration then you may be experiencing a personality clash – or to be more accurate a pyschological type mismatch.

Carl Jung described a theory of psychological types that was later developed into the Myers-Briggs Type Indictator (MBTI). This extensively validated method classifies people into sixteen broad groups based on four dimensions that are indicated by a letter code. It is important to appreciate that there are no good/bad types or right/wrong types – each describes a mode of thinking: a model of how we gather information, make decisions and act on those decisions. Everyone uses all the modes of thinking to some degree – we just prefer some more than others and so we get more practice with them. The purpose of MBTI is not to “correct” someone elses psychologcial type – it is to gain a conscious and shared awareness of the effect of psychological types on interpersonal and team dynamics. For example, some tasks and challenges suit some psychological types better than others – they resonate – and when this happens these tasks are achieved more easily and with greater satisfaction. “One’s meat is another’s poison” sums the idea up. Just having insight into this dynamic is helpful because it offers new options to avoid frustrating, futile and wasteful conflict. So if you are curious find out your MBTI – you can do it on line in a few minutes (for example http://www.personalitytest.net/types/index.htm) and with that knowledge you can learn what your psychological type implies. Mine is INFJ …

11/07/2010

Are we Stuck in a Toxic Emotional Waste Swamp?

Have you ever had the uncomfortable experience of joining a new group of people and discovering that your usual modus operandi does not seem to fit? Have you ever experienced the pain of a behavioural expectation mismatch – a clash of culture? What do we do when that happens? Do we keep quiet, listen and try to work out the expected behaviours by observing others and then mimic their behaviour to fit in? Do we hold our ground, stay true to our norms and habits and challenge the group? Do we just shrug, leave and not return?

The other side of this common experience is the effect on the group of a person who does not match the behavioural norms of the group. Are they regarded as a threat or an opportunity? Usually a threat. But a threat to whom? It depends. And it primarily depends on the emotional state of the chief, chair or boss of the group – the person who holds the social power. We are social animals and we have evolved over millions of years to be hard-wired to tune in to the emotional state of the pack leader – because it is a proven survival strategy!

If the chief is in a negative emotional state then the group will be too and a newcomer expressing a positive emotional outlook will create an emotional tension. People prefer leaders who broadcast a positive emotional state because it makes them feel happier; and leaders are attracted by power – so in this situation the chief will perceive a challenge to the balance of power and will react by putting the happy newcomer firmly in their place in the pecking order. The group observe the mauling and learn that a positive emotional attitude is an unsuccessful strategy to gain favour with the chief – and so the status quo is maintained. The toxic emotional waste swamp gets a bit deeper, the sides get a bit more slippery, and the emotional crocodiles who lurk in the murk get a tasty snack. Yum yum – that’ll teach you to be happy around here!

If the chief has a uniformly positive emotional approach then the group will echo that and a newcomer expressing a negative emotional state creates a different tension. The whole group makes it clear that this negative behaviour is unwelcome – they don’t want someone spoiling their cosy emotional oasis! And the status quo is maintained again. Unfortunately, the only difference between this and the previous example is that this only-happy-people-allowed-here group is drowning in emotional treacle rather than emotional turds. It is still an emotional swamp and the outcome is the same – you get stuck in it.

This either-or model is not a successful long-term strategy because it does not foster learning – it maintains the status quo – tough-minded or touch-feely – pessimistic or optimistic – but not realistic.

Effective learning only happens when the status quo is challenged in a way that respects both the power and authority of the chief and of the group – and the safest way to do that is to turn to reality for feedback and to provide the challenge to the group. To do this in practice requires a combination of confidence and humility by both the chief and the group: the confidence to reject complacency and to face up to reality and the humility to employ what is discovered to keep moving on, to keep learning, to keep improving.

Reality will provide both positive and negative feedback (“Nuggets” and “Niggles”) and the future will hold both positive and negative challenges (“Nice-Ifs” and “Noo-Noos”). Effective leaders know this and are able to maintain the creative tension. For those of us who are learning to be more effective leaders perhaps the routes out of our Toxic Emotional Waste Swamps are drawn on our 4N charts?

27/06/2010

Can an Old Dog learn New Tricks?

