Technology Drives Breakfast Group Crazy

At a meeting of our Masterminds Breakfast Club for business consultants, we featured a topic about CRM and online collaboration software. The eight professionals present, between us, used thirty-four different software packages and online helper services, ranging from Salesforce, Mail Chimp and Constant Contact, to DropBox and CrashPlan to Wufoo Form Builder. While all of these technologies are exciting in themselves, most of the consultants at the table visibly drooped with the daunting prospect of researching, learning, selecting and implementing the various solutions. And, many expressed frustration that the process of learning about these solutions is actually four or five steps removed from actually doing any work for clients, or building the business.

When we tried to decide on a platform to use for inter-group collaboration, we had eight different opinions, all valid, and thirty four software options, all valid. And that's just scratching the surface of what's available.

So, there's lots of innovation going on out there in the market and the selection is almost endless. But, it's also extremely inefficient when there's no generally-accepted standard. And, it's tiring and cumbersome to collaborate with different groups, when each group has adopted a different set of solutions or a different platform.

Variety may be the spice of life, but our businesses are wasting too much time on choosing the spices and not enough time on preparing and serving the main course. If the market could cooperate more and decide on some standards, our lives could get a whole lot easier. And, our businesses would get a whole lot more productive.

Business Ain't Science

Some really interesting science-based companies were presenting their Exciting Investment Opportunities to a group of potential investors. Half of these really-interesting companies were wasting their breath due to a common and faulty belief - the belief that business is just about having good science, good products, good technologies. As they made their investment pitches to the business community, most of them talked about the science, as if they were presenting a technical paper to the scientific community.

They spoke at length about the chemical compositions of their bio-products, while investors wanted to know the market advantages and ther strategy for entering the market. They charted graphs of technical tests, while investors wanted details about competitors, industry partnerships, barriers to entry, and supplier and distribution agreements. The Chief Science Officers spoke in technical jargon, while the audience expected discussion about return on investment and exit strategies.

One lesson is - know your audience and tailor your presentation to what they're looking for. The more important lesson though, is - having a good product is not enough. You are not investment-ready when you have a good idea, a good product, or good science. You are investment-ready when you have a good business opportunity, and that goes far beyond the science.

He Was Terrible - Will Never Use In The Future

After a recent presentation about quality to a large group of Saskatchewan health care leaders, the feedback forms about my presentation ranged widely, from "What I Liked Most" about the workshop, to "What I Liked Least". I've learned to expect variation, and, striving to improve, I try to learn and adapt based on all the feedback I receive.

The most critical feedback comment I received after this presentation was:

The message of giving patients what they want, when they want it is not realistic. He was terrible - will never use in the future.

Now this one threw me at first, as the insecure side of me reacted to the "He was terrible" part. I quickly re-read some of the other "He was great" comments to restore myself, and then thought about this one for a while. I'm certainly open to adapting my speaking style, or my audience participation exercises, or the ways I present information, but that didn't seem to be what this commenter was saying.

The message here, as far as I could see, was that giving patients "what they want, when they want it", was not realistic. Granted, there's plenty of room for misinterpretation, since it was a very brief comment with no opportunity for discussion or clarification. Still, this is a deeply disturbing comment coming from a health care leader.

If we don't give patients "what they want, when they want it", what do we do instead? What is "realistic" for the health care industry?

1. Not give patients what they want. Perhaps we should ignore our patients' desires for good health, for effective interventions, for relief of pain and symptoms, for respect, for information, for good service. My mom wanted an appointment with her doctor this week; the clinic's schedule wouldn't allow it. Maybe that's a good thing?
2. Give patients what they don't want.  Perhaps we should try to increase the number of hospital-acquired infections, clinical errors, or prescription drug interactions. A study published in the Journal of the American Geriatric Society found that one out of thirty senior hospital admissions were due to adverse drug reactions.
3. Give patients what we want. Perhaps we need to reschedule their appointments more at our convenience, make them walk further around the hospital, drive to an even-more-distant specialty hospital, and put a few more people into each bed while we're at it.
4. Not give them help when they want it. Face it, patients are whiners. The whole idea of wanting health care when you're sick is just so needy. Perhaps it would be better to extend wait times even further, and add more handoffs and waiting rooms to each procedure along the way.
5. Give them help when we want to. Perhaps it would be better to require people to pre-schedule their visits to the emergency department, or maybe spread out their influenza infections throughout the year. Or, like a recent friend's experience, send notice of a scheduled specialist appointment at an arbitrary date in about six months, then push it back two months, then push it back another three months.

