wasting time with vague solutions part 1 - balestracci

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Published on Quality Digest(http://www.qualitydigest.com )Home> Wasting Time With Vague Solutions, Part 1

Wasting Time With Vague Solutions, Part 1Helping management deal with common cause

Davis Balestracci

Published: 09/14/2012

Let's revisit two scenarios from my July 2012 column, "The Sobering Reality of 'Beginner's Mind.'"First, a medical center's Harvard MBA COO insisted on nothing less than 100-percent computer uptime,no excuses. His IT department's inability to get 100-percent uptime consistently has resulted in yetanother monthly "account for results" meeting.

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The agenda: Get the result for the past month; show some type of table or bar graph summary (typicallya red/yellow/green assessment accompanied by a variation on "this month, last month, 12 months ago");listen to the predictable litany of excuses for why it didn't happen the past month; and come up with the

(latest) plan on how to fix it... until the next unexpected thing happens.

As an alternative, I showed a run chart and its analysis, which demonstrated the behavior to be commoncause. The monthly meeting to discuss that specific month's downtime and "do something" is a specialcause strategy. Based on the run chart, there is no evidence of improvement so far, but do you thinksome complexity might have been added during this time? Let's go a little further.

Because the run chart showed no evidence of a "shift" (that is the main purpose of a run chart), one cannow proceed to construct a control chart using allthe data for the average:

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Since the calculated upper process limit was > 100 percent, which is impossible, the upper limit hasbeen set at 100 percent. Using the standard nine special cause tests, there is no further evidence of anyspecial causes, and this chart confirms that the occurrence of 100 percent is within the naturalperformance of the process.

So, do we have to accept these limits and stop blaming the workers until management does somethingabout it? Or, as some improvement "experts" say, "Because it's common cause, we need a total redesignof the process, but need management's support in implementing it."

Second scenario: Here is the chart looking at a healthcare organization's "never event" occurrences:

Knowing what you know now, the "zero" quarters are within the natural variation of the process, andthere are no special cause tests triggered. (Of the 29 events that occurred during this time period, howeffective have their 29 individual "root cause analyses" been?)

So, what is typically done in these two cases?

Tell management they need to accept this level of performance because "Deming says" that it's theirob to do something about it. Then ask them, "Do you want to do something about it?" (Not




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recommendedI hope your rsum is up to date.)

Use the, "It's common cause, so we need a totally redesigned process" strategy. Explain tomanagement, "We need a new process. Even though Deming says it's your job, we'll do it, but we needyour support every step of the way, especially as we benchmark and implement the new process." (Beenthere? Care to predict how this will end?)

Say that your department will "own it," and put these two key issues on the organizational A-1 priorityimprovement project listwhich is already awfully long. (When you bring it up to your staff, they're all"too busy" to take on any more work.)

Be a truly accountable professional and facilitate it yourself. Create a team of middle managerswho,alas, are also "too busy," so they arrange to send one of their best workers. An "emergency" comes upfor many of these workers the day of the scheduled meeting (besides, they're also "too busy"), so theyask a frontline person to go in their place because "Deming says that the frontline has all theanswers." (I've done this and first meeting, it's not unusual to observe a sea of hostile faces. I go aroundthe room and ask, "Do you know why you're here?" and most answer with an angry, "No!" or, "I wastold to be here." Dj vu?)

If you're in healthcare, lucky you! You can join one of those Institute for Healthcare Improvement(IHI) collaboratives, for which executives seem all-too-willing to pay to show that they're "behind"quality (some even get w-a-a-ay behind it and virtually disappear until the "account for results" and theirexpense item shows up on the agenda at the next executive meeting). Be sure to have your five-minutesummary "showing results" ready for the next exec meetingprovided you don't get bumped by thelatest financial crisis or patient complaint that "shouldn't have happened."

Regardless of all the barriers thrown your way, you somehow manage to get these projects started. Ifnothing else, some type of improvement team is put together for at least a brainstorming session, andyou facilitate an Ishikawa cause-and-effect fishbone diagram answering, respectively, for our twoexamples above: What causes downtime? What causes never events?

I'm willing to bet that everyone reading this has at one time or another been involved in producing "thefishbone diagram from hell." Brian Joiner has a wonderful saying: "Vague solutions to vague problemsyield vague results." Joseph Juran said it many times: "There is no such thing as 'improvement ingeneral.'" And they are both fond of the Pareto principle. Before you get too many (busy) peopleinvolved, is there something you can do tofocussuch vague issues?

One could ask: "What is the 20 percent of this process causing 80 percent of the problem?"and thendoing a cause-and-effect diagram.

But wait: Don't jump to the tempting "simple, obvious... and wrong" special data collection from hell tofind the 20 percent, either. (Mea culpa.)

To be continued in part 2.

About The Author




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Davis Balestracci

Davis Balestracciis a member of the American Society for Quality and past chair of its statisticsdivision. These thoughts are taken from chapter nine of his book, Data Sanity(Medical GroupManagement Association, 2009), with a foreword by Dr. Donald Berwick. It offers a new way ofthinking via a common organizational language based in process and understanding variation.Balestracci would love to wake up your conferences with his dynamic style and entertaining insightsinto the places where process, statistics, organizational culture, and quality meet. Visit his websiteformore information.

Source URL (retrieved on 09/24/2012):http://www.qualitydigest.com/inside/quality-insider-

article/wasting-time-vague-solutions-part-1.html

Links:[1] http://www.qualitydigest.com/inside/quality-insider-column/sobering-reality-beginner-s-mind.html[2] http://www.ihi.org

2012 Quality Digest Magazine. All Rights Reserved.


9/25/2012http://www qualitydigest com/print/21804

wasting time with vague solutions part 1 - balestracci

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