Tools for Leaders

Regaining Focus - Keep it Simple

Regaining Focus - Keep it Simple

The Junkyard: Artifacts of Lost Focus

I recently talked to a colleague about her experience with the shifting sands of continuous improvement in healthcare. She walked me through the programmatic junkyard cluttered by the past 14 years of leadership thought. It was right to think that service can be a differentiator. It was right to focus on quality, and, oh yea, safety. It was right to look around at trends in healthcare management and hop on the lean bandwagon, then the six sigma one, then the lean sigma one. The biggest problem, said she, was that they kept losing focus. Each initiative would start out with energy and verve. But, soon, what looked promising, was quickly seen as a flash-in-the-pan.

Repackaging the Same Thing Makes it Fuzzy

I’m teaching a course called Operational Excellence in Healthcare at a local university. Every year I have to prepare by doing a literature scan and each time I do that I find great sources that echo my colleague’s sentiments.

This year, I found this 2009 article, published in International Journal for Quality in Healthcare by Kieran Walshe . A key finding by Walshe is that we keep repackaging the same thing and get limited results.

Over the last two decades, we have seen the successive rise and fall of a number of concepts, ideas or methods in healthcare quality improvement (QI). Paradoxically, the content of many of these QI methodologies is very similar, though their presentation often seeks to differentiate or distinguish them. Kieran Walshe

1)Even operational excellence is simply repackaging total quality. I’ve argued such in the past. We have to get focused if we want the movement to succeed. Walshe goes on to say:

The repeated presentation of an essentially similar set of QI ideas and methods under different names and terminologies is a process of ‘pseudoinnovation’, which may be driven by both the incentives for QI methodology developers and the demands and expectations of those responsible for QI in healthcare organizations. We argue that this process has important disbenefits because QI programmes need sustained and long-term investment and support in order to bring about significant improvements. The repeated redesign of QI programmes may have damaged or limited their effectiveness in many healthcare organizations.

His point is well-taken: by constantly re-packaging, and buying the next, new shiny thing that comes along (promising the same benefit), we do a disservice to the idea of sustained and thus continuous improvement. So, what advice can I give to regain focus? Keep it simple.

From Fuzzy to Focus: Simplicity

Regardless of what you call it, simplicity will help you gain or regain focus. Here are three ways to navigate to simplicity.

Have a single, compelling, common aim that always pricks your value system.When you think of lean or six sigma or even early attempts at TQM, you know that having a target condition is essential to solving problems. Without a standard, it’s impossible to improve. The result in the early days was to set up metrics willy nilly. By willy nilly, I mean we’d set up global metrics that seemed right based on the external pressures instead of aiming at something compelling. Or, we’d set sub-optimized metrics that were myopic and parochial. Use a single, compelling, common aim that pricks values to create sets of aligned metrics. Ask yourself this: if we hit all of our targets would we lurch forward to our compelling aim? If hitting some of your targets would have you careening off-aim, look how you are defining improved performance.

Avoid the Perfection Trap where you end up going too deep without respecting learning by experimenting. My colleague described something called “Communication Boards” as a thing she could see in the junkyard. While the boards were a well-intentioned tactic, equally well-intentioned folks worked hard at getting them “right”. Even in my own practice, I’ve had to coach leaders who tended to be individual-performance driven to back down from seeking perfection. In a classic case of losing the forest for the trees, people who seek perfection lose focus on forward progress by focusing on jots and tittles. Forever, continuous improvement has been based on trial and error. Shewhart via Deming gave us a nifty learning aid: the pdCA cycle and we know that it’s all pdCA. When we try to perfect one thing, we neglect perfecting the things connected to it. I can have a perfect visual scorecard, but have weak problem solving “feeding” it. Better to try and fail and learn the system-ness of continuous improvement (thank you, Dr. Deming) than to perfect one component of the system. Simplify things by navigating to pdCA not perfection.

Early adopters may not be the best building block for focused change; rather, move as a team. This idea may take some time to sink in. I’m a fan of transformation thinking. I know in my heart that I should do something with my early adopters. Some would advocate pointing to them and saying, “See, this is what I mean! Look at how positive this is!” Thinking that the example is convincing, we’d expect others to just follow. The problem with this line of thinking and the reason that it adds to lost focus, is that like the Perfection Trap, we lose a sense of the whole. Drawing on what I learned as a young Naval officer learning infantry tactics (that’s a long story), a team that is moving as a team packs a bigger punch than one moving as a set of individuals. Early adopters tend to run out in front and it is right to harness their energy. But it’s equally wrong to let them outstrip the team and get too far out in front. A strung out team can lose people, picked off one-by-one by the flaming arrows of fuzziness in purpose, direction, and distraction. To stay focused keep it simple: move as a team.

