Government Performance Improvement

Maintaining Business Continuity in Crisis – COVID-19

Maintaining Business Continuity in Crisis – COVID-19 150 150 Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense
Submitted By: Brian MacClaren

Author: Paul Dean, NOVACES (Washington, D.C.)

Amidst the uncertainty of the current environment, the currency of information expires within a few short weeks, sometimes merely within days.  Indeed, the global outlook in February 2020 is entirely alien in the context of what we now know two months later.  However volatile our predicament may seem though, two things are certain: the pandemic of COVID-19 will ultimately end, and another pandemic looms on the horizon.  While it is exceedingly difficult to consider returning to the status quo, it is imperative that leadership aligns business objectives with that inevitability in mind.  Whether the crisis subsides in six weeks or six months, the organizations that can maintain continuity in their operations will emerge leaps and bounds ahead of their peers when the dust settles.

A calamity of this scale is unprecedented in our lifetime, so it is of little wonder that organizations are channeling the entirety of their resources towards combating the issue.  In fact, the gravity of the situation almost necessitates this colossal response.  However, many institutions are failing to consider the trade-offs of this all-in approach.  The intent of this paper is to shed light on these concerns in the hope that leaders will evaluate the true opportunity costs at stake and calibrate a more measured response.  The ideal end state is to achieve impactful contributions at the current worldwide forefront while simultaneously accomplishing most business objectives that existed prior to the crisis.  There are numerous paths to attaining this end, but each response will require a certain measure of the following key tactics: reallocation of human capital, focused process improvement, and strategic emphasis.

Reallocation of Human Capital.  A catastrophic event has the potential to shake the foundation of an organization’s strategic vision, and talent management is typically the first casualty.  As Von Molke’s timeless insight goes, “no plan survives first contact”, and leaders’ first impulse in dire circumstances is to forgo previously assigned roles and responsibilities.  In doing so, they immediately redirect most of their assets to address the issue at hand.  Although this may be the best tactic for weathering the adverse effects of the predicament, it will not age well.  If management dedicates an overabundance of human capital to the principal problem, they will neglect to realize the gains from their routine business operations.  A rudimentary example will illustrate this further.

In a hypothetical scenario, an organization has ten lines of effort.  Each line of effort conveniently utilizes ten percent of the overall manpower.  Further, the program management office has rank ordered each of the groups by strategic importance from one to ten.  In the event of a disaster, senior management decides that they will re-purpose personnel from the bottom five lines of effort to their new crisis management response team.  While they will still reap the rewards of five of their original objectives and mitigate the crisis, they are absorbing an enormous opportunity cost by indefinitely forestalling the other five objectives.  An alternative and far more efficacious approach is to sub divide the workload of the degraded lines of effort among the team members of the remaining five groups.  Figure 1 captures the benefits of optimizing human capital:

maintaining-business-continuity-figure-1

Figure 1.

Although it seems untenable to suddenly modify the workload of a small portion of employees, properly assessing the available human capital will show that there are individuals who are up to the task.  To be clear, the untimely upheaval in company structure will still diminish business objectives, but having a dedicated team maintaining forward progress outside the scope of the crisis will ensure the continued delivery of value to the organization.  Notwithstanding, maintaining business continuity with severely constrained resources will require the innovative tools of focused process improvement.

Focused Process Improvement.  If rearrangement of the manpower inventory is the catalyst for achieving business continuity, then harnessing process improvement tools is the fuel that keeps the initiatives in motion.  Unfortunately, channeling resources to alleviate crisis magnifies the effects of the triple constraints on enduring efforts.  Inadequate resourcing, condensed timelines, and reduced scope all threaten to test the limits of the team, so innovative approaches are vital.  Leaders must empower their subordinates by deferring to their expertise and affording them the latitude to accomplish tasks via unconventional approaches.  With newfound influence, the team will be able to rapidly identify various inefficiencies and defects in the organization’s processes.  Often it takes extraordinary and challenging circumstances to identify issues that would never be addressed under the status quo.  Identifying problems is only half the battle though.  Failing to conduct analysis and provide a viable solution can simply exacerbate the issue.  Hence, focused process improvement is an invaluable asset that will help frame the problem and keep the team fixated on improvement.  An example of an all too common bureaucratic procedure will exemplify this.

