Tag Archives: management tools

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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Interview on PDSA, Deming, Strategy and More

Bill Fox interviewed me and has posted part one of the interview on his web site: Predicting Results in the Planning Stage (sorry, the link has been hijacked to forward to an unrelated page [so obviously I removed the link], I have posted the interview which can now be reached here):

Bill: John, what is your best process improvement strategy or tactic that has worked well for you or your clients?

John: I would say the PDSA improvement cycle and a few key practices in using the PDSA properly like predicting the results in the plan stage—something that a lot of the times people do not do—to determine what would be done based on the results of that prediction.

People discover, especially when they’re new to this stuff, regarding the data that they’re collecting, that maybe even if they got the results they are predicting, they still don’t have enough data to take action. So you figure that even if that number is 30, they would need to know three other things before they make the change. So then, in the plan stage, you can figure that you need to address these other issues, too. At any time that people are collecting data is useful to figure out, for instance: “What do we need to do if the result is 30 or if the result is 3?” And if you don’t have any difference, why are you collecting the data?

Another important piece is the D in Plan, Do, Study, Act. It means “do the experiment”. A lot of times, people get confused into thinking that D means deploy the results or something like that, but thinking of D as ‘doing the experiment’ can be helpful.

A really big key between people that use PDSA successfully and those who don’t is that the ones that do it successfully turn the cycle quickly.

Another response:

Bill: What is the biggest misunderstanding about the Deming Management System you think people have?

John: I would say that there are a couple. The followers that want to pin everything to Deming tend to overlook the complexities and nuances and other things.

The other problem is that some of the critics latch on to a specific quote from Deming, something like a one-sentence long quote, and then they extrapolate from that one sentence-long quote what that means. And the problem is that Deming has lots of these one-sentence quotes that are very memorable and meaningful and useful, but they don’t capture every nuance and they don’t alone capture what it really means (you need to have the background knowledge to understand it completely).

They are sort of trying to oversimplify the message into these sound bites, and I find that frustrating. Because those individual quotes are wonderful, but they are limited to one little quote out of hours of videotape, books, articles, and when you don’t understand the context in which that resides, that’s a problem.

See the full interview for more details and other topics. I think it is worth reading, of course I am a bit biased.

Related: more interviews with John HunterInterviews with John Hunter on his book: Management MattersDeming and Software DevelopmentLean Blog Podcast with John Hunter

How to Get a New Management Strategy, Tool or Concept Adopted

Often when learning about Deming’s ideas on management, lean manufacturing, design of experiments, PDSA… people become excited. They discover new ideas that show great promise to alleviate the troubles they have in their workplace and lead them to better results. But how to actually get their organization to adopt the ideas often confounds them. In fact, I believe most potential improvements efforts may well fail even before they start because people can’t get past this problem.

I believe the way to encourage adoption of management improvement tools, methods and ideas is to solve people’s problems (or give them new opportunities). Instead of trying to convince people by talking about why they need to adopt some new ideas, I think it is much better to show them. To encourage the adoption of whatever it is (a philosophy like Deming or a new tool) try to find projects that would be good candidates for visible success. And then build on those successes.

For adopting whole new ways of working (like lean thinking) you go through this process many times, adding more and more new ideas to the accepted way of doing things. It is a bit easier if you are the CEO, but I think the strategy is very similar whoever you are. For smaller efforts a boss can often just mandate it. But for something like a large improvement in the way work is done (adopting a lean management system, for example), the challenge is the same. You have to convince people that the new methods and ideas are valuable and that they can use the ideas to help improve results.

Start small, it is very helpful if initial efforts are fairly small and straight forward. You often will have limited resources (and limited time people are willing to invest) at first. so start by picking projects that can be accomplished easily and once people have seen success more resources (including what is normally the most important one – people’s time) should be available. Though, honestly getting people to commit will likely be a challenge for a long time.

It is a rare organization that adopts a continual improvement, long term focus, system thinking mindset initially. The tendency is often strong to focus on fire fighting, fear (am I taking a risk by doing x, if I spend time improving y – what about the monthly target my boss is measuring me on…) and maintaining the status quo. It is baffling to many hoping for improvement, when you have huge successes, and yet the old way of doing things retains a great hold. The inertia of organizations is huge.
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Understanding Psychology: Slogans – Risky Tools

De-motivation Poster

Slogans mainly are bad. But like most things they can be used in ways that help or hurt. The main problem is when they substitute for a method to achieve the aim (most of the time). If the slogan serves like a mission statement to focus people on something useful to focus on and it is one minor part of a system to achieve a result it can be fine and even useful.

