Patient Centered Doesn't Mean Patient Directed

One thing I find annoying is when people talk about patient "choice" as if that is the fundamental principle in health care. We often try to simplify things so much that they are untrue. Health care is complex and trying to point to pithy sayings does more harm than good I think.

Patient focus matters but there are conflicts between what is the best care and what patients want. And there are conflicts between what those paying for care want and drug companies want and hospitals want and doctors want. These require difficult choices and in order to optimize results we need very well designed systems that take these issues into account.

Sadly I think the USA generally has very bad systems in place. The rest of the world isn't that great either, but by and large is better than the USA and much cheaper. Most health care providers care about patient care and often make heroic efforts to provide it. But the systems are just lousy.

Those systems that seem the most lousy to me around extracting cash from payers - it is absolutely horrible in so many ways in the USA. Sadly this creates hugh waste in the USA that is ripe for improvement (and has been for at least 30 years). Patient care also has plenty of room for improvement, but thankfully it isn't as messed up as the whole payment system is.

One of the things people ignore is that we are not talking about GM in the 1980s being pitiful compared to Toyota. When we look at how poorly the USA health care system does it is in comparison to other rich countries it isn't a comparison to "Toyota." It is more like being pitiful compared to 1980s Fiat or something. When you are twice as expensive with no better results than Toyota that is somewhat lame. When you twice as expensive as not very well run systems with no better results that is super lame. And then add on the top of it that you bankrupt hundreds of thousands of people a year, force people to avoid health care so they don't go bankrupt...

We need to have systems that are patient focused but that doesn’t mean patients dictate treatment. And we need to see a much wider system than we normally do. We need to be focused on healthy living not just disease treatment. And given the mess that is the USA health care system we need to focus on reducing the burden of coping with the horrible USA health system bureaucracy - that system does great damage to those having to deal with it (and it is nearly all waste that shouldn't be creating such hardship).

Response to: A Story About a Hospital Putting Safety First Over Patient Satisfaction

Related: USA Health Expenditures Reached $2.8 trillion in 2012: $8,915 per person and 17.2% of GDP - Our Failed Health-care System - Overview of 5 Nations Health Care Systems

Influential Women in the Field of Quality Management

My response, off the top of my head (there are plenty of others to include) to Who Has Inspired You About Quality? by Nicole Radziwill.

I searched online and found a nice “List of Gurus” that someone put together that includes my extra picks! But!! There’s a problem with it. Where area the women? The one woman in this list is someone I’ve never heard of, which is odd, since I’ve read papers by (or about!) all of the other people referenced in the list. Which brings me back to my original point: Where are all the women quality gurus? It’s time to start celebrating their emerging legacy. If you are a woman who has made significant contributions to our understanding and/or practice of quality and improvement, Please contact me. I’d like to write an article soon.

Joyce Orsini and Gipsie Ranney have done lots of good stuff. So has Clare Crawford Mason.

Gertrude Mary Cox isn't known so much for "quality" as statistics but she was an impressive person and a generation or two ahead of others (and it really is related to quality).

Mary Poppendieck has really good stuff at the intersection of quality and software development.

Meg Wheatley was really popular in the 1990s in the systems thinking area of quality. I thought her stuff was good, but wasn't as impressed with it as many people - I haven't seen her stuff in a long time.

There are a couple recent podcasts from the Deming Institute with Paula Marshall, Andrea Gabor and Monta Akin (as well as others listed above).

Most, or all, of those could be good articles.

Related: My post on Who Inspires Your Management Thinking and Action? - women in science and engineering

A Good Management Culture Encourages the Debate of Ideas

my comments on Political Correctness Comes To Lean

Criticism is one of the ways in which knowledge advances. It is a type of thoughtful feedback (and subsequent dialogue) that helps expose blind spots, identify misunderstandings, provide alternate explanations, or uncover errors that others cannot see or are unwilling to acknowledge.

...

Without criticism from others, we are unlikely to challenge our own thinking or escape the comfort of self-satisfaction. We fall prey to the confirmation bias and accept information that confirms one’s views and reject all information that does not. We also develop a love for the status quo. Criticism is rejected without consideration and attributed to people who are simply uninformed or who suffer from professional jealousies.