Using the same theoretical company in the previous example, the business continuity team quickly realizes that there are significant procedural hurdles when moving projects through the project life cycle.  Mandatory phase gate meetings, progress reviews, and numerous stakeholder updates overburden the team’s capacity.  Furthermore, each of these engagements requires follow-up documentation that gets routed for signature approval through several departments.  The team decides to focus solely on this governance aspect of the lifecycle process and determines that they can reduce the number of touch points by 75 percent.  These measures alleviate the already constrained continuity team’s responsibilities and allow them to devote more of their time to advancing the timely completion of deliverables.

In unprecedented times, the amplification of constraints calls for both inventive allocation of talent and the application of process improvement to continue impacting the bottom line.  However, these tactics are not fruitful if the organization lacks the proper vision.

Strategic Emphasis.  The utility of creative solutions is meaningless if leaders do not support it.  Although the world has turned its attention exclusively towards the crisis, the onus is on management to keep delivering value while concurrently averting the fallout of the pandemic.  The shadow of disaster shrouds mundane operations from view, but a failure to sustain continuity will incur a hefty cost when normality returns.  The leaders who understand the criticality of these costs will divide their talent pool in a way that does not bring standard operations to a grinding halt.  They will vest their teams with the proper tools and message the strategic importance of bringing those tools to bear.  Ultimately, this top-level emphasis is a transparent way to show that leaders acknowledge the gravity of the current environment yet have the foresight to anticipate the future that lies ahead.

Although all eyes are now on the pandemic, there will come a time when they revert to steady state operations.  When that time comes, those who took the twofold approach towards maintaining business continuity and confronting COVID-19 will emerge in far greater standing.  Rather than spend months or even years picking up the pieces in the aftermath, the organizations that practiced resiliency and portrayed adaptability will be paragons for future success when the next catastrophe strikes.

Improving Project Portfolio Performance with Buffers

Improving Project Portfolio Performance with Buffers 150 150 Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense

Click the link below to view the TOCICO 2015 presentation “Improving Project Portfolio Performance with Buffer-Type Flexibility and Task-level DBR”

TOCICO PPM Buffer-type Flexibility + Task-level DBR

Utah’s SUCCESS Framework on the Inside, for Success on the Outside

Utah’s SUCCESS Framework on the Inside, for Success on the Outside 150 150 Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense
Submitted By: Brian MacClaren

Click the link below to view the “Working with the SUCCESS Framework on the Inside, for Success on the Outside” presentation at TOCICO 2015.

Link to presentation slides:

TOCICO_UCI 9-2-2015

Link to video:

Working with SUCCESS Framework

Catching the HRO Wave: Marching Towards “Zero Harm to Patients”

Catching the HRO Wave: Marching Towards “Zero Harm to Patients” 150 150 Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense
Submitted By: Dr. Bahadir Inozu

After seeing the benefits of becoming a High Reliability Organization (HRO) in other industries, Military Healthcare System (MHS) is transforming into an HRO, as mandated following a  Secretary of Defense ordered review of safety, access, and quality in 2014.  This review stated that, “The foundation for improving performance in the MHS rests on combining the concepts of an integrated health care system with those of high reliability organizations. The principles of a high reliability organization are operationalized through leadership engagement, a culture of quality and safety, robust process improvement,” according to the review.

HROs are able to reduce errors through culture changes and technology while working in an inherently high-stress, high-tempo environment. In collaboration with George Mason University, NOVACES sponsored a one-day workshop on “Developing a Culture of Safety in Health Care: The Benefits of Becoming a High Reliability Organization” on June 24, 2015 in Fairfax, Virginia to raise awareness about the benefits of HRO to encourage other Healthcare Systems to become HRO’s.

The workshop started with a focus on “Why Change?” and it provided a basis for understanding how adopting HRO operational practices can help create a culture of safety, reduce the number of errors, and meet safety, quality, and efficiency goals.

Why should hospitals become High Reliability Organizations?

It is estimated that as many as as many as 400,000 preventable deaths occur every year in the United States in civilian hospitals, according to an article published in the Journal of Patient Safety in 2013. Indeed, almost everyone knows at least one person who was harmed due to preventable mistakes at hospitals. Hence, there appears to be a consensus to increase the patient safety levels to new heights.

The Goal of becoming an HRO is “zero preventable harm in high risk operations.” Other high risk industries have achieved this goal to a certain extent such as the Aerospace, Civil Aviation, Nuclear Power Industries as well as Nuclear Submarines and Aircraft Carriers. Transformation to HROs is long overdue for the healthcare industry.

“If done properly, the quality of care will markedly improve throughout the transformation process. HRO is not just another initiative, it’s a commitment to your patients that’s too important not to make,” said Spence Byrum, CEO of HRS Consulting, Inc. He saw its amazing impact in aviation, as a former United States Coast Guard pilot.  There is a pending rule that will further reduce reimbursement for hospitals not proficient in an “all hazards” approach to disaster preparedness. “Reimbursements will go down if hospitals do not take an all hazards approach,” Byrum warned.