I learned a new trick this week and I am very pleased with myself for two reasons. Firstly because I had the fortune to have been recommended this trick; and secondly because I had the foresight to persevere when the first attempt didn’t work very well. The trick I learned was using a webinar to provide interactive training. “Oh that’s old hat!” I hear some of you saying. Yes, teleconferencing and webinars have been around for a while – and when I tried it a few years ago I was disappointed and that early experience probably raised my unconscious resistance. The world has moved on – and I hadn’t. High-speed wireless broadband is now widely available and the webinar software is much improved. It was a breeze to set up (though getting one’s microphone and speakers to work seems a perennial problem!). The training I was offering was for the BaseLine process behaviour chart software – and by being able to share the dynamic image of the application on my computer with all the invitees I was able to talk through what I was doing, how I was doing it and the reasons why I was doing it. The immediate feedback from the invitees allowed me to pace the demonstration, repeat aspects that were unclear, answer novel queries and to demonstrate features that I had not intended to in my script. The tried and tested see-do-teach method has been reborn in the Information Age and this old dog is definitely wagging his tail and looking forward to his walk in the park (and maybe a tasty treat, huh?)

12/05/2010

How might some people be offended by performance charting?

Some fabulous new SPC software, called BaseLine© is now available – it’s designed for organizations and individuals who see the advantages in having people use a standard performance charting tool that’s statistically robust yet straight forward to use even for the uninitiated. As well as being highly accessible, at under £50 it is easily the most inexpensive option now available.

There is even a time-unlimited FREE version.

How might some people be offended by performance charting?

The idea behind BaseLine© is that most every organisation is these days awash with time-series data, usually held in spreadsheet form, yet very little of it is used to diagnose systemic change. Even people who are held accountable for performance are often unaware of the gold that lies beneath their feet – or if they are aware, are for some reason reluctant to make use of it. Because BaseLine© is so accessible – there really is no longer any reason to avoid using SPC, but wait ..

.. observing those who are taking the plunge it’s becoming clearer to me where this reluctance might be coming from. Whilst some of it is due undoubtedly to low organisational expectation, I’m detecting that some of it is also due to low self-perception of capability, and some might even be because BaseLine© somehow confronts the personal value-set of particular managers. Let me refer to these value sets and capabilities as “memes”(1) and allow myself the luxury of speculatively labelling each one – so that I can treat each as a hypothesis that might later be tested – to see if the accumulating evidence either supports or refutes it. So here goes ..

1. The “Accountability-avoidance” meme – Those comfortable and skilled enough to hold a senior position may still however be inhabited by this meme, which can actually apply at any level in an organisational hierarchy. To most people it is an essential underpinning of their self-esteem to be able to feel that they’ve personally made a contribution whilst at work. It’s safer therefore (at least unconsciously) to be able to avoid roles for which any direct or personal performance measurement is attached – and there are plenty of such roles.
2. The “anti-Management” meme – According to this meme there’s something dehumanising about asking anyone to manage a process that delivers an outcome to someone who might appreciate it. Those who embody this value-set may also think that Management sounds altogether too boring when compared to Leadership since not much good happens unless people can feel good about it, and people have to be led to achieve anything meaningful and lasting. If there’s any management to be done it should be done by the followers.
3. The “anti-Control freak” meme – People holding this meme tend to dislike the whole idea of control, unless it’s the empowering of others to be in control – and even this may be considered too dangerous since the power to control anything can so easily be abused.
4. The “anti-Determinism” meme – Inside this meme Albert Einstein is considered as having completely supplanted the Newtonian “predict and control paradigm” as opposed to having merely built upon it. Life is viewed as inherently uncertain, and there’s a preference for believing that little can be reliably predicted, so it’s best to adopt an “act first/ ask questions later” approach. Deepak Chopra fans for example will know that “the past is history, and the future a mystery” and that therefore almost any form of planning is repellent – instead, emergence is the thing most highly valued.
5. The “Numerophobia” meme – so widespread is the tendency to avoid numbers, it may be easier to think of this as a syndrome rather than a meme – indeed, in the extreme it is a medical condition called “dyscalculia.” Whilst few people readily admit to being illiterate, there are many who are relatively happy to announce that they “don’t do numbers” – and some have even learned that it pays to be proud of it. In one recent UK study 11% were designated illiterate, but 40% innumerate.
6. The “iNtuitives rule” meme – People who are inhabited by this meme are those who may well feel comfortable weaving (even spinning) their story without the benefit of data that’s been fully “sensed”. The Myers Briggs Type Indicator – scores around 25% of people as N (iNtuitive), the remaining 75% being Sensors – who prefer to look for and absorb data via their 5 senses, data that to them feels tangibly “real.” On average around 12% people score as having N/T (intuitive thinking) preferences – yet exec teams & boards often score at more than 50%. Is this because they have had to become comfortable feeling disconnected from the customer interface, or because they were always that way inclined and therefore gravitated towards the apex of the hierarchy?
7. The “anti-Science” meme – According to this meme even the fact that I’m labelling these value-sets/ memes at all, will be seen as being antithetical – regardless of whether it might in some way prove to be a useful scientific device for advancing knowledge. People in organisations may behave in a way that’s anti-science in that tasks and projects are typically carried out in a Plan-Do-Review sequence – unaware that Plan-Do-Study-Act represents the scientific method in action, and is an entirely different paradigm.
8. the “protect my group or profession” meme – According to this meme, people are confident that they know what they know – and have spent several years of their life being trained to acquire that knowledge. They less aware of the extent to which this has formed their mental maps and how these in turn direct their opinions. When in doubt, reference is made to the writings and utterances of their personal or professional gurus – and quoted verbatim, frequently out of context. When a new tool arrives, the default position is: if I don’t recognise it, it should be rejected – until one of the gurus authenticates it.

