Operational Excellence Mixtape: February 15, 2019


Healthcare – Creating Value for Patients

Daily safety huddles are simple, inexpensive, and effective methods to raise and escalate patient safety risks.  Start your safety huddles today with some tips from the Institute for Healthcare Improvement.

I get asked all the time whether lean “works” in healthcare.  Here's a simple case from Cleveland Clinic where a team improved the capacity of the Neurology OR primarily through simple visual management and huddles.  Anyone can apply these tools.  Seriously.

A lot of people fear going to the doctor or dentist, myself included.  I especially dislike the feeling of judgement and being lectured to, and it turns out I'm not alone.  A study shows that patients often lie to doctors, thus compromising their care, for fear of judgment, lecture, rejection, or punishment.  To provide the best possible care, doctors will need to foster environments of trust and remove fear.

Operational Excellence

Setting individual quotas and targets with the expectation of improving system performance is almost always bad (ask Wells Fargo how that turned out for them) – yet this pathetic and counterproductive practice continues. Here's a good piece from The Hustle describing how quotas cause harm, disengagement, and the counterproductive gaming of measurement systems by staff.   

Process behavior charts offer up significant advantages as an improvement method than traditional scorecards and actual vs target comparisons, that are deeply ingrained in corporate “performance management” toolkits. Adopting new methods to measure performance requires an openness to learning new techniques and may require the “unlearning” of long-held methods.

When setting goals, there has always been debate on whether the A in SMART should be “Attainable” or “Ambitious”.  A study from INSEAD shows that too modest attainment goals draw out our negative bias towards what won't work, but also shows that we view a modest attainment goal as a more viable option to maintaining the status quo when given a choice.  Setting a modest attainment goal should be preferred over a maintenance goal.

Leading & Enabling Excellence

“We need to change the culture” is a common refrain from leadership when seeking improvement and excellence, yet very few can describe the culture they seek, and far fewer can describe how to foster the change (usually this is delegated to HR).  Dan Markovitz asserts that too many focus on tools and artifacts with too little investment to achieve shifts in culture.  

It's not uncommon to find staff from 4 generations in the same workplace these days, which can create some very different expectations from staff and leaders.

Elon Musk thinks that appealing to people's sense of purpose will cause them to get results by simply working harder, resulting in improved profitability.   This is little more than modern-day sloganeering and poster campaigns that Deming often warned against.  It will be interesting to see how this plays out.

Coaching – Developing Self & Others

Beware the gatekeeper!  “Confirmation bias is the most dangerous cognitive bias in the world, and nothing will convince me otherwise.”  Brilliant.

Seeking perfection.  Excellence.  Life-hacking.  Don't waste time.  As with everything in life, a focus on efficiency requires moderation.  Maximum efficiency actually constrains a system, including humans, and actually locks in the status quo.  Seek balance and some inefficiency to create room for discovery, innovation, and life.

Books, Podcasts, Videos

What is Lean? What is Operational Excellence?  Mark Graban explains in a 3 minute clip.

Psychological Safety is a necessary condition for sustainable operational excellence. Here's an excellent podcast on Psychological Safety with Amy Edmondson

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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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