Checklists Save Lives

photo of surgery room

Checklists are a simple quality tool that have been used widely for decades. Pilots use them, without fail, to save lives. Some surgeons have been using them and the evidence is mounting that checklists can save many more lives if more in health care use them. Studies Show Surgeons Could Save Lives, $20B by Using Checklists

Eight hospitals reduced the number of deaths from surgery by more than 40% by using a checklist that helps doctors and nurses avoid errors, according to a report released online today in the New England Journal of Medicine.

If all hospitals used the same checklist, they could save tens of thousands of lives and $20 billion in medical costs each year, says author Atul Gawande, a surgeon and associate professor at the Harvard School of Public Health.

In his study, which was funded by the World Health Organization, hospitals reduced their rate of death after surgery from 1.5% to 0.8%. They also trimmed the number of complications from 11% to 7%.

The study shows that an operation’s success depends far more on teamwork and clear communication than the brilliance of individual doctors, says co-author Alex Haynes, also of Harvard. And that’s good news, he says, because it means hospitals everywhere can improve.

Researchers modeled the checklist, which takes only two minutes to go through, after ones used by the aviation industry, which has dramatically reduced the number of crashes in recent years.

This is more great evidence of the value of applying simple management tools that are already well known. The idea that improvement takes brand new breakthrough ideas is just plain wrong.

Related: Using Books to Ignite ImprovementThe Power of a ChecklistNew, Different, BetterManagement Improvement History and Health CareOpen Source Management TermsFast Company Interview with Jeff Immelt

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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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Curious Cat Management Carnival: Select 2008 Highlights

Over the last couple of years the quality of management material available online has increased dramatically. And blogs have provided much of the best management material. The Curious Cat Management Improvement Carnival now provides highlights 3 times a month. Each carnival post highlights recent management related posts from several management blogs. And for the 2008 year in review 9 blogs have each taken a handful of management blogs and provided annual highlights.

In this post we will cover four blogs: Lean Software Engineering, Timeback Management, Know HR and Quality and Innovation. All I aim to do in the post is highlight a few excellent posts for the year. To capture the depth of these blogs add them to your RSS reader and read them throughout the year.

Lean Software Engineering by Corey Ladas (a management carnival host) and Bernie Thompson does an excellent job of discussion the application of lean manufacturing ideas in software development. Corey also published: Scrumban, Essays on
Kanban Systems for Lean Software Development
this year. The blog is a must read for anyone working in software development applying lean thinking.

  • Boehm’s Spiral Revisited by Bernie Thompson – “Twenty years ago this month, in response to the problems associated with waterfall-style approaches to software projects, Barry Boehm proposed his Spiral Model of Software Development. Which bore some resemblance to Deming’s “Plan, Do, Check, Act” cycle.
  • Queue utilization is a leading indicator by Corey Ladas – “there is a very pragmatic reason to adopt a Lean workflow strategy, regardless of what sort of product you are building: Lean scheduling provides crystal clear leading indicators of process health. I am speaking of kanban limits and andon lights.”
  • Two axioms of lean software development by Corey Ladas – “Axiom 1: It is possible to divide the work into small value-adding increments that can be independently scheduled. Axiom 2: It is possible to develop any value-adding increment in a continuous flow from requirement to deployment. “
  • Perpetual multivote for pull scheduling by Corey Ladas – “In our system, development capacity can free up at any time. When it does, the next candidate should have been previously selected so that the team can get right to work. That means we’ll have to make frequent updates to the selection process. If we’re going to do this frequently, it has to be inexpensive. Consensus building is expensive. My goal is to do this with no estimates and no meetings.”

The Timeback Management blog by Dan Markovitz focuses on applying lean principles to promote effective management. And as the name suggest he also posts on making effective user of your time.

  • The Danger of Easy Access – “When we don’t value our limited time and attention sufficiently, we open the floodgates to infinite requests from coworkers — to our detriment… Get lean: in the tradition of Toyota’s andon, put up a sign at your cube or office that says when you’ll be available to talk.” [I must admit I have challenges with the common lean view of open offices, for the same reasons Dan mentions here. I prefer the model Joel Spolsky uses for software development staff, where collaboration is encouraged but developers have private offices. I am sure I benefit from a distraction free environment. There is debate in the lean blogosphere about the proper lean model though. My belief is that partially the answers lies in examining what is right for the specific office in question (though perhaps I am just clinging to an outdated idea). I find Instant Messaging (IM) useful (for encouraging collaboration and providing less distraction – including allowing people to work from home). This disruption from IM seems less obtrusive and you can set a status as Dan mentions to indicate how hesitant people should be before sending an IM. – John Hunter]

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Disruptive Innovation Example: Eliminate Your Phone Bill

Clayton Christensen’s ideas on disruptive innovation are very powerful. I have written about Innovation Thinking with Clayton Christensen previously. Here is an example of such innovation. All you need is a broadband internet connection and you can Kiss your phone bill good-bye:

The Ooma service uses so-called Voice over Internet Protocol (or VOIP) technology to deliver calls to your existing phone using a broadband connection. Consumers need only to buy a $249 Ooma Hub (it was a hefty $399 when the service launched last year); all domestic calls are free. (Ooma charges a few pennies a minute for international calls to landlines and 20 to 30 cents a minute for overseas calls to mobile phones. Calls from Ooma box to Ooma box are free.)

