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11/28/2016

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Welcome back

Thoughts Questions

®Butts-Dion, Crowe and Taylor 2

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Trends and Patterns(quantitative: run charts, statistical

analysis, qualitative study)

System Structure(pattern of interrelationship among key components of the system: hierarchy, process flows, attitudes and perceptions

Mental Models(key assumptions)

Leverage for Improvement

The Fifth Discipline FieldbookPage 97 - 103

Events

(crisis, anecdotes, problems)


Listen. Really Listen!

“These terms — co-production, patient-centered care, what

matters to you — they’re encoding a new balance of power:

the authentic transfer of control over people’s lives to the

people themselves. That includes, and I have to say this,

above all, it has to include the voices of the poor, the

disadvantaged, the excluded, [the marginalized]. They

need our mission most.”

P4

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1990’s

The prevailing style of management must undergo transformation. A system can not understand itself. The transformation requires a view from the outside. The aim of this chapter is to provide an outside view—alens—that I call a system of profound knowledge. It provides a map of theory by which to understand the organization that we work in.

W.E. DemingNew Economics (1994) pg. 92

Appreciation for a System

Theory of Knowledge

Psychology

Knowledge about

variationProcess


System of Profound Knowledge

Process

System

Variation

Knowledge

Psychology


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Instructions1) We will show you a picture

or a cartoon

2) You will help identify the Lens component from the picture.

3) We will explore the Lens through large and small group discussion.

4) Each table group will capture the conversation and ideas on the flip chart at their table (World Café idea)

5) Hint: PDSA in your near future!


first component

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I am sure glad the hole is not in our end!


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SYSTEMSWhat do we know or believe about systems?

What is in our system lens?

• A system is a network of interdependent components that work together to try to accomplish the aim of the system.

• The beginning of the system starts with the customer

• If each part of a system, considered separately, decides to operate as efficiently as possible, then the system as a whole will not operate to maximum effectiveness.

• The obligation of any component is to contribute its best to the system, not to maximize its own …measures.

• We should work on our processes, not the outcome of our processes….

Collection of thoughts and excerpts from variousW. Edwards Deming publications and teachings

1.6 Deming’s view of Production as a System (1994)

Design

and

Redesign

Consumer

researchSuppliers of

Raw MaterialsReceipt and

test of

Materials

Consumers

Distribution

Test of processes,

machines, methods,

costs

Production, assembly, finishing, inspection

A

B

C

D

E

F

G

Stage 0:

Generation of ideas

Deming and Ackoff (1.46)


http://www.youtube.com/watch?v=2MJ3lGJ4OFo&feature=related

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Case study: Systems Thinking

• Optimization and Sub -optimization

• The simple story of blue pads


Case study: Systems Thinking

• Optimization and Sub -optimization

• Your story


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System Criteria

• Living systems are integrated wholes whose properties cannot be reduced to those of smaller parts.

• Shift attention back and forth between system levels– systems within systems

– with emerging properties at different levels

• There are no parts; there are patterns, an inseparable web of relationships, a network

Fritjof Capra

The Web of Life pp36-37


Systems Thinking

• Is a language for learning and acting

• Helps us see how we create our reality

• Points to higher leverage solution to problems

• Helps us to understand and describe complex issues

• Is a discipline for seeing structures ( the patterns and connections) underlying seemingly diverse personal, organizational, societal issues

Leading Learning Organizations

Innovation Associates, Inc.


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The first lesson is that blaming the fallibleindividuals at the sharp-end is universal, natural,emotionally satisfying, and legally convenient.

Unfortunately, it has little or no remedial value.

On the contrary, blame focuses our attention onthe last and probably the least remedial link in theaccident chain: the person at the sharp end.

James T. Reason


second component

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Variation exists……


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VARIATION

• Variation Exists!

• Common cause variation is always present • Common causes tend to be numerous• Common cause variation is produced by the

aggregate of the variation in all the variables. It is also known as: random variation, chance variation, or un-assignable cause of variation

• Special causes are not present at all times• Special cause is in addition to common cause • Special cause is produced by a non-typical

variable. Special causes are also known as assignable and non-random

• Mistake 1. To react to an outcome as if it came from a special cause , when actually it came from a common cause.

• Mistake 2. To treat an outcome as if it came from common causes of variation, when actually it came from a special cause.

