Improvement Science
A Forum for Improvement
What is the Dis-Ease?
Mar 7th
Do you ever go into places where there is a feeling of uneasiness? You can feel it almost immediately – there is something in the room that no one is talking about. An invisible elephant. This week I have been pondering the cause of this dis-ease and my eureka moment happened while re-reading a book called “The Speed of Trust”. A common elephant-in-the-room appears to be distrust and this got me thinking about both the causes of distrust and the effects of distrust. My doodle captures the output of my musing. For me, a potent cause of distrust is to be discounted; and discounting comes from disrespect. This can happen both within yourself and between yourself and others. If you feel un-trust-worthy then you tend to disengage; and by disengaging the system functions less well – it becomes dysfunctional. Dysfunction erodes respect and so on around the vicious circle.
This then led me to the question: Why haven’t we all drowned in our own distrust by now? I believe what happens is that we reach an equilibrium where our level of trust is stable; so there must be a counteracting trust-building force that balances the trust-eroding force. That trust-building force seem to comes from our day-to-day social interactions with others.
The Achilles Heel of negative-cause-effect circles is that you can break into them at many points to sap their power and reduce their influence. So, one strategy might be to identify the Errors of Commission that create the dis-ease of dis-trust.
Consider the question: “If I have developed a high level of trust then what could I do to erode it as quickly as possible?”.
Disrespectful attitude and discounting behaviour would be all that is needed to start the vicious downward spiral of distrust disease.
Who of us never disrespect or discount others? Are we all infected with the same disease? Is there a cure or can we only expect to hold it in remission? How can we strengthen our emotional immune systems and neutralise the infective agents of the Disease of Distrust?
Can the Finance tail wag the Quality dog?
Feb 16th
Money is the “fuel” that all organisations need to survive because all endeavours incur costs. It is the flow of money that is important – static money is just a number. Money is used to buy time - more specifically LIFE-time. We trade our life-time for money which we then use to buy the goods and services that we need to survive in the modern world. These goods and services are delivered by processes that require people’s time to design, implement, operate and improve. So we all want the best value-for-money that we can get; the best value-for-lifetime. So what happens when the flow of money is constrained? Value, Lifetime and Money are interdependent – restrict the flow of any of the three and all three slow down. It is inevitable. With this perspective it does appear that the finance tail can wag the quality dog; and the lifetime tail can wag the quality dog too. So when you experience low quality goods or services try asking this question: “Is it the flow of money, motivation or both that is the root cause?” Stories please ….
What blocks improvement?
Feb 13th
My focus this week has been to ask the question “What blocks improvement?”. The answers that I found most interesting were “I didn’t realise there was a problem.” and “I feel there is a problem but I don’t know where to focus my attention.” This set me pondering and eventually I had a bit of an “eureka” moment. It isn’t something that is present that creates this blindness – it is something that is missing. And the only way you can see what isn’t there is by comparison with when it is there – just like the game of “Spot the Difference”. When I compared what I saw with what I know is possible the thing I didn’t see was a fast-feedback loop. Hence the doodle. It appears that there are at least four dimensions to feedback – sign, magnitude, accuracy and timing. The speed of the feedback needs to be appropriate to the speed of the improvement; so if we want rapid improvement we need a fast-and-accurate feedback loop - a learning loop. A slow or inaccurate learning loop not only doesn’t work – it can actually make the problem worse. So, my take-home this week is to actively search for the learning loops and if I don’t see one then I have something to focus on improving.
What do you do when you don’t know what to do?
Feb 4th
One of the scariest feelings I experience is when I am asked “What should we do?” or “What would you do?” and there is an expectation that I should know what to do; and I don’t. What do I say “I don’t know” or do I play for time and spout some b*****t and hope my lack of knowledge is not exposed? Reflecting on this uncomfortable and oft repeated experience I am led to some questions:
1. Where does the expectation come from? The person asking, myself or both?
2. Where does the feeling of fear come from? What am I scared of? Who am I scared of?
Pondering these questions I have the fleeting impression that my fear comes from me. I am afraid of disappointing myself. It is me that I am scared of. Then the impression is replaced by a conscious process of looking for evidence that proves that it can’t be me – it must be someone else making me feel scared - and to feel better I have to shift the blame from myself. Oooooo … that’s a bit of an “Eureka” moment! And now have a new choice. Choose to behave like of a victim of myself and shift the blame; or choose to address the problem – my deep fear of part of myself. Phew! I feel better already - I have a new opportunity to explore …
The effect of feedback?
