Posts Tagged ‘Quality Management’

BPM & CM – My takeaway from the Global Summit

July 20, 2015

Thanks to Dr. Charles Webster (@wareflo), I attended the 2015 BPM & CM global summit in Pentagon City last month.
During the three-day summit, Dr. Webster interviewed me and several other attendees, and broadcast live over Periscope.
His intention was to find out what we each hoped to get out of the sessions, and then to follow up afterwards to find out what we saw as the major takeaways.

It has taken me nearly a month to settle on what I took away from the seminar, but here is my answer to his question:

  1. There was an elephant in the room
  2. The field has achieved a great deal of progress, but still has a long way to go
  3. There is a huge opportunity to improve healthcare

Before I talk about those, here are my top three favorite sessions

  1. Chuck Webster’s session on wearable workflow featuring @MrRimp. (It’s not every day you get that level of geekiness crammed into a presentation)
  2. Anne Rozinat’s session on process mining using Disco
  3. Aaron Drew, U.S. Department of Veterans Affairs & Business Architecture Leadership Panel, who spoke about the future of the VA’s VistA EHR design

Chuck thrilled us all with MrRimp, and hinted at a future in which wearable technology would form part of seamless workflow. From door to doc and beyond, wearables are going to play a major role in healthcare, and will shift the patient to the center of a care team, rather than simply being the topic of clinician discussions. Wearable workflow also has the promise of having adaptive business processes in which the currently error-prone activities of basic data capture are shifted from clinicians to machines. Shifting this burden will free up hours per day per clinician, while increasing data reliability.

Anne eloquently stepped us through the concepts and technology behind process mining, and gave examples that were clear and compelling. Process mining is a big deal in healthcare, as I discuss in a whitepaper on process discovery in quality improvement. The big deal is that current methods to discover the as-is workflow are resource intensive and slow. Variation in healthcare settings is high, and processes may vary not just from hospital to hospital, but ward to ward, and even shift to shift.

If you have a healthcare system with dozens or hundreds of care facilities, scaling this is close to impossible, and even in a single facility with a small number of wards, can be daunting and expensive. Process mining does not entirely overlap with observational methods of process discovery, but it comes close enough to bring real-time process discovery within the reach of small and large healthcare systems alike.

Aaron described a future in which BPM is built into the EHR, and where patient centered care teams could interoperate seamlessly without the EHR creating obstacles and pitfalls. The original VHA EHR was built to solve the problem of running a single medical facility and managing diverse treating specialties within a single environment. Since then it has been pressed into service as a means to do care and bed management across the nation as well as handle medication ordering, medical imaging, and disaster planning.

This venerable but dated EHR has architectural limitations that are no longer up to the challenges and demands of the modern care environment. The VistA Evolution project details a ground-up rebuild of the architecture and technology, and will put VHA back in the lead with a groundbreaking EHR.

That’s my top-three picks for sessions.

Now for the elephant

During one of the sessions, the presenter was explaining how he wished that US management and C-Suite were as tuned into the need for efficient and effective BPM as the executives he encountered in Germany. What followed was, from my perspective, a remarkable response from the audience. As a qualitative researcher and quality improvement practitioner in healthcare, whenever an audience is animated it’s important to pay attention.

Nowhere on the agenda was a discussion related to management itself, none of the sessions involved management best practices, and no speaker directly addressed the topic of executive sponsorship and behavior. Governing policies regarding process improvement and quality weren’t a listed topic. However, what came thick and fast, in raised voices, were accounts and agreements that US business practices were a major impediment to improving processes.

One person gave an account of how short-term focus and lack of forward vision was crippling attempts to improve workflow in the business operation. Another described how quarterly metrics resulted in punitive reactions to improvements, and that improving a process for long-term success were often cancelled by management because of a short-term focus. Somebody else gave a personal account of management cancelling projects that were designed to improve quality and efficiency. The projects couldn’t deliver within a financial quarter, and so they were terminated.

Whether the specific projects were viable or not, is something we can never know. What was clear is that the tone and degree of participation in this session, and on this specific topic, were remarkable. The topic evoked a far higher degree of audience participation, and the degree of vociferous agreement stood out. The thing that nobody was talking about, but was evidently on everyone’s mind, was that US business models are a significant cause of bad business processes.

That bears some thinking, especially in the US healthcare market, where the cost of bad processes is paid in blood and death.

BPM & CM advancement

With the release of BPMN v2.0, and the advent of DMN v1.0, the field now has an accepted set of standards that can be used to model business processes. This is great news for fields that include quality improvement, business reengineering, and business design. This means that a wide variety of workflow and process design tools will produce interoperable if not entirely interchangeable process models. It also opens the door to being able to build processes that can be directly embodied in business logic in the workplace.

What is less stellar is that while over 80% of all process models are created and reside in Microsoft Visio, the model you created in Visio only pretends to be a BPMN model. It’s like a picture of a dollar bill – it looks like one, and it can be named “dollar bill”, but you can’t buy anything with it. You can’t just flow your business data through the Visio diagram to see if something is wrong.