“You have a plan. Then life will let you know whether your plan is any good!” said W. Earl Carnes, who served as a Senior Advisor of DOE for High Reliability & Liaison with the Institute of Nuclear Power Operations (INPO).  He added “It is hard to see what HRO’s do. Most organizations focus on tools, but attempts to adopt practices without understanding concepts, models and principles routinely meet with failure. What is missing is how they think, how they work together, what they view as important. Perhaps the best way to learn is to listen to their stories, to hear about both what they do and how they think.”

“People who understand this approach best are those who have been vulnerable… People who have been at risk of dying” said Dr. Daved van Stralen, who pioneered the application of HRO principles in healthcare. He added, “There is a cross over, a threshold that changes the way they think. It is hard to translate that to other people.”

“Your life is a lot safer because of HROs” said Mark A. Crafton, Executive Director of State and External Relations at The Joint Commission. He gave examples from other his risk industries including aviation, banking and theme parks. Universal Studios in Orlando is a good benchmark, where the goal is to ensure safety of staff and visitors. Entire park and each stunt are under constant video surveillance and safety personnel intervene immediately when a safety risk is detected.

Some of the leading hospitals already started their journey to HRO transformation include Atlantic Health, Barnes-Jewish, Baylor, Cedars-Sinai, Cleveland Clinic, Exempla, Fairview, Floyd Medical Center, Froedtert, Intermountain, Johns Hopkins, Kaiser-Permanente, Mayo Clinic, Memorial Hermann, New York-Presbyterian, North Shore-LIJ, Northwestern, OSF, Partners HealthCare, Sharp Healthcare, Stanford Hospital, Texas Health Resources, Trinity Health, VA Healthcare System-CT, Virtua, Wake Forest Baptist, Wentworth-Douglass and MedStar Health. And the list is growing fast with the addition of the Military Health System.

The workshop participants also discussed “What blocks us from reaching the HRO goal? What are the constraints and how to break them? Which information will we need?” In the next article we will discuss these and “What to Change” to become an HRO.

Our work in Utah was featured on the Governor’s blog!

Our work in Utah was featured on the Governor’s blog! 150 150 Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense

Submitted By: Brian MacClaren

Recently our work with the State of Utah was highlighted on Governor Herbert’s blog. To read his post, check out this link:

http://blog.governor.utah.gov/2014/08/why-it-matters-the-effort-to-reduce-recidivism/

Improvements from State of Utah’s SUCCESS Program Adds Jobs for Inmates and Doubles Revenue at Utah Correctional Industries

Improvements from State of Utah’s SUCCESS Program Adds Jobs for Inmates and Doubles Revenue at Utah Correctional Industries 2560 996 Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense

Submitted By: Robyn Burghard

Utah’s SUCCESS Program led by the Governor’s Office of Management and Budget (GOMB) has reported positive results on an initiative that supports of Governor Herbert’s mission to reduce recidivism (the relapse of criminal behavior) in the State. NOVACES, a management consulting firm that provides performance improvement solutions to the government, is teamed with Goldratt Research Labs to deliver operational excellence training and facilitation support to Utah Correctional Industries (UCI) as part of the initiative.

Studies show that 66% of inmates return to prison within three years of release, whereas inmates with UCI work experience return only 55% of the time. NOVACES is teaching new skills to the inmates and streamlining manufacturing processes in an effort to increase revenue and expand opportunities for inmates at UCI’s Furniture shop.

With the help of NOVACES and GOMB staff, UCI applied operational excellence methods to increase production capability in the furniture manufacturing process. As a result, the furniture shop was able to better manage production and could deliver more orders on time to its customers. The production capacity and revenue was more than doubled, and most importantly this has generated new job opportunities for inmates.

UCI expects to add between 21 and 26 new jobs for inmates as a result of the new manufacturing processes. Currently there are over 7,000 inmates in the Utah prison system at an average cost of $28,000 an inmate per year. Although 3,417 inmates are eligible to work, currently just 740, or 21%, are employed by UCI. Their goal is to be able to provide a job for every eligible inmate.

This initiative’s success will enable UCI staff to further expand process improvements to its 16 industries including construction, furniture, print shop, signs, and embroidery. Alan James, Director of UCI, thanked NOVACES for the excellent work on the initiative and expressed support of  replicating the outstanding success of the furniture shop in other UCI businesses.

