But take a look anyway, if you have an interest in process improvement in hospitals. This is a collection of my best posts on this topic.

Tuesday, December 17, 2013

On learning organizations

Please check out this new article I wrote for the Athenahealth Leadership Forum.  The lede:

A colleague once said, “Every plan is excellent, until it’s tested. It’s execution that’s the problem.” And so it is. 


Project advocates enter every endeavor with a theory of the case, a vision of how things should be. But, as my late colleague Donald Schön noted, reflective practitioners are constantly reviewing the evidence to modify their framework in response to reality.

Lean organizations understand that there is no group of central planners clever enough to design an optimum complex process. Lean leaders do not lack for a strong purpose—indeed audacious goals are favored—but neither do they lack humility. 

Lean and other similarly designed organizations can only exist where the senior leadership is a strong advocate for the proposition that reflective practice is the best way to achieve outstanding performance for their customers. The leaders of such organizations embed that modesty and reflection in every aspect of their lives.

Thursday, December 12, 2013

Oatmeal at IHI: The sequel

I never thought that I would be compelled to write another post about the manner in which oatmeal is served at the IHI Annual National Forum at the Marriott World Center in Orlando.

Let me take you back to the original posts from 2010: 1, 2, 3, 4.  Short version: The ladles (see above) provided to guests on the breakfast buffet were too large relative to the bowls, so oatmeal was being spilled all over people's hands and their bowls.  

Unsanitary and messy work-arounds were developed by the guests (like using the tea cup seen above.)  I wrote a blog post about the issue, and the hotel responded by eliminating self-service and assigning staff to serve oatmeal at several stations, providing them with slightly smaller ladles.

Now, three years later, I stopped by an oatmeal station and noticed that the ladle used by the server was still too large relative to the bowl size. So even with an experienced server, the oatmeal often spills over the edge of the bowl onto the hand of the server and the outside of the bowl.  The server then has to use a small towel to clean off both the hand and the bowl.

I say, sympathetically, "That would be easier with a smaller ladle."

Response, "These are the smaller ladles. We use them instead of the regular ones when this group [i.e., IHI] is here.

"You mean you use bigger ones when there are other groups here?"


I'm speechless.

Tuesday, December 3, 2013

MVP is a most valuable principle

A few weeks ago, I wrote about the tendency of many start-up companies who try to sell their wares to hospitals to ignore the needs of the various constituencies and therefore fail to make sales.  I concluded:

It is possible to sell great new ideas to hospitals, but they need to satisfy the interests of several constituencies in those organizations.  They must improve the work flow of the staff on the floor and units, making day-to-day life easier and not harder. They must improve the safety and quality of care, but in a manner that does not expose the hospital to greater liability: Indeed they should help reduce liability. Finally, they should demonstrate cost savings and be priced in such a manner as to allow the hospital to show cash flow improvements rather than be a drain.

I was reminded this week by Caren Weinberg, senior lecturer of invovation and entrepreneurship at Ruppin Academic Center in Israel, that even this prescription is not necessarily going to result in a successful product roll-out.  The element that I neglected to mention is the Lean concept of minimum viable product.  Taking off on the practice of PDCA (plan, do, check, act) cycles, Ash Maurya notes that "the basic idea is to maximize validated learning for the least amount of effort. After all, why waste effort building out a product without first testing if it’s worth it?"

Coincidentally, this message was reinforced at an MIT Enterprise Forum at Tel Aviv University, where Wix founder & CEO Avishai Abrahami was providing advice to entepreneuers.  Here's one of his slides:

Over time, he explained, the firm can add incremental features and improvements, all the while testing them with customers.

The alternative approach that I have seen is for a firm to spend inordinate amounts of time and effort designing a spectacular technological fix to a series of problems without testing early concepts or prototypes against customers' needs and wants.  It enters the market with a perfectly engineered product, only to discover that it is off track from what the market demands. Having depleted the company's capital, it falls into a financial hole and has trouble digging out.

Thanks to Caren for the reminder that MVP stands for a "most valuable principle!"

Monday, December 2, 2013

Joining Lean practictioners in Israel

Many thanks to Boaz Tamir, head of Israel Lean Enterprise (part of the Lean Global Network), for an invitation to present at a session for a number of businesses that are involved in adopting the Lean process improvement philosophy in their organizations.  Examples included Intel, the Strauss Group (food and beverage supplier), Bank Hapoalim, and yes (satellite broadcasting.)  The attendees were intrigued with the lessons from my book Goal Play! about how to create learning organizations.

I was honored to share the stage with Micha Popper, from Haifa University, who studies and teaches about leadership.  He told a particularly apt story about how the Israeli Air Force improved their learning process.  Years ago, after the missions, the pilots would sit around and tell each other stories about what had happened during their flights. Later, when technology had improved to document the actual flight conditions and history of each flight, their stories were bolstered by actual data.  The debrief sessions that resulted were much more accurate. More to the point, the flight teams–who previously had a natural tendency to hide or forget their mistakes–became much more open about disclosing their errors, comparing them one with the other, and then learning from the experience.  The result was a documented improvement in pilots’ abilities.