USA Spent $2.6 Trillion, $8,402 per person,17.9% of GDP on Medical Expenses in 2010

Total health expenditures in the USA in 2010 reached $2.6 trillion, $8,402 per person or 17.9% percent of GDP. All these are all time highs. Every year, for decades, health care costs have taken a larger and larger portion of the economic value created in the USA.

In 2009 the USA Spent Record $2.5 Trillion, $8,086 per person 17.6% of GDP on Medical Care.

USA health care spending grew 3.9% in 2010 following an increase of 3.8% in 2009. While those are the two slowest rates of growth in the 51 year history of the National Health Expenditure Accounts, they still outpaced both inflation and GDP growth. So yet again the health system expenses are taking a bigger portion of overall spending. This has been going on so long that the USA spends double what many other rich countries do on healthcare with no better results.

As a result of failing to address this issue for decades the problem is huge and will likely take decades to bring back just to a level where the burden on those in the USA, due to their broken health care system, is equal to the burden of other rich countries. Over 2 decades ago the failure in the health care system reached epidemic proportions but little has been done to deal with the systemic failures. Dr. Deming pointed to excessive health care cost, back then, as one of 7 deadly diseases facing American business. The fact that every year costs have increased more than GDP growth and outcome measures are no better than other rich countries shows the performance has been very poor. The disease is doing even more harm today.

Some good things have been done over the years, most notably by Don Berwick while at the Institute for Healthcare Improvement. He was effectively thrown out of office by the politicians recently. The same politicians that have through decades of such foolish acts contributed more than any other group to the broken health care system that burdens the USA today. In the last 10 years a significant amount of good work has also been done in “lean healthcare”: applying lean thinking to healthcare. But it is similar to the quote that a “bad system will beat a good person.” With all the bad systemic issues the efforts, good as they are, in lean healthcare are mainly improving around the edges. Of course, “around the edges” of a $2.6 Trillion dollar system can still be extremely valuable and important.

Related: USA Heath Care System Needs ReformUSA Spends Record $2.3 trillion ($7,681 Per Person) on Health Care in 2008Systemic Health Care Failure: Small Business CoverageMeasuring the Health of NationsHow to improve the health care system performanceManagement Improvement in HealthcareUSA Spent $2.2 Trillion, 16.2% of GDP, on Health Care in 2007

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Trust But Verify

The following are my comments, which were sparked by question “Trust, but verify. Is this a good example of Profound Knowledge in action?” on the Linked In Deming Institute group.

Trust but verify makes sense to me. I think of verify as process measures to verify the process is producing as it should. By verifying you know when the process is failing and when to look for special causes (when using control chart thinking with an understanding of variation). There are many ways to verify that would be bad. But the idea of trust (respect for people) is not just a feel-good, “be nice to everyone and good things happen”, in Deming’s System of Profound Knowledge.

I see the PDSA improvement cycle as another example of a trust-but-verify idea. You trust the people at the gemba to do the improvement. They predict what will happen. But they verify what does actually happen before they run off standardizing and implementing. I think many of us have seen what happens when the idea of letting those who do the work, improve the process, is adopted without a sensible support system (PDSA, training, systems thinking…). It may actually be better than what was in place, but it isn’t consistent with Deming’s management system to just trust the people without providing methods to improve (and education to help people be most effective). Systems must be in place to provide the best opportunity to succeed. Trusting the people that do the work, is part of it.

I understand there are ways to verify that would be destructive. But I do believe you need process measures to verify systems are working. Just trusting people to do the right thing isn’t wise.

A checklist is another way of “not-trusting.” I think checklists are great. It isn’t that I don’t trust people to try and do the right thing. I just don’t trust people alone, when systems can be designed with verification that improves performance. I hear people complaign that checklists “don’t respect my expertise” or have the attitude that they are “insulting to me as a professional” – you should just trust me.

