Category Archives: Public Sector

Burning Toast: American Health System Style

Democrats and Republicans have created a health care system in the USA over the last 40 years that “burns toast” at an alarming rate. As the symptoms of their health care system are displayed they call in people to blame for burning toast.

Their participation in the “you burn, I’ll scrape” system is even worse than the normal burning then scraping process. They create a bad system over decades and ignore the burnt toast just telling people to put up with it. And when some burnt toast can’t be ignored any longer they then blame individuals for each piece of burnt toast.

They demand that those they bring before them to blame, scrape off the burnt toast. And they act shocked that the “toaster” burns toast. It is the same “toaster” they designed and maintain at the behest of those benefiting from burnt toast and of course it burns toast (those results are the natural outcome of the system they designed and maintain).

We need to fix the decades old broken toaster that the Democrats and Republicans built and have maintained. Dr. Deming called excessive healthcare costs a deadly disease decades ago yet Democrats and Republicans allowed it to continue harming us year after year and decade after decade.

We don’t need distractions blaming a few individual for what the two parties have created and maintained for decades. We need leaders to address the real issues and stop the distraction that those benefiting from the current system want to continue to see from those in Washington.

You don’t fix the system if all you do is blame individuals for each piece of burnt toast. Fixing blame on each piece of burnt toast is exactly what those that have continued to make sure the system is designed to continually burn toast love to see. It is a good way to make sure the fixes needed to the design of the toaster are not addressed. Both political parties have done well by those they receive payments from to ensure that the current toaster isn’t changed.

For decades the data shows the USA health care system costs are nearly double that of other rich countries with no better results. And we are not comparing to some perfect ideal, those efforts we compare to need much improvement themselves. So how bad much the USA health care system be to cost nearly twice as much as those systems that have plenty of room for improvement themselves?

Related: EpiPen Maker Also Hiked Prices on a Slew of Other MedicationsUSA Health-Care System Ranks 50th out of 55 CountriesDrug Prices in the USA, a system continually burning toast (2005)USA Heath Care System Needs Reform (2009)2015 Health Care Price Report – Costs in the USA and Elsewhere

The Education System

The current topic for ASQ Influential Voices to address is the importance of the education system and the impact on the capability of employees.

The education system is important and not very good in my opinion. As a kid I found it boring and constraining and a system designed more to extinguish my quest for knowledge than increase my desire to learn. As a kid I was told by adults that adults knew better and I shouldn’t complain.

I was told “don’t you realize you are in one of the best school systems in the USA?” With a bit of data I was convinced that seemed likely. To me this seemed like an even more ominous sign. If the best was this bad what was everything else like?

The argument that made the most sense to me (for why I should be happy with, or at least accept, the lousy system I was stuck in) was that as a kid I probably just didn’t understand why this environment that seemed to bore not just me, but most all the kids around me and this system that crushed our desire to learn must somehow be working otherwise the adults would certainly fix it.

As an adult what I find is my thoughts as a kid were essentially completely correct (except that last one that adults wouldn’t stick with some pitiful system without good reason) and plenty of education experts had been saying the same things. Adults seem perfectly fine not adopting proven better education practices just as they are fine not adopting proven better management practices.

When Dr. Deming was asked what to do instead of performance appraisal, when he railed against performance appraisal, he said do “whatever Peter Scholtes says.” To the question of what we should we do about the education system I say do whatever David Langford and Alife Kohn say.

I know more about the specifics of what educational systems following David Langford’s idea are like, and all I can say is they are wonderful. If I had kids I would definitely consider moving somewhere that had such a system (like Leander, Texas where they have been moving down that path for 20 years). They focus on helping student learn in a way that is so much more sensible than the one I had to sit through and most everyone reading this had to sit through.

The percentage of students that graduate with a desire to keep learning from an educational system like Leander is much greater than the traditional path. My high school had more National merit scholars than any public high school in the USA the year I graduated (some prep schools beat us, but only a few – partially because we were so large and they are often small). We had many students that were smart, dedicated and capable of succeeding at prestigious universities. Of course with tons of University of Wisconsin faculty as parents this is not a very surprising result.

