Posts

Posted on

Doing Our Way to New Thinking.

Most of our thinking happens out of awareness – it is unconscious. Most of the data that pours in through our senses never reaches awareness either – but that does not mean it does not have an impact on what we remember, how we feel and what we decide and do in the future. It does.

Improvement Science is the knowledge of how to achieve sustained change for the better; and doing that requires an ability to unlearn unconscious knowledge that blocks our path to improvement – and to unlearn selectively.

So how can we do that if it is unconscious? Well, there are  at least two ways:

1. Bring the unconscious knowledge to the surface so it can be examined, sorted, kept or discarded. This is done through the social process of debate and discussion. It does work though it can be a slow and difficult process.

2. Do the unlearning at the unconscious level – and we can do that by using reality rather than rhetoric. The easiest way to connect ourselves to reality is to go out there and try doing things.

When we deliberately do things  we are learning unconsciously because most of our sensory data never reaches awareness.  When we are just thinking the unconscious is relatively unaffected: talking and thinking are the same conscious process. Discussion and dialog operate at the conscious level but differ in style – discussion is more competitive; dialog is more collaborative. 

The door to the unconscious is controlled by emotions – and it appears that learning happens more effectively and more efficiently in certain emotional states. Some emotional states can impair learning; such as depression, frustration and anxiety. Strong emotional states associated with dramatic experiences can result in profound but unselective learning – the emotionally vivid memories that are often associated with unpleasant events.  Sometimes the conscious memory is so emotionally charged and unpleasant that it is suppressed – but the unconscious memory is not so easily erased – so it continues to influence but out of awareness. The same is true for pleasant emotional experiences – they can create profound learning experiences – and the conscious memory may be called an inspirational or “eureka” moment – a sudden emotional shift for the better. And it too is unselective and difficult to erase.

An emotionally safe environment for doing new things and having fun at the same time comes close to the ideal context for learning. In such an enviroment we learn without effort. It does not feel like work – yet we know we have done work because we feel tired afterwards.  And if we were to record the way that we behave and talk before the doing; and again afterwards then we will measure a change even though we may not notice the change ourselves. Other people may notice before we do – particularly if the change is significant – or if they only interact with us occasionally.

It is for this reason that keeping a personal journal is an effective way to capture the change in ourselves over time.  

The Jungian model of personality types states that there are three dimensions to personality (Isabel Briggs Myers added a fourth later to create the MBTI®).

One dimension describes where we prefer to go for input data – sensors (S) use external reality as their reference – intuitors (N) use their internal rhetoric.

Another dimension is how we make decisions –  thinkers (T) prefer a conscious, logical, rational, sequential decision process while feelers (F) favour an unconscious, emotional, “irrational”, parallel approach.

The third dimension is where we direct the output of our decisions – extraverts (E) direct it outwards into the public outside world while intraverts (I) direct it inwards to their private inner world.

Irrespective of our individual preferences, experience suggests that an effective learning sequence starts with our experience of reality (S) and depending how emotionally loaded it is (F) we may then internalise the message as a general intuitive concept (N) or a specific logical construct (T).

The implication of this is that to learn effectively and efficiently we need to be able to access all four modes of thinking and to do that we might design our teaching methods to resonate with this natural learning sequence, focussing on creating surprisingly positive reality based emotional experiences first. And we must be mindful that if we skip steps or create too many emotionally negative experiences we we may unintentionally impair the effectiveness of the learning process.

A carefully designed practical exercise that takes just a few minutes to complete can be a much more effective and efficient way to teach a profound principle than to read libraries of books or to listen to hours of rhetoric.  Indeed some of the most dramatic shifts in our understanding of the Universe have been facilitated by easily repeatable experiments.

Intuition and emotions can trick us – so Doing Our Way to New Thinking may be a better improvement strategy.

Posted on

Three Blind Men and an Elephant

The Blind Men and the Elephant Story   – adapted from the poem by John Godfrey Saxe.

 “Three blind men were discussing exactly what they believed an elephant to be, since each had heard how strange the creature was, yet none had ever seen one before. So the blind men agreed to find an elephant and discover what the animal was really like. It did not take the blind men long to find an elephant at a nearby market. The first blind man approached the animal and felt the elephant’s firm flat side. “It seems to me that an elephant is just like a wall,” he said to his friends. The second blind man reached out and touched one of the elephant’s tusks. “No, this is round and smooth and sharp – an elephant is like a spear.” Intrigued, the third blind man stepped up to the elephant and touched its trunk. “Well, I can’t agree with either of you; I feel a squirming writhing thing – surely an elephant is just like a snake.” All three blind men continued to argue, based on their own individual experiences, as to what they thought an elephant was like. It was an argument that they were never able to resolve. Each of them was concerned only with their own experience. None of them could see the full picture, and none could appreciate any of the other points of view. Each man saw the elephant as something quite different, and while each blind man was correct they could not agree.”

The Elephant in this parable is the NHS and the three blind men are Governance, Operations and Finance. Each is blind because he does not see reality clearly – his perception is limited to assumptions and crippled by distorted data. The three blind men cannot agree because they do not share a common understanding of the system; its parts and its relationships. Each is looking at a multi-dimensional entity from one dimension only and for each there is no obvious way forward. So while they appear to be in conflict about the “how” they are paradoxically in agreement about the “why”. The outcome is a fruitless and wasteful series of acrimonious arguments, meaningless meetings and directionless discussions.  It is not until they declare their common purpose that their differences of opinion are seen in a realistic perspective and as an opportunity to share and to learn and to create an collective understanding that is greater than the sum of the parts.

Posted on

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.

Posted on

Reality trumps Rhetoric

One of the biggest challenges posed by Improvement is the requirement for beliefs to change – because static beliefs imply stagnated learning and arrested change.  We all display our beliefs for all to hear and see through our language – word and deed – our spoken language and our body language – and what we do not say and do not do is as important as what we do say and what we do do.  Let us call the whole language thing our Rhetoric – the external manifestation of our internal mental model.

Disappointingly, exercising our mental model does not seem to have much impact on Reality – at least not directly. We do not seem to be able to perform acts of telepathy or telekinesis. We are not like the Jedi knights in the Star Wars films who have learned to master the Force – for good or bad. We are not like the wizards in the Harry Potter who have mastered magical powers – again for good or bad. We are weak-minded muggles and Reality is spectacularly indifferent to our feeble powers. No matter what we might prefer to believe – Reality trumps Rhetoric.

Of course we can side step this uncomfortable feeling by resorting to the belief of One Truth which is often another way of saying My Opinion – and we then assume that if everyone else changed their belief to our belief then we would have full alignment, no conflict, and improvement would automatically flow.  What we actually achieve is a common Rhetoric about which Reality is still completely indifferent.  We know that if we disagree then one of us must be wrong or rather un-real-istic; but we forget that even if we agree then we can still both be wrong. Agreement is not a good test of the validity of our Rhetoric. The only test of validity is Reality itself – and facing the unfeeling Reality risks bruising our rather fragile egos – so we shy away from doing so.

So one way to facilitate improvement is to employ Reality as our final arbiter and to do this respectfully.  This is why teachers of improvement science must be masters of improvement science. They must be able to demonstrate their Improvenent Science Rhetoric by using Reality and their apprentices need to see the IS Rhetoric applied to solving real problems. One way to do this is for the apprentices to do it themselves, for real, with guidance of an IS master and in a safe context where they can make errors and not damage their egos. When this is done what happens is almost magical – the Rhetoric changes – the spoken language and the body language changes – what is said and what is done changes – and what is not said and not done changess too. And very often the change is not noticed at least by those who change.  We only appear to have one mental model: only one view of Reality so when it changes we change.

It is also interesting to observe is that this evolution of Rhetoric does not happen immediately or in one blinding flash of complete insight. We take small steps rather than giant leaps. More often the initial emotional reaction is confusion because our experience of the Reality clashes with the expectation of our Rhetoric.  And very often the changes happen when we are asleep – it is almost as if our minds work on dissolving the confusion when it is not distracted with the demands of awake-work; almost like we are re-organising our mental model structure when it is offline. It is a very common to have a sleepless night after such an Reality Check and to wake with a feeling of greater clarity – our updated mental model declaring itself as our New Rhetoric. Experienced facilitators of Improvement Science understand this natural learning process and that it happens to everyone – including themselves. It is this feeling of increased clarity, deeper understanding, and released energy that is the buzz of Improvement Science – the addictive drug.  We learn that our memory plays tricks on us; and what was conflict yesterday becomes confusion today and clarity tomorrow. One behaviour that often emerges spontaneously is the desire to keep a journal – sometimes at the bedside – to capture the twists and turns of the story of our evolving Rhetoric.

This blog just such a journal.

Posted on

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?

You can do that here.

For more posts like this please vote here.
For more information please subscribe here.

Posted on

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

Posted on

Lub-Hub Lub-Hub Lub-Hub

If you put an ear to someones chest you can hear their heart “lub-dub lub-dub lub-dub”. The sound is caused by the valves in the heart closing, like softly slamming doors, as part of the wonderfully orchestrated process of pumping blood around the lungs and body. The heart is an impressive example of bioengineering but it was not designed – it evolved over time – its elegance and efficiency emerged over a long journey of emergent evolution.  The lub-dub is a comforting sound – it signals regularity, predictability, and stabilty; and was probably the first and most familiar sound each of heard in the womb. Our hearts are sensitive to our emotional state – and it is no accident that the beat of music mirrors the beat of the heart: slow means relaxed and fast means aroused.