What scares me most about this critical comment is the suggestion that good customer service in the health care industry is not realistic. In every other industry, customer service (giving customers what they want, when they want it) is critical to business, a differentiator between success stories and business failures. Yet somehow it's "not realistic" in health care? I don't think so.

In today's StarPhoenix, Mark Lemstra wrote that Health care needs ideas, not more money, I couldn't agree more. And some of the old ideas and attitudes might have to go, to make room for new ones.

But We're Different !

I recently spent a day at a great Quality in Healthcare conference and repeatedly heard variations on this theme:

• "We're different"
• "This isn't like manufacturing."
• "Health care is more complex."
• "Health care is the Mother of all service industries."
• or the admission from a recently enlightened doctor who admitted "I didn't used to think I was in a service industry; I'm a urologist, not a waiter."

In talking to other sectors about various process improvement methods, I hear similar laments:

• "That wouldn't apply here."
• "We're already lean and mean, we don't need that stuff."
• "Yes, but we're in the [totally unique] industry. That [pick one - manufacturing/service/health care/mumbo jumbo] stuff doesn't make sense for us."

And yet, when I pursue the topic, and explore what issues they're having, and what they want to achieve, I hear the same things from everyone in every industry:

• "We need to do more with less."
• "We've got to increase our capacity."
• "How do we get our people engaged?"
• "We've got to reduce warranty claims/errors/defects/problems/lead time"
• "There's a lot more competition."
• "We've got to streamline our process."
• "We've got to get different departments to work together."

Sure, the specific words might change from industry to industry, but the concepts are identical. Yes, your industry is different, you may work on house plumbing, or oil refinery piping, or sales pipelines, or people's pipes (like our urologist buddy), but the desire for improvement, and the methods for improvement, are universal.

Medical clinics can learn from restaurants about access and queuing. Restaurants can learn from manufacturers about flow and efficiency. Manufacturers can learn from financial services about customer relationships. And financial planners can learn from entertainers about thrilling customers.

Like everyone else, you are different. But the way to be really truly different is to realize how much the same you are. Then, you can learn from all industries, not just your own.

Ten Years to Fix a Gate - Why We Should Procrastinate

In a few short minutes, you can easily create a To Do list that will take forever to complete. "Invent an anti-gravity machine" would be one example. "We should renovate the kitchen," would be another. Whether in business or personal life, you can easily take on more projects than you can possibly complete within the available time and money. So, we make our To Do lists, and some things stay on the lists forever.

One anonymous do-it-yourselfer had "rebuild the gate" on his To Do list for about ten years. When he finally got around to it, the job only took about three hours, start-to-finish. Think of the mental energy consumed by this as - four or five times a day for ten years - this poor sap would go through the gate and think "I've got to fix this."

Yet, despite what his wife and her mother may have thought, our do-it-yourselfer was probably not a "lazy good-for-nothing bastard who's ruining my life!" In fact, he was actively working on many other projects throughout that time, although he did take the occasional nap on the couch. Day-after-day, month-after-month, something else on the list was always a higher priority than fixing the gate. And so it was continually put off, until one day, it finally made the cut.

There's lots of advice out there on how to avoid procrastination, and if you have a chronic problem with that, certainly explore your options for becoming more decisive and action-oriented. But there are definitely situations where procrastination is exactly the right thing to do.

