1. Process Management
The management of any activity can be usefully construed as the management of processes,
where a process is understood to be any system, procedure or routine that converts particular
inputs to particular outputs with some predictability.
There are both natural processes such as condensation, evaporation and erosion, and man-made
processes such as manufacturing and patient care. In each case, these processes are members of a
hierarchy of processes. That is, they are at the same time both components of some more
encompassing process (e.g., business and health care, respectively) and are themselves composed
of yet other processes (e.g., production scheduling, machining and inspection in the case of
manufacturing, and scheduling, examining, diagnosing, treating, housing and feeding in the case
of patient care).The component processes that comprise any higher level process can be related
to one another serially (i.e., the output of one becomes the input to another) or in parallel (i.e.,
two processes either receive their inputs from, or provide their outputs to, a common third
process). Where the output of one process becomes the input of another process it is useful to
think of the second process as the “customer” of the first, “supplier,” process.1
Process Management For Whose Benefit?
It is popular in management circles today to emphasize the importance of satisfying customers.
Some very useful tools, most notably quality function deployment (QFD),2 have been developed
to aid in the identification of customer needs and the design of processes to generate products
and services that will satisfy those needs. However, it is important not to neglect others who have
a claim on the performance of a process while attempting to rectify any past neglect of the
customer.
There are always a number of important stakeholders in a process in addition to those that might
be classified as customers in any ordinary sense of that term. Stakeholders are those
organizations, groups or individuals who must be satisfied to assure the continued viability of the
process. For businesses the stakeholders would typically include the investors and lenders who
furnish the funds required to operate the business, the employees who contribute to and depend
upon the business’s success, the suppliers to the business and the government and community in
which the business is located in addition to the customers. In a hospital the patients would be the
most obvious analog to the customers of a business. However, many other groups of individuals
have an equally important claim on the results of hospital processes including the medical staff,
employees, health care insurers, and the individuals and organizations that pay the premiums.
It would be naive at best to focus on the satisfaction of one or a few stakeholders at the expense
1 Schonberger, Richard J., Building a Chain of Customers: Linking Business Functions to Create the World
Class Company, (The Free Press, New York, 1990).
2 Sullivan, L. P., “Quality Function Deployment,” (Quality Progress, June 1986), p. 39; Stocker, Greg D.,
“Using QFD to Identify Customer Needs,” (Quality Progress, January 1991), p. 120; and Ronald G. Day, Quality
Function Deployment: Linking a Company with Its Customers, (ASQC Quality Press: Milwaukee, 1993).
Copyright © 1993, 2012 Paul M. Konnersman. All rights reserved.

2. Process Management
Plan Process Improve Process
Execute Process Control Process
Fig. 1. Process Flow Schematic: Process
Management
Copyright © 1993, 2012 Paul M. Konnersman. All rights reserved.

3. Process Management
of others. The challenge of successful process management, whether in business or health care, is
to satisfy all of the stakeholders who have a claim on the process simultaneously. Happily, there
is nothing about the concepts and tools of process management which limits their application to
the satisfaction of any one class of stakeholders.
The Pervasiveness and Importance of Variability
Whether we are dealing with natural or man-made processes, we never have enough knowledge
of the causal relationships underlying the process or of the initial states of the relevant causal
factors, to predict the outcomes from the process with absolute certainty. This means that we can
never completely eliminate variation in the output of our processes.
On the other hand, variation is costly and the costs increase with increased variation. 3 The
management of variation is therefore, an important element of effective process management and
the reason that the most effective approaches are grounded in statistical concepts and
methodologies.
The Four Phases of Process Management
Process management can be usefully separated into four complementary phases: planning,
execution, control and improvement (see Figure 1).
1. Planning. Planning the process entails the characterization of the process as a set of
procedures or routines and the demonstration that those routines will produce a
predictable result with respect to the particular characteristics that are important to
stakeholders. Such predictable results are know as the "process capability". The
procedures may be documented in any number of ways from narrative descriptions to
outlines to flow charts to photographs or video’s. The only criteria that the documentation
needs to meet is that it adequately supports faithful replication of the process over time
and execution by different individuals. If the process capability is sufficient to meet
stakeholder expectations, the process is said to be “capable”.
2. Execution. Executing the process means carrying out the process plan in accordance
with the plan for the next higher level process—that is, executing the steps that constitute
the recruiting plan as called for in the human resource plan,and executing the human
resource plan as called for in the business plan; or, in a hospital, executing the steps
prescribed for making an incision (the “incision plan”), in accordance with the plan for
the operation, which ,in turn, is executed in accordance with the patient care plan). The
3
A brief treatment of the “Taguchi loss function” which embodies the losses due to variation can be found in
Provost, Lloyd P. and Norman, Clifford L., “Variation Through the Ages”, Quality Progress, v. xxiii, no. 12
(December 1990), p. 44. See also Douglas C. Montgomery, Introduction to Statistical Quality Control, 2nd Ed.
(Wiley:New York, 1990), pp. 532-33.
Copyright © 1993, 2012 Paul M. Konnersman. All rights reserved.