The outcome is blocked information flow, which is the opposite of what we seek to achieve in Lean management.

I agree with you. I put much of the blame on insecurity and mistaking respect for people with not making anyone uncomfortable. When people are insecure or unconfident they often take criticisms of ideas, plans, results, etc. as personal attacks. Then misunderstanding of don't be "dis-respectful" to people comes into play.

I have written about this several times

Respect for People Doesn’t Mean Avoiding Any Hint of Criticism

Building a Great Software Development Team, a significant part of which was hiring people that would debate ideas without becoming overly personally defensive.

And those posts link to more related posts. The retreat into criticism of ideas is dis-respectful is a real problem for management improvement. Usually there are plenty of other more severe problems, but if you are doing well and getting rid of common failures to manage the organization as a system, experiment and base decisions on data (in many ways) you are likely to reach a point where the fear of debating ideas common in the USA becomes a serious problem.

Related: What Does Respect for People Actually Mean? - Disrespecting most people in order to avoid confronting one person is not good management (or respect for people)

Most Popular Posts on the Curious Cat Management Comments Blog

The most popular posts on this blog:

• Profit = Market Price - Actual Cost or Price = Cost + Desired Profit (2012)
• Mistake Proofing and Mistake Making Less Easy (2013)
• Cease Mass Inspection for Quality (2006)
• 14 Plus Potentially 14 More Years for Copyrights Has Become 120 Years (2013)
• Sustaining Management Improvement Through Personnel Changes (2014)
• Causes of the Health Care Crisis (2011)
• Performance without Appraisal (2005)
• Boston Lean? (2013)
• Data Must be Understood to Intelligently Use Evidence Based Thinking (2014)
• The Failure of Hero Worship Thinking at JC Penney (2013)
• Customer Focus is Central to Lean Thinking (2012)

I started this blog over 10 years ago. After I figured out I thought blogging would work for me I created a self hosted blog and moved the content to that blog. But I kept up the post here since web pages should live forever. For several years (about 2005 to 2011), I posted occasionally to this blog, sometimes the posts were comments made on other blogs.

In 2011 I started to use this blog a bit more consistently to collect the management and leadership related comments I made on other blogs here (when they seemed to say something useful or interesting that were worth posting on this blog).

Related: 10 Most Popular Posts on the Curious Cat Management Blog in 2014 - 20 Most Popular Post on Curious Cat Science and Engineering Blog in 2014

I Don't Take "Better Management" for Granted

My response to a post on Management Innovation is at the Top of the Innovation Stack [the broken link was removed] and the authors reply to my first comment:

JD Meier: "I think we are so used to 'better management' now that we take it for granted."

You are much luckier than I (both as an employee and customer). I find very few companies show evidence of practicing what Deming, Drucker, Ackoff etc. talked about many decades ago. Better management is still a distant hope for most organizations in my opinion.

I do think Hamel talks about lots of good stuff. I admit my study of his is not extensive, but from what I remember he does tend to (as do nearly all these people trying to sell their ideas) make more of what he is saying than is merited.

It reminds me of college when about 50% of my professors in the first lecture had some version of: In [this class] we are studying the true core of knowledge, everything else is just a different take on what we will study here. If it was physics then chemistry, biology... are really sub-disciplines of physics. If it was philosophy everything else was a sub-discipline of philosophy. I thought it was pretty funny. And that passion likely made them great professors, even if I think they lost perspective on reality.

I think even many fairly good management thinkers get hung up on the wonderfulness of their thoughts and how critical their details are. I do still I do like Hamel but I think he is too caught up with his ideas and thinking what he has been looking at is more important than it really is.

My first comment:

I agree with what I think is the premise - that better management is critical for the ability for an organization to successfully innovate. And that bad management can kill otherwise excellent innovation in the other domains you list.

I think calling it management innovation however is misleading. It is true management at very valuable companies (and less valuable ones) needs a great deal of improvement. But it is mainly adopting good management practices people like Deming, Ackoff and Drucker talked about many decades ago.

Related: The Need to Improve Management While Building Organizations Fit For Human Beings - Quality and Innovation - New? Different? How About Better?

