Reducing Variation in Human Behaviour

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  • 1. Reducing Variation In Human Behavior Robert V Berry VP Strategic Improvement Premier Health Partners (937)208-2182 [email_address] © Copyright 2005 Phil Wagar Director, Organizational Effectiveness Premier Health Partners (937)208-5436 [email_address]
  • 2. Premier Health Partners
    • >10,000 employees
    • Largest non-governmental employer in Dayton
    • Multiple ambulatory care, home care, and extended care facilities
    Founded in 1932 560 licensed beds Level 2 Trauma Good Samaritan Hospital Founded in 1917 310 licensed beds Level 3 Trauma Middletown Regional Hospital Founded in 1890 850 licensed beds Level 1 Trauma Miami Valley Hospital
  • 3. PHP Process Philosophy Process Y = f (X) Customers Suppliers Outputs Inputs Valuable Effective Adequate Efficient Available
    • redesign
    • simplify
    • standardize
    f (the process) Lean
    • optimize
    • setpoints
    • control
    x (inputs to the process) Six Sigma
  • 4. A Formula For Change Technical Solution Cultural Solution Effective Results Q x A = E The Effective Result (E) of the solution is a function of the Quality (Q) of the solution and the Acceptance (A) of the idea. When human behavior is the technical solution
  • 5. Managing Human Behavior f reactor design x temperature setting pump speeds reactor pressure
    • Standardization through:
    • Bricks & mortar
    • Equipment sequence
    • Computer programming
    • Control through:
    • Computer controllers
    • Mechanical safeguards
    • Measurement gauges
    • Standardization through:
    • Documented SOPs
    • Training
    • Designed Forms
    • Control through:
    • Motivation
    • Carrot/stick
    • Recruiting practice
    … but I work in a hospital f patient transfer report (transfer of knowledge at nurse exchange) x communication skills information priority sufficient time
  • 6. Right Behavior at the Right Time time process value
    • Stable Operations
      • conformity
      • attention to detail
      • repeatability
      • standardization
    Period of stable operations
    • Process Improvement
      • creativity
      • innovation
      • strategic thinking
      • openness
    Period of process improvement (breakthrough or incremental)
  • 7. Traditional Approaches
      • Tell them what to do - repeat as necessary
      • Get other people (“trainers”) to tell them what to do - repeat until the money runs out
      • Create arbitrary numerical “stretch” goals
      • Bring it up in the yearly performance appraisal
      • Provide punishment (“discipline”)
      • Complain, but not directly to the performer
      • Create and publish a vision statement
      • Provide tote bags, mugs, motivational posters
      • Offer cash
    High Cost; Low Impact; High Stakes
  • 8. Weaknesses of Traditional Methods
      • Unscientific
      • Unsystematic
      • Frequently ad hoc; invoked in reaction to lack of progress
      • Seldom sustainable
      • Expensive
      • Tend to increase variation among individuals, when consistency is called for
      • Little measurable impact on either daily operations or commitment to process improvement
    Not a good fit with systematic, data-driven Lean/Six Sigma
  • 9. Is There Another Way?
    • What is needed:
    • A set of methods and processes for solving problems related to the performance of people in the workplace, which is:
      • Systematic
      • Scientific,
      • Grounded in empirical evidence,
      • Open to all means and media,
      • Focused on achievements that both the human performers and the organization value.
    Human Performance Technology (HPT) Source: Stolovich & Keeps: What Is Human Performance Technology , 1992
  • 10. Comparison
    • Traditional methods:
      • Hearts & minds focus
      • Ideological or emotional appeal
      • Solution oriented
      • Attempts to correct discrepant behavior
      • Seldom measurable in either processes or outcomes
      • Attracts human relations professionals
    • Human Performance Technology:
      • Behavior & achievement focus
      • Rational appeal
      • Cause oriented
      • Attempts to prevent discrepant behavior
      • Eases measurement of behaviors and achievements
      • Attracts those interested in engineering human performance
    HPT Applies Scientific, Systematic Methods to Human Performance
  • 11. Applying Human Performance Technology
    • Determine what the people are currently accomplishing
    • Determine what needs to be accomplished
    • Identify “exemplary performance”--what the best are able to do
    • Measure exemplary performance
    • Measure typical performance
    • Compute the discrepancy between typical and exemplary performance
    • Calculate the economic value of this difference
    • If economically justified, intervene to raise the level of typical performance
    • Sustain the new level of performance
    Sidebar: DMAIC Analogy This process mirrors the DOE process of screening, optimizing, defining tolerances, measuring, and controlling vital x’s
  • 12. HPT Fundamental Systems View Source: Rummler & Brache: Transforming Organizations Through Human Performance Technology , 1992 Any Business Resources Markets Products/Services Orders
  • 13. HPT Fundamental Systems View The Organization Level Function A Function B Function C
  • 14. HPT Fundamental Systems View The Process Level Process 1 Process 2 Process 3 Function A
  • 15. HPT Fundamental Systems View Process One The Job/Performer Level
  • 16. HPT Fundamental Systems View Input Output Consequences Feedback
  • 17. Six Vital X’s for Human Performance
    • Individual Performance is a function of:
      • Performance Specifications
      • Task Interference
      • Consequences
      • Feedback
      • Knowledge & Skill
      • Individual Capacity
    All six are necessary In the vast majority of cases, these last two are NOT the cause of poor performance Input Output Consequences Feedback
  • 18. Six Vital X’s for Human Performance
      • Performance Specifications
      • Task Interference
      • Consequences
      • Feedback
      • Knowledge & Skill
      • Individual Capacity
    • Chemical Reactor
    • Recipe
    • Temperature set points
    • Nurse Transfer Report
    • Clear instructions
    • Quality, quantity, timing of outputs (What will success look like?)