Perhaps with time that will change, but it isn’t a pretty picture right now.

Opportunities in Healthcare

Putting this together, if there is one industry where wearable workflow, process mining, and BPM standards could benefit operations, it is healthcare.

  1. Healthcare costs in the US, account for up to 60% of bankruptcies
  2. Preventable medical mistakes are the third highest source of untimely death
  3. Incompatible processes are the daily reality for patients and providers alike


Improving the performance and conformance of business processes, placing patients at the center of their care team, engineering humans out of data entry, and standardizing processes across points of care could save lives and money. It could shift US healthcare from being the most expensive in the world to being at least on par with the OECD averages. It could move US healthcare outcomes from the doldrums to being in the top five percentile.

That’s my story, and I’m sticking to it!

Knowledge Management – The ITIL/Quality-Management Aspect

July 2, 2010

Knowledge Management has been portrayed as being a direct descendant of the quality movement that started with W. Edwards Deming, and quite rightly we can trace many of the core tenets of KM to the various Quality Management offshoots. The concern for parsimony and efficiency, the analysis of work structures, and the interest in keeping libraries of best practices are all cemented in the foundations of both the Quality Management and Knowledge Management spheres.

It has been a source of concern however, if not irritation to many people that the focus on procedure and structure in the quality movement may have inadvertently displaced the human side of the equation, and that insufficient attention is given to learning and behavioral aspects. Sometimes the builders of procedures seem to forget* that processes and procedures are executed more in vivo than in silico, so to speak – humans would be performing the procedures rather than computers. (*Perhaps a legacy of the Taylorite turn.)

Many otherwise well-designed processes fail simply because they ignore that humans learn, do not always respond rationally, and may simply get bored (or take short-cuts as a result of learning). People require motivation, knowledge, and ability to perform a procedure, and no matter how carefully and how ingeniously a procedure is crafted, if it isn’t constructed to accommodate humans, it is bound to fail – sometimes with impressive results.

Knowledge Management on the other hand has the same basic QM background, but embraces more of the I/O Psychological understanding of humans, and pays attention to aspects of motivation and leadership, learning and knowledge-diffusion, and information-ergonomics. Think of it like the difference between the standard-model of economics versus behavioral-economics. The former presumes a perfectly rational and fully informed agent executing a self-maximizing schema, while the latter presumes a somewhat predictably irrational person who may also have biases due to either a lack of knowledge or preexisting beliefs, and may simply not be motivated to act as desired.
Bringing these two streams together again seems to have the promise of the benefits of the repeatability and predictability of procedure and the stability of established infrastructure libraries, with the human factors that can put knowledge, skills, and attitudes to work to achieve a desired or preferred end goal.

Previously, knowledge management was pretty much excluded from the world of quality management, but with the release by the British OGC of ITIL V3 in 2007, KM was overtly nominated as part of the core features, and specific processes in the Service Transition part of the ITIL Life-cycle Phases were dedicated to Knowledge Management.
This embeds a Services Knowledge Management System (SKMS) in the fabric of an operational services strategy, and while not part of the ISO20000 framework for Infrastructure or the ISO9001 Quality Management framework (and therefore not in the audit process for certification), would still be a highly convenient attachment point for expanding KM activities

There are two obvious approaches that one can take at this point – to view the relevance of the SKMS in terms of KM providing knowledge-bases for ITIL deployment and use, or additionally to view the inclusion of a KM marker within ITIL as a very expedient and advantageous eye to hook ITIL into a broader Enterprise KM approach.

Using KM only to set up ITIL Knowledge Bases seems like a bit of a waste of an opportunity, so perhaps the more productive approach would be to see how KM and QM can work together.

This can of course be viewed from both angles – a way to use KM as a vehicle to spread ITIL and QM concepts throughout an organization, or alternatively as a way to spread Knowledge Management practices on the back of the increased attention (and budget) that ITIL is currently enjoying.

Another way to picture this, is as co-infectious ideas – that is, memes that are compatible and which both act as adjuvants for each other, perhaps in a cyclical and recursive fashion. An organization deploying ITIL can gain by also spreading KM practices that extend beyond IT activities, and likewise an organization that has “caught the KM bug” could implement ITIL and gain far better advantage from IT both in cost-effectiveness of IT, as well as risk-reduction.

The potential advantages to ITIL and QM of this are many, but here are five of my favorites

  • A better way to determine when to teach and when simply to present a job aid, since while people love to know, they don’t really like to be taught anything that is boring or not clearly relevant.
  • A more effective deployment process that embeds learning in a way that increases transference by adding context and meaning.
  • Highlighting the critical question of any process: “Yes, but would they actually do it?” and addressing the motivational and leadership aspects of informational behavior.
  • Introduction of Information Ergonomics to make processes easier to understand, easier to find, and conveniently located in the person’s information ecosystem – putting regular or critical information as few mouse-clicks away as possible.
  • Establishing networks and communities of people whose processes are related and giving them stakeholdership in the design and execution (and maintenance) of procedures and processes.

The challenge of course is how to avoid killing innovation.

That is my story, and I am sticking to it

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