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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The Value of Professional Conferences. Also Why Has There Been So Little Innovation?

In the most recent ASQ Influential Voices post, Julia McIntosh takes a look at the costs and benefits of professionals attending conferences.

I still remember being in high school and George Box talking about the primary value of conferences was talking to colleagues in the hallway. This seemed very odd to me, as it seemed that the reason for going to a conference was to learn from the talks.

I also didn’t really understand the value in catching up with people in person. I could see it would be somewhat useful but I didn’t really understand the benefits of personal communication. Pretty much all of my communication at that point was person to person. So I didn’t really see the huge loss of fidelity of any other communication (phone, email…).

At early conferences that I attended my main benefit was still in sitting in sessions and learning what people had to say. I did also benefit from discussions with other attendees. And I started to form relationships with others which grew over the years. And over time the networking benefits did exceed the learning from sessions benefits.

Part of this also occurs as your knowledge increases and you have less to learn from the average speaker. George was obviously well past this stage when I was talking to him. For me I still learned a lot from some of the speakers but also found I was learning much less and skipping sessions to talk to people I could learn more from was an increasing benefit. Still I have difficulty doing that and would focus more on networking at lunch, between sessions and in the evening.

The costs of attending conferences are easy for companies to calculate. The benefits they bring are very hard to calculate. I can see why companies often are very tight with budgets for conferences.

Egyptian carving of figures into a stone sarcophagus

A stone sarcophagus from ancient Egypt. I took this photo after presenting a Deming 2 1/2 day seminar in Boston (at the Boston Fine Arts Museum – see more photos).

I think the benefits of getting people outside the building and letting them interact with others to learn and think about new ideas is very valuable. I do think it is much less valuable in most companies than is should be because they have bad management systems that are atrophied with poor practices that are going to be extremely difficult to improve even if people have good ideas to try.

The organization really should focus on improving the management system so it isn’t such a barrier to improvement. But I think most organizations instead find it easy to just estimate a poor return on investments in conferences because those returning don’t actually make any improvements. Again, I think the cause of the failure to improve is more about the bad management system than the benefit of the conferences.

Of course, to some extent, the conferences should be focusing on how to improve given so many attendees organizations are crippled with a poor management system. But often people seem reluctant to acknowledge or discuss that. And those that point out problems often are seen as the problem (based on their actions – I can only conclude blaming the messenger makes sense to some people). And these factors are often even more pronounced in those the organization is willing to invest in (they are often more focused on making the bosses happy rather than something like improvement and change which often rubs people the wrong way).

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Lessons for Managers from Wisconsin and Duke Basketball

What can managers learn from Duke and Wisconsin’s basketball teams? Duke and Wisconsin are in the college basketball championship game tonight. They reached this stage through a great deal of hard work, skill, training and coaching.

Raw talent matters to mangers and even more to college basketball coaches. But raw talent alone won’t succeed (for college basketball teams a great system starved of raw talent would also fail).

The lesson many people miss is that college teams are mostly about developing a team that wins. Developing individual players is a part of that, but it is subordinate to developing a team. I think college coaches understand this reality much more than most managers do. But a management system that develops a team that succeeds is also critical to the success of business.

Managers can learn from successful college basketball programs the importance of creating a successful team. Part of doing that is developing individual skills of players. A huge part of it is developing an understanding of the system within which those players must operate.

Recruiting is an important part of developing an elite college basketball team. And it is critical to developing a world class business organization (though recruiting is less important to business, in my opinion). Recruiting is important in business, but it is easier to be very successful with good people, the skills needed in business are not often so rare as those needed in high level basketball.

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Encouraging the Next Generation of STEM Professionals

In the most recent ASQ Influential Voices post, Bill Troy, ASQ CEO, asks: how should we encourage the next generation of STEM Professionals? I addressed a similar question in: Future Engineers and Scientists, which provides many details on this question.

The advantages of gaining science, technology, engineering and math skills (STEM) are fairly well known. However, even so, that is something to emphasize in order to encourage the next generation. While it is fairly well known it still helps to re-enforce and expand on the existing understanding. Some posts from my science and engineering blog on that topic: Engineering Graduates Earned a Return on Their Investment In Education of 21% (the highest of any discipline, math was next); Earnings by College Major, Engineers and Scientists at the Top; Career Prospect for Engineers Continues to Look Positive.

