Published on: Tuesday, August 24, 2010
Management Today is Outdated
Posted By: Robyn Greenspan
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Why have there been advances in virtually every technology invented in the last 100 years, yet management is woefully out of date? At the 2009 World Business Forum, where ExecuNet exclusively reported, strategist and innovator Gary Hamel asked the delegates, “Could technology management change in this century the way it changed in the last century? Almost all organizations are running on 19th century management systems.”
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“You won’t make change by benchmarking the Fortune 500,” Hamel said. “You have to challenge dogma, explore the fringe and experiment.”
Hamel challenged: “It’s your responsibility to put together the management process. What will it look like? How would the management model you come up with compare to the organization you work with now?”
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There was a book about small and fast eating the big and slow.
“It’s Not the Big That Eat the Small…It’s the Fast That Eat the Slow: How to Use Speed as a Competitive Tool in Business”
by Jason Jennings and Laurence Haughton
Clearly, the tax law is biased against non-government solutions to anything. Small business can’t lobby the Gooferment the way that “Big Business” can. Big Business gets: tax breaks from Gooferment in exchange for “campaign contributions” and other (possibly illegal) considerations, legal and regulatory protection that insulates it from competition ①; and political decisions on Gooferment contracts carved out for Big Business.
SOOOooo, how do the “little people” compete?
Size, speed, and ruthless fiscal discipline.
One has to admire the “movie studio” model. Resources come together for a project and depart when no longer needed. There is no eternal “organization” created.
Given that laws and regulations generally stop at a specific size, it will pay to stay under that size. (Interesting that large companies are studying how they can divide artificially to squeeze under the size requirement. So small geographic areas would be incorporated into “stand alone” entities that would then “contract” with other such entities for “services”. I’m sure that all the lawyers will get rich.)
That favors the small “movie studio” mentality.
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“UPON FURTHER REVIEW”
Interesting. I finally had time to go thru the exit documents that they made her sign before they let her go. Those instructions are ten pages of virtually unreadable “barbara streisand”. Let’s examine what the hospital bureaucrats — no doubt advised by lawyers — wasted paper and toner on.
Under the heading of “just stupid”, this patient doesn’t smoke, virtually never has. (Me either. Ever kiss a smoker? Yuck. And it makes your wee willie shrink up prematurely. For boys and girls. Look it up. That should be enough to get any youngster to quit. Unless the don’t like using. TMI? Hey this is life. Face it. Like the blog title says.) So why are there THREE separate sections of this load of “barbara streisand” about quitting smoking. One section might be a mistake, two an oversight, three is just no one reads the “barbara streisand” pumped out.
Under the heading of “downright dangerous”, are the two pages of medication instructions. (I have yet to exit the hospital with Frau where these are correct. From my memory, EVERY time we’ve left — and we’ve left a lot — there has been at least ONE serious fmpov error.) SO let’s take score of these instructions.
— We have duplicate instructions on insulin. Literally, separated by incorrect insulin instructions. Luckily, DIABETICDOC#3 was clear with her instructions about what she wanted Frau to take. “Regardless of what is in your discharge instructions”. (So obviously the docs know that these instructions are cobbled together “barbara streisand”.) And, give her even more credit, Frau’s discharge was just a rumor when she gave her exit instructions. (You have to like someone who’s on top of their game. You could almost hear her say: “I don’t care what everyone else is doing. My part of the problem is done right.” She should be in charge. Her or the cleaning lady. Both have their act together.)
— In two items, dosages have been changed which MAY or MAY NOT be correct. (If the lesser dosage is right, then where are the RXes for the new form. Since these dosages were NOT given in the hospital, we’re assuming that this is wrong.)
— Two of her important medications have no instructions at all; so in one case we resumed her old regime and in one case we did not. (Maybe that’s right, maybe that’s wrong.)
— The instructions might as well be written in Babylonian cuniform. It has chemical name, followed by another chemical name in parenthesis sometimes, dosage, instruction, start date, the phrase “ordered as”, and the brand name. (Boy that’s as clear as mud.) The start date is always identical. No where does it say “Take it”. (I know that’s “obvious”. But we are dealing with humans here.) And there’s no indication of what doctor ordered what? (Did my cardiologist really order me to take this cardiac drug or is it one of the other docs covering for him? Who gets sued when it’s wrong and kills me?)
