Mini-workshop at the Healthcare Systems Process Improvement Conference 2024
February, 2024 [date to be finalized]
Interdisciplinary Synthesis and Application of System, Process, and Project Approaches
Many challenges in healthcare require abstraction, synthesis, and application of an interdisciplinary combination of tools and approaches from other problems or disciplines. This intensive workshop will review key elements of systems thinking, process improvement, and project management, then lead attendees in synthesizing these for nontraditional or unexpected applications in healthcare.
Against a backdrop of increasing volatility, uncertainty, complexity, and ambiguity (VUCA), it is important for those who would improve healthcare delivery to expand the depth and breadth of the problem-solving value that they bring to their organizations: an ever-growing number of healthcare challenges require an interdisciplinary skillset and approach, and progressively fewer problems are found or resolved solely in processes, much less in simple replication of a previous solution. Rather, addressing the complex problems of today and tomorrow will suggest (if not demand) an amalgam of operations research, system engineering, industrial engineering, management science, operations management, even project management in addition to Lean, Six Sigma, and other process improvement.
- Explain the concept of interdisciplinary synthesis and why it is of increasing importance in healthcare
- Describe the process and the need for abstraction, then synthesis, and finally application of key elements from one scenario/discipline to another
- Apply the mindset and toolset of systems, process, and project to a wide variety of nontraditional targets
Presentation at the Healthcare Systems Process Improvement Conference 2024
February, 2024 [date to be finalized]
The Ultimate ISE “Power Couple”: Process and System
Process gets all the attention, while System is frequently mentioned yet often narrowly viewed and incompletely appreciated. However, when properly understood and utilized, System becomes a powerful companion to Process in managing complexity towards desired ends in healthcare. Come challenge, expand, and better apply your understanding of healthcare Systems.
The word, “systems” is used frequently, casually, yet variously in healthcare – and it’s easy for what we think we know to become an obstacle to greater understanding of its full meaning, implications, and applications. This presentation challenges attendees to expand that understanding, then to apply it effectively in healthcare improvement.
Popular (yet limiting or even counterproductive) conceptualizations of systems are examined, analyzed, and expanded more fully into a more complete and comprehensive understanding of systems and their nature. Process and systems are compared and contrasted: as conceptual lenses through which to view, approach, and comprehend; and as conceptual models to document, analyze, and identify opportunities for improvement. Example applications of systems (as lenses and as models) illustrate their power as a complementary approach to that of process, thereby providing a more effective toolkit for managing the complexity of healthcare ISE towards desired ends.
A systems mindset and toolset, as an adjunct to those of process, offer greater insight into the complexity and resultant problematic symptoms that pervade healthcare: explaining the past and present, predicting the future, and suggesting approaches to facilitate desired outcomes.
Attendees will gain greater appreciation and confidence in the necessity, efficacy, and feasibility of a systems lens and of systems models to improve their ability to improve healthcare.
Mini-workshop at the Healthcare Systems Process Improvement Conference 2023
February 17, 2023
Healthcare’s Critical Need for Strategic, Holistic Industrial and Systems Engineering
The 2014 PCAST report suggested ISE as an important part of redesigning the overall healthcare system, and healthcare today faces even greater challenges. However, many organizations still typecast and relegate ISEs as tactical optimizers of lower-level processes and individual encounters – typically from the perspective of providers – and such a reductionist approach is ineffective against growing complexity. We need to get ISEs capable, recognized, participating, and even leading in strategic, holistic, big-picture, long-term efforts – alongside healthcare providers, administrators, and policy-makers – that focus on the end-to-end journey of the patient and the value delivered throughout, first prioritizing effectiveness and then efficiency.