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George Box Articles Available for a Short Time

A collection of George Box articles have been selected for a virtual George Box issue by David M. Steinberg and made available online.

George E. P. Box died in March 2013. He was a remarkably creative scientist and his celebrated professional career in statistics was always at the interface of science and statistics. George Box, J. Stuart Hunter and Cuthbert Daniel were instrumental in launching Technometrics in 1959, with Stu Hunter as the initial editor. Many of his articles were published in the journal. Therefore we think it is especially fitting that Technometrics should host this on-line collection with some of his most memorable and influential articles.

They also include articles from Journal of the American Statistical Association and Quality Engineering. Taylor & Francis is offering these articles freely in honor of George Box until December 31st, 2014. It is very sad that closed science and engineering journals block access to the great work created by scientists and engineers and most often paid for by government (while working for state government universities and with grants organizations like the National Science Foundation[NSF]). At least they are making a minor exception to provide the public (that should be unlimited access to these works) a limited access to these articles this year. These scientists and engineers dedicated their careers to using knowledge to improve society not to hide knowledge from society.

Some of the excellent articles make available for a short time:

The “virtual issue” includes many more articles.

Related: Design of Experiments: The Process of Discovery is IterativeQuotes by George E.P. BoxThe Art of DiscoveryAn Accidental Statistician: The Life and Memories of George E. P. Box

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Quality Processes in Unexpected Places

This month Paul Borawski asked ASQ’s Influential Voices to explore the use of quality tools in unexpected places.

The most surprising example of this practice that I recall is the Madison, Wisconsin police department surveying those they arrested to get customer feedback. It is obvious that such “customers” are going to be biased. Still the police department was able to get actionable information by seeking the voice of the customer.

photo of a red berry and leaves

Unrelated photo from Singapore Botanical Garden by John Hunter.

Certain of the police department’s aims are not going to match well with those they arrest (most obviously those arrested wish the police department didn’t arrest them). The police department sought the voice of the customer from all those they interacted with (which included those they arrested, but also included those reporting crimes, victims, relatives of those they arrested etc.).

The aim of the police department is not to arrest people. Doing so is necessary but doing so is most similar in the management context to catching an error to remove that bad result. It is better to improve processes so bad results are avoided. How the police interact with the public can improve the process to help steer people’s actions away from those that will require arrests.

The interaction police officers have with the public is a critical gemba for meeting the police department’s aim. Reducing crime and encouraging a peaceful society is aided by knowing the conditions of that gemba and knowing how attempts to improve are being felt at the gemba.

All customer feedback includes bias and personal preferences and potentially desires that are contrary to the aims for the organization (wanting services for free, for example). Understanding this and how important understanding customer/user feedback on the gemba is, it really shouldn’t be surprising that the police would want that data. But I think it may well be that process thinking, evidence based management and such ideas are still not widely practiced as so the Madison police department’s actions are still surprising to many.

Quality Leadership: The First Step Towards Quality Policing by David Couper and Sabine Lobitz

Our business is policing, our customers are the citizens within our jurisdictions, and our product is police service (everything from crime fighting and conflict management to safety and prevention programs.)

If we are to cure this we must start to pay attention to the new ideas and trends in the workplace mentioned earlier that are helping America’s businesses; a commitment to people, how people are treated — employees as well as citizens, the development of a people-oriented workplace, and leadership can and does make a difference.

If we change the way in which we lead the men and women in our police organizations, we can achieve quality in policing. However, wanting to change and changing are worlds apart. The road to change is littered by good intentions and short-term efforts.

This article, from 1987, illustrates the respect for people principle was alive and being practiced 25 years ago; most organizations need to do a great deal more work on applying practices that show respect for people.

