Operational Excellence Mixtape: March 29, 2019


Healthcare – Creating Value for Patients

The design of payment and reimbursement systems in healthcare is a key driver of value.  In Canada, it is not uncommon for primary care physicians to institute a “one issue per visit” policy.  This clearly impacts value for patients.  It's time the causes of this practice get examined and addressed. 

I started working in healthcare in 2005 when EHRs were being touted as the blanket-solution to healthcare problems, promising safer care, system efficiencies, and save money.  What went wrong?  Read “Death By 1000 Clicks” by Fred Schulte and Erika Fry. 

“Pyjamas are the uniform of patients. PJs, nightshirts, backless gowns all send the same message: You're unwell, you're helpless, you're institutionalized and you're not going anywhere.”  An English CNO is launching a campaign to end “pj paralysis”. Patients with chronic diseases are a good source of ideas and innovation.  Consumer innovation is becoming common, but what would it take for a similar approach with healthcare?  

Lean thinkers know that overburden is a value-destroying symptom of a broken system.  Physician and provider burnout remains a serious problem in healthcare organizations and directly contributes to patient value.  It is becoming increasingly common to offer “resiliency” training to providers as a solution. I have nothing against resiliency, but as a lean thinker, I don't believe in burdening the worker with resolving systemic issues.  We can do better.  

Does robot-assisted surgery provide better value?  It appears there is little evidence yet that robot-assisted surgeries decrease complications, and the procedures are longer and costlier. Sometimes newer isn't better – yet. 

Operational Excellence

When you're investigating root cause, be careful if “people aren't following standard” becomes your focus.  You probably need to dig deeper. 

Canadian retailers claiming to be “customer-centric” continue to push work to the customer and attempt to call it efficiency.  Shoppers Drug Mart and Superstore customers indicate they are “forced” to use self check-outs when paying with debit or credit.  Interestingly, it is implied that the employees and managers do this in order to game a metric around the % usage of the self check-outs, proving once again that if you provide good people a target without expressing how you want them to achieve it, they will achieve it any way possible – usually at the expense of value to the customer.

Treat negative outcomes as just another data point.  “Failure is the cost you pay to be right” according to James Clear in this post title Treat Failure Like a Scientist.  Glorifying failure is common with mantras such as “fail fast, fail often” permeating the agile world.  This misses the point – failure without learning and doing things differently is non value added.

Sorry Lean Six Sigma people – Lean is not about “speed” or “reducing waste”. Cheryl Jekiel describes the richness of lean beyond the myopic and simplistic tropes about speed and efficiency.

Repost: An excellent collection of 109 Mental Models to help make better decisions.

Leading & Enabling Excellence

Boeing's CEO responds that the organization is “humbled and learning” in the wake of the deadly Ethiopian Airlines crash. A much improved response after defending their pilot training course, which was apparently re-designed to reduce costs and not improve the actual knowledge of the pilots.  and the FAA's decision to increase Boeing's authority to inspect and certify their own aircraft, apparently due to FAA resources being overburdened.  

Maslow's heirarchy of needs was published in 1943 with a paucity of evidence.  A new study provides empirical support for Maslow, concluding that self-actualized individuals are more motivated by growth and exploration than by fulfilling deficiencies in basic needs.  The gift card and small financial incentives have a limit folks – provide your star players with growth and exploration instead.

Are there signs of a global revolution towards humanist management? Here's an excellent summary of modern management philosophies and challenges through the lens of the journey from scientific management, the defeat of the “humanist” management philosophy by the “bureaucratic” philosophy in the 20th century, and signs of a shift in the 21st century.

If you worry that your staff aren't “busy” enough, you're a bad boss. Organizations continue to claim to prize innovation, improvement, and engagement, which require time and deliberate practice for thinking, reflecting, and experimenting – impossible if one is simply “doing” all the time.  Stop counting activity and comparing individuals on ‘action', it won't help others to innovate or improve.   Being busy is not a useful goal

Coaching – Developing Self & Others

How to Get Your To-Do List Done When You're Always In Meetings

Stressed at work?  Mentoring a colleague could help.  I've found that focusing on developing others is a great way to re-engage in your work when things aren't going as planned.

It's your fault.  Take ownership of the good or bad things that happen to you by using an active mindset instead of a passive mindset.

Books, Podcasts, Videos

Systems and incentives drive behaviours.  Safi Bahcall discusses how structure, systems, and incentives are critical to drive innovative behaviours, especially as companies grow on this HBR ideacast.

Check out Karyn Ross' book The Toyota Way to Service Excellence: Workbook, a practical, habit-forming guidebook to improve your coaching skills. 

I'm looking forward to an upcoming HBO Documentary on the Theranos scandal.

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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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