Operational Excellence Mixtape: December 6, 2019


Healthcare – Creating Value for Patients

Does Lean “work” in hospitals in the US?  Sort of, according to the Journal of Healthcare Management.  There is evidence that Lean improves efficiency and financial performance, but little evidence to support improvements in patient outcomes and patient satisfaction.  This may speak to how Lean is deployed in most hospitals with a focus on cost cutting rather than quality.  

Healthcare is rife with “quality indicators” developed by academics and bureaucrats deployed with the common belief that measuring these indicators and publishing them will drive improvements in quality. As Deming famously asked, “By what method?”  Clinical teams are navigating a maze of indicators and acknowledge that “even if data were more easily available, many clinical teams lack the analytical capacity (and time) to do much work with it”.

Many quality improvement projects related to these types of indicators have aim statements that read like “reduce CLABSI (infection) by 40%”.  Why not seek to prevent CLABSI rather than reduce it?  Brian Veara explores the impact of the difference between “reduce” and “prevent” when setting aim statements.

The health systems in UK (and in Canada) have long described the need to reduce dependency on hospitals and develop alternate care settings in anticipation of the aging population's increasing demand for healthcare services.  They have failed to provide these alternatives and predictably hospitals are ‘imploding' as wait-times reach worst-ever levels.

“If you had an orchestra, you wouldn't want a conductor who's never played an instrument”.  Physicians are happier when their leader is a physician, and leadership explains nearly half the variation in workplace satisfaction and burnout.  Good Leaders Make Good Doctors in the New York Times.  

Operational Excellence

Wonder how Amazon gets you your package so quickly?  Allaboutlean.com published a 4-part series on the inner workings of an Amazon fulfillment centre.

The US defeated Japan at the Battle of Midway in 1942, but Japan had already lost the battle by 1929 by committing to doctrine rather than humility, experimentation, and a commitment to an approach at all costs.  Steve Spear explores this in When Compliance Leadership Collides With Learning Leadership.

Improvement science and methods tend to focus on quantitative data.  Qualitative data is often more useful for case presentation and storytelling for the purpose of gaining influence and support.  David Williams reminds us of some good methods and techniques for gathering, analyzing, and displaying qualitative data in our improvement work.  

I visited UMass Memorial Health System to learn about their lean journey in 2015 and was impressed at the scale and scope of improvement work.  It appears it's matured and improved in 2019.  It takes time, leadership, systems, and a long-term outlook to transform culture – it appears UMass Memorial and Dr. Dickson are doing just that

An Amish manufacturer embraces lean and technology.

Leading & Enabling Excellence

Most of us have horror stories about a bad boss. Many people seek the “boss” role for the wrong reasons such as power and credit-seeking.  Bob Sutton shares the science behind what makes some people such bad bosses

We tend to focus on the work that is easiest or more urgent, ignoring what's most important.  We manage by due date and box-checking instead of being mission-focused.  Get your team to do more than meet deadlines by ensuring they set aside time for important work. 

Many lean experts will tell you that “it must be led by Sr. leadership”.  So what do you do if your leader doesn't lead?  Lead from the middle.  

Mental models are essential for improving decision-making and making sense of the world.  Shane Parrish has compiled the world's best mental models for you.

Coaching – Developing Self & Others

Adam Grant with another gem in The Atlantic – Stop Trying to Raise Successful Kids and Start Raising Kind Ones

We learn from failure, but is there an optimal amount of failure? Too much failure may cause us to give up, and not enough may drive boredom.  Scientists believe that people who fail 15% of the time learn the fastest.  

Interesting take on coaching – can school administrators be good coaches?  Yes and No

Books, Podcasts, Videos

The Unicorn Project is a novel about DevOps, a follow up to the Phoenix Project, where Gene Kim introduces the Five Ideals. Looks very interesting.

I love good podcasts and books on the future of work.  Fordism brought many benefits to the West in the 20th century and created a paradigm about work (3 phases of life, division of labour and subordination in return for job security and pensions).  As we continue to move away from the Fordist paradigm, what will work look like?  Azeem Azhar discusses with Laetitia Vitaud on this podcast Technology and the New World of 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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