Systems and processes have a heart beat too – but it is not usually audible. It can been seen though if the measures of a process are plotted as time series charts. Only artificial systems show constant and unwavering behaviour – rigidity –  natural systems have cycles.  The charts from natural systems show the “vital signs” of the system.  One chart tells us something of value – several charts considered together tell us much more.

We can measure and display the electrical activity of the heart over time – it is called an electrocardiogram (ECG) -literally “electric-heart-picture”; we can measure and display the movement of muscles, valves and blood by beaming ultrasound at the heart – an echocardiogram; we can visualise the pressure of the blood over time – a plethysmocardiogram; and we can visualise the sound the heart makes – a phonocardiogram. When we display the various cardiograms on the same time scale one above the other we get a much better understanding of how the heart is behaving  as a system. And if we have learned what to expect to see with in a normal heart we can look for deviations from healthy behaviour and use those to help us diagnose the cause.  With experience the task of diagnosis becomes a simple, effective and efficient pattern matching exercise.

The same is true of systems and processes – plotting the system metrics as time-series charts and searching for the tell-tale patterns of process disease can be a simple, quick and accurate technique: when you have learned what a “healthy” process looks like and which patterns are caused by which process “diseases”.  This skill is gained through Operations Management training and lots of practice with the guidance of an experienced practitioner. Without this investment in developing knowlewdge and understanding there is a high risk of making a wrong diagnosis and instituting an ineffective or even dangerous treatment.  Confidence is good – competence is even better.

The objective of process diagnostics is to identify where and when the LUBs and HUBs appear are in the system: a LUB is a “low utilisation bottleneck” and a HUB is a “high utilisation bottleneck”.  Both restrict flow but they do it in different ways and therefore require different management. If we confuse a LUB for a HUB and choose the wrong treatent we can unintentionally make the process sicker – or even kill the system completely. The intention is OK but if we are not competent the implementation will not be OK.

Improvement Science rests on two foundations stones – Operations Management and Human Factors – and managers of any process or system need an understanding of both and to be able to apply their knowledge in practice with competence and confidence.  Just as a doctor needs to understand how the heart works and how to apply this knowledge in clinical practice. Both technical and emotional capability is needed – the Head and the Heart need each other.                          

Posted on

Intention-Decision-Action

Many of us use the terms “effective” and “efficient” and we assume that if we achieve both at the same time then we can call it “success”. They are certainly both necessary but are they sufficient? If they were then every process that was both effective (zero mistakes) and efficient (zero waste) would be hailed a success. This is our hypothesis and to disprove it we only need one example where it fails. Let us see if we can find one in our collective experience.

Threats focus our attention more than opportunities. When our safety is at risk it is a sensible strategy to give the threat our full attention – and our caveman wetware has a built-in personal threat management system: it is called the Fright, Flight, Fight response. The FFF is coordinated by the oldest, most unconscious bits of our wetware and we know it as the fast heart, dry mouth, cold sweat reaction – or adrenalin rush. When we perceive a threat we are hard-wired to generate the emotion called fear, and this tells us we need to make a decision between two actions: to stand our ground or to run away. The decision needs to be made quickly because the outcome of it may determine our survival – so we need a quick, effective and efficient way to do it. If we choose to “fight” then another emotion takes over – anger – and it hijacks our rationality: arguments, fights, battles and wars are all tangible manifestations of our collective reaction – and when the conditions are just right even a single word or action may be perceived as a threat and trigger an argument, then a fight, then a battle, then a war – a classic example of a positive feedback loop that can literally explode into an unstoppable orgy of death and destruction.

Can we measure the “success” of our hard-wired FFF system: let us consider the outcome of a war – a winner and a loser; and let us also count the cost of a war – lots of valuable resources consumed and lots of dead people on both sides. Wars inflict high costs on both sides and the “loser” is the one who loses most – the winner loses too – just less. But is it all negative? If it were then no one would ever do it – so there must be some tangible benefit. When the sides are unequally matched the victor can survive the losses and can grow from “absorbing” what remains of the loser. This is the dog-eat-dog world of survival of the strongest and represents another positive feedback loop – he who has most takes more.

Threats focus our attention and if we are not at immediate risk then they can also stimulate our creativity – and what is learned in the process of managing a threat can be of lasting value after the threat has passed.  Many of the benefits we enjoy today were “stimulated” by the threats in WWII – for example: digital computers were invented to assist making ballistics calculations and for breaking enemy secret codes. Much of the theory, techniques and tools of Improvement Science were developed during WWII to increase the productivity of weapons-of-war creation – and they have been applied more constructively in peacetime.  Wars are created by people and the “great” warriors create the most effective and efficient lose-lose processes. Using threats to drive creativity is a low-productivity design – ee can do much better than that – surely?

So, our experience suggests that effectiveness and efficiency are not enough – there seems to be a piece missing – and this piece is “intention”. Our Purpose.  This insight explains why asking the “What is our purpose?” question is so revealing:  if you do not get a reply it is likely that your audience is seeing challenge as a battle – and the First Rule of War is never to reveal your intention to your enemy – so their battle metaphor prevents them from answering honestly. If you do get an answer it is very often a “to do” answer rather than a “to get” one – unconsciously masking purpose with process and side-stepping the issue.  Their language gives it away though – processes are flagged by verbs, purposes are flagged by nouns – so if you listen to what they say then you can tell.  The other likely answer is a question: not a question for clarification, a question for deflection and the objective is more threat-assessment data and more thinking and preparation time.

If the answer to the Purpose Question is immediate, an outcome, and positive then the respondent is not using a war meta-program; they do not view the challenge as a threat and they do see a creative opportunity for improvement – they see it as a Race. Their intention is improvement for all on all dimensions: quality, delivery and money – and they recognise that healthy competition can be good for both. Do not be fooled – they are neither weak not stupid – if they perceive a safety threat they will deploy all their creative resources to eliminate it.

One of the commonest errors of commission is to eliminate healthy competition; which is what happens when we have not learned how to challenge with respect: we have let things slip to the point that we are forced to fight or flee. We have not held ourselves to account and we have not learned to ask the ourselves “What is my purpose?” People need to have a purpose to channel their effectivess and efficiency – and processes also need a purpose because socio-economic systems are the combination of people and processes.

The purpose for any socioeconomic system is the generic phrase “right-thing, right-place, right-price, on-time, first-time, every-time” and is called the system goal.  The purpose of a specific process or person within that system will be aligned to the goal and there are two parts to this: the “right-” parts which are a matter of subjectivity and the “-time” parts which are a matter of objectivity. The process must be designed to deliver the objectives – and before we know what to do we must understand how to decide what to do; and before we know how to decide we must have the wisdom and courage to ask the question and to state our purpose. Intention – Decision – Action.

Posted on

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.

Posted on

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.

Posted on

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.

Posted on

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

Posted on

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. Share 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

Posted on

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!

           

Posted on

Where is the Rotten Egg?

Have you ever had the experience of arriving home from a holiday – opening the front door and being hit with the rancid smell of something that has gone rotten while you were away.

Phwooorrrarghhh!

When that happens we open the windows to let the fresh-air blow the smelly pong out and we go in search of the offending source of the horrible whiff. Somewhere we know we will find the “rotten egg” and we know we need to remove it because it is now beyond repair.

What happened here is that our usual, regular habit of keeping our house clean was interrupted and that allowed time for something to go rotten and to create a nasty stink. It may also have caused other things to go rotten too – decay  spreads. Usually we maintain an olfactory vigilance to pick up the first whiff of a problem and we act before the rot sets in – but this only works if we know what fresh air smells like, if we remove the peg from our nose, and if we have the courage to remove all of the rot. Permfuing the pig is not an effective long term strategy.

The rotten egg metaphor applies to organisations. The smell we are on the alert for is the rancid odour of a sour relationship, the signal we sense is the dissonance of misery, and the behaviours we look for are those that erode trust. These behaviours have a name – they are called discounts – and they come in two types.

Type 1 discounts are our deliberate actions that lead to erosion of trust – actions like interrupting, gossiping, blaming, manipulation, disrespect, intimidation, and bullying.

Type 2 discounts are the actions that we deliberately omit to do that also cause erosion of trust – like not asking for and not offering feedback, like not sharing data, information and knowledge, like not asking for help, like not saying thank you, like not challenging assumptions, like not speaking out when we feel things are not right, like not getting the elephant out in the room. These two types of discounts are endemic in all organisations and the Type 2 discounts are the more difficult to see because it was what we didn’t do that led to the rot. We must all maintain constant vigilance to sniff out the first whiff of misery and to act immediately and effectively to sustain a pong-free organisational atmosphere.

Posted on

Watch Out for the Overshoot!

In 1972 a group called the Club of Rome published a report entitled “The Limits to Growth” that examined the possible global impact of our current obsession with competition and growth. They used Jay W Forrester’s computer models described in World Dynamics – models of global stocks and flows of natural resources, capital and people – and explored the range future possibilities based on the best understanding of current reality. Their conclusions were not encouraging – the most likely outcome they predicted if current behaviours continued would be global natural, economic and population collapse before 2100!

Their conclusions were discounted by governments, corporations and individuals as doom-preaching but it struck a chord with many and helped to fuel the growth of the global environmental movement.

Thirty years later the original work has been revised, updated and the original predictions compared with actual changes.

The original forecast proved to be prophetic – and revealed an alarming conclusion – that we may already be past the point of no return. It is now forty years since the original work and we have enjoyed the predicted boom years of the 1980’s and ignored the warnings so many options for avoiding a future global collapse have already been squandered. Even if we corrected all the errors of commission and errors of omission today it may be too late because we over-estimate our ability to solve problems and underestimate the effect of “overshoot”.

