Tag Archives: management concepts

Improving Management with Tools and Knowledge

Too often today I hear people disparaging management tools/concepts (PDSA cycle, mistake proofing, flowcharts, design of experiments, gemba…). The frequently voiced notion is that tools are being applied and not helping improve management in the organization.

But it seems to me using these tools re-enforce the best practices of management improvement. Yes, ignoring the underlying principles (while applying tools and concepts) drastically limits how successful an organization will be in improving management practices (and limits the results the organization will achieve). But using the tools is not the problem. Using the tools is a necessary but not sufficient part of the process to improve.

What is needed is to use the tools with engaged people that are continually learning and adjusting the management system based on their increase understanding of the organization as a system. Using management tools effectively (if you are unsure of what those tools are, read the posts on this blog discussing many management improvement tools) supports gaining insight into the underlying management improvement principles.

It is important to understand there are fundamental concepts that connect and reinforce each other. And those organizations that are successful are using management tools and continually building their understanding of the underlying principles.

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Integrating Technical and Human Management Systems

ASQ has asked the Influential Voices on quality management to look at the question of integrating technical quality and human management systems. How do different systems—technical or human—work together? How should they work together?

My view is that the management system must integrate these facets together. A common problem that companies face is that they bring in technical tools (such as control charts, PDSA improvement cycle, design of experiments, kanban, etc.) without an appreciation for the organization as a system. Part of understanding the organization as a system is understanding psychology within this context (as W. Edwards Deming discussed frequently and emphasized in his management system).

To try and implement quality tools without addressing the systemic barriers (due to the management system and specifically the human component of that system) is a path to very limited success. The failure to address how the organization’s existing management system drives behaviors that are often counter to the professed aims of the organization greatly reduces the ability to use technical tools to improve.

If the organization rewards those in one silo (say purchasing) based on savings they make in cutting the cost of supplies it will be very difficult for the organization to optimize the system as a whole. If the purchasing department gets bonuses and promotions by cutting costs that is where they will focus and the total costs to the organization are not going to be their focus. Attempts to create ever more complex extrinsic incentives to make sure the incentives don’t leave to sub-optimization are rarely effective. They can avoid the most obvious sub-optimization but rarely lead to anything close to actually optimizing the overall system.

image of the cover of Managmenet Matters by John Hunter

Management Matters by John Hunter

It is critical to create an integrated system that focuses on letting people use their brains to continually improve the organization. This process doesn’t lend itself to easy recipes for success. It requires thoughtful application of good management improvement ideas based on the current capabilities of the organization and the short, medium and long term priorities the organization is willing to commit to.

There are principles that must be present:

  • a commitment to treating everyone in the organization as a valuable partner
  • allowing those closest to issues to figure out how to deal with them (and to provide them the tools, training and management system necessary to do so effectively) – see the last point
  • a commitment to continual improvement, learning and experimentation
  • providing everyone the tools (often, this means mental tools as much as physical tools or even quality tools such as a control chart). By mental tools, I mean the ability to use the quality tools and concepts. This often requires training and coaching in addition to a management system that allows it. Each of these is often a problem that is not adequately addressed in most organizations.
  • an understanding of what data is and is not telling us.

An integrated management system with an appreciation for the importance of people centered management is the only way to get the true benefit of the technical tools available.

I have discussed the various offshoots of the ideas discussed here and delved into more details in many previous posts and in my book – Management Matters: Building Enterprise Capability. An article, by my father, also addresses this area very well, while explaining how to capture and improve using two resources, largely untapped in American organizations, are potential information and employee creativity. It is only by engaging the minds of everyone that the tools of “technical” quality will result in even a decent fraction of the benefit they potentially can provide if used well.

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Visual Management and Mistake-Proofing for Prescription Pills

Good ideas often just require some sensible thought to think of an improved approach. Management concepts can help guide such thinking, such as mistake-proofing and visual management.

To apply visual management requires giving a bit of thought to how to make visually obvious what is important for people to know. Mistake proofing is often really mistake-making-more-difficult (for some reason this term of mine hasn’t caught on).

prescription pills packaged together

Image from PillPack, they provide a service to deliver packages based on your prescriptions.