Related: Quality Improvement and Government: Ten Hard Lessons From the Madison Experience by David C. Couper, Chief of Police, City of Madison, Wisconsin – SWAT Raids, Failure to Apply System Thinking in Law EnforcementMeasuring What Matters: Developing Measures of What the Police DoThe Public Sector and W. Edwards DemingDoing More with Less in the Public Sector – A Progress Report from Madison, Wisconsin

Using Incentives to Guide Social System Improvements

When confronted with the challenge of managing a social system (or market) I like to find ways to use a few simple rules that will guide the system to find improvements. I favor allowing participants in complex social system to determine how to adapt. So I support, for example, a carbon taxes where the market can decide where it is most effective to invest to reduce carbon use (both to reduce our depletion of the resource and to reduce pollution leading to climate change).

I like to try and keep prescription rules as limited as possible and instead set simple rules that will allow people to make choices. These rules will often allow for people to judge when they need to temper the extremes (in management examples) and in economic situations they often can have costs that escalate as the system is strained (so low pricing if the road is currently not heavily used and increasing the cost to users as congestion increases). The more prescriptive the rules the less ability people have to find creative solutions.

Traffic congestion is a perennial problem with high very costs to society. I very much like congestion pricing. You set a rule that puts increasing costs on those creating an overload on the system (which has costly negative externalities). Then allow people to figure out how to adapt.

The video also provides a very good example of why leadership is important. In Stockholm people were against congestion pricing (70% to 30%). This isn’t surprising they see a new tax that only is a cost. They don’t understand that the system performance is going to improve – the cost will provide a benefit. Leadership is required to push forward when the benefits are not obvious to everyone. Once people saw that congestion was greatly decreased 70% supported congestion pricing.

Jonas Eliasson: “Don’t tell people how to adapt. Nudge them. If you do it correctly – they’ll embrace the change”

Related: The Case for Physically Separated Bike LanesUrban Planning in Northern VirginiaDisregard for People by FedEX and UPS – Systems thinking allowed the engineers to design a solution that wasn’t about enforcing the existing rules more but changing the system so that the causes of the most serious problems are eliminated. – Using Outcome Measures for Prison Management

Better Management in Government

This month Paul Borawski (CEO of ASQ) has asked the ASQ Influential Voices to share their thoughts on quality management in the public sector.

photo of John Hunter with the US Capital in the Background

John Hunter with the US Capital in the background, Washington DC

I have been involved in quality improvement in government at the Office of Secretary of Defense Quality Management Office and the White House Military Office and elsewhere. Transformation and Redesign at the White House Communications Agency by March Laree Jacques provides a nice look at some good efforts. I also was on the board of the Public Sector Network which became the ASQ Government Division. There is lots of great work that has been done.

There are many issues involved, but the biggest is that the leaders in government are normally not interested in having the government perform better. They have political agendas that they are more concerned with, performance just doesn’t matter (or in some cases they even want bad results because their political view is government is bad and therefore anything that makes it look good should be avoided). So they turn the focus of the government to achieving the political aims they have and starve government organizations of talent and money that are not focused exclusively on their agenda.

This doesn’t have to be the case. If politicians cared about the results of their policies, not just the political points related to their agenda it would make sense to support better management strategies. By and large their actions indicate they are not really interested in the results.

Some in government are able to overcome bad leadership. And occasionally political leaders that actual care about results do emerge. In Dr. Deming’s Out of the Crisis he includes (on pages 245-247) an overview, by my father – William Hunter, of the efforts at the City of Madison (which was the first application of Deming’s ideas by government). My father talked to the Mayor (Joe Sensenbrenner) about a project to use management improvement ideas to improve city government performance and the Mayor went along and then became a great advocate.

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Web Seminar with Gerald Suarez: Better Thinking About Leadership

In2In offers some great opportunities for those interested in management improvement. Their conference is excellent. They also offer various conference calls with speakers knowledgeable about Deming and Ackoff’s ideas. These normally take the form of conference call presentations (similar to a podcast) followed by some question and answers. The consistently get remarkable people like, Gerald Suarez, and earlier: Peter Scholtes and Brian Joiner.