STEM careers often appeal to kids and teenagers (I Always Wanted to be Some Sort of Scientist, Apply to be an Astronaut).

Sadly we often discourage them with unnecessarily challenging education hurdles. It is true the education path for STEM is more challenging than for most careers. That is a reality that won’t change. If people are turned off by hard work, they likely wouldn’t like most STEM careers anyway. So that reality I think is fine. But the design of STEM education could be greatly improved to avoiding turning off many people who would enjoy the education and a career if the education process were better. I have also written about this previously: Improving Engineering Education, Primary School Science Education in China and the USA, Innovative Science and Engineering Higher Education, Infinity Project: Engineering Education for Today’s Classroom (providing middle school, high school, and early college engineering curricula), Engineering Education in the 21st Century, Research findings Contradict Myth of High Engineering Dropout Rate, Fun k-12 Science and Engineering Learning.

Those with STEM degrees have better career options than others (in terms of nearly everything: higher pay, lower unemployment and higher satisfaction with their careers). Some of the career options are more rigid than an average career, but many are actually more flexible and still have all the benefits. They have the opportunity for many rewarding jobs. This is of more importance for a sad reason: our failure to create organizations with a priority placed on respect for people.

Getting a STEM degree requires that students see the appeal of gaining those degrees and many do. Many students are turned off by either the hard work required to get such degrees or the less than optimal STEM education process (which often makes it much harder and also much less inspiring than required due to poor educational systems).

While continuing to promote STEM careers to the young is helpful and wise, we are doing this fairly well. Of course, everything can be done better, and we should keep striving to improve. But the main focus, In my opinion, should be on better education from k-12 all the way through the PhD level for STEM. It would also help if we stopped electing anti-science politicians.

Related: Science and Engineering Advantages for EconomiesS&P 500 CEO’s: Engineers Stay at the TopMathematicians Top List of Best Occupations (top 6 are all STEM careers)Looking at the Value of Different College Degrees

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Transforming a Management System – A Case Study From the Madison Wisconsin Police Department

This post in an excerpt from The Quality Leadership Workbook for Police by Chief David Couper and Captain Sabine Lobitz (buy via Amazon).

cover image of the New Quality Leadership Workbook for Police

The New Quality Leadership Workbook for Police

Transformational Steps
A Case Study Madison, Wisconsin (1981-1993)

Step 1: Educate and inform everyone in the organization about the vision, the goals, and Quality Leadership. This step must be passionately led by the top leader.

  • Begin discussion with top management team and train them.
  • Discuss and ask employees; get feedback from them.
  • Share feedback with the chief and his management team.
  • Get buy-in from top department managers.
  • Survey external customers—citizens; those who live and work in the community.
  • Create an employee’s advisory council; ask, listen, inform, and keep them up to date on what’s going on.
  • The chief keeps on message; tells, sells, and persuades, newsletters, meetings and all available media.

Step 2: Prepare for the transformation. Before police services to the community can be improved, it is essential to prepare the inside first — to cast a bold vision and to have leaders that would “walk the talk.”

  • Appoint a top-level, full-time coordinator to train, coach, and assist in the transformation.
  • Form another employee council to work through problems and barriers encountered during implementation of the transformation and Quality Leadership.
  • Require anyone who seeks to be a leader to have the knowledge and ability to practice Quality Leadership.

Step 3: Teach Quality Leadership. This begins at the top with the chief and the chief’s management team.

  • Train all organizational leaders in Quality Leadership.
  • Train all employees as to what Quality Leadership is, why the transformation is necessary, and what it means for them.

Step 4: Start practicing Quality Leadership. If top managers within the organization are not authentically practicing Quality Leadership neither will anyone else.

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Hire Me to Manage Your Blog or Web Presence

I would like to add a client for my blog and web presence management services. The most obvious fit is for management consultants, in my opinion, though others may also be interested.

My blogs have been honored often over the years.

As part of managing a blog on management improvement I can also write posts for the blog. If you wish I can create and host a new blog and/or website.

