21 February 2013

I get my kicks from Champlain

Samuel de Champlain is my nomination for Mr. Gemba.

I enjoyed immensely reading David Hackett Fischer's biography of the father on New France called Champlain's Dream (Simon & Schuster, 2008).  Like many of us in modern organizations, Champlain started out with a dream, had little if not negative "management" backing, did his exploration the right way, and changed his corner of the world forever.

Champlain's Dream
Let me put this in a QFD context.

Business Goals: converts Native Americans to Catholicism (as measured by # souls), create wealth for France (as measured in livers – French currency at the time), compete with English and Dutch (as measured by # ports, colonies).

Key Stakeholders: 3 successions of King Henri IV, Queen Regent Marie de Medici, and Louis XIII and their administrations. Financial backers including Compagnie de Caen and Hundred Associates.

Key Customers: various tribes of Native Americans on the St. Lawrence River, French traders, Colonists, Catholic Church clergy.

Customer Process Models: Champlain joined many tabagie (smoking festivals and meetings) with Native Americans to learn about their lives, their joys, and their struggles.

Gemba: After the "interview" research of the tabagie, Champlain then explored the St. Lawrence gemba. They joined hunts for food, parties of war, lived in their villages, ate their food, stayed on through the winter seasons (in the early 1600s, most Europeans were fair-weather visitors to North America). He did youth "student" exchanges to learn their languages and customs, etc. This is real gemba.

Customer Needs:

    About the Native Americans, Champlain learned:
  • Help feed our families (many St. Lawrence tribes were hunters and gatherers, did not store food, and suffered terribly with disease and starvation during some winters).
  • Protect us from our enemies (both Indian and European).
  • Help us live in peace.
    About Colonists:
  • I want to serve my King.
  • I want to become a land owner (almost impossible for non-nobility in France).
  • I want a place to retire with my family.
  • I want a great adventure.
  • I want to get out of debtors prison.
    About Clergy:
  • Establish the Church in North America.
  • Create a rule of law and faith (not just revenge).
  • Free to do missionary work.
    About French traders:
  • I want to trade with everyone.
  • I want to fish anywhere.
  • I want to make a lot of money.

Functional Requirements: respect for Native American cultures, no retribution, assure adequate food and nutrition, establish rule of law based on just solutions for all parties, build trust by keeping promises, religious tolerance, make colonies self-sustaining, encourage intermarriage.

The result was a mastery of exploration, cartography, co-habitation of peoples for mutual benefit, and a tremendous leadership style that got it "right" most of the time. This came from Champlain's non-judgmental willingness to learn, appreciate diversity, and explore beyond his comfort zone. In that era, it was the French who recognized the humanity of Native Americans, while the Spanish were enslaving them and the British were pushing them off their land.

Champlain's life is an example of how to do gemba right.

17 February 2013

Now’s the time!

It’s that time of the year again, when we begin the call for papers for this year’s QFD Symposium.

This year’s will be an International Symposium, taking place September 6–7 in Santa Fe, New Mexico.  It’s a great time to meet your peers of QFD as well as greet some of the gurus of quality excellence.

As usual, there will be classes, discussions and demonstrations, and we’re looking for contributors who would like to show others how they’ve successfully applied QFD to their own professional (or personal) projects.

If you have a project or paper, completed or in-progress, you’d like to share, please send an abstract now.

(photo from Symposium on QFD)

09 February 2013

Healthcare optimization and its effects on patients

This came from someone who read our recent post on healthcare improvement:

I would like to talk about a recent experience I had at a doctor’s office. Given my medical history, the experience might not be relatable to everyone but I think it highlights an important problem in the area of medical process improvement, where offices are adopting new Standard Operating Procedures to streamline patient visits, as a local improvement without seeing the big picture or global improvement.

(photo of an eye clinic)

To start, it’s important to note that I have a long history with eye doctors and have spent my whole life in the same medical system and hospital, and I have a medical record that could rival Proust’s In Search of Lost Time as a blunt weapon.  Like any experienced patient, I know the procedure for checkups and I know how my eyes should test.

On this visit, I made it quickly from the waiting room to the exam room (an area this hospital has made incredible strides in over the past twenty years) and soon my exam was underway.  The technician measured my eyesight with a multi-line letter chart and then took my eye pressure using a Tono-pen.  Both of my readings were off.

The multi-line letter chart helps prevent cheating through memorization but it makes it much harder to focus on any one line.  Tono-pens are used because they save time over traditional Goldmann tonometers (the little blue cones they press into your eyeball) but they are both less accurate and less precise. We’ll get back to the time savings in a minute.

My vision was measured at 20/30, acceptable for many people and good for others. But with my glasses, 20/15 is the norm and 20/20 is what I have on an off-day when I’m tired.  It’s not a big delta though and it can vary with things as simple as room dryness or the cleanliness of my glasses, so I was a bit annoyed with the result but not yet concerned. Then came the Tono-pen.
Tono-pens are a small handheld device for measuring intraocular pressure and they’re a godsend for measuring small children and patients who can’t sit still.  Unfortunately, I’m not one of them and given my eyes’ history, I have a very precise range of what my eye pressures should be. This particular visit, the pressure in both eyes was abnormally high by more than five; the right eye’s being nearly double its normal value and a possible signal that something might be wrong.  The technician’s response was to move me back into a waiting room while my eyes dilated, and advance to her next patient.