What do we know or believe about variation?

What is in our theory of variation lens?

Collection of thoughts and excerpts from various W. Edwards Deming publications and teachings

VARIATION


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Variation can be a very revealing voice….. need to learn to listen! Some of my first Ahaa’s!

listening with my eyes.

®Butts-Dion, Crowe and Taylor

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THELEARN NGIIN TTIT U ESATQU UMRO

Global MeasureGlobal Measure

1 1.031.09

1.44

0.88 0.880.77

0.970.85

0.68 0.68

0.86

JanFeb

MarchApr

MayJun

JulAug

SepOct

NovDec

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

Infe

ctio

n R

ate

Median 0.93

Nosocomial Infection 1997Nosocomial Infection 1997

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THELEARN NGIIN TTIT U ESATQU UMRO

Intermediate MeasuresIntermediate Measures

1. 16

0. 74

1. 13

1. 73

1. 1

1. 39

1. 21 1. 26

1. 10. 98

1. 39

1. 1

Jan Feb Mar Apr May Jun Jul Aug Sept O ct Nov Dec

0

0. 5

1

1. 5

2

Median 1.19

Nosocomial Infections Unit C - 1997Nosocomial Infections Unit C - 1997

Infe

ctio

n R

ate

Infe

ctio

n R

ate

1. 02

0. 87

1. 12

0. 8

0. 22

0. 73

0. 62

1. 471. 31

0. 63

0. 33

1. 06


0

0. 5

1

1. 5

Median 0.84

Nosocomial Infections Unit D - 1997Nosocomial Infections Unit D - 1997

Infe

ctio

n R

ate

Infe

ctio

n R

ate

0. 961. 08

0. 78

2. 07

1. 29

0. 370. 51

0. 34 0. 35

0. 530. 63

0. 54


0

0. 5

1

1. 5

2

2. 5

Median 0.76

Nosocomial Infections Unit A - 1997Nosocomial Infections Unit A - 1997

Infe

ctio

n R

ate

Infe

ctio

n R

ate

0. 7

1. 79

1. 25

1. 56

1. 35

0. 94

0. 65

0. 43

0. 25

0. 46

0. 25

0. 48


0

0. 5

1

1. 5

2

Median 0.85

Nosocomial Infections Unit B - 1997Nosocomial Infections Unit B - 1997

Infe

ctio

n R

ate

Infe

ctio

n R

ate

Variation exists in data and in

people

®Butts-Dion, Crowe and

Taylor

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third component


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Burrhus Frederic Skinner (1904-1990)

Operant Conditioning

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PSYCHOLOGY

What do we

know or believe

about

psychology?

What is in

our psychology

or human

interaction

lens?

• People are different from one another. A manager of people must be aware of these difference, and use them for optimization of everybody's abilities and inclinations. This is not ranking ..

• Merit awards and ranking are demoralizing. Rewards motivate people to work for rewards.

• Some extrinsic motivation helps to build self-esteem. But total submission to extrinsic motivation leads to destruction of the individual.

Collection of thoughts and excerpts from various W.

Edwards Deming publications and teachings


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http://www.youtube.com/watch?v=qy_mIEnnlF4

http://www.youtube.com/watch?v=qy_mIEnnlF4

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Forces of destructions (New Economics p.122)

Life begins Life ends

Extrinsic motivation

• Gradually replaces intrinsic motivation

• Competition and recognition drives actions

• Focus on the Individual not the System

• Problems attributed to Individuals not System

• Resignation to external pressure - demotivational

Intrinsic motivation

Curiosity Cooperation

Joy in Learning Self esteem Dignity



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Alphie Kohn

1. Pay is not a motivator

2. Rewards punish

3. Rewards rupture relationships

4. Rewards ignore reasons

5. Rewards discourage risk-taking

6. Rewards undermine interest



http://en.wikipedia.org/wiki/File:Alfie_Kohn.jpg

http://en.wikipedia.org/wiki/File:Alfie_Kohn.jpg

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When to Use Rewards: A Simple Flow Chart (Pink p. 69)

Use rewards, even “if-then” rewards, but

be sure to

Can you increase the task’s

challenge or variety, make it less routine, or connect it to a

larger purpose? Sure I can do

that

2. Acknowledge that the task is

boring

3. Allow people to complete the t

ask their own way

1. Offer a rationale for

why the task is necessary

That is pretty hard

YES

Is this task mostly

routine?