Niche Markets

One of the things I find amazing is how focused niche markets are. I noticed this as a kid collecting baseball cards and then paying attention to all the very focused niche markets I saw. When people find it surprising that people actual focus on that I don't really find it surprising but I do still find it interesting.

Here is a good example of what I mean, a business focused on manufacturing bottle caps specifically for use in craft and jewelry projects. That is not a market I think most people think of and say wow if only I could build a business in that market I would be set.

But by focusing on customers and building your business to give customers what they want you can build a good business. That is how the Bottle Cap Company built itself. It started out selling on bottle cap products at local farmer's markets and then ended up with an extra supply and sold that on eBay. And based on that response they saw a larger global market and expanded. And now they ship products and supplies daily all over the world from their warehouse located in Nampa, Idaho.

The success of companies like Google and Apple and Tesla are interesting. But far more success is gained in small companies providing needs to niche markets. I wrote about recent lean startup weekend in Johor Bahru, Malaysia recently along the lines of providing products and services to meet customers needs and not needing to try and become the next Twitter. Sure making billions sounds nice but that is extremely unlikely. However building a successful small business is possible by managing the business well and applying good customer focus principles.

Related: What Works for One Business May Not Work For Others - Pilot on a Small Scale First, Good Advice We Often Ignore - The Customer Knows Best?

It isn't Fair to be Judged for Performance Outside Your Control

My response to Simon Guilfoyle post

It’s also necessary to acknowledge that multiple variables affect crime rates; factors such as economic cycles, substance abuse, the weather, societal influences, changes in legislation, and so on. None of these are directly within the gift of the police to influence. Also, what about where the police cause an increase in reported crime by having the temerity to find someone carrying a weapon? Surely proactive problem-solving should not be discouraged on the basis that finding hitherto unreported criminal offences is incongruous with an over-simplified crime reduction narrative...

I would say many of the examples are outcome measures of the system - which is a better measure than is often used.

However, they are often beyond the control of individuals and even police departments overall (many other factors play a part - economic development, social services system, education system...).

Likely more directly relevant the measurement error is often so high that the figures have more to do with measurement than the actual outcome. And when the figures are being used to blame then it dramatically increases the likelihood the figures will be a poor representation of outcomes.

I would rather see more focus on outcome measures. We should also reduce incentives to misreport data (often blame related).

I think the issues you raise about the system being larger than the police can tackle alone should be a reason to INCREASE the view of the SYSTEM. The important system is LARGER than the police department. When we have institutional walls that break up the system we need to find ways to knock down those walls so the system can work together. Granted this seems nearly impossible given how much difficulty we have even just breaking down barriers inside tiny pieces of our organizations.

Nevertheless that is where the focus should be. We shouldn't decide the outcome measures are not fair given where we put organizational barriers. We should decide that we need to realize when we cut funding for x it drives bad results in section a. And when we allow y to retain fitfully outdated management practices that doesn't just impact their ability to succeed it likely creates lots of other problems all over the place.

Related: Be Careful What You Measure - Millennium Development Goals

Sustaining Management Improvement Through Personnel Changes

My reply to a comment on Reddit about my interview: Leadership While Viewing the Organization as a System.

So if a new manager is able to mess it up, the system was necessarily weak? Not sure I agree.

Looking at the context the interviewer asked about a new CIO coming in a gutting the management system. I said if they have a strong management system that can't happen. Executives can't just have whims (usually driven by a desire to "make their mark") that throw out the principles used to manage the company if there is actually a strong management system.

Most organizations just float with whatever fads are going on, so in most they can flip flop as new executives come into place.

On the question of new managers making mistakes. Yes, I agree they can. Once again good management systems make a significant effort to bring new managers up to speed. Those management systems reduce the likelihood of failures created by new managers making mistakes. Again, most organizations do a poor job of brining new managers up to speed: Toyota does a good job, the USA military does also, Costco does a good job, I think P&G does (but my information could be outdated). Many others do this well, but the majority of companies do this extremely poorly. That is a serious failure of a management system and I would put more of the blame for those failures on the poor management system, that the managers making mistakes when they were put in a position they shouldn't have been (being made responsible without proper preparation).

Related: Poor Results Should be Addressed by Improving the System Not Blaming Individuals - Management Training Program (2005 Curious Cat post) - Curious Cat Management Improvement Dictionary