All of this was done in a matter of minutes and her efficiency was through the roof!  By basic metrics, she did her job swiftly and followed exact protocol for processing patients.  After all, it’s not her fault my eyes had subpar measurements; the doctor would just have to treat it.

When my doctor arrived, she began a more thorough investigation of my eyes. Her conclusion was that everything looked great.  All of the parts in every sector had maintained their shape and size from the last visit, and there wasn’t a hint of inflammation.  Still slightly worried about the high pressures, I asked if she could re-measure them and she obliged, this time using the gold standard Goldmann tonometer (photo below). This time, everything was normal.

(photo of Goldmann tonometer, photo by Jason Ruck, Creative Commons)

The point of this writing is not to call attention to a single technician, because she did exactly as she was trained.  It is rather to show what generic service can miss and how it could be better.

Upon seeing and hearing that my eye pressures were out of line, the technician should’ve conducted a second test, possibly using the more accurate and precise equipment, and compared it to my historical figures. The problem with this is that it would’ve cost her time, and being in a low level position, she doesn’t have the clout to shrug off time requirements and quotas.

Now why is it a problem if everyone in a medical office tries to work as quickly as possible? 

Mistakes and malpractice aside, it misses the big picture.  The primary bottleneck in a doctor’s office is the doctor herself.  They are in least supply, have the busiest schedules and are almost always the reason you’re processed in a timely or slow manner; the rest of the system adjusts around them.

In this case, spending an extra three to five minutes during the technician’s stage would not have delayed my consultation or departure at all, since I still had to wait another 5+ minutes for my eyes to dilate and another 5+ after that for the doctor to become available.  The same goes for the next patient she had to visit.  If the doctor can only see 5 patients per hour and technicians prepare 10 patients per hour, the clinic will still only fully process 5 patients per hour.  The system can move no faster than the slowest link.

So not only did the time saving measures before the doctor’s stage provide no temporal benefits but in the end, the less precise device actually cost the clinic time it was meant to save.  You see, the doctor spent additional time conducting a re-measurement of my eye pressure that actually could’ve taken place twenty minutes prior when there was a buffer zone.  Reducing time during the technician’s stage meant overloading the doctor’s stage and the end result was an increase in the total time for processing.  As you can imagine, this sort of thing gets compounded with every patient.

In the late Eli Goldratt’s Theory of Constraints, it was recommended improvements to throughput must come by way of removing all unnecessary loads from the bottleneck. At a clinic, this means that anything that can be done by a technician should be done with the precision and accuracy that a doctor requires so that they do not have to repeat testing. By increasing the attention to detail of technicians, it may be possible to reduce the overall load on the doctor, thus speeding up the entire system.  This could add up to significant savings, especially in these times of concern for reducing healthcare costs for both hospitals and patients.

01 February 2013

What ever happened to customer service?

It seems these days that customer service has gone to the dogs. It used to be we gave our best customers our best service, especially in this service economy! Here are some of my recent experiences.

(photo of restaurant check holder)
Case #1
At a national chain restaurant
, the guest check holder (the leatherette bill holder the waitperson brings to your table) was redesigned. Instead of the conventional, little clear plastic pocket that was the perfect size to hold a credit card, their new design has a simple slit that is cut directly on the holder lining.
    Because there is no pocket seam to hold the card securely in place anymore, once you insert the credit card into the slit, gravity works to slip right down to the bottom of the 10" deep holder, unbeknown to the customer.

    When my waitress brought my credit card slip to sign, the card was nowhere to be seen. After a frantic search of the floor around the table, the card was found stuck inside the lining of the folder where it had slipped down to the bottom. It had a friend, too – another card lost by a previous guest over one week prior! The waitperson's response – "Oh that happens all the time." Well, if it happened more than once, why didn't they fix the problem?

    Case #2
    The new US healthcare laws require that children over 26 have their own health insurance. After transferring our son to his own insurance plan, he enrolled in automatic-pay from the bank account. The first monthly payment was deducted properly, but not the second. After several long phone calls, it turns out the second payment was deducted from someone else's bank in error. How could that be, since it's all done by computer, right?

    In fixing the problem, the insurance company not only removed the incorrect payment for the current month, but they also removed the correct payment for the previous month, meaning my son was now in arrears and at risk of losing his new insurance, even though we had followed all correct steps to transfer and set up automatic payment.

    Furthermore, their customer service representative just reported his account now shows "paid" for the next five months, even though he has not paid past the current month.

    Case #3
    (photo of smart phone roaming)
    "Global roaming" on a mobile phone is essential when traveling overseas. I recently had to activate the plan that gives me a discount on data when traveling abroad, which is important for a smart phone. Well, this took several calls with conflicting information from the various agents at my mobile service provider. One person said it was not necessary, another said it could be done now and I would be all set. A third person actually took me through the steps to change my iPhone settings so it would work. Had this third person not explained the setup to me, the phone would not have worked.

      I'm sure you must have some stories yourself. Why not share them with us?

      If you run a service or support operation, learn how to understand what your customers really want. It will earn you customer loyalty and save you money from multiple mis-handlings by your staff.

      To learn new QFD tools for this, I recommend attending the QFD Green Belt® course. I will be teaching the Orlando course on Feb. 28 - March 1, 2013. You will learn how to apply QFD correctly and most efficiently from the first time.

      The course includes Excel templates which is an economical alternative to buying commercial software that is most likely based on outdated methods. The course has no prerequisites.