People Process Technology Blog

Finding the Root Cause

Posted by: Bob Craig

Looking for the root cause? In the real world, you have to dig around in the dirt to see what’s going on. Your tools are a couple of gloves and a trowel. Any gardener will tell you that you are better off when you are messing in the roots of a plant to do the bulk of the work with your hands because the trowel can actually break the roots and damage the plant. In our business world, you also have to dig around for the root cause of performance issues as well. It might be just as messy! Your tools are two ears and a mouth. And just like a gardener, you are much better off using your two ears because your mouth may actually prevent you from finding what is really going on and can damage the relationship and the performance of the person you are working with. In fact, so many times we are in such a big hurry, and we are so busy telling them what we think they should do that we never actually hear the root cause of the problem no matter how many times they tell it to us. In any coaching conversation they should be talking way more than you and if that is not happening, you are telling instead of listening…  Listen and observe a lot today… you will be surprised what you can learn!

Lean in Healthcare or ‘We’re working the wrong problem.’

Posted by: Ken Pilone, Sr. OD/Lean Consultant, TBD Consulting

With all the fuss about the ‘Obamacare’ legislation, it seems we have lost sight of the REAL problem here.  All of the attention seems to be focused on how to pay for our nation’s healthcare needs.  Rarely if ever do you hear anybody asking, "Why are health costs so high in the first place?" 

The question needs first to be asked, why providers charge so much.  While there are no easy answers, this much is clear:  The entire end-to-end process of providing health services is riddled with waste! 

There are at least two ways to look at the formula for making a profit.  The first and most common is, cost + profit = price.  You have only to look at the Post Office to see how this plays out.  Their motto might be, “Inefficient, no problem.  Just raise the price of a stamp.”  This formula doesn’t allow for any scrutiny into what drives cost in the first place.  The second formula, and the one most overlooked is, price – cost = profit.  This works well in highly competitive markets where price is more or less dictated by the customer and thus is essentially fixed. 

Think about it.  For any consumer product to have a chance at being successful in the marketplace, it shouldn’t cause sticker-shock for the customer.  For example, if I want to buy a toaster, I can expect to pay between $15 and $50 depending on features, brand, retailer, etc.  But, if I see a toaster on the shelf with a price of $200, I might react like, Jeez, I just want toast for Pete’s sake!  Does it also do my laundry? We’re not likely to be too sympathetic if the maker responds with, “Well, that’s just what it costs to make it plus a little profit.”  That’s not our problem!  If they can’t compete, well, then they have the right to go out of business!

Herein lies the rub.  When healthcare providers THINK and subsequently ACT as if they have no real competition, where is the incentive to look for and eliminate waste?  There is also a mindset working in this industry that cost doesn’t really matter to their customers (patients) because those big, greedy, money-grubbing insurance companies are going to foot the bill anyways.  Right?  We think it’s all their fault we’re in this mess.  And the finger-pointing ensues.

If we zoom out far enough, we can find some hope from this dilemma.  Ironically, there is a potential model right under our noses in the Emergency Rooms across the country.  The routines in place when an ambulance pulls up are very tight, efficient and well-rehearsed.  This is a completely customer-centered process.  All non-essential tasks and activities are suspended until the crisis is over.

Unfortunately, we haven’t examined all other healthcare related ‘value streams’ with the same eye towards fast, efficient, waste free work. It’s as if by some invisible elastic band around us, we revert instantly back to the ‘norm’.  But, what if we used the same critical lens to look at all the other processes in place in the system?  Start with identifying who are REALLY the customers and track backwards to see how value is created for them.  Along the way we will find waste of unimaginable proportions. 

Doing this will help us solve the healthcare crisis its root cause, waste and inefficiency.  This is the center point around which healthcare providers’ lean/PI staff SHOULD be revolving.

Priorities

Guest Blogger: Bob Craig

I’m wondering when you do your thinking about what you are doing.  Bill Gates sees and thinks differently than most people do.  He has an amazing ability to find the flaws, or see opportunities, or connect the dots.  He can zoom in to details with precision or zoom out to the big picture.  He can flip back in time or fast forward to the future.  He also has the ability to focus on the merits of the idea or innovation before worrying about the business case. Chances are, you could benefit from Bill’s thinking skills, even if it simply means getting a new perspective on your problems.

First in his thought pattern is Prioritize. The question is “What’s the best thing you should be thinking about?” It starts here. Since time is your most limited and precious resource, this is about asking whether the problem is even worth your time.  Before you throw more time at it, figure out whether it’s worth it.  Is it significant?  How much time should you spend on it?  Think like Bill: Today what is your priority?