Replacing your phone service is, of course, just the start for Ooma. In some ways, calling is the Trojan horse to get the box in your house and then figure out other services to sell, like enhanced network security or kid-safe Web surfing.

I ordered mine from Amazon for $203 and have been using it for a month, it has been great. Relatively easy to setup (they had a pretty good customer survey and I recommended they use colored cables – they color cables in the drawings in the users guide but give you 3 white cable to use – they are different types of cables so it isn’t tough to figure out but that would make it a bit easier).

I have been using Vonage for awhile and it is ok, but I don’t see any reason to pay each month when Ooma doesn’t charge a monthly fee (even on the lowest option on Vonage the bill is over $22/month). When I tried to cancel Vonage they refuse to allow it through the web site. Then forced me through voice mail maze only to then say we only answer the phone for you between 9-5 EST on workdays (that is about 75% of the time they are unavailable). I called back a week later, when I got a chance and they forced me through 10 minutes of wasted time but at lest I was able to get it canceled – once they refused to allow cancellation over the web site I was worried the customer disservice would be greater than it was.

Related: Six Keys to Building New Markets by Unleashing Disruptive InnovationSave Money on FoodThe Innovators Solution by Clayton M. Christensen and Michael E. Raynor – Using Google to Eliminate IT Costs

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2008 Annual Management Blog Carnival: Part 1

The first half of the 2008 annual management blog carnival posts are online now. The posts highlight some of the best posts on management blogs in the last year. Follow the links to read some of the excellent posts that have been highlighted on the following blogs:

Related: Management Improvement Blog CarnivalManagement Carnival postsCurious Cat Management Improvement SearchThe first Management Improvement Carnival

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Statistics for Experimenters in Spanish

book cover of Estadística para Investigadores

Statistics for Experimenters, second edition, by George E. P. Box, J. Stuart Hunter and William G. Hunter (my father) is now available in Spanish.

Read a bit more can find a bit more on the Spanish edition, in Spanish. Estadística para Investigadores Diseño, innovación y descubrimiento Segunda edición.

Statistics for Experimenters – Second Edition:

Catalyzing innovation, problem solving, and discovery, the Second Edition provides experimenters with the scientific and statistical tools needed to maximize the knowledge gained from research data, illustrating how these tools may best be utilized during all stages of the investigative process. The authors’ practical approach starts with a problem that needs to be solved and then examines the appropriate statistical methods of design and analysis.

* Graphical Analysis of Variance
* Computer Analysis of Complex Designs
* Simplification by transformation
* Hands-on experimentation using Response Service Methods
* Further development of robust product and process design using split plot arrangements and minimization of error transmission
* Introduction to Process Control, Forecasting and Time Series

Book available via Editorial Reverte

Related: Statistics for Experimenters ReviewCorrelation is Not CausationStatistics for Experimenters Dataposts on design of experiments

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What to Wear to an Interview

Response to What to Wear for an IT Job Interview?. Is this just a huge bit stereotypical?

Who can blame them for not wanting to bother with their wardrobes? Fashion is fickle. Fashion is expensive. Fashion requires imagination and inspiration, and let’s face it, after a long day spent debugging code or trouble-shooting computer problems, there’s not a lot of creativity left for clothing.

But if there’s one professional occasion when a tech worker should think fashion first, it’s the job interview. CIOs says so. According to research conducted by Robert Half Technology, more than one-third (35 percent) of CIOs surveyed say that IT professionals should sport a suit for a job interview.

I don’t see any harm in wearing a suit and tie or such business attire if you have no other information to go on for IT, or other employees. That advice to candidates is perfectly fine. Asking what is appropriate attire when the interview is set is also a good idea. In fact, that is all you need to take from this post as an interviewee, in my opinion.

Is there any value in you wearing a suit? If so, then not doing so might be a negative. The psychology of what makes people uncomfortable is tricky. And dress is one of those factors that may seem trivial but to differing extents most people base opinions partial on dress (even if they claim they don’t). Some organization with casual dress codes may also look at being too dressed up as a bad sign (out of touch…). Basically they are experiencing the same discomfort with your dress even though most likely they would profess to find those making judgments based on dress to be superficial. The Manager FAQ does a good job of looking at the thought process behind some managers thinking on the topic.

My manager seems to dress funny. Is there any way to impress upon him the pointlessness of corporate appearance?