Industrial engineering typically focuses on the temporal flow of materials and information through processes; systems engineering typically focuses on hierarchical interconnectedness and architecture. A methodical, transdisciplinary synthesis of both – combined with greater literacy around medical, administrative, regulatory, financial, and sociopolitical providers, influencers, and stakeholders – can prepare ISEs to be leaders in the intentional design, implementation, troubleshooting, and improvement of the end-to-end healthcare process, within the context of the system of systems that is health-and-wellness. Such preparation must then segue into incorporation: a “seat at the table” for strategic, holistic reimagination and renovation of healthcare at the highest levels.
After laying a foundation and a vision, presenters/panelists will brainstorm with the attendees to assess where and why ISE is contributing strongly to improving the effectiveness, efficiency, and experience of healthcare, where and why it is yet not, and how to make better progress and greater inroads. Together, we will explore possible mismatches: theory versus practice; academia versus industry versus regulatory; and others. No easy answers will be presented or emergent, but this session aims to spark the interest and imagination of a sufficient number of attendees to begin the proverbial journey of a thousand miles with a single step.
Perhaps the only conclusion on which all stakeholders can agree is that healthcare, as we now know it, is pathologically unsustainable – and that drastic, transformational change of some sort is inescapable. The timing, nature, and details of such change are highly speculative and controversial, since healthcare is both the culmination and the nexus of wicked complexities that surpass our abilities even to comprehend, much less manage effectively to desired ends through convention methods. Will healthcare ISEs and SHS as a professional society actively shape the wave of coming change, ride out that wave, or be crushed by it into irrelevance?
Presentation at the Healthcare Systems Process Improvement Conference 2023
February 17, 2023
Lean Lessons in Life (and Vice Versa)
Because a problem-solving, results-oriented mindset can be difficult to “switch off” when leaving the workplace, ISEs often struggle with finding a balance between work and life: spending inordinate after-hours time on professional issues at the expense of personal obligations and opportunities, or evoking complaints from friends and family that “not everything is a problem to be solved.” Conversely, ISEs often worry over how much their personalities and personal experiences should be brought into their workplace.
What if the persistent difficulty in “finding a balance” between such compartmentalized modalities stems from seeking the wrong solution to the wrong problem?
Personal undertakings have objectives and depend upon constrained resources, so ISE methods and mindsets can improve their results; and professional undertakings require dealing with people, influenced by the respective life experiences of all involved. Therefore, instead of seeking a “balance” between professional and personal lives, perhaps we should be seeking a holistic, integrated, symbiosis – one that respects differences in contexts, objectives, and priorities while eschewing artificial, limiting distinctions.
In this presentation, such integration will be explored and illustrated through sharing of the speaker’s life experiences, including recently navigating his 98-year-old mother through a protracted and perilous journey through the healthcare system.
Intentionally cultivating a holistic, experimental, learning, continuously improving mindset – through which the entirety of an individual’s previous experience is brought to every new experience, and through which every new experience adds incremental skills, knowledge, and wisdom – allows an individual to see patterns and other similarities across what otherwise might appear to be unrelated, irrelevant circumstances. Such insights can foster greater personal and professional accomplishment, satisfaction, and fulfillment.
Some individuals may find it easy, effective, and satisfying to compartmentalize their professional and personal lives. However, many individuals may find greater peace, satisfaction, and fulfillment — as well as accomplishment — by embracing, integrating, and applying the authentic, holistic entirety of their mindset, methodologies, skills, sensibilities, and experiences to everything that they undertake, whether the label be “professional” or “personal”.
Presentation at the Healthcare Systems Process Improvement Conference 2023
February 16, 2023
Using Two-Dimensional Gap-Analysis to Facilitate Effective, Efficient Initiatives
A strong problem-statement – defining the purpose, objectives, and basic vision of “done” (and of “done well”) – is critically important for the success of any initiative. Gap-analysis is a common and extremely helpful tool for the formulation of such problem-statements: assessing and describing the current state, the desired/future state, and the key differences (“gap”) between those states can provide a highly effective foundation for an action-plan to achieve the desired results. However, traditional gap-analysis assumes consensus – shared mental models – among all stakeholders regarding the current and desired/future states, and unsurfaced lack of such consensus undermines the effectiveness of the analysis.
