Due to cost pressures that are being felt within the healthcare sector, many organizations are being approached by a multitude of process improvement strategists who are vying for leadership attention. Each strategist advocates the adoption of his or her improvement methodology in your organization. Almost all preach that if you adopt their specific tools or follow a specific way of thinking all the business problems will be solved.

After listening to multiple champions advocate their special methodology, the questions that need to be asked are how do you choose what will be best for your organization and what methodology fits the culture of your organization?

Over the years, as the Director of Material Management for not only healthcare organizations; but also, an automotive manufacturing organization, I was exposed to a number of process improvement techniques i.e. Value Analysis, Value Engineering, Quality Circles, Process Improvement, Business Process Reengineering, Toyota Production Improvement Methodology, QS9000 Standards, ISO Standards, JCAHO accreditation protocols, industrial registrar certification protocols, etc. Today, you are being exposed to "Six Sigma" which claims that focusing on reduction of variation will solve process and business problems. Many thousands of dollars and man hours were spent and are being spent in the execution of the various methodologies which overtime seem to dissipate and fade away until the next new idea comes along.

Process improvement techniques seem to conflict with each other or at least downplay the contribution of other methodologies, but in essence, they are saying the same thing with a few new glitters. This characterization creates an illusion of conflict.

While it is hard to argue against improvement the economic reality of business is we want the most improvement for the least investment. Improving all of the organizations individual processes could actually have a detrimental effect on the organizations ability to satisfy the customer’s needs and provide product and services at the right time and the lowest cost. The realized savings to the system might be less than the cost of all the improvements. So, the organization that improves things just because it can may be improving the wrong things for the business.

You must realize that the selection of a process improvement type is dependent on the culture of the organization and consider:

• Top Management commitment
• Impetus for Change and Duration
• Team Approach
• Customer Service Orientation
• Clear Lines of Responsibility
• Methodology must support the Goals of the Organization.

In any organization many activities are driven by policies and customs whose purpose has been lost in time. All change programs challenge the existing ways of doing things. This necessitates asking what purpose a specific policy serves and whether that purpose is still valid in today’s environment. You need to challenge the underlying assumptions supporting each policy. Challenging these assumptions provides a starting point for determining whether the current policy is still supporting something of value today.

For example, W. Edwards Deming’s management theories could help organizations challenge current management practices and assumptions—not by suggesting incremental improvements but by pointing to a new way of managing. Through this line of study, management can achieve a greater understanding of the way they can influence the cultural, social and economic well-being of their organization.

Champions of the various other methods say they can overcome these drawbacks because implementation of their particular methodology and focus on their tools, methods and theories will allow an improved theory of management and business strategy to emerge.

Unfortunately, when all is said and done, most attempts at new improvement techniques result in partial implementation which overtime dissipate due to lack of total inclusion of a synchronous process that is not both vertically and horizontally implemented into the organization, is too costly to implement and/or lack of long term commitment. Yet, thousands of dollars and man hours have been spent on learning, reviewing and attempting change – sometimes for change sake without the proper foundation.

Rather than choosing one specific improvement methodology which may be the craze at this time, one can consider the art of simplicity which is simply to simplify. Minimizing the financial and human investment in time and money is key in order to maximize results. One can draw the best elements from any and all strategies to improve a specific situation and/or circumstance. The "KISS" (Keep It Simple) form of philosophy that stresses the abandonment of static traditions, protocols, and customs and is about opening new avenues to fix whatever one feels wasn’t working for him. This approach is a vehicle for self-discovery. It is a process, not a product. It’s all about "self- preservation" and "best options" for the organization. It’s not all philosophical; when practiced intelligently it produces results. It means to understand the interplay of yin (the passive) and yang (the active) in everything that you do or experience. An example of this philosophy could easily be found in a production line in any business. A production line is set up as a way to minimize thought, which in turn maximizes production line speed. In theory you break up the assembly of your product into smaller easier tasks. So, as a worker, you would only have to do one or two specific tasks and then repeat these tasks over and over. As you do these tasks, day in and day out, your speed at doing these tasks increases. So, as you get faster at your job you have to think less and less about how to do your job.

Therefore, an organizational improvement strategy should be one that allows the greatest amount of flexibility to the practitioner to maximize results without the restrictors of conforming to a specific style of methodology. All of the techniques available have basic fundamental elements, for example:

• Identifying the process, protocol, problem that you need to explore.

• Who is the customer and what are their problems? Defining the nature of the perceived problem or improvement, as well as, the financial or organizational impact of said focus.

• Identification of key characteristics along with the processes that support those key characteristics. You can then identify existing output conditions along with the process elements.

• Next, you need to measure the process. Key characteristics are categorized, measurement systems are verified and data collected.

• Data is analyzed. The raw data is converted into information that provides insights into the process. These insights typically identify the fundamental and most important causes of the defects or problems.

Developing a plan of action to improve the process. Solutions to a problem are proposed in order to change the process. Outcomes of process changes are seen in the measurements. In this step, the organization can determine if the changes are beneficial, or if another set of changes is necessary.

• If the process is functioning well at the desired outcome it is put under control. This step is the sustaining portion of the process with ongoing monitoring to assure no unexpected changes occur. Quality is allegedly improved. Some elements are modified while others are discontinued. Elements are refined and improved. Mistakes and opportunities for making mistakes are reduced.

• Defining the cost benefit and operational implications of said actions.

As a manager, how do you select an improvement methodology or program? Again, the selection of a process improvement methodology is dependent on the culture of the organization. As many popular programs appear to end up in the same place addressing the same issues after a number of years of use, the main issue left to explore is the speed at which a method will be accepted into an organization along with differentiating between "reality" and "fantasy".

More organizations are trying to determine what improvement methods will work best and fit best within their culture framework. When you are working through the claims of these various programs concentrate on the primary effects of their philosophies upon your organization. If the values identified are comparable to the values of your organization, the choices are simpler and easier to match with the organizational values.

As I have implied, most improvement methodologies contribute valuable realistic concepts, ideas and techniques to an organization. The methodology needs to be able to change the cultural and behavioral aspects of the organization for the long term and have an on-going support system to proliferate the message. If it is too politically sensitive, or the organization is only fractionally committed it will not survive the test of time!!

This brings to mind the Chinese philosophy which I think every businessman and administrator needs to wake up and commit to every day:

To gain knowledge, add to you work every day.

To gain wisdom, take away from your work every day.

The challenge to all organizations and users is to adopt the best elements that maximize the return on investment of time and effort, produce the best results, are enduring and simple and do not dissipate over time. HPN

- Deming, W. Edwards, The New Economics for Industry, Government, Education, second edition (Cambridge, MA: Massachusetts Institute of Technology, 1994),

- L. E. Majewski consults suppliers and buyers in the area of Supply Chain Management, Purchasing, Cost Improvement and Operational Improvement. He served as Material Manager for several major healthcare institutions. He has developed strategies and business approaches in healthcare and industrial manufacturing. He can be reached at 313/885-3270 or leemajew@aol.com.