organizational development: finding focus

改善 © Daniel Jordan, PhD, ABPP, [email protected]

ORGANIZATIONAL

DEVELOPMENT Finding Focus: Health Care Case Study

International University

for Graduate Studies

July 2012

www.iugrad.edu.kn

Daniel

Jordan,

PhD, ABPP

© Daniel Jordan, PhD, ABPP, [email protected]


What’s your job? (or if you’re a student, what are you studying

for. If you’re unemployed, what would you like your job to be?

These questions apply to self -employed too. If you’re retired,

forget about it and go to the beach.)

What does your role add to the mission?

What percentage of your time would you estimate is spent

actually working toward your mission, what percentage is

spent doing “bureaucratic” work, fill ing out forms, meetings,

writing documentation, pushing paper, and other stuff that

really does not add direct value to the mission?

Do you see things that could be improved, wasted time and

energy, that could be made more efficient and effective?

Shout out some answers.

QUESTIONS: TAKE 5 MINUTES


,,


What is it?

Innovation

Improve existing processes, eliminate wasted effort,

improve quality

Develop new products, services or procedures that really

work

Operations

Assumes innovation is more than inspiration, it has basic

operating principles too

Tools

A set of methods to improve focus, processes and

outcomes

DEVELOPING A

PERFORMANCE MANAGEMENT SYSTEM


WE NEED THE RIGHT TOOLS . . .


. . . AND LEARN HOW TO USE THEM


. . . OR WE WIND UP LIKE THIS. . .


. . .OR WORSE, LIKE THIS . . .

Our

Project


EVEN THEN, WHEN WE START LEARNING

We wind up like this . . .

http://weloveyouso.com/2009/10/the-final-fort-submissions/


. . . INSTEAD OF THIS


TO GET THERE, WE NEED

A PLAN



COMMITMENT

It’s good to believe in

ourselves, but One man

bands don’t get very far

We have to learn team skills

We have to think and work as

teams

We have to trust and rely on

each other



TEAMWORK

And . . .



FACILITATORS



PRACTICE

And more

practice and

experience

And practice and

experience


Question: What’s the major waste in

this image?

Answer:

Transportation

Solution: Rethink

the technology

POP QUIZ


Lean Focus Reduce Non-Value

Added Time Result:

LARGE time savings Improved outcomes

LEAN PROCESS IMPROVEMENT: ELIMINATE WASTE & IMPROVE EFFICIENCY

= Value

Added Time

= Non-Value-Added

Time (WASTE)

WORK TIME Start Finish

Concept: Value-Added Time is only a small percentage of Total Work.

Focus on the large amounts of often unseen waste.

Check Begin Process

Review/Approve Re-work

Transport Work Work

Transport

Wait

Transport

Work

Wait


Myth: Management’s job to make sure

everyone is doing what they’re supposed to

do. If they are not, they need to be disciplined

and made to conform.

Myth: If someone is not working out,

something is wrong with them. They need

either to shape up or leave.

ORGANIZATIONAL MYTHS & REALITIES


Reality: The best way to facilitate

development is to help staff members become

informed, educated and empowered to

improve their own work setting and their own

performance.

Reality: Most opportunities for improving

performance lie with

The manager’s theories of change

The system of work (procedures and processes)

ORGANIZATIONAL MYTHS & REALITIES


THREE COMPONENTS OF

PERFORMANCE IMPROVEMENT

Focus:

Bottlenecks and roadblocks eliminated

Speed/Efficiency:

No waste in processes or steps

Quality/Effectiveness:

No outputs/results errors or variation from

standards or requirements

Theory of Constraints

Lean

Six Sigma

Goal: Do more with less wasted time (Lean)

Do it better (Six Sigma)

Of what we’re here to do (Theory of Constraints)

Method: Empower people to make the change


Innovation

Improve existing processes

New products, services or procedures that really work

Operations not People

Innovation has basic operating principles

Assumes that employee and program performance is

largely a function of the conditions in which work is

performed

Empowerment: Change agents are the people

involved in the process itself.

WHAT IS LEAN SIX SIGMA ABOUT?


What problems does the agency face?

Who has the problems?

What do the problems seem to be? What are resources are available to address the problems?

When do the problems occur? All the time? Under certain circumstances? At certain points in a flow?

Where does the problem occur? Which locations, why some more than others?

Why does the problem occur? (The “5 Whys” was W. Edwards Deming's advice to those seeking to understand the root cause of a problem.)