4. Process Management
plan for the higher level process tells us when or under what circumstance to execute the
plan for the lower level process.
3. Control. Controlling the process entails the assurance that the process is being operated
as planned and that results of the process are not significantly different than expected.
The basis for process control is the distinction between expected variation due to
“common causes” and unexpected variation due to “special causes.”4 Expected variation
arises from the influence on the process of factors that are unknown to the process
manager and from factors that are known but not controlled by the process manager.
Unexpected variation arises from the influence on the process of some factor that is not
normally present. While control charting may be the technique of choice for process
control, it is not necessary to make explicit use of control charts to derive value from the
concepts.
4.
Improvement. Improving the process entails the modification of the procedures or
routines and demonstration that the modified routines produce predictable results that are more
desirable than those of the unmodified routines. There are two, non-exclusive, ways in which the
new results might be superior to the old. The way that is commonly recognized is that the
average value of an output characteristic might be improved (e.g., costs or defects reduced,
productivity or revenues increased). A less commonly recognized way to improve a process that
is no less important, is to make it more reliable; that is to reduce the variation in the value of an
output characteristic (e.g, go from 100±20 procedures/day to 100±2 procedures/day).
The Order of Process Management Phases
It is generally necessary to begin with the planning phase and then proceed through the steps an
appropriate sequence. The process of process management has a number of branches where the
appropriate next step is dependent on the circumstances (see Figure 3.).
The Importance of Human Behavior
Since people are important components of a great many of the processes we manage, our success
in managing those processes is heavily dependent on the behavior of the people who play roles in
the process. Understanding of human behavior and the conditions required for people to behave
in accordance with the process plan are therefore critical to the management of such processes.5
4 Deming, “On Some Statistical Aids Toward Economic Production”, (Interfaces, vol. 5, no. 4, August
1975), p. 3 ff.
5 For more on this issue see Konnersman, Paul M., “Empowerment: What People Need in Order to
Perform,” (The Konnersman Group, Marblehead, MA, 1992).
Copyright © 1993, 2012 Paul M. Konnersman. All rights reserved.

5. Process Management
Plan Process Improve Process
Start
Determine
R Performance R S E
Requirement
S Specify Incorporate
Determine How
Process Improvement
to Improve
Capability
Determine
E Performance
Expectations Identify Cause
of Variance
Process
Capable?
Yes No
Yes Yes
Execution No Favorable
per Spec? Variance?
S No
Execute R
Correct Process
Process Execution
Spec
S P
P
Monitor Process E
Parameters
No
Results As No Significant
Yes Expected? Variance? Yes
Execute
Process Control Process
Fig. 3. Process Flow Diagram: Process Management Process
Logic & Process Data Repositories
Where:
E Expectations: What performance can the planned process be expected to produce
Performance: What performance has executed process actually produced
P
R Requirements: What performance is the process required to produce
S Specifications: How shall the process be executed
Activity supplies data to the data repository
Activity uses data from the data repository
Copyright © 1993, 2012 Paul M. Konnersman. All rights reserved.