If you are interested in learning more please contact me (you may also comment on this post to contact me). If you already have an online presence please share the web site addresses and other relevant links (Twitter etc.) and if you have specific things you would like to achieve by hiring me. Here are links to where I can be found online.

Sites I manage, include:

John Hunter at Canyonlands National Park

John Hunter at Canyonlands National Park

Related: Consulting by the minute consulting with John HunterTimeline of John Hunter’s professional lifeInterviews with John Hunter

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Improving Management Globally

In the most recent ASQ Influential Voices post, Bill Troy, ASQ CEO, asks: Why Should Quality Go Global?

ASQ’s mission statement talks about increasing the use and impact of quality in response to the diverse needs of the world. Are we doing enough, throughout the world, to accomplish that mission?

I have discussed a serious shortfall in this effort numerous times including in a reply to the ASQ blog before I was an ASQ Influential Voice – ASQ has a long way to go in promoting quality. ASQ is not doing enough. If “increasing the use and impact of quality” is indeed the mission then ASQ should make all quality articles they have published open access. If ASQ is mainly an organization focused on maximizing its revenue then selling articles that were written by authors (not paid by ASQ) and published by ASQ years and decades ago may be sensible.

ASQ has made a very small percentage of such articles available, as far as I can tell.

Not making articles open access is bad enough when all your users are in the USA. It is much worse when you aim to influence a global audience.

On the matter of the importance of promoting better management practices worldwide I agree there is a huge amount of work to be done. And there is a huge vacuum of resources for managers looking for information on how to do better.

ASQ can help fill that need. They are doing some things, including their blog and the ASQ Influential Voices program, but need to do much more to make much of a difference, it seems to me. I think they need to make the articles open access as the most important sign ASQ is changing to put the mission first; to have the organization designed to support that mission instead of the support of the organization itself as the primary focus.

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Some Thoughts on Investing from My Recent Interview

In the first few years of this blog I posted occasionally, but still much more than the last few years, on investing and economics. Now I mainly post on those topics on the Curious Cat Investing and Economics blog (see how the name and that practice are in sync with each other?).

I was recently interviewed about investing strategies and thoughts and decided to share that with the readers of this blog. Some excerpts from the interview:

I have maintained a portfolio that I call the sleep well portfolio for 10 years (started April 2005). I hardly have any turnover (under 2% annually I think) and hold stocks I would be comfortable locking in a vault for 10 years. The largest holding there is Apple, followed by Google; I also still really like Google as a long term investment. The stocks in the portfolio for the entire period are: Google, Amazon, Toyota, Intel, Pfizer…

We got out of the “Too Big to Fail” crisis, but have not addressed the core problems – and likely have made them much worse. We didn’t take the opportunity to address the financial system risks created by the actions of “Too Big to Fail” banks. And it seems to me we have left the central banks in a very vulnerable position. They have already played strategies that previously seemed impossible due to the position they were placed in, and if it happens again, what are they going to be able to do? I think the risk of massive economic failure is large enough to consider in an investment portfolio.

How would you suggest an investor guard against the potential for a massive economic disaster?

John Hunter: My main thoughts on that are to greatly value companies that are likely to weather economic calamity greater than any since the great depression. Having tons of cash obviously helps (Apple, Google…). Having a business model that puts a company in a position to make money (even if it is a lot less than they are making today) if the economy does extremely poorly, is also good (Apple, Google, AbbVie…).

It is possible for the economy to be hit so hard Apple, Google, etc. lose money. But if that happens, I believe huge numbers of other companies are going to be out of business, and the economy will be in shambles…

The sleep well portfolio has beaten the S&P 500 by about 220 basis points (on an annual rate of return basis) (see details on how marketocracy calculates returns – they reduce returns by 200 basis points to simulate investment adviser fees). The interview includes much more details as well as links to posts on my investing blog going into more detail.
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Who Inspires Your Management Thinking and Action?

This month Bill Troy, ASQ CEO, asked ASQ Influential Voices bloggers: “who influenced or inspired your management thinking and in what ways?” He discussed Paul O’Neill’s influence on his thinking [the broken link was removed – so many websites have no evidence of long term thinking]; I agree that Paul has done some very impressive work in health care.

