Operational Excellence Mixtape: August 31, 2018


Healthcare – Creating Value for Patient

Canadian healthcare is where “pilot projects come to die”.  There is a lack of a culture of innovation in Canadian health, partly due to its fragmented nature and reliance on academic and government echo-chambers to devise solutions.  

Two data points do not make a trend.  Reporting on ER Wait Times in Winnipeg continues to focus on monthly fluctuations and two-point comparisons, rather than actually seeking to answer the only question that matters: “are wait times improving?”.  The Winnipeg Sun and WRHA continue to issue reactive reports either too soon declaring victory in the battle against waitingspending time rationalizing (probably) normal variation, or determining that countermeasures are failing – all based on two-data point comparisons. I suspect the truth (not that you will find any from any reports), is that these data fall within an expected range of variation.  Mark Graban writes about the waste involved in this type of reporting, and what to do differently here. 

One of the many barriers to improving value in healthcare is measuring value.  Here the Wall Street Journal looks at the challenges in even determining what routine knee surgery actually costs.   It's difficult to create measurably better value when one can't measure value….

Operational Excellence

Is it better to scale your lean efforts “inch deep – mile wide” or “inch-wide – mile deep”?  The “model cell” approach is often debated in lean communities.  Here's a piece in support of doing a deep dive in a focused area – but don't call it a “pilot”.  John Toussaint of Catalysis also advocates for the use of the “model cell” to learn and scale transformation efforts in healthcare.  Is there a right way to scale up transformation efforts?  I think it depends (major cop out, I know).

One of the most frustrating questions for improvement professionals is “why don't proven improvements or ideas immediately catch on and scale up? “.  Too often, we expect improvements with demonstrated results to “spread” across our organizations.  This is rarely the case, and there are many reasons for this.  Here is an article from Stanford Social Innovation Review describing the reasons for the “stagnation” chasm that examines reasons proven social innovations don't catch fire – I think many of these principles apply to operations as well.

Is Toyota agile?  Aren't agile principles similar to those of the Toyota Production System?  I was surprised to learn that Toyota has been on an agile journey for two years

Lean practitioners are often tasked with explaining why lean principles are effective.  Michael Balle attempts to navigate this argument in his post “Why lean works”

Leading & Enabling Excellence

Many organizations lament that people “aren't accountable” and that accountability will solve all their problems.  This is often a case of mistaking blame for accountability, which can result in a culture of fear and judgement with little focus on improvement.  Instead, leaders can choose to create accountable teams by defining and modeling behaviours, following up, coaching, and publicly acknowledging these behaviours.

Speaking of fear and cultures of blame, the news cycle continues to report on the disastrous consequences of pressuring employees to get results at all costs at Wells Fargo,  and upselling practices at Canadian telecoms.  Deming would remind us to ask “by what method?” and define specific behaviours and processes to achieve results in a respectful and sustainable way. 

Why do people believe in some leaders and not others?  Not surprisingly, perceived competence and trustworthiness are important to establish credibility as a leader.

Here are some sure-fire ways to erode trust by bullying employees.  

Coaching – Developing Self & Others

Humility is key to self-development.  It's hard to learn if you already know everything.

Are you learning to learn faster?  Steven Spear challenges us to apply improvement principles to our own learning processes.

Books, Videos, Podcasts

I'm currently re-reading some OpEx classics such as:

The 1926 classic Today and Tomorrow by Henry Ford. In many respects, still reads as fresh thinking today.

A 1994 book about Deming called Deming's Profound Changes: When Will the Sleeping Giant Awaken? by Kenneth Delavigne and J. Daniel Robertson.  I found this at a used bookstore for a couple of bucks – it's a great read so far.

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Ryan McCormack
Ryan is an operational excellence professional with over 18 years experience practicing continuous improvement in healthcare, insurance, food manufacturing, and aerospace. He is an avid student of the application of Lean principles in work and life to create measurably better value.


  1. Thanks for the tip on the Deming book, Ryan.

    I wonder if half the battle is in the framing of things as “profound”? Does that scare people off? Just about the only thing I ever think to criticize the late great Dr. Deming for is the phrase “system of profound knowledge.” It sounds pretentious.

    That said, even with different names, do leaders really want to challenge themselves the way Dr. Deming would have challenged them?

    It’s similar to “Lean” perhaps — the name doesn’t help, but the name isn’t the main barrier to adoption.

    • It does sound pretentious. Even Deming’s vaunted 14 points can sound too academic when presented to managers. Here’s a challenge: translate Deming’s 14 points into plain language without diluting their meaning.

      • Jack Welch criticized Deming as “too academic.”

        I think Welch just disagreed with Deming, so that was a way to be dismissive.

        Yes, Deming had a Ph.D. and taught university courses, but I think his approach is pretty grounded and practical, based on real-world insights and experience.

        That said, I agree that it’s a challenge to update or translate language without creating distortions or altering the meaning.


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