The issue, to me, is not so much that slogans are innately horrible. It is that, in practice, slogan are used in harmful ways most often (especially outside of sports). They tend to substitute for system improvement. The main work of shifting psychology (we do expect to win now, we do expect a focus on reducing bugs in our code…) after years of creating a different culture has to be in changing methods, priorities, values… Slogans, if done right, can be a way of focusing on the change. Or they can be a real reminder of values. But the slogan only provides value as part of a system confirming the aim they emphasis.

Unfortunately, they also to be used as a way to focus criticisms on individuals. Don’t you know/care that our slogan says zero defects? Can’t you read? Jeez, I even put up a huge poster with our slogan saying zero defects and you can’t even do what it says in this beautiful poster? Well, I will give you a bad performance review now, you can’t say you don’t have that coming after you failed to do what our slogan told you to do.

A slogan by itself has negative value. Take any wonderful slogan and move it somewhere else it will do more harm than good. As a minor part of a system though it can tap into how we people think and act (psychology) and provide value. Be careful though, it is much easier to do harm with slogans than to provide value.

If the slogan emphasizes what is being practiced every day, it can be a helpful reinforcer. If it conflicts with what is done every day it breeds cynicism and shows disrespect for people. This which is a huge problem. And managers have to know it is very easy for people to see the lack of cloths on the emperor slogan. Dilbert does a great job showing the risks of using slogans. Those you are targeting the slogan to are more likely to think like Dilbert than the they are to think like the pointy haired boss (and if you are the one pushing the slogan that means you are well on your way to being the phb – so be careful).

Slogans clearly fall under Deming’s understanding psychology area of management. To use them effectively you need to make sure the value provided, exceeds the cost and risk. I see no better way to evaluate slogans than through the lens of Deming’s system of management, interdependent components of: psychology, systems thinking, understanding variation and theory of knowledge. If the slogan is not supported by they system of management in place it will do harm.

In response to: Are Slogans Always Bad or Can They Inspire?

Related: Deming on eliminating slogans and motivational postersEliminate SlogansToyota Targets 50% Reduction in Maintenance Wasteposts on psychologyHow to ImproveStop Demotivating Employees

Management Improvement Carnival #30

Please submit your favorite management posts to the carnival. Read the previous management carnivals.

Lean Six Sigma Case Studies

ValuMetrix Services provides some really nice lean six sigma case studies. Simple short but still with enough detail to actually provide some sense of what is going on.

While on the topic of online case studies let me plug the Curious Cat management improvement library. I think it is one of the more valuable resources for management improvement offered on the Curious Cat sites. Library shelves: health care articles, lean manufacturing articles, six sigma articles, newly added articles

via: Daily Kaizen

Related: Curious Cat Management SearchManagement Consulting, what does the web site show?Lean Management Case Study

The Power of a Checklist

Great article on The Checklist – If something so simple can transform intensive care, what else can it do? by Atul Gawande

A decade ago, Israeli scientists published a study in which engineers observed patient care in I.C.U.s for twenty-four-hour stretches. They found that the average patient required a hundred and seventy-eight individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them posed risks. Remarkably, the nurses and doctors were observed to make an error in just one per cent of these actions—but that still amounted to an average of two errors a day with every patient.

In the early years of flight, getting an aircraft into the air might have been nerve-racking, but it was hardly complex. Using a checklist for takeoff would no more have occurred to a pilot than to a driver backing a car out of the garage. But this new plane was too complicated to be left to the memory of any pilot, however expert. With the checklist in hand, the pilots went on to fly the Model 299 a total of 1.8 million miles without one accident.

Yet it’s far from obvious that something as simple as a checklist could be of much help in medical care. Sick people are phenomenally more various than airplanes. A study of forty-one thousand trauma patients—just trauma patients—found that they had 1,224 different injury-related diagnoses in 32,261 unique combinations for teams to attend to. That’s like having 32,261 kinds of airplane to land. Mapping out the proper steps for each is not possible, and physicians have been skeptical that a piece of paper with a bunch of little boxes would improve matters much. In 2001, though, a critical-care specialist at Johns Hopkins Hospital named Peter Pronovost decided to give it a try.