Suppose you are driving at night in freezing fog and you want to get to your destination as soon as possible so you press on the accelerator and your speed grows. You have not been on this particular road before but you have been driving for years and you trust your experience, skills, and reactions. Suddenly a red light appears out of the gloom – it is a stop light and it is close, too close, so you hit the brakes! You don’t stop immediately though – you are slowing down but not fast enough. The road is slippery, your tyres do not grip as well as usual, and your momentum carries you on. You are burning up the remaining tarmac fast and now you see other lights – white lights – coming from the right. A juggernaut is nearly at the crossroads and it has the green light and is not slowing down.  You are on a crash course – and there is nothing you can do – you have no options. The awful realisation dawns that you have made a fatal error of judgement and this is the end as you overshoot the red light and are crushed to a mangled pulp of metal and flesh under the wheels of the juggernaut!

The accident was avoidable – in retrospect. Was it avoidable in prospect? Of course – but only
– IF we were able to challenge our blind trust in our own capability and
– IF we were able to anticipate what could happen and
– IF we had set up trustworthy early warning signals and
– IF we had prepared contingency plans of what we would do if any of the warning bells rang.

Easy enough for an individual to do perhaps – but much more difficult for a group of individuals who have low regard for each other and who are competing to grow bigger and faster. Our mastery of  nature has given us the means to change global system dynamics – so our collective fate is sealed by our collective behaviour. We have the ability to achieve mutually assured destruction (MAD) without dropping a single bomb – and we are on course to do so not because we set out to – but because we did not set out not to. The error of omission is the stealth killer.

Is this global disaster scenario realistic? Is there anything that can be done? Are we collectively capable of doing it? The evidence suggests “yes” to all three questions – there is hope – but it will require a paradigm shift in thinking rather than a breakthrough in technology.

The laws of physics will seal our fate unless the laws of people adapt – and it may already be too late to avoid some degree of catastrophic decline – which implies billions of lives will be lost needlessly. Those of us in positions of most influence are already to old to expect to live to see the fruits of our collective error of omission – our children will bear the pain of our ignorance and arrogance.  What do you want carved on your gravestone … “Here lies X – who saw but did not act. Sorry.”

Limits to Growth – the 30 year update. ISBN 978-1-84407-144-9

Posted on

Anyone for more Boiled Frog?

There is a famous metaphor for the dangers of denial and complacency called the boiled frog syndrome.

Apparently if you drop a frog into hot water it will notice and jump out  but if you put a frog in water at a comfortable temperature and then slowly heat it up it will not jump out – it does not notice the slowly rising temperature until it is too late – and it boils.

The metaphor is used to highlight the dangers of not being aware enough of our surroundings to notice when things are getting “hot” – which means we do not act in time to prevent a catastrophe.

There is another side to the boiled frog syndrome – and this when improvements are made incrementally by someone else and we do not notice those either. This is the same error of complacency and there is no positive feedback so the improvement investment fizzles out – without us noticing that either.  This is a disadvantage of incremental improvement – we only notice the effect if we deliberately measure at intervals and compare present with past. Not many of us appear to have the foresight or fortitude to do that. We are the engineers of our own mediocrity.

There is an alternative though – it is called improvement-by-design. The difference from improvement-by-increments is that with design you deliberately plan to make a big beneficial change happen quickly – and you can do this by testing the design before implementing it so that you know it is feasible.  When the change is made the big beneficial difference is noticed – WOW! – and everyone notices: supporters and cynics alike.  Their responses are different though – the advocates are jubilant and the cynics are shocked. The cynics worldview is suddenly challenged – and the feeling is one of positive confusion. They say “Wow! That’s a miracle – how did you do that?”.

So when we understand enough to design a change then we should use improvement-by-design; and when we don’t understand enough we have no choice but to do use improvement-by-discovery.

Posted on

July 5th 2018 – The old NHS is dead.

Today is the last day of the old NHS – ironically on the 70th anniversary of its birth. Its founding principles are no more – care is no longer free at the point of delivery and is no longer provided according to needs rather than means. SickCare®, as it is now called, is a commodity just like food, water, energy, communications, possessions, housing, transport, education and leisure – and the the only things we get free-of-charge are air, sunlight, rain and gossip.  SickCare® is now only available from fiercely competitive service conglomerates – TescoHealth and VirginHealth being the two largest.  We now buy SickCare® like we buy groceries – online and instore.

Gone forever is the public-central-tax-funded-commissioner-and-provider market. Gone forever are the foundation trusts, the clinical commissioning groups and the social enterprises. Gone is the dream of cradle-to-grave equitable health care  – and all in a terrifyingly short time!

The once proud and independent professionals are now paid employees of profit-seeking private providers. Gone is their job-for-life security and gone is their gold-plated index-linked-final-salary-pensions.  Everyone is now hired and fired on the basis of performance, productivity and profit. Step out of line or go outside the limits of acceptability and it is “Sorry but you have breached your contract and we have to let you go“.

So what happened? How did the NHS-gravy-train come off the taxpayer-funded-track so suddenly?

It is easy to see with hindsight when the cracks started to appear. No-one and every-one is to blame.

We did this to ourselves. And by the time we took notice it was too late.

The final straw was when the old NHS became unaffordable because we all took it for granted and we all abused it.  Analysts now agree that there were two core factors that combined to initiate the collapse and they are unflatteringly referred to as “The Arrogance of Clinicians” and “The Ignorance of Managers“.  The latter is easier to explain.

When the global financial crisis struck 10 years ago it destabilised the whole economy and drastic “austerity” measures had to be introduced by the new coalition government. This opened the innards of the NHS to scrutiny by commercial organisations with an eager eye on the £100bn annual budget. What they discovered was a massive black-hole of management ignorance!

Protected for decades from reality by their public sector status the NHS managers had not seen the need to develop their skills and experience in Improvement Science and, when the chips were down, they were simply unable to compete.

Thousands of them hit the growing queues of the unemployed or had to settle for painful cuts in their pay and conditions before they really knew what had hit them. They were ruthlessly replaced by a smaller number of more skilled and more experienced managers from successful commercial service companies – managers who understood how systems worked and how to design them to deliver quality, productivity and profit.

The medical profession also suffered.

With the drop in demand for unproven treatments, the availability of pre-prescribed evidence-based standard protocols for 80% of the long-term conditions, and radically redesigned community-based delivery processes – a large number of super-specialised doctors were rendered “surplus to requirement”. This skill-glut created the perfect buyers market for their specialist knowledge – and they were forced to trade autonomy for survival. No longer could a GP or a Consultant choose when and how they worked; no longer were they able to discount patient opinion or patient expectation; and no longer could they operate autonomous empires within the bloated and bureaucratic trusts that were powerless to performance manage them effectively. Many doctors tried to swim against the tide and were lost – choosing to jump ship and retire early. Many who left it too late to leap failed to be appointed to their previous jobs because of “lack of required team-working and human-factor skills”.

And the public have fared no better than the public-servants. The service conglomerates have exercised their considerable financial muscle to create low-cost insurance schemes that cover only the most expensive and urgent treatments because, even in our Brave New NHS, medical bankruptcy is not politically palatable.  State subsidised insurance payouts provide a safety net  – but they cover only basic care. The too-poor-to-pay are not left to expire on the street as in some countries – but once our immediate care needs are met we have to leave or start paying the going rate.  Our cashless society and our EzeeMonee cards now mean that we pay-as-we-go for everything. The cash is transferred out of our accounts before the buy-as-you-need drug has even started to work!

A small yet strident band of evangelical advocates of the Brave New NHS say it is long overdue and that, in the long term, the health of the nation will be better for it. No longer able to afford the luxury of self-abuse through chronic overindulgence of food, cigarettes, and alcohol – and faced with the misery of the outcome of their own actions –  many people are shepherded towards healthier lifestyles. Those who comply enjoy lower insurance premiums and attractive no-claims benefits.  Healthier in body perhaps – but what price have we paid for our complacency? “

On July 15th 2012 the following headline appeared in one Sunday paper: “Nurses hired at £1,600 a day to cover shortages” and in another “Thousands of doctors face sack: NHS staff contracts could be terminated unless they agree to drastic changes to their pay and conditions“.  We were warned and it is not too late.

Posted on

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.

Posted on

Systemic Sickness

Sickness, illness, ill health, unhealthy, disease, disorder, distress are all words that we use when how we feel falls short of how we expect to feel. The words impliy an illness continuum and each of us appeara to use different thresholds as action alerts.

 The first is crossed when we become aware that all is not right and our response and to enter a self-diagnosis and self-treatment mindset. This threshold is context-dependent; we use external references to detect when we have strayed too far from the norm – we compare ourselves with others. This early warning system works most of the time – after all chemists make their main business from over the counter (OTC) remedies!

If the first stage does not work we cross the second threshold when we accept that we need expert assistance and we switch into a different mode of thinking – the “sick role”.  Crossing the second threshold is a big psychological step that implies a perceived loss of control and power – and explains why many people put off seeking help. They enter a phase of denial, self-deception and self-justification which can be very resistant to change.

The same is true of organisations – when they become aware that they are performing below expectation then a “self-diagnosis” and “self-treatment” is instigated, except that it is called something different such as an “investigation” or “root cause analysis” and is followed by a “recommendations” and an “action plan”.  The requirements for this to happen are an ability to become aware of a problem and a capability to understand and address the root cause both effectively and efficiently.  This is called dynamic stability or “homeostasis” and is a feature of many systems.  The image of a centrifugal governor is a good example – it was one of the critical innovations that allowed the power of steam to be harnessed safely a was a foundation stone of the industrial revolution. The design is called a negative feedback stabiliser and it has a drawback – there may be little or no external sign of the effort required to maintain the stability.

