Tag Archives: process improvement

Passions

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During Thanksgiving it’s a time for food, family, and watching copious amounts of TV and movies. This year those movies included “Somm” which is a movie about 4 guys trying to take the Master Sommelier test. Which apparently only about 12% pass each year. Not a super low amount, but also not an easy exam in any way shape or form. It got me thinking about if I could become a Somm (as they are called in the business according to the movie). I think that I do have the right kind of mind for the job, remember flavors of wines the history of region of wine and all of that is right up my alley. I know that, because that’s what I used to do with beer. I used to be able to rattle of several types of beers that if you liked one kind or style that might push your boundaries and give some of the reasoning behind it. I was able to explain why a beer tasted the way it did, etc… That was something I loved and was really passionate about. However, wine just doesn’t hold the same level of interest to me. I don’t know if it’s because beer feels much more close to home, my friends drank beer and avoided wine or what it is. Even now that I cannot drink beer I still haven’t really replaced it with a beverage I’m passionate about. I drink both wine and cider, but I don’t feel a deep down passion for them. Likewise I don’t think I could do that with whiskey, even though I really enjoy drinking whiskey, it just hasn’t captured my imagination as a GREAT drink that I want to learn everything about.

More broadly, the movie has had me thinking about what I’m truly passionate about. I know that a great deal of my interests are reflections of what my friends are interested in. If I’m surrounded by people that love watching football, I’ll watch a lot more football, similarly for college basketball or hockey. I enjoy the games when I watch them, but I rarely will seek them out on my own. I think this is something that is driving my wife crazy, I simply don’t have a lot of things that I’m passionate about that I’ll invest a huge amount of time into. It’s frustrating for me too. I think that is probably the hardest thing about me being Gluten Free I’ve really lost a great passion of mine.

I think many people will agree that I’m passionate about certain things in our political system. I’m all about free speech, investing in science and technology to grow and enable our economy. But I’m also not 100% all in. I’ve been thinking about how to get involved and in what way I’d do this. Ideally, I’d work at a think tank, but there aren’t many around Portland and many of them are either left wing or right wing. I think on many topics I’m a moderate, so neither party truly inspires much confidence.

I’m also passionate about making people’s lives better at work, but I’m not really getting much support at my organization and I’m getting beaten down. It’s one of the most frustrating things you can deal with on a daily basis, knowing there’s a better way to do things, walking your leaders to the kool-aid, but seeing them spit it out and start drinking from the mud instead.

So this leaves in an odd position. The things I’m passionate for I can’t really follow through, which makes me ask What do I have passion for, what should I try to be doing to find things I could become passionate about, how should I act on the topics I do have passion for? I know that there’s something more out there that I could or should be doing, but i have no idea how to get there.

What should a manager manage?

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Managers should not be managers of people, they must manage processes. Managers should be leaders of people not managers of people. Managing people by watching them closely is not typically a very effective method to ensure that work is completed. Micromanagement breeds mistrust between employee and manager. Through managing the quality of the processes the manager is able to increase the likelihood of success of their people.

All work is a process. Even if there doesn’t appear to be a process if the work is to be fully completed there are a series of steps that must be completed. It doesn’t have to be a good process, a repeatable process, or particularly effective but if the work is completed it followed a process. Furthermore, if more multiple people do the same type of work without a clearly defined process it’s likely that there will inconsistent results to their work. A manager owns the overall output of all the work of their employees. If the work is consistently subpar or employees have a difficult time picking up the way to do the work that is expected of them, this is the responsibility of the manager to address. It doesn’t matter how amazing the employees are, they could have been consistently excelling in a previous, if the processes are terrible those employees will not succeed.

Not every type of work can effectively be managed through traditional software. For example, software and technology development in both these are “knowledge” activities that unlikely would benefit from a highly structured process. In these cases there are two things that help manage the process. First creating a regular process of checking in, managing what work the developers should be doing, and working to eliminate roadblocks – in software this is Agile software development. Second you create a standard process to feed in consistent data into the truly creative process and consistent outputs so that the consumers of the work are able to use the output of the creative process effectively in their work.

To manage the processes managers need to equip their employees and themselves with tools to do root cause analysis, conduct structured problem solving, and rigorous process improvement. Managers need to take ownership of the end to end process, the data their employees use to complete their work, and the quality of the results. It is important that this becomes the norm as it will switch blame from people, who generally want to do the right thing, to the process and how work is completed.

This is not to say that whenever people deviate from the agreed upon process that the manager shouldn’t address that or if people still fail to meet expectations while working in the process that they can’t be fired. However, leading employees to identify broken processes, supporting them in fixing them, and providing tools to do so becomes the role of the manager rather than micromanaging their employees.

Strategy and Business Management

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As I mentioned in my Business and Silver Bullets article, there are a lot of different approaches to managing your business, or at least a portion of your business. None of these approaches are easy to implement and it seems that there’s a bit of a revolving door around what leadership approach is the best for a given business. Furthermore, it’s troubling to me that organizations are looking at initiatives like Lean and Six Sigma as only operational improvement opportunities. As I’m reading through how Business Architecture works, it’s obvious to me that many of the organizational deployments of LSS have failed in reaching their full potential. I saw it at Samsung, AMD, and I’m skeptical of the full reach I’m going to have at Regence. It’s not a failure of the individuals deploying it or of a given leader, it’s a failure of the full organization to accept that changes need to happen. Organizations need to integrate approaches like LSS into their core strategic planning process. Otherwise those methodologies will only impact a limited area and won’t appear to have a holistic approach to making changes to an organization.

