Operational Excellence Mixtape: March 13, 2020

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Healthcare – Creating Value for Patients

Running controlled experiments for evaluating interventions in healthcare is usually infeasible – the presentation of patients can be random and most factors are impossible to control.  However, experimenters can benefit from the quasi-random assignment possible in semi-controlled experiments.  Read more on Leveraging Natural Experiments to Evaluate Interventions in Learning Health Systems.

In Canada, you hear about “hallway medicine” during every political campaign.  In the US, you don't hear this term.  It's not because of private versus public healthcare, but rather that the Canadian system lacks a good bridge between acute care settings (hospital) and alternate level of care (ALC / PCH) settings for sub-acute frail elderly patients, while the US uses Skilled Nursing Facilities (SNFs) to address this phase of care. Perhaps Canada can learn more by Adopting a US plan for Easing Hallway Medicine.   

Canada and the UK are committed to the narrative of “hospital bad / community good”, partly because hospitals are chronically overflowing.  But sometimes the best option is a hospital admission and some patients are “considerably transformed and substantially restored” as a result.  

You can get food, music, entertainment, repair services, transportation, anything on Amazon on demand at your doorstep – but not healthcare. Is it time to revisit the house call as an option in our healthcare system?  The house call: 5 lessons I have learned as a doctor

Operational Excellence

“Lean is about speed” or “doing things faster” – common refrains from the uninitiated who observe Lean's use of takt time, cycle time, and focus on flow.  Lean's relationship with time has long been misunderstood, but John Shook does a great job of explaining it in Lean is a Time-Based Strategy

Operational excellence practitioners and leaders often lament that others “don't get it” and push hard to change people's minds.  Instead of pushing, we should figure out what barriers leader encounter that prevent them from change, and focus on removing them, according to this excellent essay in The Wall Street Journal, How to Change Anyone's Mind

There are differences between “complicated” and “complex”.  The methods used to improve a complicated system won't work on a complex system.  Read more on these implications in 7 Differences Between Complex and Complicated.   

To get to the “real” problem, you have to keep asking questions to uncover the underlying assumptions and potential causes.  Here's a great example in Keep Digging on signal v. noise.

In 2014, the Toronto Transit Commission (TTC) adopted the Japanese method of shisa kanko, or “point and acknowledge”, resulting in a 50 per cent decrease in critical safety incidents.   Automation will end the unusual safety practice of “point and acknowledge” in Toronto subways.

Leading & Enabling Excellence

Coaching – Developing Self & Others

Recognition is an important driver of engagement, but celebration should be balanced by reflection on what could be improved.  Here's How to Practice Hansei, the Japanese Art of Self-Criticism.

Coaching and helping others can be addictive.  To help avoid the dark side of coaching, here are 4 ways to Overcome Your Obsession With Helping Others.

The tyranny of metrics continues. Pressure to meet corporate goals by any method can cause risky behaviour, such as employees cutting corners on safety, senior management suppressing facts from consulting reports, and overburdening professionals. The New York Times describes these conditions at Walgreen's in Complaints of Medication Errors Go Missing.

How does an organization design the ‘right' organizational structure to drive excellence with modern management theory and workforces?  Like most effective structures, it evolves over time.  Learn how Haier has developed a unique structure over time, in Evolve or Die.

All mentors can coach, but not all coaches can mentor.  Mentors should be invested in the long-term growth and development of others.  The 3,000 Year Old Lesson in Executive Mentorship

Books, Podcasts, Videos

In lean, we emphasize the practice of “going to see” in order to learn directly from the source.  Malcolm Gladwell travels to Japan to learn firsthand how engineering and a culture of excellence merge at Lexus in his new 6-part podcast “GO and See”.  

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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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