Leader: Do This to Focus

Each time I start a new engagement, I try to begin with an assessment. I start the assessment by wandering around looking for artifacts. Some are active, in use and healthy. Though, I have to confess that I mostly find these in pockets and lacking system-ness. Most of what I find has been neglected and collecting dust. Junk in the programmatic junkyard, evidence of another short-lived movement.

Leader: get rid of the junk, go back to the basics and keep it simple to keep it focused. Simplicity begets focus. Focus begets results.

Next time I’ll take on Regaining Focus Part Two: System-ness through Integration.  Until then, pursue #better and stay excellent.


1. Kieran Walshe; Pseudoinnovation: the development and spread of healthcare quality improvement methodologies, International Journal for Quality in Health Care, Volume 21, Issue 3, 1 June 2009, Pages 153–159,
Regaining Focus Part Two: Three Ways to Systematize for Focus

Regaining Focus Part Two: Three Ways to Systematize for Focus

In part one of this two-part series, I started the argument that to regain focus, you needed to simplify. I mentioned colleague who described the programmatic junkyard of artifacts strewn about over the years as she and her team pursued various forms of continuous improvement. In this installment, I want to make the case that to systematize is to focus.

Deming was pretty clear on the contribution that the system makes, at least in the negative sense:

“I should estimate that in my experience most troubles and most possibilities for improvement add up to the proportions something like this: 94% belongs to the system (responsibility of management) and 6% special.”1)

If you are experiencing unfocused movement, your continuous improvement efforts may lack systematization. Great, so what is that?


Systems are made up of components, which are parts of the whole by definition. It’s a Latin word that means put together. Components are parts, so they each have a function that serves the whole. Systemized parts – components – won’t function properly apart from the system. Your heart is a pump, but a heart with no lungs doesn’t do much for me.

When you apply this thinking to a continuous improvement management system, you begin to realize that having a standard problem-solving method apart from having a way to prioritize problems gets suboptimal results. You solve problems, but they may not be the right problems. Solving the wrong problems degrades your organizational focus.

Complementary Components

For the components to yield optimal results, though, they have to be complementary: they should have good synergies and blend into one another. Having a problem-solving method that doesn’t mesh with your problem prioritization component just confuses.

I’ve worked with clients who have – in the past – put so much emphasis on what they were calling strategy deployment or hoshin planning, without having a component in their system to aim for the long term or to learn what their annual improvement portions were. They’d plan projects and rapid improvement events – tying up many people and a lot of resources – without knowing whether that specific improvement was needed. Instead of having a long-range plan for improvement and learning what to improve over daily, weekly, monthly and annual cycles, they’d stop once a year, speculate what would be needed the next year, then scramble everyone to do rapid improvement events. The only thing focused about rapid improvement events is the time and attention of the folks working on them…until they’re not working on the rapid improvement and they lose their focus to day-to-day problems that sap their energy.

If components don’t complement one another, they are more like tools in a toolbox. They are helpful at the moment, but like so many other continuous improvement concepts, we use them episodically and for a limited purpose. Limited, part-time, use isn’t focused.

Connected Complementary Components

A socket wrench and a crescent wrench may be complementary, but when they are rattling around in toolbox, waiting for someone to use them, they are hardly connected.

Complementary components have to be connected to gain focus. The walls of my house are incredibly useful, defining the space we live in and protecting from the elements. They provide pathways for wires, and pipes and they frame the windows that let in light and fresh air. I love walls. The roof of my house is useful, too. It keeps us dry and shaded.

At the core, my walls and my roof are entirely complementary. They both are made of the same materials, more or less. They both protect and define the space of our home.

Imagine, though, that my roof was laying in the yard beside my house, disconnected from the walls. It has the potential to protect my family, but because it isn’t connected, it doesn’t.

We can build components of systems that are very complementary, but not connected. Every component in a continuous improvement system obeys four rules: the pdCA cycle, defined responsibilities by role, visual management, and standardization. Each component is related and complements the other. But, when I connect them, the system comes to life to do what it’s designed to do. When I have a daily meeting and limit the conversation to problem-solving, it creates outputs that connect into other components: learning what’s important to solve, elevating problems that can’t be solved, and even learning how to help my team. Without problem-solving, a daily meeting is just another discussion, a transaction amongst thousands that create a cloud of ambiguity and sloppy execution.

Leader: Your Call to Action

Leader: systematized components define world-class operations. Think of a well-oiled machine humming along. Think of a team that’s playing championship ball or an orchestra that’s playing every note correctly. These are examples of many parts working as a whole, systematized components that align and focus your precious time and resources. If focusing better is what you need to reset or recenter your continuous improvement journey keep it simple and systematize.

Until next time, pursue #better and stay excellent my friends.


1. W. Edwards Deming Quotes. (2018). Quote by W. Edwards Deming. [online] Available at: [Accessed 12 Mar. 2018].
When in Doubt, It's All pdCA

When in Doubt, It's All pdCA

It’s all PDCA! My long term mentor and friend Rodger Lewis would often get to the end of his patience with me and conclude our lesson with this simple, true and profound exclamation.  It is all plan, do, check act.  What did he mean?