Gerald Suarez is kicking off the new InThinking Network monthly webinar series. I worked for Gerald at the White House Military Office. He is one of the best presenters and most knowledgeable experts on Deming and Ackoff’s ideas working today.

Gerald Suarez will present on February 9th on the topic of “Better Thinking About Leadership.” This is a great opportunity and there is no cost to participate. If you participate from outside the USA you can connect via Skype (from the USA you will be given a toll-free number to connect with – or Skpye, if you wish). If you can’t join the call, audio downloads will be available at some later date. Register here. If you can’t make the live event, I strongly recommend listening to the audio download once it is made available.

The format of these sessions is a 90-minute session, each month – from February through November. They are held the second Thursday of the month, from 11:30 AM to 1 PM Pacific Time.

Future sessions that we have to look forward to include:

  • Paul Hollingworth will present in March: An Introduction to Systems Thinking
  • Graham Rawlinson, in May to explore “Thinking About Thinking”
  • Gipsie Ranney, in September: “Cause(s) of Concern,” a session designed to present and advance the understanding of common causes and special causes of variation.

Gerald is currently a professor on the faculty of the University of Maryland’s Robert H. Smith business school and works as a consultant and keynote speaker. Look for him to share his expertise in leadership, which includes 8 years of service in the White House under Presidents Clinton and Bush, as the Director of Presidential Quality — the first such post in the institution’s history.

Related: Transformation and Redesign at the White House Communications AgencyManaging FearThe aim of leadership is not merely to find and record failures of men

Dr. Deming in 1980 on Product Quality in Japan and the USA

I posted an interesting document to the Curious Cat Management Library: it includes Dr. Deming’s comments as part of a discussion organized by the Government Accounting Office in 1980 on Quality in Japan and the United States.

The document provides some interesting thoughts from Dr. Deming and others; Dr. Deming’s statements start on page 52 of the document. For those really interested in management improvement ideas it is a great read. I imagine most managers wouldn’t enjoy it though (it isn’t giving direct advice for today, but I found it very interesting).

Some selected quotes from the document follow. On his work with Japan in 1950:

This movement, I told them, will fail and nothing will happen unless management does their part. Management must know something about statistical techniques and know that if they are good one place, they will work in another. Management must see that they are used throughout the company.
Quality control must take root with simple statistical techniques that management and everyone in the company must learn. By these techniques, people begin to understand the different kinds of variation. Then quality control just grow with statistical theory and further experience. All this learning must be guided by a master. Remarkable results may come quick, but one has no right to expect results in a hurry. The learning period never ends.

The statistical control of quality is not for the timid and the halfhearted. There is no way to learn except to learn it and do it. You can read about swimming, but you might drown if you had to learn it that way!

One of the common themes at that time was Deming’s methods worked because Japanese people and culture were different. That wasn’t why the ideas worked, but it was an idea many people that wanted to keep doing things the old way liked to believe.

There may be a lot of difference, I made the statement on my first visit there that a Japanese man was never too old nor too successful to learn, and to wish to learn; to study and to learn. I know that people here also study and learn. I’ll be eighty next month in October. I study every day and learn every day. So you find studious people everywhere, but I think that you find in Japan the desire to learn, the willingness to learn.

You didn’t come to hear me on this; there are other people here much better qualified than I am to talk. But in Japan, a man works for the company; he doesn’t work to please somebody. He works for the company, he can argue for the company and stick with it when he has an idea because his position is secure. He doesn’t have to please somebody. It is so here in some companies, but only in a few. I think this is an important difference.

At the time the way QC circles worked in Japan was basically employee led kaizen. So companies that tried to copy Japan told workers: now go make things better like the workers we saw in Japan were doing. Well with management not changing (and understanding Deming’s ideas, lean thinking, variation, systems thinking…) and staff not given training to understand how to improve processes it didn’t work very well. We (those reading this blog) may all now understand the advantages one piece flow. I can’t imagine too many people would jump to that idea sitting in their QC circle without having been told about one piece flow (I know I wouldn’t have), and all the supporting knowledge needed to make that concept work.