IT, Change Management and Training: They MUST Work Together for Successful EMR Implementation

Posted by:  Jonena Relth, President and Leadership Evangelist of TBD Consulting.

 

Ok, so we know that electronic medical records systems (EMRs) are designed to transform traditional, paper-based medical records into cutting-edge, electronic records that provide entire clinical teams with a more complete picture of their patients' needs and more tools to continue delivering superior healthcare.

 

What many leaders don't understand is why our best efforts to implement EMR systems fall on deaf ears and our medical professionals are struggling to make the change from paper to paper-lite. After all, we've done our best to build new and improved workflows and customized the system to meet the needs of our users. Well, my experience has been with EMR implementation is that leaders don't understand that the most important component of an EMR implementation is related to change management – the people side of integrating new processes and technology.

 

IT professionals aren't change management experts, nor are they training professionals. Without the three disciplines working together during the entire life of the project, all the "I's" won't get dotted and the "T's" won't get crossed.  In other words, you'll have a software system installed but the people you want to use it won't be communicated with in a way that allows them to accept and adopt the changes, nor will they be trained in a way that meets their learning style.

 

Effective EMR training requires a comprehensive change management initiative that informs and involves the intended users. Changes shouldn't be just "told" to people.  Everyone needs the opportunity to assimilate information about the changes coming and be able to ask questions, etc.  Just putting a positive spin won't work.  Allow people the opportunity to accept, embrace and adopt the changes - which will result in their integrating the system in their daily tasks once the system goes live. This takes time and serious effort by the change management experts who will determine various methods to ensure change options such as live meetings, newsletters, interactive webinars, website, posters and other media, etc.  Oh yeah, and don't forget the food. Tip to remember: "If we feed them, they will come."  (Sounds like a move, huh?)

 

That leads me to my next pet peeve: One-size-fits-all training.  Just because the IT folks learn best with hands-off WBT or that the training folks prefer face-to-face instruction, doesn't mean that all the audience will fit into one of those categories.  People have different learning styles and learning requirements.  For instance, it's going to be a VERY hard sell to get physician to stop seeing patients in order to sit through a day of un-paid training.  Let's face it; physicians make their living by seeing patients.  For this reason, we need to provide just-in-time training with super users or short e-Learning modules that the physicians can take during their breaks.  And depending on their roles and learning styles, clinical staff could be trained with a combo of e-Learning and Day-in-the-Life, Face- to-Face training.

 

In any event, the training should be carefully designed using a systematic approach that builds on the organizations stable foundation of processes.  Only by doing this will the training meet the needs of both the users and the different departments.  And don't forget that the training plan should include assessment so you will know if the users are able to apply the new skills, knowledge and information they learned.  Last, but not least, be sure to implement some sort of easily accessed, online reference and/or learning management system where current users can go for refresher information and new users can take training and read up on what they missed during go-live training.

 

Sounds like a lot, I know; but without all three - - IT, Change Management and Training, EMR implementations will not succeed to the level our organizations need.  With these professionals working together, we can achieve:

• Increased adoption of the many changes from paper to paper-lite
• Increased project ROI
• Improved patient safety and patient satisfaction due to greater accuracy by users
• Improved employee satisfaction because they can provide quality patient care
• Comprehensive, user-friendly, training that is designed and delivered before go-live to everyone who will use the EMR
• Validated transfer of knowledge via learning assessments in the training
• Refresher and ongoing training available for future employees and contractors
• Shortened user time to efficiency
• User-friendly online reference tools and/or learning management system

As always, I love to get comments from my readers.  Please let me know if your experience with EMR implementations and training are in alignment with mine.

 

Jonena

 

TBD Consulting has a 19-year, proven track record for ensuring employee performance improvement which translates to EMR usage and patient care success.  Organizations interested in ensuring true ROI for an EMR implementation, please contact our Corporate office at 602-263-1961.

 

TBD Consulting, Inc. Solutions…Not Just Strategies!

The Training Brand is Back! - Good news for HRD

Posted by: Jonena Relth, President and Leadership Evangelist, TBD Consulting

Training Magazine and Conferences are back! This is very good news for the performance improvment industry.  Jonena

******************************

Reposted from Google Alerts

In case you haven't already heard through the grapevine, the Training brand is back! It's been acquired by Minneapolis-based Lakewood Media Group, led by a group of former Lakewood Publications executives, including Phil Jones one of the first Training editors and later VP of Conferences. Lakewood Media Group is the perfect fit as Training was the flagship brand at Lakewood Publications.

