Reducing Variation in Human Behaviour

Reducing VariationIn Human Behavior

Robert V Berry

VP Strategic Improvement

Premier Health Partners

(937)208-2182

[email protected]

© Copyright 2005

Phil Wagar

Director, Organizational Effectiveness


(937)208-5436

[email protected]

November 18, 2005 Reducing Variation In Human Behavior 2


>10,000 employees Largest non-governmental employer

in Dayton Multiple ambulatory care, home

care, and extended care facilities

Founded in 1932560 licensed beds

Level 2 Trauma

Good Samaritan Hospital


Level 3 Trauma

Middletown Regional Hospital


Level 1 Trauma

Miami Valley Hospital


PHP Process Philosophy

ProcessProcess

Y = f (X)

Customers Suppliers

Outputs Inputs

Valuable

Effective

Adequate

Efficient

Available

Valuable

Effective

Adequate

Efficient

Available

• redesign

• simplify

• standardize

f(the process)

Lean

• optimize

• setpoints

• control

x(inputs to the process)

Six Sigma


A Formula For Change

Technical Solution

Technical Solution

Cultural Solution

Cultural Solution

Effective Results

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

Managing Human Behavior

freactor design

xtemperature setting

pump speeds

reactor pressure

Standardization through:• Bricks & mortar• Equipment sequence• Computer programming

Control through:• Computer controllers• Mechanical safeguards• Measurement gauges

… but I work in a hospital

fpatient transfer report

(transfer of knowledge at nurse exchange)

xcommunication skills

information priority

sufficient timeStandardization through:• Documented SOPs• Training• Designed Forms

Control through:• Motivation• Carrot/stick• Recruiting practice


Right Behavior at the Right Time

time

processvalue

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)


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 StakesHigh Cost; Low Impact; High Stakes


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 SigmaNot a good fit with systematic, data-driven Lean/Six Sigma


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)Human Performance Technology (HPT)

Source: Stolovich & Keeps: What Is Human Performance Technology, 1992


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 PerformanceHPT Applies Scientific, Systematic Methods to Human Performance

Comparison


Applying Human Performance Technology

1. Determine what the people are currently accomplishing

2. Determine what needs to be accomplished

3. Identify “exemplary performance”--what the best are able to do

4. Measure exemplary performance

5. Measure typical performance

6. Compute the discrepancy between typical and exemplary performance

7. Calculate the economic value of this difference

8. If economically justified, intervene to raise the level of typical performance

9. Sustain the new level of performance

1. Determine what the people are currently accomplishing

2. Determine what needs to be accomplished

3. Identify “exemplary performance”--what the best are able to do

4. Measure exemplary performance

5. Measure typical performance

6. Compute the discrepancy between typical and exemplary performance

7. Calculate the economic value of this difference

8. If economically justified, intervene to raise the level of typical performance

9. 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


HPT Fundamental Systems View

Any BusinessResources Markets

Products/Services

Orders

Source: Rummler & Brache: Transforming Organizations Through Human Performance Technology, 1992



The Organization Level

Function A

Function B

Function C



Process 1 Process 2 Process 3

Function A

The Process Level



Process One

The Job/Performer Level



Input Output Consequences

Feedback


Six Vital X’s for Human Performance

Individual Performance is a function of:

1. Performance Specifications2. Task Interference3. Consequences4. Feedback5. Knowledge & Skill6. Individual Capacity

Input Output Consequences

Feedback

All six arenecessary In the vast

majority of cases, these last two are NOT the cause of poor performance




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)




Chemical Reactor

• Mechanical failure

• Impurity


• Sufficiency of time, especially when task is new

• Sufficiency of forms, communication tools

• Management support, direction, visibility

• Potential distractions

(See Potential Constraints list)




Chemical Reactor

• None

• Awareness of consequences requires consciousness


• 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




Chemical Reactor

• Process control

• Process adjustment


• 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




Chemical Reactor

• Designed in

• Unchanging


• Knowledge about linkage of this new process to important values: patient care, expert nursing, etc.

• Skills related to communicating:

Listening

Informing

Documenting

Maintaining focus




Chemical Reactor

• Designed in

• Unchanging


• 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.




Three Traps for Improvement Consultants or Teams

1. Ignoring or minimizing X1, X2, X3, and X4

2. Over-reliance on training (X5)

3. The “Fundamental Attribution Error”: assuming that failure to perform is strictly a function of X6


Right Behavior at the Right Time

time

processvalue


The same six X’s apply to

sustaining consistent

performance. . .

. . . and to periods of innovation,

although the nature of each X

will change.


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

Reducing VariationIn Human Behavior

Robert V Berry

VP Strategic Improvement


(937)208-2182

[email protected]

© Copyright 2005

Phil Wagar

Director, Organizational Effectiveness


(937)208-5436

[email protected]


FYI: Forms of task interference

1. Absenteeism or turnover of key personnel

2. Delay in approval of actions

3. Inadequate clerical support4. Shortages of supplies or

materials5. Excessive restrictions on

operating expenses6. Inadequate working

conditions7. Inability to hire needed

staff

8. Performance of co-workers

9. Performance of subordinates

10. Performance of management

11. Unclear structure or relationships

12. Excessive paperwork

13. Unpredictable workload

14. Excessive workload

15. Changes in policy & procedure

Where to look if people “aren’t doing it right.’Where to look if people “aren’t doing it right.’


FYI: Forms of task interference

16. Negative pressure from co-workers

17. Unpredictable changes to the type or amount of work assigned

18. Lack of proper equipment19. Inadequate

communication within the organization

20. Variability in the quality of raw materials

21. Economic conditions (interest rates, labor availability, costs of basic goods and services)

22. Inadequate training

Source: Kane, 1982; Bernadin: Increasing the Accuracy of Performance Measurement, 1990

Where to look if people “aren’t doing it right.’Where to look if people “aren’t doing it right.’

Reducing Variation in Human Behaviour

Education

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