Content By Davis Balestracci

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By: Davis Balestracci


When improvement initiatives don’t yield the results promised, it’s very tempting to have the knee-jerk reaction of blaming the workers for their poor attitudes and lack of work ethic. But what if one took a counterintuitive approach: looking within one’s business systems for the true causes for low motivation—and for their remedies?

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By: Davis Balestracci

How true are the following statements as you perceive things in your work environment?

1 = Not true at all
2 = True to a small extent
3 = True to some extent
4 = Mostly true
5 = Completely true

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By: Davis Balestracci


“What if I were to tell you that one of the most important keys to your organization’s success can be found in a very unlikely place—a place many of you may consider to be complicated, inaccessible, and perhaps even downright boring? What if I were to tell you that this key to success is already one of the most ubiquitous and impactful forces in your organization? It’s there, waiting for you to tap into it. This key to success is measurement.”

No, that’s not me talking above, but my respected colleague Dean Spitzer, from his wonderful book, Transforming Performance Measurement (AMACOM, 2007). He’s a former executive at IBM, where he did groundbreaking research on “the socialization of measurement” and was a thought leader in identifying innovative performance measurement models.

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By: Davis Balestracci

I received the following note from a physician who is very interested in improvement: “I am not sure I understand what a process behavior chart and a moving range chart do to the discussion, and what do the colored lines represent? aka ‘Still confused.’”

His comment was in response to my column, “What Are You Tolerating?”, which included the two graphs in figure 1. I’d like to take a step back and address his question in the hopes of helping him (and you) avoid yet another vague meeting about a vague problem with some vague data. “Off to the Milky Way,” incidentally, was one of W. Edwards Deming’s favorite expressions and describes that scenario very well.



Figure 1: No. of falls, year-over-year, and last 12 months

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By: Davis Balestracci


As a consultant, it’s easy to lose touch with reality and become a platitude-spouting machine. I always like hearing from my readers because it keeps me grounded—and I try my best to reply to them all. My heart lies with the hard-working front-line folks doing the real work.

As long as I can offer real solutions and reassurance to people passionate about improvement, as in the unedited conversation below, my passion for helping practitioners like this to create a culture where improvement is embedded into the organizational DNA will not fade.

It started innocently enough with a comment on my article, “What Are You Tolerating?”

Reader
I guess I’d say that based on an I-MR chart [i.e., individuals-moving range chart], there is no statistical proof that the improvement efforts they made have done anything to reduce the number of falls. Basically, this year and last year are not significantly different.

But that doesn’t necessarily mean that the improvement efforts that they’ve done so far are all a waste of time, does it? Surely, there is a way to have an impact.

I’m curious: What would your advice be?

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By: Davis Balestracci

What exactly is “culture?” As Jim Clemmer puts it, “Culture is ‘the way we do things around here’… especially when the boss isn’t looking.”

As I asked in my January 2013 column: Do cultures’ (unwritten) expectations unwittingly create the leaders they have? Are various guises of “traditional management” still the norm?

Any organization dedicated to true transformation must make the necessary transition from a “quality as bolt-on” mindset to “improvement as built-in” mindset. For this to be successful, formally addressing issues of “culture” is a given.

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By: Davis Balestracci

At the end of my December 2012 column, “Evolving Beyond Platitudes to Holistic Improvement,” I described three different management styles. Management expert Peter Block saw the need to evolve away from traditional management, and in “As Goes the Follower, So Goes the Leader,” he describes a simulation designed by the late Joel Henning in which teams are asked to role-play three different styles of leadership. Each is given a short case study, asked to define the problem, and then do one of three things.

I paraphrase the simulation and its results below.

Team 1 role-plays a high-control, autocratic leadership style (i.e., traditional management). This team devises a solution and runs an employee meeting as a true autocrat would do it: The team has all the answers and restricts the questions for the end. This could be perceived that employees are the problem, and all they need to do is follow the leader, embrace the vision, and be rewarded for their compliance (they will also save their jobs).

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By: Davis Balestracci

The 24th Institute for Healthcare Improvement (IHI) Annual Forum took place on Dec. 9–12, 2012. It is probably the leading health care improvement event in the world. I have presented there for 20 consecutive years and watched it evolve from barely 1,000 attendees to well over 5,000. What’s changed during these past 24 years?

Here are two quotes from past plenary speeches of the always-inspiring Donald Berwick, M.D., its former CEO. See if you can guess how old they are. Even if you’re not in healthcare, they are applicable to any industry, but I would ask you to think about your recent healthcare experiences, and those of your families:

1. “Now, in healthcare, among the people at this forum, we have made the needed preparations for change. Our preparations are sufficient. We have studied enough. We have reviewed our cultures enough. We have spent the time we needed, enough time, in training and planning and filling our kit with new and useful tools and methods. We know how. Now, we must remember why....”

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By: Davis Balestracci

Previously I discussed three common cause strategies (links below) that help to expose all existing, underlying special causes of variation. They also provide necessary insight into how the current process came to be and allow construction of a baseline for assessing the effects of an intervention.

Common cause strategy No. 1: Exhaust in-house data in “Wasting Time With Vague Solutions, Part 2
Common cause strategy No. 2: Study the current process in “Wasting Time With Vague Solutions, Part 3
Common cause strategy No. 3: Process dissection in “Another Strategy for Determining Common Cause

W. Edwards Deming considered this a major achievement—getting a process to the point where only common cause is present. He felt that it was only after all lurking special causes were exposed and appropriately dealt with that improvement could begin.

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By: Davis Balestracci

Remember the early days of TQM? When I present to healthcare audiences, all I have to do is mention “lab turnaround time” to get a collective groan and smile. That was always one of the initial forays into what was called total quality management (TQM) or continuous quality improvement (CQI).

Most initial projects like lab turnaround time quickly turned into the project from hell due to over-collection of lots of vague data resulting from a huge cause-and-effect (Ishikawa) diagram that answered a vague question such as, “What causes long turnaround times?” It can be so tempting to naively jump right to today’s strategy before even knowing where to focus I’d like to revisit this situation using 20–20 hindsight to teach some lessons. (Of course, today you would first connect any project work to a “big dot” in the boardroom, right?)