Problems arise when parts of this expectation-awareness-feedback-adjustment process are missing, do not work, or become disconnected. If there is an unclear expectation then it is impossible to know when and how to react. Not being clear what “healthy” means leads to confusion. It is too easy to create a distorted sense of normality by choosing a context where everyone is the same as you – “birds of a feather flock together”.

Another danger is to over-simplify the measure of health and to focus on one objective dimension – money – with the assumption that if the money is OK then the system must be OK.  This is an error of logic because although a healthy system implies healthy finances, the reverse is not the case – a business can be both making money and heading for disaster.

Failure can also happen if the most useful health metrics are not measured, are measured badly, or are not communicated in a meaningful way.  Very often metrics are not interpreted in context, not tracked over time, and not compared with the agreed expectation of health.  These multiple errors of omission lead to conterproductive behaviour such as the use of delusional ratios and arbitrary targets (DRATs), short-termism and “chasing the numbers” – all of which can further erode the underlying health of the system – like termites silently eating the foundations of your house. By the time you notice it is too late – the foundations have crumbled into dust!

To achieve and maintain systemic health it is necessary to include the homeostatic mechanisms at the design stage. Trying to add or impose the feedback functions afterwards is less effective and less efficient.  A healthy system is desoigned with sensitive feedback loops that indicate the effort required to maintain dynamic stablity – and if that effort is increasing then that alone is cause for further investigation – often long before the output goes out of specification.  Healthy systems are economic and are designed to require a minimum of effort to maintain stability and sustain performance – good design feels effortless compared with poor design. A system that only detects and reacts to deviations in outputs is an inferior design – it is like driving by looking in the rear-view mirror!

Healthy systems were designed to be healthy from the start or have evolved from unhealthy ones – the books by Jim Collins describes this: “Built to Last” describes organisations that have endured because they were destined to be great from the start. “Good to Great”  describes organisations that have evolved from unremarkable performers into great performers. There is a common theme to great companies irrespective of their genesis – data, information, knowledge, understanding and most important of all a wise leader.

Posted on

The Ten Billion Barrier

I love history – not the dry boring history of learning lists of dates – the inspiring history of how leaps in understanding happen after decades of apparently fruitless search.  One of the patterns that stands out for me in recent history is how the growth of the human population has mirrored the changes in our understanding of the Universe.  This pattern struck me as curious – given that this has happened only in the last 10,000 years – and it cannot be genetic evolution because the timescale is to short. So what has fuelled this population growth? On further investigation I discovered that the population growth is exponential rather than linear – and very recent – within the last 1000 years.  Exponential growth is a characteristic feature of a system that has a positive feedback loop in it that is not balanced by an equal and opposite negative feedback loop. So, what is being fed back into the system that is creating this unbalanced behaviour? My conclusion so far is “collective improvement in understanding”.

However, exponential growth has a dark side – it is not sustainable. At some point a negative feedback loop will exert itself – and there are two extremes to how fast this can happen: gradual or sudden. Sudden negative feedback is a shock is the one to avoid because it is usually followed by a dramatic reversal of growth which if catastrophic enough is fatal to the system.  When it is less sudden and less severe it can lead into repeating cycles  of growth and decline – boom and bust – which is just a more painful path to the same end.  This somewhat disquieting conclusion led me to conduct the thought experiment that is illustrated by the diagram: If our growth is fuelled by our ability to learn, to use and to maintain our collective knowledge what changes in how we do this must have happened over the last 1000 years?  Biologically we are social animals and using our genetic inheritance we seem only able to maintain about 100 active relationships – which explains the natural size of family groups where face-to-face communication is paramount.  To support a stable group that is larger than 100 we must have developed learned behaviours and social structures. History tells us that we created communities by differentiating into specialised functions and to be stable these were cooperative rather than competitive and the natural multiplier seems to be about 100.  A community with more than 10,000 people is difficult to sustain with an ad hoc power structure with a powerful leader and we develop collective “rules” and a more democratic design – which fuels another 100 fold expansion to 1 million – the order of magnitide of a country or city. Multiply by 100 again and we get the size that is typical of a country and the social structures required to achieve stablity on this scale are different again – we needed to develop a way of actively seeking new knowledge, continuously re-writing the rule books, and industrialising our knowkedge. This has only happened over the last 300 years.  The next multipler takes us to Ten Billion – the order of magnitude of the current global population – and it is at this stage that  our current systems seem to be struggling again.

From this geometric perspective we appear to be approaching a natural human system barrier that our current knowledge management methods seem inadequate to dismantle – and if we press on in denial then we face the prospect of a sudden and catastrophic change – for the worse. Regression to a bygone age would have the same effect because those systems are not designed to suport the global economy.

So, what would have to change in the way we manage our collective knowledge that would avoid a Big Crunch and would steer us to a stable and sustainable future?

Posted on

Disruptive Innovation

Africa is a fascinating place.  According to a documentary that I saw last year we are ALL descended from a small tribe who escaped from North East Africa about 90,000 years ago. Our DNA carries clues to the story of our journey and it shows that modern man (Africans, Europeans, Asians, Chinese, Japanese, Australians, Americans, Russians etc) – all come from a common stock. It is salutory to reflect how short this time scale is, how successful this tribe has been in replacing all the other branches of the human evolutionary tree, and how the genetic differences between colours and creeds are almost insignificant.  All the evolution that has happened in the last 90,000 years that has transformed the world and the way we live is learned behaviour. This means that, unlike our genes, it is possible to turn the clock backwards 90,000 years in just one generation. To avoid this we need to observe how the descendents of the original tribe learned to do many new things – forced by their new surroundings to adapt or perish.  This is essence of Improvement Science – changing context continuously creates new challenges – from which we can learn, adapt and flourish.

To someone born in rural England a mobile phone appears to be a relatively small step on a relentless technological evolution – to someone born in rural Africa it is a radical and world-changing paradigm shift – one that has already changed their lives.  In some parts of Africa money is now managed using mobile phones and this holds the promise of bypassing the endemic bureaucratic and corrupt practices that so often strangle the greens shoots of innovation and improvement. Information and communication is the lifeblood of improvement and to introduce a communication technology that is reliable, effective, and affordable into a vast potential for cultural innovation is rather like introducing a match to the touchpaper of a firework. Once the fuse has started to fizz there is no going back. The name given to this destabilising phenomenon is “disruptive innovation” and fortunately it can work for the good of all – so long as we steer it in a win-win-win direction. And that is a big challenge because our history suggests that we find exploitation easier than evolution and exploitation always leads to lose-lose-lose outcomes.

So while our global tribe may have learned enough to create a global phone system we still have much to learn about how to create a global social system.

Posted on

Small Step or Giant Leap?

This iconic image of Earthrise over the Moonscape reveals the dynamic complexity of the living Earth contrasting starkly with the static simplicity of the dead Moon. The feeling of fragility that this picture evokes sounds a warning bell for us – “Death is Irreversible and Life is not Inevitable”. In reality this image was a small technical step that created a giant cultural leap.

And so it is with much of Improvement Science – the perception of the size of the challenge changes once the challenge is overcome. With the benefit of hindsight it was easy, even obvious – but with only the limit of foresight it looked difficult and obscure.  Our ability to challenge, learn and adopt a new perspective is the source of much gain and much pain. We gain the excitement of new understanding and we feel the pain of being forced to face our old ignorance.  Many of us deny ourselves the gain because we cannot face the pain – but it does not have to be that way. We have a tendency to store the pain up until we are forced to face it – and by this means we create what feel like insurmountable barriers to improvement.  There is an alternative – bite sized improvement – taking small steps towards a realistic goal that is on a path to our distant objective.  The small-step method has many advantages – we can do things that matter to us and are within our circle of influence; we can learn and practice the skills in safety; and we can start immediately.

In prospect it will feel like a giant leap and in retrospect it will look like a small step – that is the way of Improvement Science – and as our confidence and curiosity grow we take bigger steps and make smaller leaps.  

Posted on

Synigence

The “Qualigence, Quantigence and Synergence” blopic has generated some interesting informal feedback and since being more attuned to this concept I have seen evidence of it at work in practice. My own reflection is that synergence does not quite hit the spot because syn-erg-gence can be translated as “knowing how to work together” and from this small niggle a new word was born – synigence – which I feel captures the concept better. It is an improvement. 

Improvement Science always considers a challenge from three perspectives – quality, delivery and quantity. The delivery dimension involves time and can be viewed both qualitatively and quantitatively.  The pure qualitative dimension is the subjective experience (feelings) and the pure quanitative dimension is the objective evidence (facts) – very often presented in the Universal Language of Money (ULM). The diagram attempts to capture this idea of three perspectives and that there is common ground between all three;  the soil in which the seeds of improvement take root. There is more to it though – this common ground/vision/goal/sense does not look the same from different perspectives and for synergy to develop the synigent facilitator needs to be capable of translating the one vision into three languages. It is rather like the Rosetta Stone an ancient Egyptian grandiorite stele inscribed with a decree issued at Memphis, Egypt in 196 BC on behalf of King Ptolemy V. The decree appears in three scripts: Ancient Egyptian hieroglyphs, Demotic Egyptian script, and Ancient Greek and, as it presents essentially the same text in all three scripts, it provided the key to the modern understanding of Egyptian hieroglyphs.  With this key the wisdom of the Ancient Egyptians was unlocked.

