Operational Excellence Mixtape: August 30, 2019


Healthcare – Creating Value for Patients

The last place I want to receive care is the hospital.  There are innumerable advantages to being treated in home for the patient, family, and healthcare system.  Treating acute care patients in the home is tricky, and has been tried before without much sustainability.  NEJM Catalyst features a case study from Security Health Plan of Wisconsin that has developed a scaleable model for treating acute care patients in their homes.

Eric Topol argues that the time is right for doctors to organize to fight for keyboard liberation, cognitive doctor work, and the tyranny of procedure-based productivity in this New Yorker article Why Doctors Should Organize.

Emergency Room “Hallway Medicine” can generally be retraced to policy decisions in the 1990's to reduce acute care bed bases by 30%.  Most bureaucrats assumed that this could force systemic redesign that would alleviate the need for hospitalization – but many of those never came.  Alan Drummond wrote a great article on the urgency around bed utilization challenges today in Ontario

Operational Excellence

North American companies are often reluctant to discuss cost reduction openly – mostly because traditional cost reduction focuses solely on headcount reduction.  Jean Cunningham visits Toyota and reminds us that a focus on cost reduction is more than headcount reduction – transparency, specific measures of total cost, long-term goal setting, eliminating defects, reducing waste, redeploying capacity, maximize utilization of existing assets, and kaizen.  

Dan Markovitz reminds us that our brains crave forward progress, no matter how small, in Start Small. Move Fast. 

“What's the ROI on continuous improvement?”.  This can be a difficult question to answer in a manner consistent with financial business case methodology.  Jon Miller explores this in “Why Can't We See the Financial Impact of Continuous Improvement?”. 

Innovation Labs are becoming commonplace in most large organizations.  As with any transformational group or program, it is essential to establish clarity on purpose of the innovation lab, what problems it intends on solving and how it intends on going about this.   If you want an innovation lab that actually innovates, avoid “innovation theater”

I often get asked how standardization can be accomplished in a service or healthcare process where the consumer or patient is different every time. Standardized work, of course, focuses on outcome, not rote replication of steps.  Michael Balle expertly responds to this oft-asked question in “How can there be standards in a service job where no two instances are the same?”.

We are born curious and intrinsically motivated.  Education systems and then management systems in the workplace can contribute to removing the natural curiosity we were born with.  Mike Stoecklein encourages managers to develop systems to drive creativity and curiosity in the workplace in “Learn Continuously – act like a six-year old”.

Has agile become more religion than methodology?  Kurt Cagle knew that it was the end of agile when the hockey stick ceremonies began. 

Leading & Enabling Excellence

For the first time in modern history, CEOs claim to believe that people are more important than profits.  But then again, talk is cheap. 

Leaders who view improvement as “on top of” doing work often ask unhelpful questions such as “how much time should we spend on lean?”.  Larry Fast offers up his experience in tackling this question

Bruce Hamilton (old lean dude of Toast Kaizen fame) discusses authority vs accountability

Coaching – Developing Self & Others

High-performing teams have productive disagreements

Five questions I wish I'd asked my mentor when I was younger.

Books, Podcasts, Videos

Ed Neidermeyer reveals a riveting and cautionary tale of how Tesla struggles to produce at scale using Silicon Valley mindsets in his new book Ludicrous.  Listen to this excellent podcast with Mark Graban on the Lean Blog Interviews podcast where Ed discusses the history of Tesla and his perspectives on its challenges to manufacture quality vehicles at scale.  

I enjoyed listening to Horst Schulze of Ritz Carlton and service excellence fame discuss the importance of purpose in everything we do on What's Next! with Tiffani Bova.

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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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