1. The options just don't feel right. Sometimes, especially with difficult or unusual problems, the options we've come up with just don't seem adequate. We may arrive at this conclusion as a result of rigorous analysis or as a result of intuition. Either way, the problem sometimes needs to simmer a little longer for a more complete solution to emerge. Creative problem solving is a process, and part of the process is being exposed to an adequate supply of new ideas and stimulus to work with. Sometimes that simply requires you to wait.
2. We're not convinced it's important. Again, whether from analysis or intuition, we just don't have enough evidence to convince us that the task is necessary. While we routinely make decisions despite incomplete information, sometimes there just doesn't seem to be a compelling case for action. One technology company had planned a major re-write of some embedded software, but tabled the project for a few months due to significant debate about the necessity. In those few months, a new hardware innovation made the re-write unecessary and eliminated the need for hundreds of hours of engineering and development.
3. We're not convinced of the value. Even if we're quite sure the project is important and we have a clear path forward, we worry that the solution will cost more than the problem we're solving. While this can just be fear talking, often it's a signal that we need to collect more data or do an experiment. A mid-size manufacturer was planning a major marketing campaign that would cost more than they'd ever considered in the past. Rather than not making a decision out of fear, rather than diving in despite the concerns, and rather than simply waiting for enlightenment, they did some carefully measured tests of the concept. Within a few months of this intentional procrastination, their testing providing convincing data that the approach would be effective. Waiting, and using the waiting to study and learn, proved to be just the ticket for success.
4. You don't have a plan. Project management is all about breaking the work down into manageable, achievable chunks; little steps that, when added together over time, get the whole project done. If you've been putting something off that is valuable, important and right, perhaps you are not yet ready to tackle the project. Perhaps you need to step back from "starting the project" and invest some time in "planning the project" - creating a sensible work breakdown structure, and a plan for success. Perhaps that's why you've justifiably been delaying the start.

So, if you've been putting things off, and putting things off, and putting things off, you may just be a lazy good-for-nothing bastard. Or perhaps you've been doing exactly the right thing.

For 80,000 people to support you on your journey, consider joining the Procrastination Facebook group tomorrow, or maybe sometime next week, or maybe next year.

A Little Recycling Incident at the Hospital

The nurse was pushing a wheelchair with a garbage bin full of cardboard on it. As she passed the seating area where I was waiting and reading a book, she asked another nurse "What do you do with your recycling?" As she saw hesitation in the other's face, she quickly clarified "Do you recycle?"

The other laughed and said "We gave up - we didn't know what to do with it, so we just throw it out now."

A third nurse who was passing by volunteered, "We've been putting it in the garbage room in a big clear plastic bag."

"Does it get recycled?" asked the first.

"I'm not sure, but since the bag is clear, we figured they could see what was in it so they wouldn't just throw it out."

The three spent a few more minutes speaking, hoping that it would get recycled and wishing for a better system, then the first nurse found a clear bag, put the cardboard in it, and left it, pushing the now-empty garbage bin on the wheelchair back to her ward. I don't think anyone will ever know if this particular cardboard actually ended up recycled or tossed, but it was well-intentioned.

People try to do what's right. Sometimes they give up when it seems futile, when there's no system, when it doesn't seem worth the effort any more. Sometimes they pesist, continuing to try and ask around, working with others to try to find a solution. And sometimes they innovate and just start doing something, anything, in an attempt to solve the problem with hopes that it will be successful.

It may seem obvious, but management needs to foster these messy little initiatives - creating an environment and providing support for people to make their own jobs better and better, day by day.

How Creative Thought Happens

Creative thinking is often seen as elusive and rare; it's something that creative people do; it's something that we wish would happen more in our organizations. Yet creative thinking follows a relatively predictable process, with overlapping phases that go something like this:

1. A problem emerges. If the problem seems important enough, it motivates us to seek a solution.
2. We try to solve it. Using our existing, habitual actions and routine methods, we put some concentrated effort into solving the problem.
3. We get frustrated. When our standard approaches don't work, we feel tension, discomfort and frustration and back away from the problem for a while. We're not sure how to move forward.
4. Our perspective shifts. As the problem simmers, we start to perceive it in different ways; new points of view emerge that offer glimmers of hope. We become able to reformulate the problem in ways that suggest new paths forward.
5. A tentative solution appears. Often in a moment of insight, often with a sense of exhilaration, a possible solution presents itself. Our previous frustration and our shifting perspective allow us to see this solution that we couldn't see before.
6. We test it. As we flesh out the idea and elaborate on it, we compare it against reality, against the constraints of the problem. If it doesn't prove itself, we may loop back to any of the earlier stages.
7. We communicate it. If the solution meets the tests, if it solves the problem, we implement it and communicate to all who are affected by the problem.

