Operational Excellence Mixtape: May 24, 2019


Healthcare – Creating Value for Patients

Compelling people with evidence or demanding compliance does very little to drive adoption of new practices – handing out articles, making posters and Powerpoint presentations to ‘educate', and conducting audits will continue to disappoint.  What will help?  Create real ownership (not demand ‘buy-in'), deeply understand and respect the motivations of stakeholders, and demonstrate results by getting early adopters to practice first.  Here's an excellent case study in HBR from McLeod Health in South Carolina on creating adoption of a Surgical Checklist.  

I try not to make any major decisions at work after 3 pm.  Why?  I'm tired and my brain isn't as sharp. It turns out, doctors get fatigued too, and it results in a difference in the care provided. More in the New York Times piece Don't Visit Your Doctor In The Afternoon. 

Harvard Business Review has published a feature on CareMore Health's home-based primary care program that keeps high-cost, high needs patients out of hospital.  It's not surprising that patients prefer treatment in home or that the outcomes are encouraging. 

Canada's healthcare system was designed in the 1960s – and not much has changed. Wait times continue to be higher than in other countries with universal healthcare.  Reform is usually centered around hypotheses about shuffling around the assets in the current system instead and debating where care should be delivered rather than how care should be delivered and funded.  We need to improve the system.

Spreading and scaling improvement in healthcare (or anywhere for that matter) is a perennial challenge.  BMJ taps into multiple improvement disciplines in this exploration of spreading and scaling up innovation and improvement

Operational Excellence

Net Promoter Scores (NPS) are all the rage as a proxy indicator for customer value.  The Wall Street Journal casts doubt on its effectiveness and describes the noise in the metric in The Dubious Management Fad Sweeping North America.  Large organizations are famous for treating “big dot” or noisy outcome metrics as gospel.

Understanding and managing variation is helpful for driving improvement.  Many attempt this by writing a procedure and demanding compliance – usually without success. Here are 7 helpful ways to manage process variation. 

A lean (not LEAN) practitioner reflects on his evolving definition of lean in Defining lean is useful, lean definitions are useless.

One of the barriers to structured problem solving, like A3 thinking, is the bias we have for taking action over defining the problem.  Don't confuse motion with getting results.  Read more about the Do Something Syndrome: Why Motion Trumps Results.

Lean in construction is pretty popular now.  Many lean practitioners struggle to articulate or quantify the improvements that lean can deliver, but not Ray Lota.  Here Ray explains the benefits of lean in construction at the Lean Construction Institute of Canada.

Seeking truth is essential to improvement.  Seth Godin outlines different kinds of truth.

Many organizations invest in quality or safety “systems” that generate a lot of bureaucracy and documentation, but are light on results.  Here's a good piece on why these systems fail to deliver the desired results.

Leading & Enabling Excellence

Change Management is often considered a ‘program' using a central one-size fits all approach for large organizations.  Boston Consulting Group debunks this approach in The Science of Organizational Change.

After partially blaming pilots for the 737 MAX crashes, Boeing is now attempting to engage pilots to lead the public relations effort to rebuild trust in the public.  Not surprisingly, some are resistant.  

The New York Jets are a case study in how NOT to lead. 

We will experience 20,000 years of progress in the 21st century.  In the Age of Emergent Change, Beth Comstock describes the essential skills to lead and thrive.

Coaching – Developing Self & Others

Many of us have had training on “Active Listening”.  Listener extraordinaire Oscar Trimboli, author of Deep Listening, offers up a fresh take on listening skills in the 5 Myths of Listening.  I ordered Oscar's book on Deep Listening this week – I'm looking forward to it.

The debate over the effectiveness of performance reviews continues

Books, Podcasts, Videos

For healthcare improvement folks, I highly recommend the LeanBlog podcast with Dr. Rob Hackett as he discusses the #theatrecapchallenge.  It's a great study in the different factors that drive resistance to improvement in healthcare.

What do open floorplan offices, Myers-Briggs Type Indicators, and Learning Styles have in common?  They are management fads debated by Adam Grant and Stephen Dubner (of Freakonomics fame) in this short and interesting podcast Fadbusting.

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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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