 

The acquisition of the Training brand includes its print and digital products, online and face-to-face events, and the prestigious Training Top 125 awards program. What's more, we're both back on board with Lakewood Media Group and we'll continue to work with all of you to develop the best in conference content.

 

Training 2011 Conference & Expo will be held as scheduled February 7-9 in San Diego. Stay tuned for more info, including a Call For Presenters for this event. We look forward to working with you all again!

 

Julie Groshens and Leah Nelson
Training magazine Events
julie@trainingmag.com and leah@trainingmag.com

 

Needs Assessment Requires Experience, Objectivity, Confidentiality and Efficiency

Posted by: Jonena Relth, President and Leadership Evangelist

 

IF done right, a needs assessment will positively impact your return on investment (ROI).

 

As performance improvement professionals, we are naturally approached with requests for training development and delivery.  These are two of TBD’s core competencies, but we would do our clients a huge disservice if we simply sprang into action to develop instructor-led or online curriculum without first pausing to ask some important questions, such as:

©      What gives you the impression that your employees don't know how to perform the job or task?

©      Have they already received training for this skill?

©      Is there anything else that might prevent or discourage their expected performance on the job?

©      How is their lack of performance in this area affecting your customers? Your bottom line?

Once we have answers to a few basic questions, we conduct a needs assessment to determine whether it is the lack of skills, knowledge, training or other factors that are preventing your employees from doing their best on the job.  When you can affect a positive change in performance, you can increase your ROI and improve your employee and customer satisfaction.

 

 

However, when making changes, whether involving small procedural changes or large system implementations, there are consequences, both intended and unintended, to other parts of your organization. Before making changes, you need to view the organization holistically, which is where the value of a needs assessment is realized because it opens up other pieces to the employee performance puzzle such as:

© What are the positive and negative consequences of leaving things as they are?

© What positive and negative consequences will be felt by the departments directly involved, before and during and after the change?

©  How will the changes affect the organization as a whole?

 

 

Why ask an outside firm to conduct the needs assessment?

 

Although you can conduct a needs assessment yourself, there are several good reasons to engage an outside firm:

©      Experience.  An outside firm with extensive experience in conducting needs assessments can quickly identify the root cause of a performance issue and clearly define the problem.  This allows you to zero in on the right solutions and increase your ROI.

©      Objectivity.  The outside firm does not have preconceived ideas or a stake in a particular outcome, so you remove some of the bias created when conducting an in-house, needs assessment.

©      Confidentiality.  Employees who participate in the data gathering phase feel “safer” that the information they provide to an outside party will not be linked to their names and impact their careers.

©      Efficiency.  An outside firm can quickly organize and execute the process with minimal disruption to your business.

 

How is a needs assessment conducted?

 

The questions we ask and the process we use will relate directly to the performance issue you have identified.  The bottom line is that one size does NOT fit all.

 

First, it's important to use a variety of methods to collect information from senior leaders, supervisors and front line employees.  Most often, we use questionnaires and focus groups, either in person or virtually.  We review existing training, reference systems, hiring practices, dashboard stats, performance review forms and other resources.  Depending on the complexity of the issue, the data gathering can be completed in just a few days or could take weeks - or even months, but you can usually plan on getting a pretty clear picture of what's going on within 2 months.

 

Once you've gathered enough information, summarize the findings and your recommendations in a report.  The recommendations should outline performance improvement solutions that may or may not include training.  Be sure to recommend next steps and estimate costs to implement the solutions.

 

If it’s not a training issue, what else could be preventing your employees from performing on the job?

 

©      Communication.  Your employees know how to do the work.  However, they are not clear about which tasks are the most important or where they should be spending the majority of their time.  Perhaps they do not have important information at their fingertips.

©      Empowerment.  Your employees know how to do the job but are discouraged from making important decisions on the spot.  One client wanted employees to hold firm in pricing discussions with customers, and even provided repeated training for their employees in this area.  However, supervisors were regularly reversing staff decisions if the customer complained.  The employees soon figured out that it wasn’t worth debating with customers only to be overruled by their supervisors. 

©      Incentives are disincentives.  Incentives can backfire if the wrong behavior is reinforced.  For example, if employees are incented to reduce the amount of time spent on the phone with each customer, they may rush through calls, thereby negatively impacting customer service goals and your ROI.

©      Environment.  Your employees have been trained to perform a task a certain way, but few people around them follow the “official” procedures.  When they ask for guidance, they receive conflicting answers.

 

Asking the right questions and analyzing the answers is the gateway to the right solutions.