    • Job aids to reduce reliance on memory
    • Training events to reduce variation in what people see and hear
    • Method for evaluating what people see and hear (calibration)
  • 19. Six Vital X’s for Human Performance
      • Performance Specifications
      • Task Interference
      • Consequences
      • Feedback
      • Knowledge & Skill
      • Individual Capacity
    • Chemical Reactor
    • Mechanical failure
    • Impurity
    • Nurse Transfer Report
    • Sufficiency of time, especially when task is new
    • Sufficiency of forms, communication tools
    • Management support, direction, visibility
    • Potential distractions
    • (See Potential Constraints list)
  • 20. Six Vital X’s for Human Performance
      • Performance Specifications
      • Task Interference
      • Consequences
      • Feedback
      • Knowledge & Skill
      • Individual Capacity
    • Chemical Reactor
    • None
    • Awareness of consequences requires consciousness
    • Nurse Transfer Report
    • Nurses (and patients) experience positive consequences from new process
    • Natural positive consequences are best; artificial or imposed positive consequences may help
    • Reduce negative consequences for doing it right; some are hidden
    • Create negative consequences for poor performance, if necessary
  • 21. Six Vital X’s for Human Performance
      • Performance Specifications
      • Task Interference
      • Consequences
      • Feedback
      • Knowledge & Skill
      • Individual Capacity
    • Chemical Reactor
    • Process control
    • Process adjustment
    • Nurse Transfer Report
    • Immediate feedback provided to nurses about
      • doing it right (reinforcement),
      • almost right (adjustment), or
      • wrong (redirection)
    • Requires a “coaching” skill set
    • Peers can provide feedback, if skilled
    • Need for feedback declines over time
  • 22. Six Vital X’s for Human Performance
      • Performance Specifications
      • Task Interference
      • Consequences
      • Feedback
      • Knowledge & Skill
      • Individual Capacity
    • Chemical Reactor
    • Designed in
    • Unchanging
    • Nurse Transfer Report
    • Knowledge about linkage of this new process to important values: patient care, expert nursing, etc.
    • Skills related to communicating:
      • Listening
      • Informing
      • Documenting
      • Maintaining focus
  • 23. Six Vital X’s for Human Performance
      • Performance Specifications
      • Task Interference
      • Consequences
      • Feedback
      • Knowledge & Skill
      • Individual Capacity
    • Chemical Reactor
    • Designed in
    • Unchanging
    • Nurse Transfer Report
    • Do nurses have the requisite attitude, motivation, desire, professionalism to succeed?
    • Difficult or slow to change if dysfunctional; solutions lie in hiring and selection systems; tolerance of character issues; nursing “culture,” etc.
  • 24. Six Vital X’s for Human Performance
      • Performance Specifications
      • Task Interference
      • Consequences
      • Feedback
      • Knowledge & Skill
      • Individual Capacity
    • Three Traps for Improvement Consultants or Teams
      • Ignoring or minimizing X 1 , X 2 , X 3 , and X 4
      • Over-reliance on training (X 5 )
      • The “Fundamental Attribution Error”: assuming that failure to perform is strictly a function of X 6
  • 25. Right Behavior at the Right Time
      • Performance Specifications
      • Task Interference
      • Consequences
      • Feedback
      • Knowledge & Skill
      • Individual Capacity
    The same six X’s apply to sustaining consistent performance. . . . . . and to periods of innovation, although the nature of each X will change. time process value
  • 26. Summary
    • Lean & Six Sigma principles are 100% applicable to transactional settings…
      • Service and Transactional processes rely heavily on consistency of human behavior
      • The Control Phase must be adapted to recognize the complexities of measuring and managing human activities
      • Tools such as Human Performance Technology exist to help manage the right behavior at the right time
    • Leverage other disciplines to help apply the rigor
  • 27. Reducing Variation In Human Behavior Robert V Berry VP Strategic Improvement Premier Health Partners (937)208-2182 [email_address] © Copyright 2005 Phil Wagar Director, Organizational Effectiveness Premier Health Partners (937)208-5436 [email_address]
  • 28. FYI: Forms of task interference
    • Absenteeism or turnover of key personnel
    • Delay in approval of actions
    • Inadequate clerical support
    • Shortages of supplies or materials
    • Excessive restrictions on operating expenses
    • Inadequate working conditions
    • Inability to hire needed staff
    • Performance of co-workers
    • Performance of subordinates
    • Performance of management
    • Unclear structure or relationships
    • Excessive paperwork
    • Unpredictable workload
    • Excessive workload
    • Changes in policy & procedure
    Where to look if people “aren’t doing it right.’
  • 29. FYI: Forms of task interference
    • Negative pressure from co-workers
    • Unpredictable changes to the type or amount of work assigned
    • Lack of proper equipment
    • Inadequate communication within the organization
    • Variability in the quality of raw materials
    • Economic conditions (interest rates, labor availability, costs of basic goods and services)
    • Inadequate training
    Source: Kane, 1982; Bernadin: Increasing the Accuracy of Performance Measurement , 1990 Where to look if people “aren’t doing it right.’