From Davis Balestracci -- How about Some Radical Organizational (Re)-Education?

Published: Mon, 04/16/12

From Davis Balestracci -- How about Some Radical Organizational (Re)-Education?

[~ 800 words:  Take 4-6 minutes to read over a break or lunch]
Solve Problems that Matter
Hi, Folks,
Many of you have learned and maybe even teach the Pareto chart.  But, how many of you apply the Pareto principle, also known as the 80/20 rule (a particular favorite of 20th century quality giant Joseph Juran) to your work?  My respected colleague Jay Arthur ( goes even a step further:

"In case after case working with various businesses, I have found that less than 4% of your business causes over 50% of the waste, rework, cost, and lost profit.  So forget the old 80/20 rule. Narrow your focus even further to maximize your gains and minimize your Six Sigma startup costs. Only involve 4% of your staff in the initial wave of improvements focused on mission-critical elements of your business."
But he warns of the dark side of the 4-50 Rule:  "50% of your effort only produces 4% of the benefit."
And Brian Joiner warns, "Vague solutions to vague problems yield vague results."
Two Traps
And research by the Juran Institute concluded that many projects fail for two major reasons:

1. Too much detailed flow-charting [which can also result in a potential "Ishikawa cause-and-effect diagram from hell"]
2. No good baseline estimate of the problem.

Why too much flow-charting?  Because you need to apply the Pareto Principle one step further on a chosen situation: What is the 20% of that process causing 80% of the problem? -- then do a detailed flow chart showing exactly how things get done and by whom in that specific area, which also considerably narrows the brainstorming if an Ishikawa cause-and-effect diagram is used as well.
So, back up a bit and start with what Joiner and The TEAM Handbook call a "top down flow-chart":  Break up your situation/process into five to seven sub-process and, for each, document only the specific tasks that occur at each stage -- not how they get done. 
[If complete documentation is important for, say, a certification, the additional detail can be eventually added post-project once the major issue is solved.]
The top down flow-chart can identify possible data collection points or traceability markers where a well-designed data stratification will usually help isolate the vital "20%." [A future newsletter]
Regarding (2), as I have demonstrated time and time again, an initial time plot - run chart - of a crucial indicator that shows the extent of the problem should even precede all of the flow-charting...and it would be best if this indicator somehow cascades to connect to a "big dot" in the board room. 
Most health care organizations have a tailor-made opportunity:  Safety.  You could start as shown in my 17 October 2011 newsletter, which would begin needed initial conversations as Dr, Donald Berwick describes in one of my favorite quotes:
"Several important things happen when you plot data over time.  First, you have to ask what data to plot.  In the exploration of the answer you begin to clarify aims, and also to see the system from a wider viewpoint.  Where are the data?  What do they mean? To whom?  Who should see them?  Why?  These are questions that integrate and clarify aims and systems all at once...When important indicators are continuously monitored, it becomes easier and easier to study the effects of innovation in real time."
When all this has been done:  applying the Pareto principle, what particular aspect of safety is causing most of the problem - or organizational heartburn?
Improve Your Improvement Process
Note again the title of this newsletter.  Why not consider this approach as piloting a new start to your organizational improvement education process -- with the major goal of improving your improvement process?
Initially, it seems tempting to put a separate team on each aspect of safety (in this case, complaints, med errors, falls, pressure sores, bacteraemias -- 5 teams total). Consider this initial one-team approach: Some of the technical AND improvement knowledge will no doubt spill over into the other areas, making any subsequent projects far more effective -- getting better faster.
As Juran liked to say, "There is no such thing as 'improvement in general'," and you should realize that improving your improvement process to get better faster is part of your charter as change agents!

So, do you dare to stop all of your current education/training efforts to begin to consider this, as I challenged you in this past newsletter?
With this approach, here's a chance to teach run charts (construction / interpretation, common / special cause), flow-charting (top down, detailed, deployment, value-add), data issues (operational definitions, design of a good data collection process), and stratification to further isolate the major sources of variation within your chosen topic - in the context of solving a major organizational problem with a high probability of success (especially if you're willing to take one other risk I'll talk about next time). 
To me, this is far more interesting than a red bead experiment demonstration or flow-charting the process of making coffee, or, as I saw once, a cause-and-effect diagram for improving the baking of chocolate chip cookies...
A friendly warning via one of my 10 Commandments for Change Agents:
"Remember: Quality may be very interesting to thee, but thee must realize that thy neighbor's job takes up over 100% of their time."

As you've heard me say many times, don't teach people statistics. Teach them how to solve their problems!  It will also get you that seemingly elusive respect you deserve.

Until next time...

Kind regards,
P.S. Need some help in redesigning your approach to organizational education?
I recently received this very kind feedback:

"One of our physicians went to one of your seminars and was so impressed. He came back...and wanted to change the way we present data clinic wide. It wasn't until I read your book that I realized how we should accurately collect data and present it. I have changed how I display data...Graphs are finally meaning something and telling us something useful. I have taken some stats classes trying to improve the way I present data. Nothing really helped until your book!

"Thank you for the work you do and sharing it in a way that I could understand."

--Care to help your departments become more effective and passionate about improvement with an all-day seminar and follow-up?  Click here.

--Shall we have a chat about some mentoring to get the respect you deserve?  Click here.

--Need an entertaining, stimulating plenary speaker for your professional conferences?  Click here.
--If your leadership is finally truly serious about improvement, and open to some next steps, consider suggesting this retreat.  Click here.

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