{"id":3919,"date":"2015-01-10T13:26:34","date_gmt":"2015-01-10T13:26:34","guid":{"rendered":"http:\/\/www.saasoft.com\/blog\/?p=3919"},"modified":"2015-01-10T13:26:34","modified_gmt":"2015-01-10T13:26:34","slug":"sfqp","status":"publish","type":"post","link":"https:\/\/hcse.blog\/?p=3919","title":{"rendered":"SFQP"},"content":{"rendered":"

\"SFQP\"<\/a>The flavour of the week has been “chaos”.\u00a0 Again!<\/p>\n

Chaos dissipates energy faster than calm so chaotic behaviour is a symptom of an inefficient design.<\/p>\n

And we would like to improve our design to restore a state of ‘calm efficiency’.<\/p>\n

Chaos is a flow phenomenon … but that is not where the improvement by design process starts.\u00a0 There is a step before that … Safety.<\/p>\n

\n

Safety First
\n<\/strong>If a design is unsafe it generates harm.\u00a0 So we do not want to improve the smooth efficiency of the harm generator … that will only produce more harm!\u00a0 First we must consider if our system is safe enough.<\/p>\n

Despite what many claim, our healthcare systems are actually very safe.\u00a0 For sure there are embarrassing exceptions and we can always improve safety further, but we actually have quite a safe design.<\/p>\n

It is not a very efficient design though.\u00a0 There is a lot of checking and correcting which uses up time and resources … but it helps to ensure safety is good enough for now.<\/p>\n

Having done the safety sanity check we can move on to Flow.<\/p>\n

\n

Flow Second<\/strong>
\nFlow comes before quality because it is impossible to deliver a high quality experience in a chaotic system.\u00a0 First we need to calm any chaos.\u00a0 Or rather we need to diagnose the root causes of the chaotic behaviour and do some flow re-design to restore the calm.<\/p>\n

Chaos is funny stuff.\u00a0 It does not behave intuitively.\u00a0 Time is always a factor.\u00a0 The butterflies wing effect<\/em> is ever present.\u00a0 Small causes can have big effects, both good and bad.\u00a0 Big causes can have no effect.\u00a0 Causes can be synergistic and they can be antagonistic.\u00a0 The whole is not the sum of the parts.\u00a0 This confusing and counter-intuitive behaviour is called “non linear” and we are all rubbish at getting a mental handle on it.\u00a0 Our brains did not evolve that way.<\/p>\n

The good news is that when chaos reigns it is usually possible to calm it with a small number of carefully placed, carefully timed, carefully designed, synergistic, design “tweaks”.<\/p>\n

The problem is that when we do what intuitively feels “right” we can too easily make poor improvement decisions that lead to ineffective actions.\u00a0 The chaos either does not go away or it gets worse.\u00a0 So, we have learned from our ineptitude to just put up with the chaos and to accept the inefficiency, the high cost-of-chaos.<\/p>\n

To calm the chaos we have to learn how to use the tools designed to do that.\u00a0 And they do exist.<\/p>\n

\n

Quality
\n<\/strong>Safety and Flow represent the “absolute” half of the SFQP cycle.\u00a0 Harm is an absolute metric. We can devise absolute definitions and count harmful events.\u00a0 Mortality.\u00a0 Mistakes.\u00a0 Hospital\u00a0 acquired infections.\u00a0 That sort of stuff.<\/p>\n

Flow is absolute too in the sense that the Laws of Physics determine what happens, and they are absolute too. And non-negotiable.<\/p>\n

Quality is relative.\u00a0 It is the ratio of experience and expectation and both of these are subjective but that is not the point.\u00a0 The point is that it is a ratio and that makes it a relative metric.\u00a0 My expectation influences my perception of quality, as does what I experience.\u00a0 And this has important implications.\u00a0 For example we can reduce disappointment by lowering expectation; or we can reduce disappointment by improving experience.\u00a0 Lowering expectation is the easier option because to do that we only have to don the “black hat” and paint a grisly picture of a worst case scenario.\u00a0 Some call it “informed consent”; I call it “abdication of empathy” and “fear-mongering”.<\/p>\n

Variable quality can\u00a0 come from variable experience, variable expectation or both.\u00a0 So, to reduce quality variation we can focus on either input to the ratio; and the easiest is expectation.\u00a0 Setting a realistic expectation just requires measuring experience retrospectively and sharing it prospectively.\u00a0 Not satisfaction mind you – Experience. Satisfaction surveys are largely meaningless as an improvement tool because just setting a lower expectation will improve satisfaction!<\/p>\n

And this is why quality follows flow … because if flow is chaotic then expectation becomes a lottery, and quality does too.\u00a0 The chaotic behaviour of the St.Elsewhere’s\u00ae\u00a0<\/em>A&E Department that we saw last week implies that we cannot set any other expectation than “It might be OK or it might be Not OK … we cannot predict. So fingers crossed.<\/em>”\u00a0 It is a quality lottery!<\/p>\n

But with calm and efficient flow we experience less variation and with that we can set a reasonable expectation.\u00a0 Quality becomes predictable-within-limits.<\/p>\n

\n

Productivity
\n<\/strong>Productivity is also a relative concept.\u00a0 It is the ratio of what we get out of the system divided by what we put in.\u00a0 Revenue divided by expense for example.<\/p>\n

And it does not actually emerge last.\u00a0 As soon as safety, flow or quality improve then they will have an immediate impact on productivity.\u00a0 Work gets easier.\u00a0 The cost of harm, chaos and disappointment will fall (and they are surprisingly large costs!).<\/p>\n

The reason that productivity-by-design comes last is because we are talking about focussed productivity improvement-by-design.\u00a0 Better value for money.\u00a0 And that requires a specific design focus.\u00a0 And it comes last because we need some head-space and some life-time to learn and do good system design.<\/p>\n

And SFQP is a cycle so after doing the Productivity improvement we go back to Safety and ask “How can we make our design even safer and even simpler?<\/em>” And so on, round and round the SFQP loop.<\/p>\n

Do no harm, restore the calm, delight for all, and costs will fall.<\/em><\/strong><\/p>\n

And if you would like a full-size copy of the SFQP cycle diagram to use and share just click here<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

The flavour of the week has been “chaos”.\u00a0 Again! Chaos dissipates energy faster than calm so chaotic behaviour is a symptom of an inefficient design. And we would like to improve our design to restore a state of ‘calm efficiency’. Chaos is a flow phenomenon … but that is not where the improvement by design … <\/p>\n

Continue reading “SFQP”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20,32,35,40],"tags":[],"class_list":["post-3919","post","type-post","status-publish","format-standard","hentry","category-flow","category-productivity","category-reflections","category-sfqp"],"_links":{"self":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/posts\/3919","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3919"}],"version-history":[{"count":0,"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/posts\/3919\/revisions"}],"wp:attachment":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3919"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3919"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3919"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}