Operational Excellence Mixtape: February 1, 2019


Healthcare – Creating Value for Patients

Why do we have to wake up patients to take vital signs every 4 hours if they are stable?  Why does a patient need daily labs if there results have been stable for days?  Because we've always done it that way and we have stopped asking questions or thinking critically, so much so that the Journal of Hospital Medicine started a series of articles on Things We Do For No Reason

10 years ago, in an effort to control costs and create incentives to improve care, American hospitals were penalized for readmitting Medicare patients. Not surprisingly, hospitals found a way to improve the metrics, but there's no consensus or evidence that this has resulted in better care. Well-intentioned programs that use metrics and targets with punitive incentives will consistently achieve one thing: people will find any way possible to meet the target, regardless of the intention.

Healthcare has a history of approaching quality from a mostly technical, academic, or regulatory lens based on ‘accreditation' audits and clinical journals. Joe Mando proposes that patients are the true source and measure of whether quality is improving in this reminder of the first order principle of creating value for patients and customers.

The conditions required for excellent patient safety have been well-studied and demystified for quite some time, yet the results still lag. The Canadian healthcare industry loves packaging standards into “algorithms” and “bundles.” The Patient Safety Culture “Bundle” for CEO's / Senior Leaders is a concise prescription for the conditions and behaviours required to improve patient safety.

Operational Excellence

Improvement and innovation is not about 10x disruptive ideas, being ‘agile', or perpetual brainstorming, despite the enduring myths perpetuated by innovation gurus. In reality, innovation is often re-purposing existing technology, incremental improvements, and deep understanding of problems.

Design thinking is increasingly popular in the service industry and is often positioned as a “new” discipline. Like many methodologies being pitched by consultants as ‘new', design thinking has evolved steadily since the 1960'sThis article describes the long history of design thinking in product and service design.

Here's a good piece on how kata can transform your lean deployment.

Understanding the customer is essential to successful design. Ford engineer Dave Pericak deeply engaged with his customer base, especially women, to help redesign the Mustang that resulted in  a 49% improvement in sales in this excerpt from Designing the Future: How Ford, Toyota, and Other World-Class Organizations Use Lean Product Development to Drive Innovation and Transform Their Business by James M. Morgan and Jeffrey K. Liker, p.44-49 (McGraw-Hill Education, October 2018).  

What should we measure? Many seek out what others measure and copy that. Don't steal metrics – find your own goals.

Leading & Enabling Excellence

Herb Kelleher, the legendary transformational leader and former CEO of Southwest Airlines passed away last month, resulting in many excellent tributes to his leadership contributions including Fortune's Remembering Herb Kelleher, and Forbes' Southwest Airlines Founder Herb Kelleher Was The Brand's Storyteller-In-Chief.

Many list humility and curiosity as essential traits for transformational leaders. A recognition that what you believe may, in fact, be wrong is foundational for scientific thinking, but our brains are prone to intellectual blindspots that make it difficult to see our own ignorance. This article explores the importance of intellectual humility and knowing you might be wrong. Similarly, a lack of humility can cause us to overlook or dismiss crucial information. In How Not to be Stupid, Adam Robinson discusses factors that result in sometimes catastrophic errors.

Psychology has always played a huge role in improvement and excellence (Deming included psychology as part of his System of Profound Knowledge). Dan Schmitz discusses the SCARF model that leaders can use to help staff navigate change and process redesign.

I worked for a perfectionist for many years. The challenge to get perfect results often pushed me to get results I may not otherwise have achieved, but it had its challenges too. Is perfectionism a strength or weakness? A meta-analysis of 95 studies shows that perfectionism is strongly related to higher levels of burnout, stress, and workaholism. 

Organizations continue to seek gimmicks and superficial incentives to increase employee engagement based on the results of annual surveys instead of leading more effectively (who has time for that?). The Manitoba Government, which is widely expected to slash hundreds of jobs from its workforce in 2019 demonstrates questionable judgment by creating a ‘gnome' gimmick to visit staff in a bid to help drive engagement. It's a shame – Manitoba is home to an excellent engagement advisor – David Zinger – who prescribes  “good work, done well, with others every day” as an effective approach to engaging staff. Maybe they should give him a call.

Tim McMahon, author of the blog A Lean Journey, offers up 10 Tips for Being a Better Leader.

Coaching – Developing Self & Others

Organizations continue to lament the challenges in recruiting talent, but why not develop your own talent?  “Keeping hold of skilled workers already in your employ might actually be the better — and cheaper — path.”

Creating and breaking habits may be the ultimate meta-skill, and there is a growing collection of books, podcasts and studies devoted to the topic. The NY Times compiled the best tips from journals and books in How To Crush Your Habits in the New Year.

It's natural to fall in love with your ideas and stick to it, but sometimes transformational leadership means facing reality with courage. Here's a good reminder of the Dead Horse Theory – “when you discover you're riding a dead horse, the best strategy is to dismount“.

Books, Podcasts, Videos

Innovation consultant Matthew May discusses Winning the Brain Game with Markus Andrezak on this excellent podcast on the flaws of thinking that prevent us from solving problems and reminds us that there is a lot of opportunity to “think inside  the box” if it's properly framed. Don't be put off by the bizarre intro music – it's a great discussion!

Book Recommendation: Starting new habits and stopping old habits is a critical meta-skill for improvement. Atomic Habits by James Clear breaks down the process for creating and quitting habits.  Check out James' recent appearance on EntreLeadership podcast to promote his work.

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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.


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