How does the problem occur? What actually happens? Map out the events or processes.

Where is the leverage to solve these problems? Pick your points of focus carefully.

SETTING PRIORITIES


Improved ROI

Greater public accountability

Reduced duplication and repetition of

efforts

Increased understanding of

accomplishments and priorities

Increased cooperation and teamwork

Increased quality, not just quantity

Improved problem-solving practices

RESULTS


Customer Value Stream

(“Voice of the Customer”)

Business Value Stream

(Voice of the Business”)

Stakeholder Value Stream (and others)

The Customer’s Value Comes First!

WANTS, NEEDS, DESIRES =

VALUE STREAMS


High proportion of mental health client charts

have as the closing note “client is resitant to

treatment.”

Mother brings child to clinic for childhood IZs.

Teen girl comes to clinic for birth control.

Discuss: Do you have some other examples of

systems gone awry?

CUSTOMER – “BUSINESS” CONFLICTS


WE MUST LEARN TO FOCUS TO SEE WHAT

IS GOING ON AROUND US


Help customer voice what they really want:

Refine and expand their vision.

Make sure you are really listening, match what

you hear to what they say.

Retool procedures, eliminate activities that

are not needed, and maybe move to new

technologies.

In short: The first step in a change effort is to

do a really great consult and assessment.

MORAL OF THE STORY


DEFINING

FOCUS

Focus

Comes

First

LEAN 6

SIGMA:

FOCUS,

SPEED,

QUALITY Six Sigma

Lean Speed

Quality


Focus

Performance Improvement


Lean All effort is

“Value-Added”

“War on Waste”

THEORY OF CONSTRAINTS

& LEAN 6 SIGMA

Six Sigma No defects, variation, “do -

overs”

Operational vision,

common focus

Methods and tools

Feedback driven

Optimize performance

Constraints:

Macro, Meso, Micro Focus the analysis

Address factors that

limit moving forward or

achieving goals

A Six Sigma process

with its own subroutine


“Nearly 100% of innovation is

inspired not by “market analysis”

but by people who are supremely

[ticked] off at the way things are.”

Tom Peters

THEORY OF

CONSTRAINTS:

DEFINING

VALUE

Micro

Meso

Macro


CONSTRAINTS:

MICRO, MESO, MACRO

Identify* Scope Match: Develop a charter (plan)

that matches the problem and its boundaries and

hits the leverage points.

Exploit: Look for new opportunities, weaknesses

Subordinate: transform weaknesses into strengths,

look for “Rule Creep” as well as “Practice Creep”

Elevate: Focus on leverage and strengths

Repeat (as needed, new

constraints may pop up)

Constraints are not just

eliminated, but as often,

controlled and manipulated *Eliyahu M. Goldratt


ELEVATE OPPORTUNITIES AND

CONSTRAINTS TO DEFINE CUSTOMER VALUE

Get to the root: Who is the customer(s)? What do they want? Getting this right may be the biggest constraint. If you don’t get this right, all the rest of what you do transforms into waste.

Distinguish:

Client/Customers

Users

Bystanders (might be impacted

and have concerns)

Stakeholders


THE “YOU’LL SHOOT YOUR EYE OUT”

CONSTRAINT


Customer Foxholes : What the customer didn’t

discuss or didn’t have the insight to see themselves.

Our Foxholes (perception limits, biases, assumptions)

going in. Identify them, think about them, work on

them. We may also delimit ourselves in what we

think we can do or deliver.

Negative Synergy : What the customer says, what we

hear, what we think we can do, can put the process

into a self-limiting trap.

VISION CONSTRAINT: FOXHOLE EFFECTS


Four Factor Model

OPPORTUNITIES

AND CONSTRAINTS:

BUILDING

YOUR CHANGE

TEAM

Policies, Rules,

Regulations

Tools and Technologies

Processes & Practices

People: Skills,

Perceptions, Positions, Desires,

Goals

Four Factor Model


TO CREATE CHANGE TEAMS

START WITH THE PEOPLE

Do not choose team members because of their

positions, rank, seniority,

Choose them for their:

Desires, goals, skills, talent, stick-to-itivness, passion

for greatness, teaming, motivation, creativity, critical

thinking, experience, follow-through . . . .

In fact, do not mention job titles, official

positions, they are irrelevant.

Do the people individually and collectively have

the “wanna”to make change?