My learning this week is that this is less on an exercise in how to influence others and more of an exercise in how to influence oneself and by that route the sum can become greater than the parts.  Things that looked impossible for either working alone (or more often in conflict) now become not only possible but also inevitable.  Once we have seen we cannot forget – and once we believe we cannot understand that it is not obvious to everyone else: and there lurks a trap for the unsynigent – it is not obvious – if it were we would have seen it sooner ourselves.

Posted on

Ignorance Mining

Ignorance means “not knowing” and as the saying goes “Ignorance is bliss” because we do not worry about what we do not know about.  Or do we?

We are not totally ignorant – because we know that there are “unknowns” that would be of value to us. This knowledge creates an anxiety that we are very good at pushing out of awareness and despite the denial the unconscious feeling remains and it is emotionally corrosive. Repressed anxiety leads to the counter-productive behaviour of self-deception and then to self-justification – both of which are potent impedients to improvement.

We habitually, continuously and unconsciously discount the importance of what we do not know and in so doing we create internal emotional dissonance.  Our inner conflict drives external discounting behaviour and the inevitable toxic cultural consequence – Erosion of Trust.  Our inner conflict also drives internal discounting behaviour and the inevitable toxic emotional consequence – Erosion of  Confidence. This is the toxic emotional waste swamp that we create for ourselves and is the slippery slope that leads down to frustration, depression, cynicism and apathy. Ignorance  leads to anxiety and fear – and because we have conditioned ourselves to back away from fear we reflexly back away from ignorance and we end up trading fear for frustration. We do it to ourselves first and then we do it to others.

The antidote is counter-intuitive: it is to actively acknowledge and embrace our ignorance – and to do that we have to deliberately expose our own ignorance because we are very, very good at burying it from conscious view under a mountain of self-deception and self-justification.  We need to become Ignorace Miners.

The opposite of ignorance if knowledge and the good news is that we only need to scratch the surface to find knowledge nuggets – not huge ones perhaps – but plentiful. A bag of small knowledge nuggets is as valuable as an ingot of insight!

Knowledge nuggets are durable because they withstand cultural erosion but they can get washed away in the flood of toxic emotional waste and they can get buried under layers of cynical-resentful-arrogant-pessimism (CRAP).  These knowledge nuggests need to be re-gathered, re-freshed and re-cycled – and it is an endlessly exciting and energising experience.

So, when we are feeling fustrated, demotivated and depressed we just need to give ourselves a break and indulge in a bit of gentle ignorance mining – and when we do we will start to feel better immediately.

Posted on

Qualigence, Quantigence and Synergence

It seems that some people are better than others at figuring out what to do when presented with a new challenge.

Every day we are all presented with new challenges – c’est la vie – and for one challenge some of us seem to know what to do and others of us are left scratching our heads.

Yet, when presented with a different challenge the tables are turned.

Why is that?

Until recently I believed that improvement was just a matter of accumulating enough knowledge and experience – but the pattern seems to be evident in people of all ages and experience: there seems to be more to it than just experience.

So, I searched the Internet on the topic of “problem solving” and many of the references mentioned the word “intelligence” – a word that generates mixed feelings for me.

My mixed feelings came from an experience I had as a student. I am, by nature, both competitive and curious and I felt it would be useful to know my IQ and to meet others who shared my curiosity – so I did the Mensa test. I “passed” and was duly invited to a get-together at a local pub and was informed that I only needed to look for the distinctive yellow magazine to identify the meeting table (mensa is latin for table). I did not need the magazine to identify the table of Mensans and after that first encounter I chose not to return.  I had a sense that there was something missing – high IQ was not enough – and it was that “something” I was looking for.

I now know that mixed feelings are often a symptom of an over-simplification; a signpost to a deeper awareness; and a hint to keep digging for the deeper meaning. Here is a definition of the word “intelligence” that I found on Wikipedia:

“Intelligence: A very general mental capability that, among other things, involves the ability to reason, plan, solve problems, think abstractly, comprehend complex ideas, learn quickly and learn from experience. It is not merely book learning, a narrow academic skill, or test-taking smarts. Rather, it reflects a broader and deeper capability for comprehending our surroundings—”catching on,” “making sense” of things, or “figuring out” what to do.

This definition resonates and prompted a question:
“Are there more forms of intelligence than the ones we are familiar with in the Mensa-style Intelligence Quotient (IQ) tests? And if so, how many forms of intelligence are there and what are their characteristics?”

My intuition said “Yes – there are more than one” and I had the sense that are at least two forms; one that is conscious and that deals with quantities – so I labelled that as quantity-intelligence or quantigence; and another that is unconscious and deals with qualities – so I labelled that as quality-intelligence or qualigence.

It also felt that these are not independent of each other – they do not feel like two separate dimensions – they feel like two views of the same thing.  It just did not feel right that we might be observed, measured and scored on independent IQ scales and then classifed, arranged, ranked, selected, compared, and improved; it feels more dynamic than that.

Perhaps it is how well we are able to employ the multiple forms of IQ in a dynamic and synergistic way to figure out what to do more easily, more quickly and more often.

But what does all this have to do with Improvement Science?

Well because improvement only happens after we figure out what to do and then we actually do it. Both diagnosis and treatment are necessary and the sequence order is important – treatment before diagnosis carries a greater risk of unintended consequences – and unintended consequences are usually negative.

Challenges that require a balance of qualigence and quantigence at the diagnosis stage will appear “tougher” to solve and siuch challenges will tend to accumulate as a list of long-standing, unsolved and unspoken niggles – like a veritable herd of emotional elephants in the room.

This niggle-mine seems to be where the greatest opportunities for improvement are buried – nuggets of new knowledge waiting to be uncovered.

How then do we know if we have a qualigence-quantigence gap?

I concluded that if we are continually struggling with the same old problems; are spending a lot of effort, time, and money; and are not making progress then we  can be sure we have a gap somewhere. The questions are “what, where and how to convert our niggles into nuggets – our weaknesses into strengths?”.

It would appear that we need three ingredients – qualigence, quantigence, and an ability to dynamically integrate them into something that is even greater than the sum of the parts – something we might call synergy-intelligence or synergence.

To test this idea I searched the Internet for the word “synergence” and found many hits that resonated with this concept. Good.

Our next step might be to look more closely at the three ingredients and to ask:

  • Q1.  What would I need to diagnose and treat a quantigence gap?
  • Q2. What would I need to diagnose and treat a qualigence gap?
  • Q3. What would I need to diagnose and treat a synergence gap?

These are powerful questions.

Posted on

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.

Posted on

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?         

Posted on

“Wars Not Make One Great.”

There appear to be two kinds of conflict: the one initiated by an individual and the one initiated by a group.  There also appears to be a natural cycle to conflict – the individual acting on behalf of a group gains power and can become so disconnected from reality that they are later removed from power by the evolving group. So, both autocracy and democracy appear to have a light-side and a dark-side: with the benefit leading the risk. The problem is that this system design creates the necessary and sufficient conditions for oscillating behaviour: boom-to-bust; centralise-to-decentralise; expand-to-contract. It it not a true cycle though because time cannot be reversed, we can never go back to a previous time – so what we see as oscillating is more like a driver swerving from one side of the  road to another when the road ahead is not straight and the forward view is limited.  To progress quickly along a winding road at night we need early warning of the next bend, good lights, quick  reflexes, and a responsive engine, brakes and steering. We need quick and accurate feedback and the confidence to decide and act.  The less feedback we get the more bumps we have, the lower our confidence falls, and the slower our progress becomes until we are paralysed with anxiety and fear.  Asking for feedback is relatively easy – giving feedback is much more difficult because to be effective it must be tailored to the recipient. General and anonymous feedback is ineffective. This implies that the person who asks for feedback must also specify why they want it and how they want it – they need to set out the terms of the psychological contract.  Without that clarity we descend into confusion. Conflict is often seen as unhealthy and destructive and when conflict is manifest as as battle the out-of-date paradigm that is blocking progress is destroyed but the collateral damage is the price that is paid.  Innocent bystanders get caught in the crossfire. It is this fear of collateral damage that often paralyses action and hands power to the autocrat. The good news is that conflict can be healthy and constructive  – when it is manifest as a race for understanding, for meaning and for a common purpose.  As a race and a challenge and with vision, agility and energy the unknown winding road ahead can be transformed into a safe and exhilarating ride!

Posted on

Do You Have A Miserable Job?

If you feel miserable at work and do not know what to do then then take heart because you could be suffering from a treatable organisational disease called CRAP (cynically resistant arrogant pessimism).

To achieve a healthier work-life then it is useful to understand the root cause of CRAP and the rationale of how to diagnose and treat it.

Organisations have three interdependent dimensions of performance: value, time and money.  All organisations require both the people and the processes to be working in synergy to reliably deliver value-for-money over time.  To create a productive system it is necessary to understand the relationships between  value, money and time. Money is easier because it is tangible and durable; value is harder because it is intangible and transient. This means that the focus of attention is usually on the money – and it is often assumed that if the money is OK then the value must be OK too.  This assumption is incorrect.

Value and money are interdependent but have different “rates of change”  and can operate in different “directions”.  A common example is when a dip in financial performance triggers an urgent “drive” to improve the “bottom line”.  Reactive revenue generation and cost cutting results in a small, quick, and tangible improvement on the money dimension but at the same time sets off a large, slow, and intangible deterioration on the value dimension.  Money, time and  value are interdependent and the inevitable outcome is a later and larger deterioration in the money – as illustrated in the doodle. If only money is measured the deteriorating value is not detected, and by the time the money starts to falter the momentum of the falling value is so great that even heroic efforts to recover are futile. As the money starts to fall the value falls even further and even faster – the lose-lose-lose spiral of organisational failure is now underway.

