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21st Century “Leadership”—A Blinding Flash of the Obvious: Isn’t it about time?
Davis BalestracciDavis BalestracciHarmony Consulting, LLC
Phone: (207) – 899-0962
e-mail: [email protected]
Web Site: www.dbharmony.com
“Mission Possible”: Reforming Tasmania’s Health System
9 November 2007
Fill out assessment on Page 3 of Handout
Road map Part 1—summarised on pp. 16-22
– Think “process”– WASTE caused by data Insanity– Liberate TIME to do Part 2
Break “assignment”– Read pp. 5-7– Fill out p. 8
Part 2—pp. 9-13 Part 3—DIALOGUE/Questions “Assignment”—pp. 14-15
If you have your kitchen redone…
Do you TELL the contractor that:– The dishes MUST stay in the
cupboards?– All meals MUST be prepared in the
kitchen and eaten on time? You can’t be “a little bit
pregnant” about quality either…
What was your score?
Level of Executive Commitment < 45?
– Permission– Lip service
46 – 55?– Passionate lip service
> 55?– Involved leadership– Strategic service/quality leadership
It’s not about the problems that march into your offices…
The important problems are the ones no one is aware of!
[Jim Clemmer paragraph, p. 4]
EVERYTHING is a process! [p. 21]
**Your current processes are perfectly designed to get the results you are already getting…and will continue to get
Processes “speak” to us through data
It's not about 'costs!' Confusion…conflict…complexity…
chaos Do you ever waste time waiting, when
you should not have to? Do you ever redo your work because
something failed the first time? Do the procedures you use waste steps,
duplicate efforts, or frustrate you through their unpredictability?
Is information that you need ever lost? Does communication ever fail?
6 Sources of Problems with a Process
Inadequate knowledge of how a process does work– Variation in people’s perceptions of
how things work Inadequate knowledge of how
a process should work– Variation in people’s perceptions of
how things should work– Given the current process
state/objective, poor process design
[p. 22]
Errors and mistakes in executing procedures– Variation in how individuals are
trained to do the work– Variation in how people actually do
the work– Some people have developed
beneficial “knacks” to work around process design limitations
– Underlying process issues that cause everyone working in the process to make the mistake
Current practices that fail to recognise the need for preventive measures– Environmental factors that make the
process “perfectly designed” to have undesirable variation / “incidents” occur
– Human fatigue / attention Unnecessary steps, inventory
buffers, wasteful measures/data– Complexity added in the past due to
inappropriate reactions to experienced variation
– Implementing untested solutions that are simple…obvious…and wrong
Variations in inputs and outputs
Improving quality = Improving processes
Using statistics = Prediction
TQM…CQI…Six Sigma…Lean Six Sigma…TOYOTA Lean Six Sigma
IT’S ALL THE SAME!– Obsession with waste…use of data…
teamwork It’s all about improving
PROCESSES! Lean: #1, #4, #5 Toyota Lean: Seeing “Time” as
Inventory
DB article: p. 22
STATISTICS?!
Action
Process
OutputMeasurement
Process
Collection
Process
MetObjectives
AnalysisProcess
Interpretation
Process
Useless
No
Yes
P M M M E M
PMMMEM
PMMMEM
People
Methods
Machines
MaterialsEnvironment
Measurements
Data
P M M M E M
Use of Data as a Process
Definition, collection, analysis, interpretation
Yep…Statistics
Statistics: #2, #3, #6– Expose variation– Design tests of theories– Assess interventions– Hold gains– React appropriately to variation
The use of data is a process…
…actually, FOUR processes– Definition– Collection– Analysis / display– Interpretation
POOR use of data is WASTE– Unbeknownst, many meetings are reacting
to variation in the DATA process Not maths, but statistical THINKING
– Based in “process”– Common language to depersonalise issues– Improve the quality of conversations– React appropriately to variation
Déjà vu? How many meetings?
Pages & pages…
I HATE bar graphs & trend lines!!!!!