改善

"If you want

to build a

ship, don't

drum up the

people to

gather wood,

divide the

work, and

give orders.

Instead,

teach them to

yearn for the

vast and

endless sea."

Antoine de

Saint-

Exupéry,

“The Little

Prince”


Blind Spots

Mindsets

Assumptions

Habits

Norms

History

Products/Services

Processes

Perceptions

Operations

Resistance

INVISIBLE CULTURE TRUMPS TOOLS

Must address

Tools and Culture

to avoid unintended

consequences &

less than desirable

long-term success with

Process Management

Focus, Process, Goals, Results,

Needs, Wants, etc.

Improvement Tools

Invisible Culture: Hard to Measure & Change

Treatment Therapy

Consultation


Borrowing from human service delivery model

Understand the culture of the customer

History of their development

How they do things

Who’s really in charge, degree of horizontal vs

vertical organization, etc.

Outside mandates: Laws, rules, customs

Current technology, flexibility in technology

CULTURAL COMPETENCE:

PERSONAL AND ORGANIZATIONAL

Micro Constraints:

Personal

Readiness

MANAGING

PERSONAL,

ROLES,

POSITIONS

Micro

Meso

Macro


FIRST STEP: ASSESS

PERSONAL READINESS FOR CHANGE

Denial vs Responsi-bility and Reality

•Precontem-plation: “What problem?” “What responsibility?”

Minimization vs Recognition

•Contemplation: “Problem exists, I can’t do anything about it”

Justification vs Acknowledge-ment

•Move to “Preparation”: Identify issues, options, strategies

Blame vs Affirmation, Solidarity & Critique* •Active Change Agent: Recognizes “connection” with others, engages the process, acts on tactics from the array of options

Stasis vs Ongoing & Progressive Action •Maintenance: Continues to improve, begins to collaborate, expands s to broader areas

(Or not . . . )

Meso Constraints:

Group Readiness

MANAGING

AGREEMENT

AND

CONFLICT

Micro

Meso

Macro


ASSESSING MESO-CONSTRAINTS


GROUPTHINK None of Us is as Dumb as all of Us Together


May seem counter-intuitive.

Agreement can be a bigger risk than conflict.

Be careful to listen for what the customer is really

saying.

Avoid “Trips to Abilene.”

Always ask, “Have we just engaged in Groupthink?”

before settling on agreements.

Do not push for early agreement, do not stifle

dissent, manage it. “Tell me more . . .”

Clarify what you are agreeing to and how it fits into

your larger mission or goals. Does the agreement

have a “niche” in the larger picture?

GROUPTHINK:

MANAGE AGREEMENT, NOT JUST CONFLICT


Establish clear Voice of Customer (stakeholders, bystanders, etc.), Voice of Analysis, Voice of Process. Ask 5 “Whys, Whats, Hows, Wheres, Whens” for each.

Look for mismatches and their root causes.

Find out what the customer really needs. Find out what would “float their boat!”

Listen carefully, look for gaps, problems, issues, inconsistencies, lack of clarity.

Look at what we can currently deliver.

Modify our view of what we do, then do it.

Then work on all three issues at once.

HOW DO WE DO THIS?


THEORY OF CONSTRAINTS’

PERFORMANCE GOAL

Focus your analyses

Address factors that limit moving forward or

achieving the goals, question the goals too

One step in the Six Sigma process with its

own subroutine

Example: Critical Path Analysis

Multiple people, multiple tasks that have to

converge. Which “path” is the longest? Fix it first.

Macro Constraints:

Contextual

Readiness

MAGIC OR

MAYHEM:

“BLUE INK”

CONSTRAINTS

Micro

Meso

Macro


MACRO CONSTRAINTS

Macro (System) Constraints

Rules, regulations, funding, disconnect

between mandates and needs, unclear

standards or requirements

“Rule Creep”

“Blue Ink Standards”

“Tribal Wisdom”


MACRO-CONSTRAINTS: READINESS

Assessment and Action (Rosenblatt) Observe: look around, learn, identify environmental constraints

Analyze: break them down, study their structures and processes, be objective

Conclude: Summarize the macro-constraints, describe them, “know them”

Recommend: Actions may often be outside your , may need to work with others

Enact: Sometimes this just means wait, may be up to policy - makers to act, may need work- arounds

(Repeat)


TRY IT

Brainstorm some examples of each level of constraints:

Macro, meso and micro.

Spend 10 minutes using the analytic steps to understand

them.