People who demonstrate in their attitude and behaviour that they are miserable at work provide the cardinal sign of falling system value. A miserable, sceptical and cynical employee poisons the emotional atmosphere for everyone around them. Misery is both defective and infective.  The primary cause of a miserable job is the behaviour exhibited by people in positions of authority – and the more the focus is only on money the more misery their behaviour generates.

Fortunately there is an antidote; a way to break out of the vicious tail spin – measure both value and money, focus on improving value and observe the positive effect on the money.  The critical behaviour is to actively test the emotional temperature and to take action to keep it moving in a positive direction.  “The Three Signs of a Miserable Job” by Patrick Lencioni tells a story of how an experienced executive learns that the three things a successful managerial leader must do to achieve system health are:
1) ensure employees know their unique place, role and value in the whole system;
2) ensure employees can consciously connect their work with a worthwhile system goal; and
3) ensure employees can objectively measure how they are doing.

Miserable jobs are those where the people feel anonymous, where people feel their work is valueless, and where people feel that they get no feedback from their seniors, peers or juniors. And it does not matter if it is the cleaner or the chief executive – everyone needs a role, a goal and to know all their interdependencies.

We do not have to endure a Miserable Job – we all have the power to transform it into Worthwhile Work.

Posted on

In Whom and in What do We Trust?

The issue of trust has been a recurring theme again this week – and it has appeared in many guises.  In one situation it was a case of distrust – I observed an overt display of suspicious, sceptical, and cynical behaviour. In another situation it was a case of mistrust – a misplaced confidence in my own intuition. My illogical and irrational heart said one thing but when my mind worked through the problem logically and rationally my intuition was proved incorrect. In another it was a case of rewarded-trust: positive feedback that showed a respectful challenge had resulted in a win-win-win outcome. And in yet another a case of extended-trust: an expression of delighted surprise from someone whose default position was to distrust.

Improvement Science rests on two Foundation stones Trust and Capability. First to trust oneself to have the confidence and humility to challenge, to learn, to change, to improve, to celebrate and to share; second to extend trust to others with a clear explanation of the consequences of betraying that trust; and third in building collective trust by having the courage to challenge trust-eroding behaviour.

At heart we are all curious, friendly, social animals – our natural desire is to want to trust. Distrust is a learned behaviour that, ironically, is the result of the instinctive trust and respect that, as children, we have for our parents.  We are taught to distrust by observing and copying distrustful and disrepectful behaviour by our role models. So with this insight we gain access to an antidote to the emotional poison of distrust: our innate child-like curiosity, desire to explore, appetite for fun, and thirst for knowledge and meaning. To dissolve distrust we only need to reconnect to our own inner child: One half of the foundation of Improvement Science.

Posted on

Deming’s “System of Profound Knowledge”

W. Edwards Deming (1900-1993) is sometimes referred to as the Father of Quality. He made such a significant contribution to Japan’s burgeoning post-war reputation for innovative high-quality products, and the rapid development of their economic power, that he is regarded as having made more of a difference than any other individual not of Japanese heritage.

Though best known as a statistician and economist, he was initially educated as an electrical engineer and mathematical physicist. To me however he was more of a social scientist – interested in the science of improvement and the creation of value for customers. A lifelong learner, in his later years (1) he became fascinated by epistemology – the processes by which knowledge is created – and this led him into wanting to know more about the psychology of human behaviour and its underlying motivations.

In his nineties he put his whole life of learning into one model – his System of Profound Knowledge (SoPK). What follows is my brief take on each of the four elements of the SoPK and how they fit together.

THE PSYCHOLOGY OF HUMAN BEHAVIOUR
Everyone is different, and we all SEE things differently. We then DO things based on how we see things – and we GET results – of some kind. Over time we shore up our own particular view of the world – some call this a “paradigm” – our own particular world view – multiple loops of DO-GET-SEE (2) are self-reinforcing and as our sense making becomes increasingly fixed we BEHAVE – BECOME – BELIEVE. The trouble is we each to some extent get divorced from reality, or at least how most others see it – in extreme cases we might even get classified by some people as “insane” – indeed the clinical definition of insanity is doing the same things whilst expecting different results.

THE ACQUISITION OF KNOWLEDGE
So when we DO things it would be helpful if we could do them as little experiments that test our sense of what works and what is real. Even better we might get others to help us interpret the results from the benefit of their particular world view/ paradigm. Did you study science at school? If so you might recognize that learning in this way by experimentation is the “scientific method” in action. Through these cycles of learning knowledge gets continually refined and builds. It is also where improvement comes from and how reality evolves. Deming referred to this as the PLAN-DO-STUDY-ACT Cycle (1) – personally i prefer the words in this adjacent diagram. For me the cycle is as much about good mental health as acquiring knowledge, because effective learning (3) keeps individuals and organizations connected to reality and in control of their lives.

UNDERSTANDING VARIATION
The origins of PDSA lie with Walter Shewhart (4) who in 1925 – invented it to help people in organizations methodically and continually inquire into what is happening. He observed that when workers or managers make changes in their working practices so that their processes run better, the results vary, and that this variation often fools them. So he invented a tool for collecting numbers in real time so that each process can be listened in to as a “system” – much like a doctor uses a stethoscope to collect data and interpret how their patient’s system is behaving, by asking what might be contributing to – actually causing – the system’s outcomes. Shewhart named the tool Statistical Process Control – three words, each of which for many people are an instant turn-off. This means they miss his critical insight that there are two distinct types of variation – noise and signal, and that whilst all systems contain noise, only some contain signals – which if present can be taken to be assignable causes of systemic behaviour. Indeed to make it more palatable the tool might better be referred to as a “system behaviour chart”. It is meant to be interpreted like a doctor or nurse interprets the vital sign graph on the end of a patient’s bed i.e. to decide what action if any to take and when. Here is an example that has been created in BaseLine© which is specifically designed to offer the agnostic direct access to the power of Shewhart’s thinking. (5).

THINKING SYSTEMICALLY
What is meant by the word “system”? It means all the parts connected and interrelated as a whole (3). It is often helpful to get representatives of the various stakeholder groups to map the system – with its parts, the flows and the connections – so they can see how different people make sense of say.. their family system, their work system, a particular process of interest.. indeed any system of any kind that feels important to them. The map shown here is one used that might be used generically by manufacturers to help them investigate the separate causal sources of systemic variation – from the Suppliers of Inputs received, to the Processes that convert those inputs into Outputs, which can then be received by Customers – all made possible by vital support processes. This map (1) was taught by Deming in 1950 to Japan’s leaders. When making sense of their own particular systemic context others may prefer a different kind of map, but why? How come others prefer to make sense of things in their own way? To answer this Peter Senge (3) in his own equivalent to the SoPK says you need 5 distinct disciplines: the ability to think systemically, to learn as a team, to create a shared vision, to understand how our mental models get ingrained, and lastly “personal mastery” … which takes me back to where I started.

Aware that he was at the end of his life of learning, Deming bequeathed his System of Profound Knowledge to us so that we might continue his work. Personally, I love the SoPK because it is so complete. It is hard however to keep such a model, complete and as a whole, continually in the front of our minds – such that everything we think and do can be viewed as a fractal of that elegant whole. Indeed as a system, the system of profound knowledge is seriously – even fatally – undermined if any single part is missing ..

• Without understanding the causes of human behaviour we have no empathy for other people’s worldviews, other value systems. Without empathy our ability to manage change is fundamentally impaired.

• Without being good at experimentation and turning our experience into Knowledge – the very essence of science – we threaten our very mental health.

• Without understanding variation we are all too easily deluded – ask any magician (6). We spin our own reality. In ignoring or falsely interpreting data we are even “wilfully blind” (7). Baseline© for example is designed to help people make more of their time-series data – a window onto the system that their data is representing – using its inherent variation to gain an enhanced sense of what’s actually happened, as well as what’s really happening, and what if things stay the same is most likely to happen.

• Without being able to see how things are connected – as a whole system – and seeing the uniqueness of our own particular context, moment to moment, we miss the importance of our maps – and those of others – for good sense-making. We therefore miss the sharing of our individual realities, and with it the potential to spot what really causes outcomes – which neatly takes us back to the need for empathy and for understanding the psychology of human behaviour.

For me the challenge is to be continually striving for that sense of the SoPK – as a complete whole – and by doing this to see how I might grow my influence in the world.

Julian Simcox

References

1. Deming W.E – The New Economics – 1993
2. Covey S.R. – The 7 habits of Highly Effective People – 1989
3. Senge P. M. – The Fifth Discipline: the art and practice of the learning organization – 1990
4. Wheeler D.J. & Poling S.R.– Building Continual Improvement – 1998
5. BaseLine© is available via www.threewinsacademy.co.uk.
6. Macknik S, et al – Sleights of Mind – What the neuroscience of magic reveals about our brains – 2011.
7. Heffernan M. – Wilfully Blind – 2011

Posted on

Politics, Policy and Police.

I love words – they are a window into the workings of our caveman wetware. Spoken and written language is the remarkably recent innovation that opened the door to the development of civilisations because it allowed individual knowledge to accumulate, to be shared, to become collective and to span generations (the picture is 4000 year old Minoan script) .