QC circles can make tremendous contributions. But let me tell you this, Elmer. If it isn’t obvious to the workers that the managers are doing their part, which only they can do, I think that the workers just get fed up with trying in vain to improve their part of the work. Management must do their part: they must learn something about management.

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Lean Thinking in Minnesota Government

The Office of Governor Pawlenty issued a press release on Minnesota’s Drive to Excellence effort:

Increased Quality via Lean Continuous Improvement Reform – The State has adopted
“Lean Thinking” as its preferred process improvement tool. So far, 18 agencies are actively
involved, with 302 staff members participating in 38 Kaizen improvement events. These
events have yielded significant improvements in the delivery of state government services,
from issuing duplicate birth certificates to processing State Soldiers Assistance requests.

The Drive to Excellence includes 15 specific projects for reforming state government, ranging
from strategic procurement to a Lean continuous improvement effort and the reform of state grants
management. The projects focus on improving quality and customer service and reducing costs in
the delivery of government services to citizens.

Read about more public sector management improvement efforts on my Public Sector Continuous Improvement Site.

Related: Six Sigma In New York Local GovernmentTransformation and Redesign at the White HouseThe Georgetown Kentucky WayPublic Sector Management

Federal Government Chief Performance Officer

A Quality Manager for Obama

President-Elect Obama has hired a quality manager, and her name is Nancy Killefer. She is the newly appointed “Chief Performance Officer” whose mandate is to manage budget reforms while eliminating waste in government processes, ultimately making it more effective. An MIT & McKinsey alum, Time calls her the “first official waste watchdog.”

Previous administrations have had exactly the same thing (regardless what Time magazine says), so I don’t think we should get carried away. Eliminating wasteful government spending is a refrain from every new administration. She will be running the Office of Management and Budget (OMB) and have this new title “Chief Performance Officer.” OMB has been the official waste watchdog, for at least decades. They are far from understanding muda. Time will tell if there is any change on that score going forward, I am skeptical.

Here is very typical OMB language from a 1995 memo by Alice M. Rivlin, Director of OMB:

Management controls are the organization, policies, and procedures used to reasonably ensure that (i) programs achieve their intended results; (ii) resources are used consistent with agency mission; (iii) programs and resources are protected from waste, fraud, and mismanagement; (iv) laws and regulations are followed; and (v) reliable and timely information is obtained, maintained, reported and used for decision making.

I worked with improving management in the federal government at the Office of Personnel Management, Office of the Secretary of Defense, Quality Management Office and the White House Military Office. I was one of the founders of the ASQ Public Sector Network (now Government Division) and have managed the Public Sector Continuous Improvement Site since 1995. There have been plenty of great efforts to improve management in government that have made real progress. But there is much more that needs to be done.

There are complications in applying management improvement in government but they are fairly minor comparatively. In general, the difficulty is not the necessary adjustments for a different environment than the private sector, but similar challenges to improving private sector management.

In 1982, The Grace Commission provided a report to the Regan Administration. Radio Address to the Nation on the Management of the Federal Government by Ronald Reagan, October 29, 1988

“We also set up the Private Sector Survey on Cost Control led by Peter Grace — almost 200 top business executives. This Commission spent months looking at every part of the Government, finding out where modern business practices could eliminate waste, fraud, and abuse in the Government. When they were through, they’d come up with 2,478 suggestions. And almost every recommendation we could put into effect without congressional action has been implemented. And we’ve saved close to $80 billion. We’re hoping that the next Congress will pitch in and do its part.”

The Clinton administration had the National Performance Review which was the closest thing to an attempt to move toward my concept of management improvement.

The current administration had their own President’s Management Agenda. Government Accountability: Efforts to Identify and Eliminate Waste and Mismanagement Hearing before the Committee on International Relations, House of Representatives, September 4, 2003.
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