Sorry, driving out fear (and building trust – one of Deming’s 14 points) is not about catering to every person’s desire. For Deming’s System of Profound Knowledge: respect for people is part of a system that requires understand variation and systems thinking and an understanding of psychology and theory of knowledge. Checklists (and other forms of verification) are not an indication of a lack of trust. They are a a form of process measure (in a way) that has been proven to improve results.

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2011 Management Blog Roundup Completed

The 2011 Management Blog Roundup has been completed. I hope you enjoyed it and learned from the great posts highlighted by all the participants in this effort. The final group of posts to be added are:

I offer my thanks to all the bloggers who took the time to participate.

I hope you found many concepts and ideas to adopt at your organization in 2012. And lets hope that those companies we have to deal with in 2012 are adopting these ideas so we can have much more rewarding and enjoyable experiences as customers.

Related: More 2011 Management Blog Roundup Posts AddedNewly Added 2011 Management Blog Roundup Posts2010 Annual Management Blog Review

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2011 Management Blog Roundup: Stats Made Easy

The 4th Annual Management blog roundup is coming to a close soon. This is my 3rd and final review post looking back at 2001, the previous two posts looked at: Gemba Panta Rei and the Lean Six Sigma Blog.

I have special affinity for the use of statistics to understand and improve. I imaging it is both genetic and psychological. My father was a statistician and I have found memories of applying statistical thinking to understand a result or system. I also am comfortable with numbers, and like most people enjoy working with things I have an affinity for.

photo of Mark Anderson

Mark Anderson

Mark Anderson’s Stats Made Easy blog brings statistical thinking to managers. And this is not an easy thing to do, as one of his posts shows, we have an ability to ignore data we don’t want to know. Wrong more often than right but never in doubt: “Kahneman examined the illusion of skill in a group of investment advisors who competed for annual performance bonuses. He found zero correlation on year-to-year rankings, thus the firm was simply rewarding luck. What I find most interesting is his observation that even when confronted with irrefutable evidence of misplaced confidence in one’s own ability to prognosticate, most people just carry on with the same level of self-assurance.”

That actually practice of experimentation (PDSA…) needs improvement. Too often the iteration component is entirely missing (only one experiment is done). That is likely partially a result another big problem: the experiments are not nearly short enough. Mark offered very wise advice on the Strategy of experimentation: Break it into a series of smaller stages. “The rule-of-thumb I worked from as a process development engineer is not to put more than 25% of your budget into the first experiment, thus allowing the chance to adapt as you work through the project (or abandon it altogether).” And note that, abandon it altogether option. Don’t just proceed with a plan if what you learn makes that option unwise: too often we act based on expectations rather than evidence.

In Why coaches regress to be mean, Mark explained the problem with reacting to common cause variation and “learning” that it helped to do so. “A case in point is the flight instructor who lavishes praise on a training-pilot who makes a lucky landing. Naturally the next result is not so good. Later the pilot bounces in very badly — again purely by chance (a gust of wind). The instructor roars disapproval. That seems to do the trick — the next landing is much smoother.” When you ascribe special causation to common cause variation you often confirm your own biases.

Mark’s blog doesn’t mention six sigma by name in his 2011 posts but the statistical thinking expressed throughout the year make this a must for those working in six sigma programs.

Related: 2009 Curious Cat Management Blog Carnival2010 Management Blog Review: Software, Manufacturing and Leadership

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More 2011 Management Blog Roundup Posts Added

As we start 2012, the 4th Annual Management Blog Roundup continues. Once again some of the most popular management bloggers are taking a look back at the last year in the management blogging world. The following reviews have been added since my last update:

These posts provide many great ideas for you to apply in the new year. The 2011 management blog roundup has more great posts coming up in the next week. The home page for this collaborative effort of many management bloggers provides links to all the posts in the 2011 Management Blog Roundup.

Related: 2010 Management Blog Roundup2011 Management Blog Roundup BeginsCurious Cat Management Blog Directory

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2011 Management Blog Roundup: Lean Six Sigma Blog

For my contribution to the 4th annual management blog roundup I am taking a look at 3 management blogs. In this post I look back at the year that was at the Lean Six Sigma blog.