I have written about my management influences in the past: Active Management Improvement Leaders (2006) and Who Influences Your Thinking? (2005).

photo of Bill Hunter and John Hunter

Bill Hunter and John Hunter

My largest influence by far is my father, William Hunter. Here is a good example of why: Managing Our Way to Economic Success, Two Untapped Resources: potential information and employee creativity. In another post I also wrote about my early influences related to quality management as I grew up in Madison, Wisconsin.

From an early age I learned to experiment, appreciate and understand data, respect people and continually improve. These lessons were a natural part of growing up in our family.

Another influence, and natural part of growing up in our family was George Box. He was Dad’s colleague and shared all the qualities listed above; we often saw him at our house or visited their family at George’s house.

They both shared the expectation that you continually seek to learn and improve. They both shared the scientist and engineering mindset that ideas should be tested and probed and new methods and ideas discovered. They also believed that making improvements in the real world was the goal. The aim was not merely to think up new ideas but to implement them to improve people’s lives. They shared a passion for freeing the minds of everyone to allow everyone to have joy in work and life.

Brian Joiner was also around as I grew up and to a lessor extent so was Peter Scholtes. After I graduated from college and started to work I actually worked with Peter actually more than the others (I created and still maintain Peter’s website) and he had a great influence on my management thinking. Again all that I said about George and Dad applies to Peter. Peter was less focused than the statisticians (the other 3 and Deming were statisticians) on data, but they were all cut from the same cloth.

And through all of them I was exposed to Dr. Deming’s ideas and those also have had a great influence on my thinking. As you can see from the characteristics listed above that it all fits together very well, which isn’t a surprise. The reason Dad, Brian, Peter, George and Deming worked with each other and shared ideas was that the ideas they all were pursuing fit together. Dad was writing back and forth with Deming all the way back in the 1960’s and continued until he died. In Out of the Crisis, Deming asked Dad to write a few pages on the work with the City of Madison applying the management improvement ideas.

Dad had decided he wanted to help the City after returning from a summer lecturing in China on design of experiments (mainly). He worked with Peter Scholtes (at that time a City employee) on the project with the City of Madison’s vehicle maintenance garage. The Mayor, Joe Sensenbrenner, wrote up those experiences in the Harvard Business Review (Quality Comes to City Hall). Peter then went to work for Joiner Associates and soon he and Brian were working with Deming, speaking at his 2 day seminars.

Brian had previously worked at the UW-Madison Statistics department that George established. Dad followed George from Princeton, where as a under-graduate student he took a graduate course George taught. Dad was the first PhD graduate of the department and became a professor the next year.

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10 Most Popular Posts on the Curious Cat Management Blog in 2014

Here is a list of the 10 most popular posts on this blog last year (as measured by views counted by my analytics applications). The posts were published in 2010 (4 posts), 2013 (2), 2014 (2), 2005 (1) and 2012 (1).

graphic image showing the PDSA cycle

PDSA Improvement cycle graphic from my book – Management Matters

One of the things this illustrates is why it is so important to have urls (web addresses) live forever. The idea that ancient (in web thinking) content doesn’t matter is not accurate. My site is a tiny population and shouldn’t be used to make a judgement but from what I have read is this is very common for sites with high quality content. If the content is good, the shelf live usually isn’t just 1 week (or even 1 decade).

Looking at the top 10 posts by year, gives a view of the data that shows 2010 seems to be special. But I think it is just random variation at play. Or maybe 2010 me deserved a big bonus for such great writing?

Posts in early 2014 have an advantage in making the list. There is a big spike in views in the first couple weeks. So if the post gets to count those and has a long time in 2014 it is more likely to make the top 10 (if it is later in the year though the advantage of the spike is offset by only having a portion of the year to gain views). Both 2014 posts in the top 10 were from March. In the next 10 most popular posts 5 were from 2014 (2010 had 2 and 2008, 2009 and 2011 had 1 each).

Related: Post Number 1,000 on the Curious Cat Management BlogUse Urls: Don’t Use Click x, Then Click y, Then Click z InstructionsCurious Cat Blog Network

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