First, what is pdCA? The plan, do, check, act cycle (or plan, do, study, act cycle for the purists out there) is what W. Edwards Deming called the cycle of continuous improvement.  The Deming Institute says, “The PDSA Cycle is a systematic series of steps for gaining valuable learning and knowledge for the continual improvement of a product or process. Also known as the Deming Wheel, or Deming Cycle, the concept, and the application was first introduced to Dr. Deming by his mentor, Walter Shewhart of the famous Bell Laboratories in New York.” (my emphasis added).

Look, it is pretty simple.  Make a plan.  From problem-solving thinking, you could think of the plan as what should (or shouldn’t) have happened.  It might be a target condition (all the patients discharged by noon), or it might be a target (complete five gas masks every hour, today).

Now, do the process to hit the plan.

Now, check to see if what you did met the plan.  If it didn’t, act: adjust the process so the next time around, you hit the plan. In other words, improve the process.

My mentor, Lewis, made a point to teach us that while the pdCA cycle is never-ending, you often have to start somewhere.  Somewhere was at eleven o’clock, which meant, if you are facing a flat pdCA cycle, you start somewhere between act and plan.  We called that starting point “Analysis,” which pleasantly started with an A and meant that we didn’t have to modify the pdCA cycle heretically.

The question is, what do you do at eleven o’clock? How do you analyze before you plan. Leader’s Standard Work should activate analysis as part of the coaching cycle. As the transformation begins, what leaders do on a daily basis begins to change, radically.  Part of the leader’s job is to go and see to get the facts so he can grasp the situation.  Lewis called this the “three G’s” – go and see, get the facts and grasp the situation.  It is directly related to Taichi Ohno’s practice of direct observation.  Once the leader grasps the true nature of a situation or – even better – a problem, he can formulate adjustments to the process, improving it, giving it the very next best shot at hitting the plan or the target.

The thing about pdCA is that it really might be part of the DNA for the rest of the operational excellence strategy.  Every component in every level of the system has pdCA designed into the way it works.  Without it, each component would bring only limited help to the others.

  • Problem-solving: what should have happened (the plan), what did happen (do and check), how can we contain what happened, so it doesn’t get any further (act), why did it happen (analysis), now what should we do so that doesn’t happen again (adjust).


  • Innovation (suggestion) system: that doesn’t work real good (check), what if I make a quick change (act), what was the effect of that (analysis), it worked (plan do), let’s make sure it keeps working (check)

Gary Convis, former president of Toyota Motor Manufacturing, North America once said that after working at Toyota for ten years, he was just beginning to understand the plan, do, check, act cycle.   Like my CEO friend says: looks simple, plays hard. Lewis, wizened and salty, knew pdCA deeply and knew that the “all” in "'s all pdCA..." meant that every part of the system must obey the pdCA cycle.  He also knew that at the end of every proverbial rope – when patience was gone – drag it all back to the pdCA cycle and begin again. It’s all pdCA!


Reduce Variability | Attack Your Management System

Reduce Variability | Attack Your Management System

The most variable processes in your organization are the ones in your management system. Let me start by defining a management system: it is the set of processes and logic your leaders use to make decisions, influence your team and navigate obstacles to produce whatever it is you produce for your customers.   The problem with approaches that I’ve seen to continuous improvement is that leaders think the thing to do is to attack processes to reduce variability.  Lean practitioners attack the waste in a process (often without addressing the uneven demand on the process first).  Six Sigma practitioners root out variation in production processes.

Why don’t we attack the variability in management processes first?  Well, for sure, it is the tougher road to hoe.

Here are a case and point.  How does your organization manage meetings?  Is there a standard for planning the meeting?  For agendas? For record-keeping?  If any of that is standardized, does it apply to all your meetings or just project-based meetings?  Imagine implementing a standard for all your meetings – what kind of push-back would you get?

What is the effect of variability in your management system?  I’d hazard a guess that if you did some time-based cost analysis that your non-standardized management processes cost you a heck of a lot of money.

The countermeasure, at the macro level, is to standardize your management system.

Lean thought leaders have pointed out to me over the years that our system – the one that places cultural transformation by creating a standardized management system ahead of team-based problem solving – lacks attention to “standardization.”   They suggest that the origins of lean thinking require standardization early in the transformation citing “without a standard you can’t have improvement.”

I don’t disagree: our approach is to standardize the management system first. Many look past the management system to the process because that is what the current take on continuous improvement would have you do.  Some look at the management system and accept that it is necessarily variable.


Do you want a transformed culture? Attack the daily experience found where your management processes intersect the people trying to make or deliver for your customer.

You may even find that a significant amount of the variability that you see in your production process has its root in your management system.


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