The entire ten page document is a virtually unreadable. I have 20/20 corrected vision. And, I know the tricks one can play with fonts and kerning to pack print on a page. There is a mix of fonts, bolding, and compression that make it a mess to try and read. (Didn’t these folks ever hear of “information mapping”?) As “evidence”, I have a the input from a sample of one, Frau. After scribbling her name on the last page, with it being literally the last thing between her and the door, she look at it, said to me “it’s junk. Can you see if there’s anything important in it?” And, that’s an opinion I can agree with.
How would I improve it?
Well since not everyone getting out of the hospital has 20/20 vision or a Patient Advocate (PiA) to worry about the “barbara streisand”, I’d completely redesign it using the principles of Information Mapping. It’s not a form; it’s a letter. Signed by the principle doctor and nurse.
It should say. “In order to recover, we want you to take” and then a simple list of drug, dose, and time. And, leave the chemical jargon to the pharmacist. If the patient take Nexium, don’t tell them to Esomeprazole Delayed Release.
For each specialty, it should say: “your DIABETICDOC want you to take:”.
Then a section on follow ups. And don’t tell the patient to do the work. “We have taken the liberty to schedule the following appointments. DIABETICDOC on August 31 at 10AM, BLOODDOC on August 13 at 10AM, CARDIODOC on September 15 at 10AM. You, of course, are free to reschedule these as needed.” (Wow, do some value adding work? What a novel idea.)
Print it all in a nice clean 16 point font and we’re good to go.
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ROFL! Yesterday, before Frau was given her release, yet another hospital manager came by to talk about the patient’s perception of her care. Since Frau was sleeping, the lady “nursing director” talked to me. She was taking names of did a good or bad job. Since both patients in the room were “unavailable” (i.e., sleeping), guess I was selected to be a proxy.
I’m not good with names, but this floor was better in general than the CCU or the last floor she was on two weeks ago.
I dusted off my “consulting hat” and asked “Why six sigma?” SHe didn’t answer but asked what my Six Sigma background was. See asking “why” there times is how Six Sigma-ites get to the real reason why you’re doing something. I told her that I had some minor experience in it and challenged her about answering the question.
We got into a discussion of how the technology, process, or people could be deployed that would have transformed that into a patient centric focus.
Another example was the call bell that neither differentiates between urgency or type of need.
Another example was there’s no feedback loop to collection and action what the patient sees.
She gave up saying “they didn’t have …” because it was painful obvious even to her that they do NOT want “patient focused” because they have all their processes. So be honest and call it “processed focused care”.
My observation is, imho, they don’t want to change. They want the praise that comes with being Six Sigma, but they don’t want to do the heavy lifting. My experience with TQM, Six Sigma, and other quality initiatives is that the problem is ALWAYS leadership. They may “talk the talk” but they don’t “walk the walk”. You can put up all the funny inspirational signs on the wall you want, but people are smart. They see your mixed messages and adapt.
In this case, it is NOT “patient centric care”.
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Interesting. During the current admission of my wife, at least four people have transcribed her medication list. Everyone has errors in it. It’s a printed document from my computer.
Time for a little BPR?
And, they purport to be a six sigma enterprise.
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Obviously, FEDEX didn’t.
I’m probably not going to be home for this delivery. So why doesn’t the website allow me to have options?
I know when I will or won’t be home for the delivery, but I can’t tell them.
I know that maybe I’d like to pick it up from them, but I can’t tell them.
I know my relative-in-law will be home around the corner, but I can’t tell them.
I guess they forgot the Customer in the “Package Delivery System”.
p.s., I see from the track of the trek, that it made some long stops along the way. And, that increases Customer satisfaction? My McBa from China came in the same amount of time. Isn’t that strange?
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Dear Blue Cross Blue Shield of Georgia Member
This weekend there was a patch implemented that corrected the Portal Error members have been receiving. Please go to the Blue Cross Blue Shield of Georgia website and try to access your account. If you continue to get the Portal Error, please give Web Support a call at (866) 292-6253 Monday-Friday 8 a.m. – 6 p.m. excluding Holidays. Please reference this email when speaking to a Technician.
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I’d call this “using the User as unpaid debugging help”!
It doesn’t show the proper respect for the User, Customer, or Client.
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