Your manager is probably aware that, in the abstract, the way she dresses changes nothing. However, part of her job is to interact with other people, and there are rules of etiquette for these dealings. Your manager’s clothing, even when she’s not dealing with other people, is selected in part as a way of telling you that she takes you seriously; it’s just like calling people “sir”. It’s a convention, but that doesn’t mean it’s not a real convention, and your manager is honoring it.

Even if there is no value to doing so there are many people who make judgments on silly factors like clothing.

Now for the most important point for manager’s, from this post, if you evaluate software developers on how they dress please quit and go work in some other line of work. You really don’t have what is needed to manage software developers or system administrators. If you are hiring someone to sit in meetings with MBAs and translate technology to them, then maybe being comfortable in a suit is a valued trait. But if you are hiring someone to create code 90+% of the time the suit is a completely silly measurement of value.

Related: Curious Cat Management Improvement JobsIT Talent Shortage, or Management Failure?Hiring the Right WorkersGoogle’s Answer to Filling Jobs Is an Algorithm
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Cost Cutting is Much Different than Waste Removal

Cost Cutting is Much Different than Waste Removal by Jim Womack

The very last thing to consider is the one thing managers seem to embrace most readily: cost cutting. This means leaving out steps and features that actually create value from the perspective of the customer and removing employees who are actually needed to get the job done right using the current process. The hope, usually wrong, is that the customer won’t notice.

This last expedient is the one I most fear, because it is likely to be justified in the name of “lean.” Every recession seems to produce a major cost-cutting campaign sold by traditional consultants. Their key promise is rapid financial payback, even within one quarter, and the only practical way to achieve this is layoffs. I truly hope that the recession of 2009 will not be known to history as the “lean” recession and everyone in the Lean Community should vow to avoid the cost-cutting urge in their own organization.

To avoid the need for cost cutting, I hope that every would-be lean enterprise will assign someone responsibility for developing a “recession A3” that carefully reviews the background situation. The critical step in the A3 process will then be to develop a set of countermeasures that can protect the organization and its people through the current recession while laying the ground work for a sustainable lean enterprise in the future.

Related: Operational ExcellenceGoing lean Brings Long-term PayoffsBad Management Results in LayoffsCutting Hours Instead of People

Posted in Economics, Lean thinking | Tagged | 1 Comment

A Programmer’s View of the Universe

A few weeks ago I wrote about integrating information technology and business process management. This post from Steve Yegge is interesting and discusses one reason I find that a good strategy. Programmers, by and large, are good, practical systems thinkers (this is in the management context, thinking of inter-related systems, whatever those systems are – not to be confused with a computer system).

A programmer’s view of the Universe, part 1: The fish

The first thing you notice as a programmer is that it trains you — forces you, really — to think in a disciplined way about complex logic problems. It also gives you a big booster shot of confidence around problem-solving in general. Junior programmers tend to have very high opinions of themselves; I was no exception.

In time, though, programming eventually humbles you, because it shows you the limits of your reasoning ability in ways that few other activities can match. Eventually every programmer becomes entangled in a system that is overwhelming in its complexity. As we grow in our abilities as programmers we learn to tackle increasingly complex systems. But every human programmer has limits, and some systems are just too hard to grapple with.

When this happens, we usually don’t blame ourselves, nor think any less of ourselves. Instead we claim that it’s someone else’s fault, and it just needs a rewrite to help manage the complexity. In many cases this is even true.

Over time, our worldwide computer-programming community has discovered or invented better and better ways ways to organize programs and systems. We’ve managed to increase their functionality while keeping the complexity under control.

But even with such controls in place, systems can occasionally get out of hand. And sometimes they even need to be abandoned altogether, like a dog that’s gone rabid. No matter how much time and love you’ve put into such systems, there’s no fixing them.

Programmers also tend to be active life long learners. This isn’t to say programmers tendencies are all easy to manage. They also are more likely not to accept what most people are willing to accept and can therefore be annoying to some. Now, I happen to think it is good to question conventional wisdom and authority… (which might explain one reason I am annoying), but it also explains why often management find dealing with IT staff annoying. Programmers often refuse to accept management’s belief system, including that the programmers job is just to do whatever the manager tells them to.

Related: A programmer’s view of the Universe, part 2: Mario Kart What Motivates Programmers?Reddit, a live view of how software coders thinkExplaining Managers to ProgrammersA Career in Computer ProgrammingProgrammers – cartoon formSigns You Have a Great Job … or Not

Posted in Creativity, Management, Respect, Software Development | Tagged , , , , , | 1 Comment

Management Blog Carnival: 2008 Overview

Over the next 2 weeks several management blogs will be posting their contributions to the management improvement annual blog carnival. Posts will highlight some of the best posts on other management blogs in the last year.

This posts is updated to link to annual review posts as they are posted.

See all previous management improvement blog carnivals.

Happy Holidays,

Related: Management Improvement Carnival, Best of 2007Curious Cat Management Improvement SearchManagement Management Improvement Blog Carnival

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