There are countless structured approaches that aim to foster creativity and accelerate such a process, but there is strong agreement that there is such a process. The details vary but the process above is typical and representative. For in depth reading on the subject, consider Creativity and the individual and The Resolution of Conflict.

Sewer Rats and Corporate Learning

If you ever have to kill a sewer rat, you can take advantage of a serious weakness of the varmints - they remember what they've experienced and use their memories to predict what will happen in new situations. "But wait," you cry, "how can memory and experience be a weakness? How can memory and experience make a rat vulnerable? Isn't experience a good thing?"

As it goes in the sewers, so it goes in the corporate world, with a high value placed on experience and corporate learning. An entire industry has sprung up around the areas of knowledge capture and learning management systems. Companies create Chief Knowledge Officers (CKO) and pursue Knowledge Management (KM) solutions. We strive to capture memory and experience in our companies, but we never really question memory and experience themselves? When does memory help us? Does experience ever hurt us?

We assume that memory is good, that past experience protects us, that our accumulated memories and experiences help us make better decisions in the future. However, the influential pshychiatrist W. Ross Ashby, in his classic paper Principles of the Self-Organizing System suggested that there is no faculty or ability that is universally good, universally beneficial. An ability is only good or bad in relation to the environment. And this takes us back to our sewer rats.

A normal sewer rat is very suspicious. It has learned, in the relatively consistent world of the sewer, not to trust strange new food sources. If you put a pile of appealing, but poisoned, food in the sewer, the rats will hesitantly eat only a tiny sample of it, not enough to kill them. Because their environment is generally stable, their memory serves them well and protects them from this new and dangerous situation. But their memory is not always helpful.

In Ashby's words, "If, however, wholesome food appears at some place for three days in succession, the sewer rat will learn, and on the fourth day will eat to repletion, and die. The rat without memory, however, is as suspicious on the fourth day as on the first, and lives. Thus, in this environment, memory is positively disadvantageous." So, if the sewer environment includes the pest-control practice known as pre-baiting, memory and experience will lead rats to their death. What does this suggest for business?

If your business is in a stable, predictable industry in a consistent, unchanging business environment, experience and memory are valuable assets. If what happened before is a good predictor of what will happen next, experience is valuable. If how we handled this before is still useful and relevant, we can use it to determine how we will handle this today. If, however, your business is in an emerging industry, operating in a fast-paced unpredictable environment, the value of experience lessens, and may even become harmful. This is a judgement we all have to make as we face decisions and predictions about the future, as we design strategies and tactics, and as we choose people for our teams.

There are several areas where there is tension between those who have knowledge, experience and memory and those who don't. Consider the following:

• Is seniority justification for higher pay? Those who've been around longer have seen situations that new hires have not. But, new hires have fresh outlooks unconstrained by the way things were done before. Which is more valuable to your organization given the situations you're facing today?
• Should you promote from within? Internal people know the history of what's gone before, of how we got to where we are; outside hires do not. Depending on what you're facing, is knowledge of this history valuable or harmful?
• Do you seek answers from within your industry? If you're in health care, do you look to other health care organizations for solutions, or do you seek new practices from the world's of customer service, food processing, and manufacturing?
• Do you need to improve? The way you do things today was developed in yesterday's environment to face yesterday's challenges. Is it appropriate for today's environment and tomorrow's challenges?
• Are your policies bloated by past experience? Every time an incident happens, we add some wording to our policies, yet we almost never take things away. It grows and festers until we have six pages just dealing with dress code including precise definitions of "spaghetti straps", "midriff" and a working definition of what constitutes "visible underwear".

