21 st Century “Leadership”—A Blinding Flash of the Obvious: Isn’t it about time?

1. 21st Century “Leadership”—A Blinding Flash of the Obvious: Isn’t it about time? Davis Balestracci Harmony Consulting, LLC Phone: (207) – 899-0962 e-mail: davis@dbharmony.com Web Site: www.dbharmony.com “Mission Possible”: Reforming Tasmania’s Health System 9 November 2007 Fill out assessment on Page 3 of Handout

2. Road map • Part 1—summarised on pp. 16-22 • Think “process” • WASTE caused by data Insanity • Liberate TIME to do Part 2 • Break “assignment” • Read pp. 5-7 • Fill out p. 8 • Part 2—pp. 9-13 • Part 3—DIALOGUE/Questions • “Assignment”—pp. 14-15

3. If you have your kitchen redone… • Do you TELL the contractor that: • The dishes MUST stay in the cupboards? • All meals MUST be prepared in the kitchen and eaten on time? • You can’t be “a little bit pregnant” about quality either…

4. What was your score? • Level of Executive Commitment • < 45? • Permission • Lip service • 46 – 55? • Passionate lip service • > 55? • Involved leadership • Strategic service/quality leadership

5. It’s not about the problems that march into your offices… The important problems are the ones no one is aware of! [Jim Clemmer paragraph, p. 4]

6. EVERYTHING is a process! [p. 21]

7. **Your current processes are perfectly designed to get the results you are already getting…and will continue to get Processes “speak” to us through data

8. It's not about 'costs!' • Confusion…conflict…complexity…chaos • Do you ever waste time waiting, when you should not have to? • Do you ever redo your work because something failed the first time? • Do the procedures you use waste steps, duplicate efforts, or frustrate you through their unpredictability? • Is information that you need ever lost? • Does communication ever fail?

9. 6 Sources of Problems with a Process • Inadequate knowledge of how a process does work • Variation in people’s perceptions of how things work • Inadequate knowledge of how a process should work • Variation in people’s perceptions of how things should work • Given the current process state/objective, poor process design [p. 22]

10. Errors and mistakes in executing procedures • Variation in how individuals are trained to do the work • Variation in how people actually do the work • Some people have developed beneficial “knacks” to work around process design limitations • Underlying process issues that cause everyone working in the process to make the mistake

11. Current practices that fail to recognise the need for preventive measures • Environmental factors that make the process “perfectly designed” to have undesirable variation / “incidents” occur • Human fatigue / attention • Unnecessary steps, inventory buffers, wasteful measures/data • Complexity added in the past due to inappropriate reactions to experienced variation • Implementing untested solutions that are simple…obvious…and wrong

12. Variations in inputs and outputs Improving quality = Improving processes Using statistics = Prediction

13. TQM…CQI…Six Sigma…Lean Six Sigma…TOYOTA Lean Six Sigma • IT’S ALL THE SAME! • Obsession with waste…use of data… teamwork • It’s all about improving PROCESSES! • Lean: #1, #4, #5 • Toyota Lean: Seeing “Time” as Inventory DB article: p. 22

14. STATISTICS?!

15. Use of Data as a Process Definition, collection, analysis, interpretation

16. Yep…Statistics • Statistics: #2, #3, #6 • Expose variation • Design tests of theories • Assess interventions • Hold gains • React appropriately to variation

17. The use of data is a process… • …actually, FOUR processes • Definition • Collection • Analysis / display • Interpretation • POOR use of data is WASTE • Unbeknownst, many meetings are reacting to variation in the DATA process • Not maths, but statistical THINKING • Based in “process” • Common language to depersonalise issues • Improve the quality of conversations • React appropriately to variation

18. Déjà vu? How many meetings? Pages & pages…

19. I HATE bar graphs & trend lines!!!!!

20. Practical Accumulated Records Compilation Passive Analysis Regressions Correlations Profound Analysis Relying (on) Computers Planning After Research Completed P.A.R.C. Analysis

21. Study: Whites may sway TV ratings • …associate professor & Chicago-based economist reviewed TV ratings of 259 basketball games… • …attempted to factor out all other variables… • Win-loss records of teams • Times games were aired • “The economists concluded that every additional 10 minutes of playing time by a white player increases a team’s local ratings by, on average, …5800 homes.”

22. C R A P • o edr • n cmo • t oic • i rne • n did • u inu • o nir • u gse • s ts • r • a • t • i • v • e

23. “Traffic Lights” ? RUBBISH!

24. Folks, I can’t make this up… “The target is for 90% of the bottom quartile to perform at the 2004 average by the end of 2008.” ?????????????????????????????