We are lucky to have so many great management blogs to read all year. They provide inspiration and great advice to managers. Though, one of my frustrations is how few good six sigma resources there are online. In this area we are unlucky. The disparity between the amazingly high number of very high quality lean blogs and agile software development blogs compared to almost nothing of similar quality for six sigma content is dramatic (and unfortunate).

photo of Ron Pereira

Ron Pereira

Ron Pereira is the managing partner of Lean Six Sigma Academy and the Gemba Academy which provide high quality online lean manufacturing training. One of the ways Ron stands out are his posts that make continuous improvement a family affair (which I appreciate given that I grew up in such an environment).

In Let’s Dance he looks at understanding psychology as it relates to working with groups/teams (in this case his daughters soccer team): “my coaching style and my assistant coach’s style had become a bit too intense and, as a result, the girls were playing tight and scared to make mistakes… We kept this ‘dancing’ theme alive for the rest of the season. During warm-ups before games I, and the girls, would dance like fools. The other teams watched us like we were nuts… but we didn’t care. We kept right on laughing and dancing.” Take a look at this post, it really packs in a ton of great thoughts for managers.

Another way Ron stands out is with his webcasts on discussion lean terms (the gemba glossary). In this webcast he looks at the topic of standardized work processes.

One of the great things about blogs is the focus on what people really deal with day in and day out. It is nice to read about a great management system in a book like the Leader’s Handbook by Peter Scholtes. But what do you do when you are in a much more common situation, where others don’t share your desire to reshape the management system into something new and better? Ron took a look at this in his post: 3 Things You Can Do When Your Manager Doesn’t Support Continuous Improvement: “The best way to combat this is to demonstrate the value without them asking you to. In other words, make something better and let them know about it. And when I say make it better I mean it. Do something to positively impact the business.”

Another wonderful family related post by Ron this year was Training Wheels – “Like most young people my boy was itching to take the training wheels off his bicycle… The best part of all is he’s learning to solve his own problems. He’s not waiting for people to hand him things on a platter… How many times do we continuous improvement practitioners moan and groan about the lack of management support when, in actuality, even though they may not care they won’t stop you from making things better?”

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2011 Management Blog Roundup: Gemba Panta Rei

For my contribution to the 4th annual management blog roundup I will take a look at 3 management blogs. In this post I look back at the year that was at the Gemba Panta Rei blog.

We are lucky to have so many great management blogs to read all year that provide inspiration and great advice. This year 12 management bloggers contributed to highlight nearly 40 blogs, be sure to check out all the posts.

photo of Jon Miller

Jon Miller

Jon Miller is the of the Executive Director of Kaizen Institute Consulting Group and author of the excellent Gemba Panta Rei blog. With so many good management blogs it is hard to read all the good posts, but this is one blog that is at the top of my to do list.

Jon provides extremely thought provoking posts that challenge managers to think. Over the years I have been thinking about why so many organizations fail to get most of the benefits provided by lean thinking and I have become more convinced in recent years a significant problem is the oversimplification and desires for solutions that don’t require thought. If you are not willing to spend time thinking about the profound implications of lean thinking the benefits you can achieve are several limited. Jon’s blog will help you by providing a reminder. But you then have to think yourself about how the ideas he raises relate to your situation. A few posts from last year in this vein:

  • The New Math of Daily Kaizen – “When kaizen is done in ways that it involves everybody and everywhere, but not on a daily basis, the gains from each additional person or area is additive. However, when even one person in one area is able to do kaizen every day, a curious thing happens. The impact is not additive. It is geometric, transformational.” [Lean is geometric, transformational, when done right. Reading Jon’s blog and adopting fundamental changes in how you think and work is how you can find yourself on this path instead of one where you have incremental success but not much more. – John]
  • Lean Maturity and the Four Stages of Competence – “The lean journey is a long and arduous one. It spans one’s full lifetime… There is a larger contest that is being played out every day: the battle of backsliding versus continuous improvement.”
  • The Importance of Thinking About the Box – “The fruit I buy travels in boxes of metal, wood, cardboard and finally reaches me in a plastic container. Nature only makes containers that are edible, biodegradable or both. That is a thinking box worth stepping back into.”
  • Why Don’t We See More QC Circles? – “Even today the span of control of a typical leader is far too large and ineffective, driven by direct-to-indirect labor ratios and financial models that are divorced from the reality that people who function in small teams can solve and prevent problems in ways that lower cost. [I recently posted some comments on QC circles – John]
  • Kitchen Jidoka: Low Cost Automation Example – “separate human work and machine work so that humans can do less non value added and more value added work within a given period of time… Second, autonomation is used to prevent processes from making error after error by building in en error prevention or detect-and-stop functions.

Another theme on the Gemba Panta Rei blog is ambiguous visual controls. Effective visual management tools greatly enhance safety, productivity and usability. But using a concept is not the same thing as successfully using it, as the periodic posts on failed attempts Jon posts illustrates very well. Ambiguous Visual Controls: Airport Hotel Edition, too much information, in the park, lost in the supermarket

Take a look at the other 2011 Management Blog Roundup posts.
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Newly Added 2011 Management Blog Roundup Posts

The 4th Annual Management Blog Roundup is making good progress. It is wonderful how many great blogs there are to chose from. Even with us covering 40 management blogs there are many more great management blogs we didn’t include. The following reviews have been added since our initial post:

image of the cover of A Factory of one by Daniel Markovitz

A Factory of One by Daniel Markovitz

These posts provide many excellent management ideas and the annual review has many more great posts coming up. The home page for this collaborative effort of many management bloggers provides links to all the posts in the 2011 Management Blog Roundup.

Related: 2010 Management Blog RoundupCurious Cat Economics, Investing and Personal Finance Carnival

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Eliminate the Waste of Waiting in Line with Queuing Theory

One thing that frustrates me is how managers fail to adopt proven strategies for decades. One very obvious example is using queuing theory to setup lines.

Yes it may be even better to adopt strategies to eliminate as much waiting in line as possible, but if there is still waiting in line occurring and you are not having one queue served by multiple representatives shame on you and your company.

Related: Customer Focus and Internet Travel SearchYouTube Uses Multivariate Experiment To Improve Sign-ups 15%Making Life Difficult for Customers

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Be Thankful for Customer That Are Complaining, They Haven’t Given Up All Hope

I ran across this message and liked it (by wuqi256):

My time spent in a fast food chain (factory worker on weekends and security guard at night, yes really thanks to them, i have great jobs like that) when i was young trying to feed the family and study at the same time was quite useful.

They taught me that “Customers who complain are the best customers, it shows that they have still residual faith and goodwill in the organisation hence we should sift out those frivolous complains from those genuine ones that need our urgent attention” These are people who we can and should do a lot for as a complaining customer still has a very high chance of becoming a “returning” customer.

The customers that we fear for the most are those that either have voiced out or not heard or those who have given up and moved on to another organisation. Those we can no longer do much for as they no longer give us a chance. Discontentment is one thing but find the root cause, remove the straw from the cauldron and the water will stop boiling.

I know I often don’t bother voicing my concerns when I have given up all hope the organization has any interest in customer service. Sadly this is a fairly common situation.

It isn’t easy to do, but organizations that are customer focused need to be taking advantage of those customers helping you by expressing the frustration (that many of your customers experience, but don’t express). To do so organizations need to develop a culture where everyone is encouraged to improve your processes. The tricky part is not claiming that is what you want, but actually creating and maintaining the systems that bring that about.

Related: The Problem is Likely Not the Person Pointing Out The ProblemCustomer Service is ImportantCustomers Get Dissed and Tell

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