Wow, when I started the list I didn’t think there would be as many as eight.

Individuals and organizations that are already, or can become, comfortable with applying the scientific method in their organisations – and personally – as a system, will see the profundity in a tool like BaseLine©. Others will miss it altogether, and one or more of the memes listed above could be preventing them seeing it. I’ll continue to collect more data, both sensed and intuited, and report on my findings in a future blog.

One source of test data will of course be the comments I solicit from readers of this blog, so having read these labels and descriptions, do you notice any reactive feelings? If so, can you accurately describe what you feel most confronted by? I’d be delighted to hear from you.

(1) Richard Dawkins coined (or adapted) the word “meme” in The Selfish Gene (1976) as a value set, or a postulated unit of cultural ideas, symbols or practices – which can be transmitted from one mind to another through writing, speech, gestures, rituals or other imitable phenomena. It’s sometimes used synonymously with the phrase “world view.” Clare Graves then made the Value meme (vMeme) a core concept in his Spiral Dynamics model – see Beck D.E & Cowan C.C. : “Spiral Dynamics – Mastering Values, Leadership, and Change” – 1996

25/04/2010

Can We See a Story in the Data?

I often hear the comments “I cannot see the wood for the trees”, “I am drowning in an ocean of data” and “I cannot identify the cause of the problem”. We have data, we know there is a problem and we sense there is a soluton; the gap seems to be using the data to find a solution to the problem.

Most quantitative data is presented as tables of columns and rows of numbers; and is indigestable by the majority of people. Numbers are a recent invention on a biological timescale and we have not yet evolved to effortlessly process data presented in that format. We are visual animals and we have evolved to be very good at seeing patterns in pictures – because it was critical to survival. Another recent invention is spoken language and, long before writing was invented, accumulated knowledge and wisdom was passed down by word of mouth as legends, myths and stories. Stories are general descriptions that suggest specific solutions. So why do we have such difficulty in extracting the story from the data? Perhaps it is because we use our ears to hear stories that are communicated in words and we use our eyes to see patterns in pictures. Presenting quantitative data as streams of printed symbols just doesn’t work as well. To see the story in the data we need to present it as a picture and then talk about what we perceive.

Here are some data – a series of numbers recorded over a period of time – what is the story?

47, 55, 40, 52, 55, 70, 60, 43, 51, 41, 73, 73, 79, 89, 83, 86, 78, 85, 71, 70

Here is the same data converted into a picture. You can see the message in the data … something changed between measurement 10 and 11. The chart does not tell us why it changed – it only tells us when it happened and sugegsts what to look for – anything that is capable of causing the effect we can see. We now have a story and our curiosity is aroused. We want an explanation; we want to understand; we want to learn; and we want to improve. (For source of data and image visit www.valuesystemdesign.com).

A picture can save a thousand words and ten thousand numbers!

10/04/2010

Are your Targets a Pain in the #*&!?

If your delivery time targets are giving you a pain in the #*&! then you may be sitting on a Horned Gaussian and do not realise it. What is a Horned Gaussian? How do you detect one? And what causes it? To establish the diagnosis you need to gather the data from the most recent couple of hundred jobs and from it calculate the interval from receipt to delivery. Next create a tally chart with Delivery Time on the vertical axis and Counts on the horizontal axis; mark your Delivery Time Target as a horizontal line about two thirds of the way up the vertical axis; draw ten equally spaced lines between it and the X axis and five more above the Target. Finally, sort your delivery times into these “bins” and look at the profile of the histogram that results. If there is a clearly separate “hump” and “horn” and the horn is just under the target then you have confirmed the diagnosis of a Horned Gaussian. The cause is the Delivery Time Target, or more specifically its effect on your behaviour. If the Target is externally imposed and enforced using either a reward or a punishment then when the delivery time for a request approaches the Target, you will increase the priority of the request and the job leapfrogs to the front of the queue, pushing all the other jobs back. The order of the jobs is changing and in a severe case the large number of changing priorities generates a lot of extra work to check and reschedule the jobs. This extra work exacerbates the delays and makes the problem worse, the horn gets taller and sharper, and the pain gets worse. Does that sound a familiar story? So what is the treatment? Well, to decide that you need to create a graph of delivery times in time order and look at the pattern (using charting tool such as BaseLine© www.valuesystemdesign.com makes this easier and quicker). What you do depends on what the chart says to you … it is the Voice of the Process. Improvement Science is learning to understand the voice of the process.