Our work in Utah was featured on the Governor’s blog!

Our work in Utah was featured on the Governor’s blog! 2560 996 Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense

Submitted By: Brian MacClaren

Recently our work with the State of Utah was highlighted on Governor Herbert’s blog. To read his post, check out this link:

http://blog.governor.utah.gov/2014/08/why-it-matters-the-effort-to-reduce-recidivism/

Veterans Health Administration Steadily Increasing Use of Lean Six Sigma Process Improvement to Support Its Systems Redesign Initiative

Veterans Health Administration Steadily Increasing Use of Lean Six Sigma Process Improvement to Support Its Systems Redesign Initiative 150 150 Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense
Submitted By: Brian MacClaren

Troop drawdowns in Iraq and Afghanistan and impending cuts in number of troops directed by the DoD has created an urgent need for business transformation within the VA hospital system that supports our veterans after they have transitioned back to civilian life.  Among the various improvement strategies for the VHA is the Systems Redesign, which aims to improve healthcare quality and access to care for veterans.

Systems Redesign leadership in the VHA has been using the process improvement methodology called Lean Six Sigma, which in the last decade has become a key management strategy and driver of change for civilian hospitals, to provide fundamental quality and process improvement tools to the teams who are leading transformation efforts within the VA Medical Centers.

Fargo VA Medical Center could be considered one of the more advanced VA medical centers in terms of adoption of Lean Six Sigma. The organization held a workshop in 2012 on how to manage improvement initiatives, which included an overview of the Lean Six Sigma methodology. Since then, the adoption of Lean Six Sigma has been steadily growing within the organization.

To develop the program from its early stages, leaders of Fargo VA Medical Center Systems Redesign contracted with NOVACES, a management consulting firm that specializes in performance improvement for veteran healthcare, for guidance on how to incorporate the VA High Performance Development Model and Veterans Health Administration System Redesign objectives.

“The right blend of Systems Redesign, TAMMCS, Lean Six Sigma and PDSA in a collaborative setting creates an environment for VA medical centers, like the one being experienced in Fargo, that promotes the kind of improvements needed to continue providing our nation’s veterans with the very highest quality healthcare services,” said retired U.S. Navy Captain Charles Mount, director of government healthcare services at NOVACES.

 

Other VA healthcare facilities, including VISN 8 Bay Pines VA Medical Center and North Chicago VA James A. Lovell Federal Health Care Center (FHCC) are also rigorously investing in Lean Six Sigma by training staff and leadership and completing improvement projects that are aligned with strategic plans.

Similar to the widespread adoption of Lean Six Sigma in civilian healthcare, healthcare performance improvement experts promote the rigor and analytical capabilities of this healthcare process improvement methodology to also drive the tremendous amount of change that the currently strained VHA healthcare system must undergo to meet the demand for care generated by the nation’s 22 million veterans.

Twelve Days of Constraints Management: #3 WIN-WIN

Twelve Days of Constraints Management: #3 WIN-WIN 1656 1158 Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense
Submitted By: Brian MacClaren

#3. WIN-WIN

A house divided cannot stand. People want to do good, but sometimes our perspective of the system gets in the way. Constraints Management fosters a scientific, humanistic, win-win approach where all stakeholders benefit. Resistance to change is therefore minimized, speeding up the rate of adoption and improving the likelihood of success for Lean Six Sigma efforts.

12 Days of Constraints Management

That’s another reason and another day closer to the holidays. To get us into the spirit, I have been running the “Twelve Days of Constraints Management.” This holiday series focuses on why integrating Constraints Management (or Theory of Constraints) with Lean Six Sigma can be a force multiplier for your organization. Enjoy!

Twelve Days of Constraints Management: #4 EXECUTION

Twelve Days of Constraints Management: #4 EXECUTION 1656 1158 Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense
Submitted By: Brian MacClaren

#4. EXECUTION

Performance improvement initiatives are projects. When projects are poorly executed, benefits are lost and penalties are incurred. This includes opportunity costs associated with wasted resource potential. Critical Chain Project Management, a component of the Theory of Constraints toolkit, accelerates Lean Six Sigma projects and is the gold standard for resource management.

12 Days of Constraints Management

That’s another reason and another day closer to the holidays. To get us into the spirit, I have been running the “Twelve Days of Constraints Management.” This holiday series focuses on why integrating Constraints Management (or Theory of Constraints) with Lean Six Sigma can be a force multiplier for your organization. Enjoy!

Novaces | Lean Six Sigma Training | Process Improvement | Healthcare | Government | Defense