Jan 30th
I find that I have to draw pictures when I am thinking - it seems to help. One thing I have been thinking about this week is how to predict the outcome of an action; because I don’t want to do something that has a negative outcome that I did not anticipate.
I know that whatever I do will change the “system” and may have an ongoing effect that may be positive and negative. Once the ball is rolling even reversing my action may not change the course.
So the problem I have is that, although I can work out what I feel is the best thing to do now, I do not seem to be able to predict the knock on effects of my actions. I know from experience that I may be the recipient of the future effect of my actions today. I will get feedback one way or the other.
So here’s my problem: how do I work out what is the best thing to do now? Any tips anyone?
Improvement costs more doesn’t it?
Jan 23rd
We all know the phrase “you get what you pay for” and we all know from experience that higher quality goods and services cost more. So, it follows that if we improve the quality of our product or service then we’re always going to have to charge our customers more for it. But is that always the case? If we add extra value to the product then it is likely that it will cost us more to do that and we may have to pass that cost on; but improvement often comes from removing something that was preventing a higher quality output. When we remove something our costs are likely to go down and this reduction in cost can be passed on to the customer. Unfortunately the idea that lower costs mean lower quality is also deeply engrained into our thinking – so if a supplier offers what appears to be higher quality at a lower price we get suspicious. There must be a catch or a trick. So, to avoid disappointing your customers when you make an improvement by removing an impediment to quality - increase the price a bit. That way your costs go down, the price goes up, the customers expectation is met and everyone is happy; your customers and your accountant! Surely there must be catch?
How do you make a Healthcare System fall over?
Jan 17th
The NHS is having a difficult time at the moment - it has a difficult time every winter but this year looks worse than last and that was worse than the year before. Many hospitals now have no hope of meeting the Government target for 4-hour waits in A&E (less than 2%) for this quarter.
The answer that everyone is looking for is “How do we solve the crisis quickly?” but it occurred to me that there might be an alternative way to approach this problem …
Imagine we had a system of emergency care that is stable, predictable and capable of meeting the Quality Target. Now try to think of the easiest ways to push it out of control and into chaos – the only caveat is that they have to be legal, sound reasonable to the Board, and be feasible to implement.
What would your top 3 destabilising actions be?
Errors of Omission and Commission
Jan 17th
I like doodling on Post-It® Notes and playing with two-by-two tables and recently I came across one that triggered a bit of an “Eureka”
moment.
The two dimensions were Action (Nothing-to-Something) and Outcome (Worse-to-Better). We are all familiar with the good feeling that comes from doing something and seeing things get better; and the not-so-good feeling of doing something and seeing things get worse! I discovered that this latter option is called the “Error of Commission” and is the one we fear most because we leave an audit trail of evidence that can be traced back to our action. It does not seem to matter that we did not intend the outcome to be worse.
However, the 2 x 2 table also suggests that there are two other combinations. How do we feel when we do nothing and things get better? What do we learn from that experience? And how do we feel when we do nothing and things get worse? This, I discovered, is called the “Error of Omission” and is an error that is more difficult to learn from because there is no audit trail of cause-and-effect evidence. It is also the error that generates the greatest sadness – a feeling of loss of what might have been.
Both the Error of Commission and the Error of Omission can lead to unintended negative consequences. It appears that our systems are better designed to manage the Errors of Commission. I wonder if we could learn to better protect ourselves from the Errors of Omission?
Is Improvement just Chance?
Jan 17th
We all know stories of how major discoveries were made by chance – the so called “Eureka” moments. These apparently accidental leaps of insight have led to many of the improvements that we now take completely for granted. But are these just random accidents? Are there some other principles at work here that if we understood better we could increase the chance of a eureka moment? What are your thoughts?