From my experiences Lean and Six Sigma methodologies can indicate the need for organizational re-alignment. These require real change with serious effort to implement those changes. In many cases those are outside the scope of the project facilitator, the leader of the process improvement center of excellence, and likely the owner of the processes. It’s got to come from an executive sponsor. They have to be able to provide the organizational courage to make real changes to an organization. Through these tools it’s possible to identify redundancies and areas where organizations require massive change.

Why don’t organization implement these changes? Too many priorities is likely one problem. Another is that these changes are hard and unless they are well versed in Lean or organizational structures, they won’t understand why the changes are fundamental to continued success of an organization. They may not understand the changes because they weren’t involved in the redesign process intimately enough. Finally, it might also be that these changes are bottoms up recommendations and not top down.

I believe this is why Business Architecture eventually was a created as a discipline. I believe in organizations that are truly Lean that these types of roles are not needed. Simply because the bottoms up approach allows the leaders to focus on different things especially since a true Lean organization is always customer centric. In organizations that there is a great deal of legacy behavior and entrenched management fiefdoms, it might be a requirement to go through an organization like Business Architecture to give the true sense of ownership to the leaders. It makes the bottoms up recommendations that come from the BA team seem like it’s a top down approach that is sanctioned by all of leadership. It let’s people see that clearer tie between the different organizations in a way that a lot of Lean work doesn’t. It’s designed to be holistic not something grown into the whole over time.

This leads to a different method for developing strategy than what a lot of Lean practitioners utilize. Business Architecture focuses on the current capabilities and works to align the strategy from there. Lean starts with the 5 year vision and goals and figures out how to align existing projects and improvement efforts to enact those goal, through providing a metric for the person doing the work on the ground.

I think that these business management approaches are both valid, I’m really biased towards Lean, but I do believe that in many organizations Business Architecture is likely required. It leaves the control a bit more in the leadership rather than the Lean approach. I believe they both can impact strategy in an effective manner, but it’s likely that BA will be more tightly coupled from the start than many Lean initiatives.

Healthcare: the Value Stream of care

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In Lean process improvement, one of the first steps you ever take is to walk the process. For manufacturing this means to go down to the floor where the product is made and walk with one piece from beginning to end. This provides the manufacturer insight into where there’s a great deal of waiting for product to come, leading to idle workers, where there’s a lot of inventory piled up – a bottle neck, if there’s a lot of rework – fixing defects like re-etching a person’s name on the back of an iPhone, and how the material flows around the floor. This works pretty well with doctor’s offices too. You can draw a map to all the different places the Dr. walks, the nurses walks, and where the patient walks. Any transportation in a Lean system is waste, so reducing that is important.

Mapping value streams essentially take this to the next level. You map all the major steps that the material that goes into your product step through before and after you. This allows a manufacturer to see all the waste before and after them, enabling them to partner with their suppliers and customers to reduce waste and unnecessary processing. For example, many of us have worked retail. Some times when you do stocking you’ll find shirts that are in bags that are in a box. This is non-value add because it’s highly unlikely that the bag would protect the shirt from getting wet in the case of a flood. So, it’s a waste of plastic for the bag, putting the bags on the shirts, and removing the bags from the shirts are all waste. Which increases the cost of a shirt. However, there’s a beginning and end of the value stream likely starting with cotton and ending with the final sale to the customer. In the case of a can of cola, it takes 319 days from the mining of bauxite to the consumption of the cola with only a total of 3 hours of actual processing of the material (Lean Thinking, Womack).

Value Stream for a can of cola through bottling (Womak Lean Thinking)

Why such a long introduction? Well, the value stream for healthcare is completely different. The beginning is when you’re born and the end is when you die. Otherwise, every activity you partake in impacts your health and the eventual cost of any episode of care. An episode of care is what happens when you directly interact with a provider, hospital, or health insurer. Arguably, these are the exception to your normal behavior and take you out of your normal routine.

Thinking about health in a value stream like this is non-intuitive for providers and insurers alike. As both have accounting practices and treatment plans that focus mainly on the episodes of care and minimize the remainder of the activities a member does. Thinking in this manner places more importance on preventative care, longer term plans for mental and physical rehabilitation, and care networks for long term diseases. This is a serious shift that is starting to occur in many insurance organizations, but aren’t very effective yet. The most effective portion of those three are the networks of patients that have a similar disease, such as Crohn’s Disease.

I believe that looking at care in this fashion will help redesign the manner that care is designed as it will focus on different portions. As my friend Rachel pointed out, behavioral health issues are typically undervalued in the value stream of healthcare. However, with this model long term care issues should be given priorities as they impact the highest percentage of the value stream. It would also force insurers and providers to look at addressing care holistically and providing the best care in the best way when they can. Sending patients to clinics that can quickly treat conditions as cheap as possible.

I’m extremely interested in how this will play out at my company as we think more holistically about value streams for health care. Checkout my last two blogs about health care:
http://scitechkapsar.blogspot.com/2013/11/heathcare-how-insurance-company-decides.html

http://scitechkapsar.blogspot.com/2013/11/healthcare-why-do-we-need-medical.html