So, as with the sewer rat, don't assume that capturing memory and experience is inherently good. If your world is stable and unchanging, it's wise and helpful to base your decision on "how we've always done things around here". However, if your environment is changing, if you're facing challenges unlike those of yesterday, you need some fresh solutions, some fresh voices, some inexperience.

If You Build a Nursing Home That Looks Like a Hospital

If you build a nursing home that looks like a hospital, the people who live there will behave like patients. They will be sick, they will be unhappy, they will defer to those giving them care.

If you build a nursing home that looks like a community of small houses, the people who live there will behave like functioning independent people. They will be active, they will take more control of themselves, they will ask for the care that they need.

Behaviours truly do emerge from the systems you set up. If you want to create a nursing home that is respectful and promotes activity and vibrant living, if you want to create an environment where multi-skilled staff do whatever is necessary to help those who live there, then the design of your building is important, the design of your policies is important, the priorities of your value systems are important.

The Village Model at Sherbrooke Community Centre in Saskatoon is living proof of this. Rather than an institutional look and feel, the resident live in a small community of joined houses, complete with indoor streets. Staff provide the medical services along with all the diverse, normal services that anyone would provide for their own homes. Residents are more independent and in control of their own care. As CEO Suellen Beatty says, "We did not realize how much simpler the environment would make our work."

It is harder to do compassionate, respectful, client-centered care in an institutional hospital setting. The systems that your people work within are important, and can make the path forward easy and natural, or bumpy and difficult.

Bigger Might Seem Better

A large software company (4,000 employees, $1 billion in annual sales) seems to have all its ducks in a row when it comes to Best Practice.

- The company has well publicized vision, mission and values statements with all the right buzzwords - things like "committed to innovation", "great teams build great companies", "honest and fair in all our dealings".

- The HR department is up-to-date with industry-standard best practices - with extensive employee surveys, performance management processes, bonus systems, and benefits packages.

- The product development teams use best-practice methodologies, like Agile Programming, ISO standards, bug tracking, multi-tier technical support, offshore development and call centers.

From the outside looking in, everything is in place. But consider this...

A group of software developers is told that mandatory overtime will be required for the summer to meet slipping deadlines. They'll be paid time-and-a-half for this extra work, but it's not optional. The developers put in the time, and still don't meet the deadlines. The underlying technology is unstable and unpredictable, but the unit manager is fired for failing to get results.

After months of continuing overtime, with no extra pay forthcoming, employees are told that the company can't pay any overtime due to the economic slump. The employees plead their case, and eventually, the company does pay for some overtime, at straight pay. When it comes to annual performance review and raise time, there are no performance appraisals (since the manager was fired) and the company gives zero raises to the group, again citing the global economic crisis.

A short while later, the company posts its financial results and has turned in the most profitable year in its history. Needless to say, the disgruntled employees are now preparing their resumes.

I used to be quite intimidated and impressed by larger organizations and the sophistication they seemed to bring to everything. They had systems and policies for everything, they documented their methods, they used best-practices, and really seemed to know what they were doing. Yet how often is this just a veneer, a facade that's put forward to give a good impression when really, their practices and processes are decayed and ineffective?

Bigger might seem better, but talk is cheap, and size definitely doesn't matter.

Freedom to Innovate

In a kids basketball game, our boys were was down by sixty points in the last quarter. They knew there was no way they could win; the other team was clearly dominant. But, since they felt they had already lost, they stopped playing to win or lose, and something interesting happened.

The boys started experimenting. Since it really didn't matter, they started trying plays and shots that were too risky to use in normal play. They'd try a flurry of silly passes, behind the back and between the legs, they'd give and go and go and go. And, not only was it fun, but they actually closed the gap and ended up losing by only forty points, instead of sixty.

Competition - trying to beat the other guy - tends to produce conservative behaviour; we stick with what works. When we free ourselves from win/lose thinking, when we play like it just doesn't matter, innovation and experimentation blossom.

When asked about the success of the last quarter, one player answered, "Since what we had been doing wasn't working anyway, it seemed OK to just play around and try some new stuff." That's innovation.