Levels of Constraints Template

Stage

Micro

(Personal)

Meso (Group,

Process)

Macro (Policy, Rules,

Structures, Systems)

Observe

Analyze

Conclude

Recommend

Enact


“You know you’ve achieved perfection in design, not when you have nothing more to add, but when you have nothing more to take away.”

Antoine de Saint-Exupéry French writer/ aviator

LEAN:

PROCESS

IMPROVEMENT


Champion: Has a vision of the need for

change, may not be directly involved in the

improvement team

Team Leads: facilitate the team process, may

know little or nothing of the work being done

Subject matter experts who know the issues,

policies, constraints

Process experts (usually the people involved in

the work)

TEAM COMPOSITION


STEPS IN “LEAN”


THE TASK ITSELF TAKES TWO SECONDS:

SET UP & TRAINING CAN’T BE IGNORED


How Do

We Know

Whether

What

We’re

Doing

Really

Works?

SIX SIGMA:

OUTCOME

IMPROVEMENT


DESIGN FOR SIX SIGMA (DFSS)

PRODUCT/PROCESS DEVELOPMENT


CURRENT PROCESS SIX SIGMA STEPS

PRODUCT/PROCESS IMPROVEMENT


DRILLING DOWN:

UNDERSTANDING

VARIANCE


SIX SIGMA

PERFORMANCE GOALS

No defects, variation, “do -overs”

Operational vision, common focus

Methods and tools

Feedback driven

Optimized performance:

Tangible results

Done right the first time

Out-of-range variability is nearly eliminated


Standard

SIX SIGMA

TYPICAL GOAL REDUCE “TWO -TAIL” VARIANCE

From this To this

Rejects Rejects

Some too fast

Some too slow

Some too big

Some too small

Some too long

Some too short

Some too hot

Some too cold


Standard

SIX SIGMA ANOTHER GOAL

REDUCE “ONE -TAIL” VARIANCE

In some cases, we have a single standard with one “tail” of error to be reduced.

“J” or “S” shaped results

Example: All requests are to be processed in one week or less.

To this

From this

Rejects

Some too fast

Some too big

Some too long

Some too hot


SIX SIGMA

OTHER TYPES OF DISTRIBUTIONS

The Loch Ness Curve Error


THE RESULT?


Focused efforts: Increased throughput, ongoing

management of constraints and reduction of

bottlenecks

Lean

Reduced cycle times and waste

Six Sigma

Uniform results, reduced variation, better quality

products and/or services


PROCESS IMPROVEMENT

“DMAIC”

Applie

d

Exe

rcis

e


DEFINE

Create a process improvement environment: How would you

set up a change that focuses on systems?

Do (or read the example) a “Walk -About”

List at least five problems identified during the “walk -about”

discussion described in the case study.


MEASURE

A number of problems were already identified in th Walk-

About.

List the ones that seem most relevant.

Add measures you would also want to know about.


ANALYZE

Get customer and stakeholder input and involve them in the

change

Set an objective performance baseline


IMPLEMENT

Create teamwork and responsibility

Simplify


CONTROL

Identify results to track and

improvements you want to see

happen

Reward staff initiatives

Get customer feedback

For more information n

1. DEFINE Create a process

Improvement environment

2. MEASURE Stakeholder involvement . set

objective performance baseline

Define Problem(s) Goal ScopeIBoundaries Get Client, Customer Staff Input Describe Expected Benefits Establish Success Criteria

3. ANALYZE Stakeholders set objective

performance baselines

Identify Root Causes Summarize & Prioritize Set Metrics & Targets Identify Solutions to: • Reduce Waste • Reduce Complexity • Increase Correct Outcomes

Describe Current State

Collect/Gather Data

Observe and Identify

Determine Capacity

4. IMPROVE Create teamwork and

responsibility, simplify

5. CONTROL Structure metrics and

Improvements, reward initiatives

Implement Controls

Record Results & Benefits

Publicize & Recognize

Knowledge Sharing

• Solicit Feedback

• Capture Lessons

Learned

Write a plan

Conduct Pilots

Test & Validate Metrics

Design Controls

Roll-Out Action Items

(Schedule)

Deploy Improvements



CONTACT FOR MORE INFORMATION

About this presentation:

Daniel Jordan, PhD, ABPP at

[email protected]

About the International University for

Graduate Studies graduate

programs:

www.iugrad.edu.kn

organizational development: finding focus

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