Start Here

No

Concentrate on building a healthy, long-term motivational environment that pays people

fairly and that fosters autonomy, mastery, and purpose. Avoid “if-

then” rewards in almost all circumstances. Consider

unexpected, noncontingent “now that” rewards. And remember

that those rewards will be more effective if:

1. They offer praise and feedback rather than things people can touch or spend

2. They provide useful information

rather than an attempt to control


fourth component

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KNOWLEDGE

What do we know or believe about knowledge?

What is in our knowledge or learning lens?

KNOWLEDGE

What do we know or believe about knowledge?

And how does it guide our action?

Information • Information is not knowledge.

Knowledge• Knowledge is built on theory. • Without theory there are no questions:

Without questions there is no learning.• A statement devoid of rational

prediction does not convey knowledge

Learning from Failure• There is no such thing as a fact• No number of examples establishes a

theory, yet a single unexplained failure of a theory requires modification or even abandonment of the theory

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Rational behavior requires theory. Reactive behavior requires only reflex action

W. Edwards Deming

Profound Knowledge is a systematic way of learning that supports developing theory, knowledge and

informs action... tbc


Theory of Knowledge

Psychology

Knowledge about

variationProcess Process

System

Variation

Knowledge

Psychology


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Out of the Crisis W. Edwards Deming (1982, 1986, 1993)


Break


then PDSA

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Question……… ®Butts-Dion, Crowe and Taylor 46

Might using the System of Profound Knowledge facilitate asking more reflective

questions helping to better listen and understand... which would

support more effective change ideas?

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As our hearing trumpet…(project...?)P48

Model for Improvement* (MFI)

*Developed by the Associates in Process Improvement. Building on the work of W.E.Deming and Walter ShewhartLangley et al, The Improvement Guide, 1996, 2011®Butts-Dion, Crowe and Taylor 49

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ActAdapt?

Adopt ? Abandon?

Next cycle?

PlanObjectiveQuestions and predictions (why)Plan to carry out the cycle(who, what, where, when) Next cycle?

StudyComplete the

analysis of the dataCompare data to

predictionsSummarize what

was learned

DoCarry out the plan(on a small scale) Document problemsand unexpectedobservationsBegin analysis

The PDSA Cyclefor Learning and Improvement

W.E.Deming referred to this as the Shewhart Cycle


Plan

The PDSA Cycle - cousins

DoStudy

Act


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Objective for this PDSA Cycle: Date:

Is this cycle used to ___develop, ___test, or _____implement a change?

What question(s) do we want to answer with this PDSA cycle:

Plan:

Plan to answer questions: Who, What, When, Where

Plan for collection of data: Who, What, When, Where

Predictions (for questions above): .

Do: Report what happened, data; and begin analysis.

Study: Complete analysis of data. Compare the data to your predictions and summarize

the learning.

Act: Are we ready to make a change (adopt, adapt, abandon)?

Plan for the next cycle:

PDSA Tip


PDSA(what predictions do we have?)

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Lens of Profound Knowledge PDSAPlan: Develop 1 (or 2)Useful Questions for each of the four Lens.

Each person write down the questions


Theory of Knowledge

Psychology

Knowledge about

variationProcess Process

System

Variation

Knowledge

Psychology


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TRIO PDSA

DO: TRIOSTwo test the questionsOne observer make notes

STUDY: ALLStudy the results per our predictions and plan. Review any incidental or unexpected events that happened.

Act: ALL Adapt, Adopt, Abandon Next Test?


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Group Debrief

PDSA’s

Trends and Patterns(quantitative: run charts, statistical

analysis, qualitative study)

System Structure(pattern of interrelationship among key components of the system: hierarchy, process flows, attitudes and perceptions

Mental Models(key assumptions)

Leverage for Improvement

The Fifth Discipline FieldbookPage 97 - 103

Events

(crisis, anecdotes, problems)


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For every complex problem, there is a

solution that is simple, neat, and wrong.

HL Mencken


http://www.unnaturalcauses.org/video_clips_detail.php?res_id=210

http://www.unnaturalcauses.org/video_clips_detail.php?res_id=210

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FINAL WORD......

Closing


Thank You!

Attention

Work

Care

Evaluations

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