Change Health Care

Posted on March 8, 2007  Comments (1)

How Toyota Can Save Your Life…at the hospital by Mark Graban, another great manifesto from Change This:

In reality, each of these deaths and medical mistakes is a systemic failure. these were problems that could have occurred, or were bound to occur, anywhere–any given patient, any given caregiver. the idea that medical mistakes, as with plane crashes, are basically random events is very scary.

True. If the context of the problem is not understood the efforts to improve will not be as effective as they could be.

Spending money hasn’t worked so far. While the united States far outspends other countries ($4500 per capita, while Switzerland is a distant second at about $3000 per capita), our life expectancy trails Japan (which spends about $2000 per capita), Switzerland, and other countries including Canada, France, Luxembourg, and even Malta. Spending more, whether it’s in manufacturing, education, or healthcare does not necessarily lead to higher quality or better results.
…
Unfortunately, the healthcare world operates in a highly litigious environment where there are financial or legal incentives to cover up and hide the cause of problems. It is easier to let an individual take the fall and let the public believe that the problem has been solved because the person at fault was fired or prosecuted.

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Motivating Employees

Posted on March 7, 2007  Comments (1)

No Matter How Badly You Want It:

“When it seems easy, it’s like they already wanted to do it in the first place.” Martin paused. “It seems impossible when they didn’t ever want to do it. So, it doesn’t seem to matter what you want, as the manager, or how badly you want it. The only thing that seems to matter is whether your team members want to do it?”

The lights were circling in Martin’s head. The whole time, as a manager, he had been looking at motivation as getting people to do something he wanted. His mind was beginning to change.

Douglas McGregor discussed this topic well in 1960. He explained theory X management (managers believe the workers will do only what they are forced, coerced into doing) and theory Y management (managers believe the workers want to do a good job and the managers job is to help them do so) in his excellent book: The Human Side Of Enterprise.

When a manager thinks in a theory y way they assume people wish to do a good job. If the employees are not doing some task the way the manager wants, the manager needs to figure out what is wrong with the system that leads to this outcome (not what is wrong with the employees).

When a manger views the problem as one of motivating workers that puts the problem within the worker. They need to be changed. That is the wrong strategy, most of the time. People want to do a good job; the job of a manager is to remove the de-motivation within the system.

Related: Motivation – Incentive Programs are Ineffective – Motivation Poster – respect for workers posts

Total Quality Software Development

Posted on March 6, 2007  Comments (0)

Total Quality Service podcast by Michael Tiemann, Redhat Software.

Do we offshore the problem to somebody else, you know get more bad software cheaper? Or do we fix the problem? I think we fix the problem. Now, in going to Japan and talking about this software quality problem it was pretty obvious I had to go and study Deming…

I think the first 10 minutes of the podcast is valuable to anyone. The last 8 minutes might not appeal to those without an interest in software development and IT.

Related: Deming’s 14 Points – Agile Management – Innovation in Software Development Process – What Business Can Learn from Open Source

Website Data

Posted on March 5, 2007  Comments (1)

The Alexa toolbar, from amazon.com (and by the guy, Brewster Kahle, who created the internet archive too, by the way) is one way to get some idea of how popular a web site is (the toolbar shows the web site rank for each site you visit). It is very inaccurate, but is free, and easy, so it is used. Alexa Toolbar and the Problem of Experiment Design shows why data based decision making is not the solution to all your problems:

What that means is that people with the Alexa toolbar installed are 25 times more likely to view a page on Matt’s site versus mine, but overall, all users view twice as many pages on my site. That’s a 50 to 1 difference introduced by the selection bias of Alexa.

As Dr. Deming said best efforts are not enough, you need to know what to do first. The same holds true with data, first you need to have useful data.

Related: Manage what you can’t measure – podcast interview: Brewster Kahle – Gladwell and more IT Conversations

All Models Are Wrong But Some Are Useful

Posted on March 4, 2007  Comments (4)

“All Models Are Wrong But Some Are Useful” -George Box

A great quote. Here is the source: George E.P. Box, Robustness in the strategy of scientific model building, page 202 of Robustness in Statistics, R.L. Launer and G.N. Wilkinson, Editors. 1979.

Related: Dangers of Forgetting the Proxy Nature of Data – articles by George Box – Quotes by Dr. W. Edwards Deming

Management Improvement Carnival #6

Posted on March 2, 2007  Comments (0)

Management Improvement ideas from around the web:

  • Lean Q&A by Jamie Flinchbaugh – “There is no recipe, no three-ring binder approach to lean. If someone brings you an approach and says “here is the best way to implement lean,” please, run away.”
  • Seven steps to remarkable customer service by Joel Spolsky – “The superficial and immediate solution is just to solve the customer’s problem. But when you think a little harder you can usually find a deeper solution”
  • The Seven Habits of Toyota People by Jon Miller – “2. Think about what is the problem… 5. Discuss things with each other 6. Are thorough about genchi gembutsu“
  • Why Write it down? by Joe Ely – “Lean is built on standard work. We write down work instructions. We write down paths for material handlers. We ask associates to write down small improvements. We write down kaizen plans.”
  • The Great Lean Consulting Shakeout by Bill Waddell – “Big consulting firms peddling ‘kaizen in a box’ – prepackaged, one size fits all, lean manufacturing through kaizen events – are collapsing as well they should… The best I can do is to teach, coach, and encourage, but you and the people in your company will have to do all of the hard work.”
  • Plan, Do, Check and Act in the Deming Wheel by Grigor – “After the solution is developed it is checked against a problem it should solve. If goal is not achieved, we should go back to a planning phase. If goal is achieved solution can be applied widely.”

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Write it Down

Posted on March 1, 2007  Comments (3)

Why Write it down?

The longer I pursue Lean, the more I am amazed with its fundamentals. I may write more about this in the near future. Like the emphasis to write things down.

Right on. In meetings writing down decisions (what is the issue, who is going to do what…) is very helpful. It is very easy for people to think people agree to some somewhat clear statements made in the meeting. Only later it becomes obvious several people have different understandings (sometimes this is even really basically know in the meeting but it is easier to let things slide instead of confronting the disagreement – but this is not helpful, it just means the issue is not properly address, it might make the meeting easier but that should not be the goal). Writing it down greatly reduces the chance of miscommunication.

Russell Ackoff also has some great stuff on the importance of documenting decisions – both to serve as guide posts to future action and to serve as documentation that can be examined over time to find historic weaknesses and strengths with decision making in the organization. The Team Handbook is a very good book for improving team meetings and team performance.

Ackoff on decision making (pdf):

Preparing a record of every decision of any significance, ones that involve doing something or (of particular importance) ones that involve not doing something. This record should include the following information:

• The justification for the decision including its expected effects and the time by which they are expected…
• The assumptions on which the expectations are based…
• The information, knowledge, and understanding that went into the decision.
• Who made the decision, how it was made, and when…
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Evolving Excellence – The Book

Posted on March 1, 2007  Comments (0)

Evolving Excellence – the book takes posts from the excellent Evolving Excellence blog by Keven Meyer and William Waddell. Those familiar with their work know that the authors provide great insight and take strong positions – they are not timid. The book is an enjoyable read and packed with great ideas focused on lean manufacturing and lean management thinking. I enjoyed the different format of reading the material presented in the blog (though I like the blog even better, linking to other resources…, but books have advantages in certain ways).

Another nice feature is since the material is from a living blog, you can visit the blog and find out new thoughts they have posted on areas that you find especially interesting in the book. The blog also includes comments others have shared on the thoughts expressed in the book and links to online resources.

Related: Curious Cat Management Improvement Blog Directory

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