We can model the problem as gaps in two orthogonal dimensions: a horizontal gap between present and desired states; and vertical gaps between divergent conceptualizations of various stakeholders for both the present and the desired state. This suggests a three-step process for effective, efficient bridging of all gaps: cultivating a shared mental model for the present state by articulating each stakeholder’s conceptualization, analyzing all areas of overlap and discrepancy, then synthesizing a practical consensus; cultivating a similarly shared mental model for the desired future state; then performing the familiar analysis of the gaps between those states.
Such methodology may initially appear to be obvious restatement and needless complication of present practice, since “everybody knows” the importance of engaging stakeholders. However, just as the systematic rigor of traditional gap-analysis reduces the likelihood of errors and omissions when crafting a problem-statement (and its resulting project-plan), similar rigor and intentionality reduces the likelihood of flaws in the foundational elements of such analysis. Explicitly developed and articulated consensus on the needs and benefits of a project can accelerate its planning, facilitate its implementation, and reduce unanticipated obstacles and unintended consequences that might otherwise threaten its efficacy and efficiency.
Post-mortem analysis of problematic initiatives often reveals root causes in two key areas: incomplete, inaccurate, or irrelevant problem-statements; and disengagement or opposition from key participants. Performing deliberate, explicit, systematic gap-analysis on stakeholders’ conceptualizations of present and future states – prior to traditional gap-analysis between those states – improves both the problem-statement itself and participants’ buy-in for the resulting initiative to address it. Such two-dimensional gap-analysis can be effective for collective initiatives at any scale, from high-level organizational strategy and redesign, to process-improvement for departments and teams, even to one-on-one professional collaboration and personal relationships.
Presentation at the Healthcare Systems Process Improvement Conference 2022
January 20, 2022
There is ever-growing need for transformational change in healthcare on many fronts: to improve quality and accessibility of care; to reduce the time, money, and other resources required to deliver that care; and to respond more effectively to pandemics such as COVID-19 and to other disruptive stressors. However, the protracted difficulty and high rate of failures of change-initiatives in healthcare – indeed, in organizations of any type, size, or sector – continues to be a significant obstacle to such transformation. We need a better, more fundamentally sound, more effective approach to designing and implementing change in healthcare.
Transformational change initiatives are far more likely to have lasting success, when principles from systems thinking, systems engineering, and industrial engineering are applied to the entirety of the initiative, such as:
- Thorough understanding of the present state of the organization, including what precisely is needing improvement and what systemic interdependencies reinforce the problematic state and/or are vulnerable to cascaded disruption;
- Unambiguous articulation of the scope, nature, costs, benefits, and verification of the desired improvement;
- Good-faith involvement of all stakeholders from inception, both for collaboration and for cooperation; and
- Looking through a variety of lenses at the needed changes, possible repercussions, and proposed solutions.
This presentation explores how understanding and approaching the organization as a system can help to identify, avoid, and address the underlying causes of change-resistance, thereby facilitating positive, lasting, transformational change.
Excerpt from the Healthcare Systems Process Improvement Conference 2021
September 7, 2021
Efficiency (of a company, organization, supply chain, or other sociotechnical system) is irrelevant if it neglects or sacrifices effectiveness, which is the capability to deliver the necessary value when and as needed – without which, the organization fails to fulfill its purpose, its very reason for existence. Furthermore, it is important to remain effective and to continue to deliver value, even when unexpected or undesirable conditions emerge, either internally or externally.
Robustness, resilience, and recoverability are among the quality attributes that characterize the capability to remain effective under stress. Unfortunately, many of our organizations and other sociotechnical systems demonstrated insufficiency of these attributes in the wake of COVID-19 – and pandemics are just one type of catastrophic stressor.