 

If performing in-depth needs assessment is not a core competency in your organization, involve outside consultants who have a proven track record of getting to the root causes of issues and who can recommend solid, "easy" to implement solutions.  Note: I've seen many pricy solutions recommended by well-meaning consulting firms that simply add layers of work and no real solution.  The bottom line should be that the solution should ultimately save you time, money and energy while you focus on what you do best – running your business.  Remember, positive ROI is a good thing.  That's why we're in business, right?

Mama always says, "It's better to find the truth now than to solve a non-issue and leave the real issue left unresolved!"

Being agile to conquer business challenges is one of the most critical success factors for organizations today.  TBD Consulting assist our clients to navigate and manage organizational and cultural changes.  We don’t just recommend strategies; we work with clients to develop a comprehensive solution to foster employee engagement in meeting business results.  With extensive, real-life experience in the corporate world, we know what works and help our clients create corporate culture solutions that actively sustain change management initiatives.

To learn more, please visit our website: http://tbdconsulting.com/index.php/solutions/organizational-development/

Or call to speak with one of our performance improvement professionals. 602-263-1961

Jonena

Opportunity: Advanced Coaching for Leaders

One size does not fit all – discover and leverage your leadership strengths.

Using our proven methodology, mid-level leaders will strategically coach and motivate their managers like the pros!  

 

You will see immediate, positive ROI from your training investment! Enable leaders to guide and motivate in a way which results in sustained change.

 

 

Two ways to learn more about the Advanced Coaching for Leaders Course:

1. Download the Course Overview.

2. Sign up for a free 90-minute, introductory webinar. (Course content – not a sales pitch!) Walk away with a leadership tool you can immediately put into use! 

• May 4th at 8 AM PT – Register
• May 4th at 11AM PT (in Second Life) – Register
• May 6th at 11 AM PT – Register
• May 12th at 4 PM PT – Register 

Facilitator: Esther Groves, Sr. Consultant, TBD Consulting, Inc.

How Big Is Your Cave?

Posted by:  Ken Pilone

Trust in your people, empower them and let them help you find and eliminate the waste that they see every day!  Unleash their passion and they will rally around you in ways you have yet to imagine!

As our economy continues to circle the drain, panic is beginning to set in.  The President has recently signed into law a bill to boost job growth.  But our confidence in our government is at an all time low.  What little credibility there may have been in our elected leaders has all but vanished in a sea of cynicism and a deep rooted sense of disillusionment and disappointment.  Fear has replaced optimism. 

This bill claims to be able to create 250,000 jobs but our economy has lost 8.4 MILLION jobs since the start of the recession.  The approach congress has taken is to provide meager tax incentives for companies that create jobs that last 1 year or longer.  How meager?  The company would get a 6.2% reduction in payroll Social Security taxes through December of 2010 and a whopping $1,000 credit for employees that lasted a year.  Huh?  In other words, you can save $1,000 if you hire a person for, say, $50,000!  Like I said, meager. We are now forced into a ‘back to basics’ frame-of-mind. 

So what do we do now?  We must attack this problem at its source.  Business has to collectively and deliberately create jobs.  We need to do it for the benefit of our nation.

We need to go back to what I call a ‘caveman mentality’.  When you think about it, why did early humans live in caves in the first place?  Answer: to avoid being eaten.  The cave was a place to shelter from the elements and predators.  But it was more than that.  It was also a place for people to work collectively for the common good.  It was a place where people could find peace and community not just protection. 

Companies are modern day caves.  They provide people with many of the same needs for shelter, a place where basic needs are met and a place for social interaction.  Just as some caves were better than others, some companies are better than others but the basic needs are the same.  What kind of cave do you have?  Do your people feel safe and secure?  Are they?

We know that business, particularly small business is and always will be, the primary economic engine that drives our economy and hence our lifestyle.  We can’t rely on the government to help us.  That much is clear.  Here’s what we need to do.  We have to manufacture jobs! 

But how do we pay for them?  Time for a little basic math.  Businesses have 3 choices; they can add profit to their cost of doing business to establish price (cost + profit = price); they can keep price steady to stay competitive and reduce cost to retain profit (price = profit – cost); or they can do both.  We can achieve more from reducing cost than from increasing profit or raising prices. 

This is how we create jobs.  We mobilize everybody in the company to find and close all the small holes in the enterprise where profit seeps out.  This allows us to keep more of what we make and to create jobs for others who desperately need a cave right now.  Open your cave to more people who will bring more diversity, creativity, innovation and profit!