27/03/2010

Am I in a Battle or a Race?

Do you see the challenges that Life presents to you as a series of fight-to-the-death battles or a series of stretch-for-the-finish races? Why does it matter which approach you choose? After all, each has a winner and a loser. Yes, one wins relative to other – but what is the absolute cost for both? The doodle illustrates the point visually. In a Battle you are in opposition and your effort, time and money are spent and dissipated against each other. The strong/angry/big will prevail over the weak/timid/small though when the protagnoists are closely matched the outcome takes longer to decide and costs more in absolute terms for both. One will eventually win while both are weakened from the effort, time and money that is spent. Contrast this with the race; the investment on both sides is in preparing for the race; in learning, training, and improving. On the day of the race the more fit/focussed/skilled competitor will win yet both are strengthened from the invested effort, time and money. In a race the more closely you are matched the more you both improve and get stronger and the quicker the outcome is decided. Exactly the opposite of the battle. It appears that Life will present us with enough new challenges to keep us occupied for the forseeable future; and to rise to those challenges will require that we all learn, train, and practice so that we have the strength, skills and stamina for the challenges we will encounter and cannot yet see. So, it seems to me to be suicidal to choose to battle with each other and to waste our limited resources of effort, time and money to the point where we are all too weak to survive the inevitable challenges that are over the horizon. So how would you know which approach you are using? Well, your feelings are more often sadness, anger or fear then you are probably using the battle metaphor; if in contrast they are feelings of confidence, determination and excitement then you probably see yourself in a race. The choice is yours.

20/03/2010

Anyone Heard of Henry Gantt?

Most managers have heard of Gantt charts and associate them with project management where they are widely used to help coordinate the separate threads of work so that the project finishes on time.

How many know about the man who invented them and why?

Henry Laurence Gantt (1861-1919) was an engineer and he invented the chart for a very different purpose – so that the workers and the managers could see at a glance the progress of the work and to see what was impairing the flow. Decades before the invention of the computer, Henry Gantt created a simple and incredibly powerful visual tool for enabling workers and managers to improve processes together.

I know how simple and powerful the original Gantt chart is because I use it all the time for capturing the behaviour of a process in a visual form that stimulates constructive conversations which result in win-win-win improvements. All you need is some squared paper, a pencil, a clock, a Mark I Eyeball or two, and a bit of practice.

13/02/2010

What Blocks Improvement?

My focus this week has been to ask the question “What blocks improvement?”. The answers that I found most interesting were “I didn’t realise there was a problem.” and “I feel there is a problem but I don’t know where to focus my attention.” This set me pondering and eventually I had a bit of an “eureka” moment. It isn’t something that is present that creates this blindness – it is something that is missing. And the only way you can see what isn’t there is by comparison with when it is there – just like the game of “Spot the Difference”. When I compared what I saw with what I know is possible the thing I didn’t see was a fast-feedback loop. Hence the doodle. It appears that there are at least four dimensions to feedback – sign, magnitude, accuracy and timing. The speed of the feedback needs to be appropriate to the speed of the improvement; so if we want rapid improvement we need a fast-and-accurate feedback loop – a learning loop. A slow or inaccurate learning loop not only doesn’t work – it can actually make the problem worse. So, my take-home this week is to actively search for the learning loops and if I don’t see one then I have something to focus on improving.

04/02/2010

What do you do when you don’t know what to do?

One of the scariest feelings I experience is when I am asked “What should we do?” or “What would you do?” and there is an expectation that I should know what to do … and I don’t.

Do I say “I don’t know” or do I play for time and spout some b*****t and hope my lack of knowledge is not exposed?

Reflecting on this uncomfortable, and oft repeated, experience I am led to some questions:

1. Where does the expectation come from? The person asking, myself or both?

2. Where does the feeling of fear come from? What am I scared of? Who am I scared of?

Pondering these questions I have the fleeting impression that my fear comes from me. I am afraid of disappointing myself. It is me that I am scared of.

Then the impression is replaced by a conscious process of looking for evidence that proves that it can’t be me – it must be someone else making me feel scared – and to feel better I have to shift the blame from myself.

Oooooo … that’s a bit of an “Eureka” moment!

And now I have a new option. Choose to behave like of a victim of myself and shift the blame; or choose to address the problem – my deep fear of part of myself.

Phew! I feel better already – I have a new opportunity to explore …