26. Vague datacollected in response to a… Vague problem will yield a… Vague solution, which, in turn, will yield a Vague result.

27. Given two numbers… SomethingImportant Yesterday Today …one will be bigger!

28. Weekend’s 13 traffic deaths surpassed last year’s total of 9 Officials seek reasons for rise in overall road deaths (600 vs. 576)

29. The “Law of Averages” “If I stick my right foot in a bucket of boiling water and my left foot in a bucket of ice water, on the average…I’m pretty comfortable.”

30. Does it look like this…?

31. ...or this?

32. The Myth of Trends “Upward Trend” (?) This month… vs. last month… vs. 12 months ago “Downturn” (?) “Rebound” (?) 3 Months of Quarterly results… “Setback” (?) This quarter… vs. last quarter… vs. same quarter last year “Turnaround” (?) “Downward Trend” (?)

33. Statistics = Understanding Variation • There are TWO kinds of variation • Special cause (Unique occurrence, “One off”) • Common cause (Inherent, “Systemic”) • Treating one as the other MAKES THINGS WORSE • The human tendency is to treat ALL variation as “one off” • Even if things “shouldn’t” happen, you might be “perfectly designed” to have them happen

34. How are they doing with guideline implementation? % Compliance This month: 69.44% Last month: 50% 12 months ago: 69.44% GOAL: 75%

35. “Statistical” definition of “trend” Special Cause – A sequence of SEVEN or more points continuously increasing or continuously decreasing. Note: If the total number of observations is 20 or less, SIX continuously increasing or decreasing points can be used to declare a trend. IMPORTANT: To be used only with tabulated data having NO context of variation [p. 16]

36. Goal: Go from 50% to 75% % Compliance 6/97 44.44 % 41.67 50.00 9/97 50.00 52.78 58.33 12/97 33.33 41.67 50.00 3/98 69.44 69.44 66.67 6/98 66.67 69.44 72.22 (Largest) 9/98 66.67 66.67 63.89 12/98 69.44 55.56 50.00 3/99 69.44 % Compliance This month: 69.44% Last month: 50 12 months ago: 69.44 GOAL: 75%

37. Special Cause: A consecutive sequence of 8 or more points on one side of the median Run Chart: A time ordered plot of process data with the MEDIAN drawn in as a reference line.

38. Goal: Go from 50% to 75%--How are they doing? [p. 17] % Compliance 6/97 44.44 % 41.67 50.00 9/97 50.00 52.78 58.33 12/97 33.33 41.67 50.00 3/98 69.44 69.44 66.67 6/98 66.67 69.44 72.22 9/98 66.67 66.67 63.89 12/98 69.44 55.56 50.00 3/99 69.44 Sorted 33.33 41.67 41.67 44.44 50.00 50.00 50.00 50.00 52.78 55.56 58.33 63.89 66.67 66.67 66.67 66.67 69.44 69.44 69.44 69.44 69.44 72.22 “Plot the dots!”

39. How many meetings?

40. “We are running a slightly higher number of cardiac arrests per month. The total amount of cardiac arrests has risen from a mean of 21.75 (June 94- May 95), to 22.92 (June 95- May 96). This is an increase in 14 cardiac arrests in the last 12 months.” Why, yes…(275 – 261) does indeed equal 14

41. “Next we interpreted the data relating to Vfib Cardiac Arrests…This could be significant to our outcome, and…indicates a need for more sophisticated statistical analysis. It was already shown that the number of cardiac arrests has increased by a mean of 1.17 per month. Now we are adding to that increase, a decrease of times we are seeing Vfib as the initial rhythm…This obviously means that over the last year, we have responded to more cardiac arrests and found them in more advanced stages of arrest.” Obviously…

42. TREND?! I think NOT!!! [p. 20]

43. “Reduce Accidents 25%!” 45 one year…32 the next… 25 % reduction achieved? [p. 18] 8 months are lower than previous year Reduction is 46.2% !

44. Goals a la Dilbert • Boss: • Our goal this year is ZERO disabling injuries. • Last year our goal was 25 disabling injuries; however, in retrospect, that was a mistake… • We had to injure nine employees to meet the goal

45. Safety Data “Plot the dots!”

46. Need “common cause” strategy • Statistics on the number of accidents does not improve the number of accidents • You cannot treat data points individually or “dissect” an accident individually • You cannot compare two points • % change, “too big” a change…

47. It does NOT mean that the current performance is “acceptable”!

48. “Red…Amber…Green…” RUBBISH! [p. 20]

49. “What about those 3 consecutive yellow months?!?!” What about them…?

50. Don’t abdicate just yet!!!