There is meaning in this for us.  Of course we must be able to make money to stay afloat.  But beyond that, why does your company exist?  Is there any higher purpose beyond trying to please your shareholders and the B.O.D.?  I hope so.  Wouldn’t you rather hire people vs. laying them off? 

This isn’t a trick question.  The fact is that it is your PEOPLE that will determine their own fate if management will only let them.  Turn them loose on the problem; not the solution.  Don’t say to them, ‘sorry folks but we have to lay off 20% of you because of lack of profit’.  Instead bring them the problem to solve.  Say something like, ‘people, we have a great problem to be solved but it can be solved with your help’. 

Take a humility pill.  And as I said above, trust in your people, empower them and let them help you find and eliminate the waste that they see every day!  Show them through your actions that there is a higher purpose.  This will unleash their passion and they will rally around you in ways you have yet to imagine!  Think of the families you will save from the abyss!

Prepare to be amazed.

All the best, Ken

Lean Leadership Summit - Top Notch Speakers & Sessions

Posted by: Jonena Relth, President and Leadership Evangelist TBD Consulting, Inc.

For people involved with or thinking of implementing Lean methodologies in your organization, this is a conference you should consider attending: Lean Leadership Summit 4/21-22 in Irvine, CA.

James P. Womack and Gary Convis will be speaking.

"Lean Leadership Summit
The "Rock Stars of Lean!" An absolutely unprecedented assemblage of many of the most capable and successful executive Lean Leaders on the planet in an intimate setting to share how they transformed their operations to create competitive advantage to grow their businesses."

http://www.advanced-imaging.com/leanleadership/

Hope to see you there! Jonena

How to Stay Afloat

Posted by: Ken Pilone, TBD Consultant and Lean Expert

If you think about it, a ship will sink just as fast from a thousand small holes as it will from one big one.  In fact, it would sink faster.  Why?  Because big holes get noticed.  The captain of the ship will swiftly mobilize every member of the crew when a torpedo hits and yet be completely oblivious to all the tiny leaks occurring throughout the ship all the time.  As long as the ship can pump the water out as fast as it comes in, nobody seems to notice. 

Think of sales as the bilge pump in this analogy.  We tend to think we can overcome our wasteful practices if we could just sell more.  This puts the company under great stress.  Wouldn’t it better to keep what you make in the first place rather than have it leak out all over the place?

The trick is to teach ALL of your staff to ‘see.’  They can be trained to identify waste that you may not be aware of in the first place.  For example, do you create reports that nobody reads?  Do you even know?  Every product, service, task and goal should be challenged to determine what value it provides and, most importantly, to whom.  Who is the ‘customer’ of the report (internal or external)?  What do they do with it?  Is it 100% useful?  What if you omitted section 3?  What improvements do they want?

Here’s an easy but powerful way to attack this.  Have your managers invite their staff to a meeting.  The price of admission is a stack of sticky notes on which each person lists every task, project, etc. they are responsible for, one task per note. The manager draws a window of 4 panes on a whiteboard as below:

RR (Right work done Right)	RW (Right work done Wrong)
WR (Wrong work done Right)	WW (Wrong work done Wrong)

The group then posts their notes on one of panes, pin-the-tail-on-the-donkey style, representing what they think the value to the customer is according to the below:

RR = work customers want and is of high quality

RW = work customers want but needs improvement

WR = work customers don’t want but is of high quality

WW = work customers don’t want and is of low quality

 

Keep in mind that some tasks may overlap two or more panes meaning that it may have some parts that are RR and other parts that may be RW, WR or WW.

 

After each person has put up their notes, stand back and look at your wall.  What do you see?  NOTE:  the top panes represent value-added work.  That is to say that you have determined that there is in fact a customer for those tasks.  Those below are, by definition, non-value added -- meaning the customer either doesn’t exist or doesn’t want that service, product, report, etc.  Pay close attention to the WR box.  This is where pet projects and sacred cows tend to collect.  This is also a great place to start in lowering the waterline to expose waste.

 

For each sticky note, an action should be taken even if it is just to validate that it is indeed work that you should be doing.  One tricky part is work that is regulatory in nature or required by company policy or procedure, e.g., creating budgets or conducting performance appraisals.  The challenge here is to first determine if it is truly needed and, if so, to be as efficient as possible so as to minimize the time you spend on work your customers aren’t willing to pay for.

Employees tend to love this process.  It is a way for them to safely tell you, the manager, what they are doing that may not, at least from their point of view, be necessary.  By listening carefully, you may be able to lighten their load a little while at the same time drawing closer to your customers and building morale and trust.

Try it.  You’ll like it.