I believe mistake-proofing should put barriers in the process that make a mistake hard. Often what is called mistake-proofing doesn’t really fit that definition. The pill package shown above for example, doesn’t prevent you from continuing past the time on the package (Monday at 8AM) without taking the pills.

To call it mistake-proofing I would like to see something that makes it harder to make the mistake of failing to take the pills: something that blocks progress beyond that time without taking the pills.

Even something as simple as an alert to your smart phone that gets your attention and doesn’t allow the smart phone to be used without indicating you have taken the pills would reach the “mistake-proofing” level in my opinion (for someone that has their phone with them at all times). The Apple Watch could be a good tool to use in this case. Even so those wouldn’t make mistakes impossible (you can say you took the pills even if you didn’t, the phone/watch may lose power…). It would depend on the situation; this smart phone/watch solution is not going to be good for some people.

Another idea is that these pill packages should be tied to the room (in a hospital) and at home if a home care nurse (or even family or others) are responsible for assuring the pills are taken with a big display that perhaps 30 minutes before the pill is due posts a message that says “pills to be taken at 8 AM” and once that time is past it could become more obvious, perhaps after 15 minutes it produces an audio alert. The actual solutions are going to be better from those that know the actual situation than someone like me just thinking up stuff as I type.

But the idea is pretty simple: when you have processes that are important and at risk of failure, design processes with elements to make mistakes hard (and ideas such as mistake-proofing and visual management can help you guide your mind to ways to create better processes).

The entire process needs to be considered. The pill packages are nice, because even in failure modes they provide good feedback: you may still fail to take them at the right time, but you can look at the location where the pill packages are kept and see
if any have a time before right now (in which case you can follow the medical guidance – take the pills right now, contact the doctor, or whatever that advice is). Of course even that isn’t foolproof, you could have put the package into your purse and it is still sitting in their but you forgot.

Still the pill packages seem like a good mistake-making-more-difficult solution. And it seems to me that process has room to make mistakes even more difficult (using a smartphone addition, for example).

Continual improvement requires a continual focus on the process and the end user for ways to increase reliability and value. Each process in question should have engaged people with the proper skills and freedom to act using their knowledge to address weakness in the current process that are most critical.

Failure to take prescriptions as directed in a common problem in health care. Knowing this should make those involved in the process think of how they can use concepts, such as mistake-proofing, to improve the results of the system.

Too often to much focus is on making better pills compared to the effort is put into how to improve results with simple concepts such as visual management and mistake-proofing.

Each small improvement contributes to creating a more robust and effective process. And engaged people should continually access how the containing systems, new processes and new capabilities may allow more small steps to provide value to those relying on your products and services.

Related: Great Visual Instruction Example for Taking PillsVisual Management with Brown M&MsQuick Mistake Proofing Ideas for Preventing Date Entry Error

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Common Cause Variation

Every system has variation. Common cause variation is the variation due to the current system. Dr. Deming increased his estimate of variation due to the system (common cause variation) to 97% (earlier in his life he cited figures around 80%). Special cause variation is that due to some special (not part of the system) cause.

The control chart (in addition to other things) helps managers to avoid tampering (taking action on common cause variation as though it were a special cause). In order to take action against the results of common cause variation the performance of the system the system itself must be changed. A systemic improvement approach is needed.

To take action against a special cause, that isolated special cause can be examined. Unfortunately that approach (the one we tend to use almost all the time) is the wrong approach for systemic problems (which Deming estimated at 97% of the problems).

That doesn’t mean it is not possible to improve results by treating all problems as some special event. Examining each failure in isolation is just is not as effective. Instead examine the system that produced those results is the best method. The control chart provides a measurement of the system. The chart will show what the process is capable of producing and how much variation is in the system now.

If you would like to reduce the variation picking the highest data values (within the control limits) and trying to study them to figure out why they are so high is not effective. Instead you should study the whole system and figure out what systemic changes to make. One method to encourage this type of thinking is asking why 5 times. It seeks to find the systemic reasons for individual results.

Related: SPC – HistoryUnderstanding Variation by Tom Nolan and Lloyd Provost (highly recommended) – Deming on Management