We are social animals and we have discovered that our lives are more comfortable and more predictable if we arrange ourselves into collaborative groups – families, tribes and communities; and through our collaboration we have learned to tame our enironment enough to allow us to settle in one place and to concentrate more time and effort on new learning.  The benefits of this strategy comes at a price – because as the size of our communities grow we are forced to find new ways to make decisions that are in the best interests of everyone.  And we need to find new ways to help ourselves abide by those decisions as individuals without incurring the cost of enforcement.  The word “civis” means a person who shares the privileges and the duties of the community in which they live.  And size matters – hamlets, villages and towns developed along with our ability to behave in a “civilised” way. Eventually cities appeared around 6000 years ago – and the Greek word for a city is “polis”.  The bigger the city the greater the capacity to support learning and he specialistion of individual knowledge, skills and experience. This in turn fuels the growth of the group and the development of specialised groups – tribes within tribes. A positive feedback loop is created that drives bigger-and-bigger settlements and more and more knowledge. Until … we forget what it is that underpins the whole design – civilised behaviour.  While our knowkedge has evolved at an accelerating pace our caveman brains have not kept up – and this is where the three “Poli” words come in – they all derive from the same root “polis” and they describe a process:

1. Politic  is the method by which the collective decisions are generated.
2. Policy is the method by which the Political decisions are communicated.
3. Police is the method by which the System of Policies are implemented.

The problem arises when the growth of knowledge and the inevitable changes that result starts to challenge the current Politic+Policy+Police Paradigm that created the context for the change to happen.  The Polices are continulally evolving – as evidenced by the continuous process of legislation. The Paradigm can usually absorb a lot of change but there usually comes a point when it becomes increasingly apparent to the society the the Paradigm has to change radically to support further growth. The more rigid the Policy and the more power to enforce if present the greater the social pressure that builds before the paradigm fractures – and the greater the disruption that will ensue as the social pressure is released.  History is a long catalogue of political paradigm shifts of every size – from minor tremors to major quakes – shifts that are driven by our insatiable hunger for knowledge, understanding and meaning.

Improvement Science operates at the Policy stage and is therefore forms the critical link between Politics and Police.  The purpose of Improvement Science is to design, test and implement Policies that deliver the collective Win-Win-Win outcomes.  Improvement Science is an embodiment of civilised behaviour and it embraces both the constraints that are decided by the People and the constraints that are defined by the Physics.

Posted on

Do Bosses need Hugs too?

The foundation on which Improvement Science is built is invisible – or rather intangible – and without this foundation the whole construction is unstable and unsustainable.  Rather like an iceberg – mostly under the surface with only a small part that is visible and measurable – and that small visible part is called Performance.

What is underneath?  To push our Performance through the surface so that it gets noticed we know we must synergise the People with the Processes but there is more to it than just that. The deepest part of the foundation, the part that provides the core strength and stability, is our Paradigm – our set of unconscious  beliefs, values, attitudes and habits that comprises our psycho-gyro-scope: our stabiliser. 

Our Paradigm creates inertia: the tendency to keep going in the same direction even when the winds of change have shifted permamantly and are blowing us off course.  Paradigms resist change – and for good reason – inertia is a useful thing when there are minor bumps on the journey and we need to avoid stalling at each one. Inertia becomes a less useful thing when we meet an immovable object such as a Law of Physics – because if we hit one of these then Reality will provide us with some painful feedback. Inertia is also less useful when we have stopped and have no momentum,  because it takes a bigger push for a longer time to get us moving again.

An elephant has a lot of inertia because it is big – and perhaps this is the reason why we refer to  attitudes and beliefs that represent resistance to change as Elephants in the Room.  The ringleader of a herd of organisational elephants is an elephant called Distrust which is the offspring an elephant called Discounting who in turn was born of an elephant called Disrespect.  We see this in organisationswhen we display and cultivate a disrepectful attitudes towards our peers, reports workers and our seniors. The old time-worn and cracked “us-versus-them” record.

So let us break into the cycle and push the Elephant called Distrust into spotlight – what is our alternative. Respect -> Acknowledgement -> Trust.   It doesn’t make any difference who you are: the most valuable form of respect is feedback:  Honest, Unbiassed and Genuine (HUG).  So if we regularly experience the Elephant called Distrust making a Toxic Swamp in our organisations and we feel discounted and disrespected then part of the reason may be that we are not giving ourselves enough HUGs. And that means the bosses too.

Posted on

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.

Posted on

The Six Learning Pebbles

Yesterday I had the great pleasure of taking Alice and Sophie to school. When I am doing the school run we often play a game of “interesting conversations” and we talked about what were were planning to do today.  “I am going to demonstrate the Six Thinking Hats method of solving problems” I said and gave a thumbnail sketch of Edward De Bono’s inspired invention. “That sounds like our Six Pebbles of Learning that we learned in SEAL” said Alice. “What is SEAL”?  I asked. “Social and Emotional Aspects of Learning” she replied “it is one of our lessons”.  My curiosity was pricked. “Wow! And what are the Six Pebbles? ” I asked.  Alice reeled them off immediately “Watching, Asking, Listening, Thinking Carefully, Perseverence and Learning from Mistakes”.  I was speechless – they didn’t teach that stuff when I was at school!  There are many organisations that invest small fortunes on “Team Development Programmes” which sounded to me like the same stuff – schools seem to have moved on a bit!

So, after a thoroughly enjoyable afternoon juggling the Six Hats I looked up the Six Pebbles on the Internet and here is what I found …
              
One stormy night, far, far away, a woman gave birth to four healthy sons. She wrapped them up and laid them in a row next to her. What would happen to them? She prayed to the magic spirit of her family. There was a flash and a beautiful spirit appeared. The spirit looked at the first baby. Out of her golden bag she drew a shiny purple stone and sang, ‘You will be a talented musician.’ To the second baby she gave a green stone and sang, ‘You will be a fantastic farmer.’ To the third baby she gave a red stone and sang, ‘You will be a talented artist.’ When she came to the fourth baby, she drew out of her bag six ugly brown pebbles. ‘And you will be a good learner’, she sang. There was a fearful bang and a flash of light and the spirit disappeared.

What did she mean?’ the woman asked herself. She looked at the pebbles. ‘It can’t be very important’, she thought. Even so she carefully put the pebbles in a small bag and hung them round the baby’s neck.

As soon as the first three sons could walk they showed their talents. People always asked to hear the first son sing. If one of their animals was sick, they brought it to the second son and he immediately knew what was wrong. The third son drew pictures so beautiful that when he was still young people asked him to decorate their houses and clothes. When the woman looked at the fourth son she kissed him on the forehead and smiled, and thought that it was a good job he had such talented brothers.The fourth son looked at the six pebbles and wondered what they meant. He was very proud of his three brothers. He wanted to be like them, so he looked carefully at what they did. He asked them questions and listened carefully to what they said. He thought about what he saw and heard. He imitated what they did and when it didn’t work he didn’t give up, but learned from it. The brothers loved him dearly and, because he was so helpful and good to be with, they spent lots of time with him. When the four sons were nearly grown up the woman said to the first three sons, ‘Go off and make your fortunes. You have all the talents you need.’ They left the farm. The fourth son asked if he could go too but the woman said, ‘You haven’t any special talents so perhaps you had better stay here. What have you got to offer the world?’

That evening she was feeling sad. ‘I wish someone was here to cheer me up,’ she said. The fourth son opened his mouth and sang a song. It was beautiful – as beautiful as the songs of the first son. The next day one of the animals was sick. The fourth son looked at the animal and knew what to do. The next day it was better, just like the animals that the second son had looked after. When the woman woke up the next day she saw a lovely new picture on the wall, as beautiful as the pictures painted by the third son.

She took the small bag from round fourth son’s neck and looked at them. She remembered what the spirit had said: ’And you will be a good learner.’

Posted on

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”.

Posted on

The Rubik Cube Problem

Look what popped out of Santa’s sack!

I have not seen one of these for years and it brought back memories of hours of frustration and time wasted in attempting to solve it myself; a sense of failure when I could not; a feeling of envy for those who knew how to; and a sense of indignation when they jealously guarded the secret of their “magical” power.

The Rubik Cube got me thinking – what sort of problem is this?

At first it is easy enough but it becomes quickly apparent that it becomes more difficult the closer we get to the final solution – because our attempts to reach perfection undo our previous good work.  It is very difficult to maintain our initial improvement while exploring new options. 

This insight struck me as very similar to many of the problems we face in life and the sense of futility that creates a powerful force that resists further attempts at change.  Fortunately, we know that it is possible to solve the Rubik cube – so the question this raises is “Is there a way to solve it in a rational, reliable and economical way from any starting point?”

One approach is to try every possible combination of moves until we find the solution. That is the way a computer might be programmed to solve it – the zero intelligence or brute force approach.

The problem here is that it works in theory but fails in practice because of the number of possible combinations of moves. At each step you can move one of the six faces in one of two directions – that is 12 possible options; and for each of these there are 12 second moves or 12 x 12 possible two-move paths; 12 x 12 x 12 = 1728 possible three-move paths; about 3 million six-move paths; and nearly half a billion eight-move paths!

You get the idea – solving it this way is not feasible unless you are already very close to the solution.

So how do we actually solve the Rubik Cube?  Well, the instructions that come with a new one tells you – a combination of two well-known ingredients: strategy and tactics. The strategy is called goal-directed and in my instructions the recommended strategy is to solving each layer in sequence. The tactics are called heuristics: tried-tested-and-learned sequences of actions that are triggered by specific patterns.

At each step we look for a small set of patterns and when we find one we follow the pre-designed heuristic and that moves us forward along the path towards the next goal. Of the billions of possible heuristics we only learn, remember, use and teach the small number that preserve the progress we have already made – these are our magic spells.

So where do these heuristics come from?

Well, we can search for them ourselves or we can learn them from someone else.  The first option holds the opportunity for new insights and possible breakthroughs – the second option is quicker!  Someone who designs or discovers a better heuristic is assured a place in history – most of us only ever learn ones that have been discovered or taught by others – it is a much quicker way to solve problems.  