For our systems to have greater capacity to maintain effectiveness in the face of stressors, they must have “something extra” in reserve, such as redundant functionality, surplus inventory, and multiple and flexible ways to accomplish specific tasks. However, the lack of a systems perspective and approach in Lean process-improvement could identify such “extra” as superfluous waste to be eliminated – and, arguably, this created much of the vulnerability that COVID-19 exposed in sociotechnical systems such as supply chains.
In short, there is indeed such a thing as a company or organization being “Too Lean”!
Featured article in PPI Systems Engineering Newsjournal
The complexity of modern organizations (and their products/services and environments) demands a systemic approach to their design, operation, and improvement. Failure to approach this complexity systemically is the root cause of most of the problems facing organizations today. A conceptual model of an organization is proposed, featuring five orthogonal elements – culture, structure, process, technology, and learning – that must be understood, approached, and managed as interdependent components of a complex, adaptive, sociotechnical system of systems. This model can be broadened, distilled, and simplified into a mindset and methodology that enables everyone throughout an organization to become agents for its continuous improvement.
Webinar on Systems Thinking
(Sponsored by the Wright State University Chapter and the Indiana Chapter of the Institute of Industrial and Systems Engineers)
October 22, 2020
An Introduction to Systems & How We Think About Them
People use the word, “system” in many different ways – but what exactly does it mean, and how can better understanding of systems lead to better outcomes? This presentation introduces the concepts of systems and systems thinking as essential skills and powerful tools in the management of complexity towards desired results. The interdisciplinary roots of systems thinking trace back to biology, ecology, sociology, and cybernetics. Every workplace and job-description can benefit from this holistic approach to understanding, anticipating, and influencing the behavior of interacting components whose “whole is greater than the sum of its parts.”
Full-day pre-conference workshop at 2020 IISE Annual Conference
(Institute of Industrial and Systems Engineers: New Orleans, LA)
[* due to COVID-19: conference converted to remote-only; workshop cancelled *]
Improving the Effectiveness, Efficiency, and Quality of Organizations as Systems, by Leveraging Disappointment
This innovative, interactive workshop explores a holistic, systemic model and approach for organizations. It explains how five subsystems – culture, structure, process, technology, and training – must be designed, implemented, operated, and improved as interdependent components of the larger sociotechnical system. It investigates common problems in organizations and illustrates their systemic identification and remediation. It contrasts centralized, episodic intervention with distributed, inherent wellness. Finally, it explores a mindset and a methodology that enables everyone throughout the organization to be ongoing agents of positive change and of improved quality, by leveraging disappointment as a trigger and focus of inquiry.
April 23, 2020
The COVID-19 pandemic has been a “stress test” on individuals, companies, and governments — and the impacts and responses suggest that we have a lot of room for improvement. One by one, our illusions (and the complacency that is both cause and effect of those illusions) are dying, as we realize that things nearly aren’t as robust as they should be.
This song charts my own journey of that unhappy discovery, told against the music of Don McLean’s classic rock ballad, “American Pie”.
While the word “systems” doesn’t appear front and center, this song addresses the systemic ripple-effects of COVID-19 (and of our responses to it) throughout our sociotechnical systems.
(10th Annual Clinical Informatics Summit, Southern California Chapter of HIMSS)
May 18, 2018
Only a small fraction of available healthcare data is analyzed presently, and the imbalance is likely to increase substantially in the near term. At the same time, there is increasing demand for data-driven healthcare decisions. If we are to address both problems without compounding them, we need to cultivate and to employ consistently a mindset that seeks the bigger picture around the purpose, provenance, and protection of healthcare data.
In this presentation, we will:
- Explore healthcare as a sociotechnical system (people, process, and technology)
- Describe quality within that systemic context
- Illustrate the crucial role of Clinical Informatics in ensuring healthcare quality
- Suggest an “Informatics Pause” as a means to avoid “data-driven dysfunction”