Pronovost and his colleagues monitored what happened for a year afterward. The results were so dramatic that they weren’t sure whether to believe them: the ten-day line-infection rate went from eleven per cent to zero. So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.

Teams also complained to the hospital officials that the checklist required that patients be fully covered with a sterile drape when lines were being put in, but full-size barrier drapes were often unavailable. So the officials made sure that the drapes were stocked. Then they persuaded Arrow International, one of the largest manufacturers of central lines, to produce a new central-line kit that had both the drape and chlorhexidine in it.

Related: Why Isn’t Work Standard?Visual Work Instructionsposts on quality toolsEuropean Blackout not Human Error-Not

Control Charts in Health Care

This post is an edited version of a message I sent to the Deming Electronic Network.

I find the “control charts in health care” thread quite interesting.

From Mike Woolbert’s post [link broken, so I removed it]
> I have read many comments about the 8 minute ambulance trip.
> This doesn’t seem to be a system measure, but a result measure.

It seems to me the 8 minute (90% of the time) measure is an attempt at a process measure (in a sense, you can see it as a result measure, but it is also a measure that will have an impact on overall results and as such can be used a process indicator). For it to be a process measure rather than than a process target however, it should actual be a measure of what has happened not a statement that we want to have 90% arrive within 8 minutes.

Jonathan Siegel’s comments [link broken, so I removed it] on this topic were excellent.

The control chart was developed to aid in process improvement. A control chart helps monitor the process (to aid in putting in place counter-measures, when needed, and for identification of special causes). The control chart can be used to see if the process is in control and what the expected results from the system are.
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Taguchi Loss Function

Topic: Management
Written in response to this post on the DEN (broken link removed). The responses on this topic show the strength of the DEN.

1) thoughtful responses that should help the person posting the original message
2) thoughtful responses that are of interest to many of us
3) the chance to explore concepts in some greater depth than we may otherwise

Relating to the 3rd item in my list I would like to explore part of Myron’s response. “Loss functions are highly personal. To ascribe a loss function to society requires plenty of hutzpah!” I think, the Taguchi Loss Function is meant to show the loss to society as a whole. My understanding, is that the Taguchi Loss Function is meant to show the overall quantifiable loss to society.

I must say that while viewing the overall loss to society is worthwhile, I think it is often more useful to see (or think of) the losses to each of the various parties. I believe this for the following 2 reasons.

First, to ascribe the loss to society, as Myron notes, requires plenty of chutzpah and I think is often going to lead to attempts to quantify impacts that are difficult to quantify. My understanding is that the Taguchi Loss Function limits the losses to quantifiable losses. If the losses are actually quantified then it should be a simple matter to include whatever losses you choose to get a picture of the factors you wish to focus on, which is good.

However, in practice, I have seen the concept of the Taguchi Loss Function used quite a bit. I have never actually seen any losses quantified and totaled and shown on a graph. I think focusing specifically on who suffers a loss and what that loss could be, can help. I think actually quantifying the losses to society can be daunting. So, while I see the value in framing the concept that way I think to actually get the losses quantified you are best served by starting with those closest to the process and then adding additional loses to those results.

Second, if you attempt to use the concept to help you manage (as a guide in decision making) the impacts to society are a factor, but, I think the loss to your company, the customer and perhaps the end user are most important. A negative impact to society at large is not going to have the same impact to a decision maker as the same negative impact to the customer. The decision maker will likely be willing to invest more to reduce the loss to a customer than to society at large (and that seems logical and sensible to me).

I believe the Taguchi Loss Function is a great conceptual model. I also think it is important to understand that the shape of a loss function in any situation depends on that specific situation. A parabola does a good job of illustrating the concept that loss is normally not binary and often increases somewhat slowly very close to the optimal result and more dramatically as the deviance from the optimal result increases. The loss is often not equal on either side of the optimal result in which case a parabola would not be the best model.

The important factor when making a decision, in a specific case, is to look at the losses that actually exist for that case. And, in my opinion, knowing where the loss is felt matters – so only viewing the overall loss to society is not sufficient. However, this concept is not part of the Taguchi Loss Function, but rather, is my opinion of how the concept can be applied most effectively. And while the concept of the Taguchi Loss function does a great job of showing why specification limits are not sufficient to good management, it is true that is some situations the loss can be pretty much binary, good (no loss) or bad (100% loss) with little, or no, “grey area.”

John Hunter