So, for a bit of fun I compared the two approaches using a computer: the competitive-zero-intelligence-brute-force versus the collaborative-goal-directed-learned-and-shared-heuristics.  The heuristic method won easily every time!

The Rubik Cube is an example of a mechanical system: each of the twenty-six parts are interdependent, we cannot move one facet independently of the others, we can only move groups of nine at a time. Every action we make has nine consequences – not just one.  To solve the whole Rubik Cube system problem we must be mindful of the interdependencies and adopt methods that preserve what works while improving what does not.

The human body is a complex biological system. In medicine we have a phrase for this concept of preserving what works while improving what does not: “primum non nocere” which means “first of all do no harm”.  Doctors are masters of goal-directed heuristics; the medical model of diagnosis before prognosis before treatment is a goal-directed strategy and the common tactic is to quickly and accurately pattern-match from a small set of carefully selected data. 

In reality we all employ goal-directed-heuristics all of the time – it is the way our caveman brains have evolved.  Relative success comes from having a more useful set of heuristics – and these can be learned.  Just as with the Rubik Cube – it is quicker to learn what works from someone who can demonstrate that it works and can explain how it works – than to always laboriously work it out for ourselves.

An organisation is a bio-psycho-socio-economic system: a set of interdependent parts called people connected together by relationships and communication processes we call culture.  Improvement Science is a set of heuristics that have been discovered or designed to guide us safely and reliably towards any goal we choose to select – preserving what has been shown to work and challenging what does not.  Improvement Science does not define the path it only helps us avoid getting stuck, or going around in circles, or getting hopelessly lost while we are on the life-journey to our chosen goal.

And Improvement Science is learnable.

Posted on

Happy Xmas

Have you ever had a Christmas day that felt like you were trying to cram too much into one day – and ended up feeling stressed and irritable – and not enjoying yourself as much as you wanted – then doing it all the same next year just because you felt it was what was expected?

This is a feeling we all get all the time with many things – we keep doing them the same way and get into a rut.

So what would happen if you changed the plan on year?
Would the world come to an end? Probably not.

What have you got to lose by pacing yourself?
It is possible to get further by going slower?

We all know that it is – we all know that if we all rush for the same goal as a disorganised rabble we can trip each other up and everyone goes slower – just observe our behaviour sometimes.  And the more stressed and panicky we get the more likely we are going to switch to look-out-for-number-one behaviour and starting pushing in and pushing others out. Someone will get through first but they do not get through as quickly as they could have. Smooth flow is more efficient than turbulent – so with consideration and collaboration everyone gets further, faster and easier. Everyone.

Posted on

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!

 

Posted on

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.

Posted on

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. 

BaseLine© is a tool designed specifically to offer the novice a path into the world of improvement statistics.

Posted on

More than the Sum or Less?

It is often assumed that if you combine world-class individuals into a team you will get a world-class team.

Meredith Belbin showed 30 years ago that you do not and it was a big shock at the time!

So, if world class individuals are not enough, what are the necessary and sufficient conditions for a world-class team?

The late Russell Ackoff described it perfectly – he said that if you take the best parts of all the available cars and put them together you do not get the best car – you do not even get a car. The parts are necessary but they are not sufficient – how the parts connect to each other and how they influence each other is more important.  These interdependencies are part of the system – and to understand a system requires understanding both the parts and their relationships.

A car is a mechanical system; the human body is a biological system; and a team is a social system. So to create a high performance, healthy, world class team requires that both the individuals and their relationships with each other are aligned and resonant.

When the parts are aligned we get more than the sum of the parts; and when they are not we get less.

If we were to define intelligence quotient as “an ability to understand and solve novel problems” then the capability of a team to solve novel problems is the collective intelligence.  Experience suggests that a group can appear to be less intelligent than any of the individual members.  The problem here is with the relationships between the parts – and the term that is often applied is “dysfunctional”.

The root cause is almost always distrustful attitudes which lead from disrespectful prejudices and that lead to discounting behaviour.  We learn these prejudices, attitudes and behaviours from each other and we reinforce them with years of practice.  But if they are learned then they can be un-learned. It is simple in theory, and it is possible in practice, but it is not easy.

So if we want to (dis)solve complex, novel problems thenwe need world-class problem solving teams; and to transform our 3rd class dysfunctional teams we must first learn to challenge respectfully our disrespectful behaviour.

The elephant is in the room!

Posted on

Does More Efficient equal More Productive?

It is often assumed that efficiency and productivity are the same thing – and this assumption leads to the conclusion that if we use our resources more efficiently then we will automatically be more productive. This is incorrect. The definition of productivity is the ratio of what we expect to get out divided by what we put in – and the important caveat to remember is that only the output which meets expectation is counted – only output that passes the required quality specification.

This caveat has two important implications:

1. Not all activity contributes to productivity. Failures do not.
2. To measure productivity we must define a quality specification.

Efficiency is how resources are used and is often presented as metric called utilisation – the ratio of how much time a resource was used to how much time a resource was available.  So, utilisation includes time spent by resources detecting and correcting avoidable errors.

Increasing utilisation does not always imply increasing productivity: It is possible to become more efficient and less productive by making, checking, detecting and fixing more errors.

For example, if we make more mistakes we will have more output that fails to meet the expected quality, our customers complain and productivity has gone down. Our standard reaction to this situation is to put pressure on ourselves to do more checking and to correct the erros we find – which implies that our utilisation has gone up but our productivity has remained down: we are doing more work to achieve the same outcome.

However, if we remove the cause of the mistakes then more output will meet the quality specification and productivity will go up (better outcome with same resources); and we also have have less re-work to do so utilisation goes down which means productivity goes up even further (remember: productivity = success out divided by effort in). Fixing the root case of errors delivers a double-productivity-improvement.

In the UK we have become a victim of our own success – we have a population that is living longer (hurray) and that will present a greater demand for medical care in the future – however the resources that are available to provide healthcare cannot increase at the same pace (boo) – so we have a problem looming that is not going to go away just by ignoring it. Our healthcare system needs to become more productive. It needs to deliver more care with the same cash – and that implies three requirements:
1. We need to specify our expectation of required quality.
2. We need to measure productivity so that we can measure improvement over time.
3. We need to diagnose the root-causes of errors rather than just treat their effects.

Improved productivity requires improved quality and lower costs – which is good because we want both!

Posted on

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:

Posted on

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.

Posted on

Must We Unlearn First?

In the famous “Star Wars” films when Luke Skywalker is learning to master the Force – his trainer, Jedi Master Yoda, says the famous line:

“You must unlearn what you have learned“.

These seven words capture a fundamental principle of Improvement Science – that very often we have to unlearn before we can improve.

Unlearning is not the same as forgetting – because much of what we have learned is unconscious – so to unlearn we first have to make our assumptions conscious.

Unlearning is not just erasing a memory, it is preparing the mental ground to replace the learning with something else.

And we do not want to unlearn everything – we want to keep the nexus of knowledge nuggets that form the solid foundation of new learning.  We only want to unlearn what is preventing us adding new understanding, concepts and skills – the invisible layer of psychological grease that smears our vision and leaves our minds slippery and unable to grasp new concepts.

We need to apply some cognitive detergent and ad some heated debate to strip off the psycho-slime.  The best detergent is I have found is called Reality and the good news is that Reality is widely available, completely free and supplies will never run out.

Watch the video on YouTube

Posted on

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

Posted on

Are there Three Languages?

When we are in “heated agreement” with each other it feels like we are talking different languages and this is a sign that we need to explore further and deeper. With patience and persistence we realise they are just dialects of the same language. Our challenge now is to learn to speak clearly in one language at a time and in the same language as the person(s) we are communicating with. Improvement Science has three primary languages – the language of quality (100% qualitative) , the language of money (100% quantitative) and the language of time (100% qualitative or quantitative depending on our perspective).  Learning to speak all three languages fluently – dreams are painted in the language of quality, processes are described in the language of time, and survival is a story told in the language of money which is the universal currency that we exchange for our physical needs (water, food, warmth, shelter, security, etc).

The engagement is emotional – through the subjective language of quality – and once engaged we have to master the flow of time in order to influence the flow of money. Our higher purpose is necessary but it is not sufficient – it is our actions that converts our passion into reality – and uncoordinated or badly designed action just dissipates passion and leads to exhaustion, disappointment and cynicism.

Posted on

Reactive or Proactive?

Improvement Science is about solving problems – so looking at how we solve problems is a useful exercise – and there is a continuous spectrum from 100% reactive to 100% proactive.

The reactive paradigm implies waiting until the problem is real and urgent and then acting quickly and decisively – hence the picture of the fire-fighter.  Observe the equipment that the fire-fighter needs:  a hat and suit to keep him safe and a big axe! It is basically a destructive and unsafe job based on the “our purpose is to stop the problem getting worse”.

The proactive paradigm implies looking for the earliest signs of the problem and planning the minimum action required to prevent the problem – hence the picture of the clinician. Observe the equipment that the clinician needs: a clean white coat to keep her patients safe and a stethoscope – a tool designed to increase her sensitivity so that subtle diagnostic sounds can be detected.

If we never do the proactive we will only ever do the reactive – and that is destructive and unsafe. If we never do the reactive we run the risk of losing everything – and that is destructive and unsafe too.

To practice safe and effective Improvement Science we must be able to do both in any combination and know which and when: we need to be impatient, decisive and reactive when a system is unstable, and we need to be patient, reflective and proactive when the system is stable.  To choose our paradigm we must listen to the voice of the process. It will speak to us if we are prepared to listen and if we are prepared to learn it’s language.