P.A.R.C. Analysis
Practical Accumulated Records Compilation
Passive Analysis Regressions Correlations
Profound Analysis Relying (on) Computers
Planning After Research Completed
Study: Whites may sway TV ratings
…associate professor & Chicago-based economist reviewed TV ratings of 259 basketball games…
…attempted to factor out all other variables…– Win-loss records of teams– Times games were aired
“The economists concluded that every additional 10 minutes of playing time by a white player increases a team’s local ratings by, on average, …5800 homes.”
o e d rn c m ot o i ci r n en d i du i n uo n i ru g s es t s
ra
ti
ve
C R A P
“Traffic Lights” ? Indicator Trust Status A&E Cancer Crit Care Medicine O&G Paeds SR&T Surgery T&O
IP Activity J J J J J K J K J JOP Activity J L K K K K J J J JA&E 4 hr Wait L LIP >6 months L J J J J J J J K LOp > 13 weeks L J J K J J J K K L
JKL Significantly Below or worse than Target
Below or Worse than Target
Status Key
On Target or Achieved
RUBBISH!
Folks, I can’t make this up…
“The target is for 90% of the bottom
quartile to perform at the 2004
average by the end of 2008.”
?????????????????????????????
Vague datacollected in response to
a…
Vague problemwill yield a…
Vague solution,which, in turn, will yield a
Vague result.
Given two numbers…
SomethingImportant
Yesterday Today
…one will be bigger!
Weekend’s 13 Weekend’s 13 traffic deaths traffic deaths surpassed last surpassed last
year’s total of 9year’s total of 9
Officials seek reasons for rise in Officials seek reasons for rise in overall road deathsoverall road deaths
(600 vs. 576)
The “Law of Averages”““If I stick my right foot in a bucket of If I stick my right foot in a bucket of boiling water and my left foot in a boiling water and my left foot in a bucket of ice water, on the average…bucket of ice water, on the average…I’m pretty comfortable.”I’m pretty comfortable.”
Does it look like this…?
0
2
4
6
8
1 0
1 2
1 4
Indiv
idual V
alu
e
...or this?
-5
0
5
1 0
1 5
Indiv
idual V
alu
e
The Myth of Trends
Time
“Upward Trend” (?)
“Downturn” (?)
“Rebound” (?)
“Setback” (?)
“Turnaround” (?)
“Downward Trend” (?)
This month…
vs. last month…
vs. 12 months ago
3 Months of Quarterly results…
This quarter…
vs. last quarter…
vs. same quarter last year
NP- Chart Coin Flip AnalysisPdouble-head = (Sum of Numerators) / (Sum of Denominators)
Davis Balestracci X Mean = N x P double-head
Harmony Consulting UCL = X Mean + 3 x sqrt[N x (P double-head) x (1 - P double-head)]www.dbharmony.com LCL = X Mean - 3 x sqrt[N x (P double-head) x (1 - P double-head)]
1) Enter data values in Columns B (# Double Heads) & C (# Participants)2) Columns E, F, G & I should automatically update when each row is entered
3) Save the file under a different name so you do not lose the original template.
Numerator Denominator Limits for the NP- Chartthe NP-ChartEvent # Double Heads # Participants LCL X Mean UCL % double-head
1 #DIV/0! #DIV/0! #DIV/0! #DIV/0!2 3
NP-Chart for Seminar Participants' "Double Heads"
0
0
0
0
0
1
1
1
1
1
1
Statistics = Understanding Variation There are TWO kinds of variation
– Special cause (Unique occurrence, “One off”)
– Common cause (Inherent, “Systemic”)
Treating one as the other MAKES THINGS WORSE– The human tendency is to treat ALL
variation as “one off”– Even if things “shouldn’t” happen,
you might be “perfectly designed” to have them happen
How are they doing with guideline implementation?
% ComplianceThis month: 69.44%
Last month: 50%
12 months ago: 69.44%
GOAL: 75%
“Statistical” definition of “trend”
Time
"Sw
eat"
Inde
xUpward Trend
Time
Downward Trend
Special Cause – A sequence of SEVEN or more points continuously increasing or continuously decreasing.
Note: If the total number of observations is 20 or less, SIX continuously increasing or decreasing points can be used to declare a trend.
IMPORTANT: To be used only with tabulated data having NO context of variation
[p. 16]
Goal: Go from 50% to 75%
% ComplianceThis month: 69.44%
Last month: 50
12 months ago: 69.44
GOAL: 75%
% Compliance6/97 44.44 %
41.6750.00
9/97 50.0052.7858.33
12/9733.3341.6750.00
3/98 69.4469.4466.67
6/98 66.6769.44
72.22 (Largest)9/98 66.67
66.6763.89
12/9869.4455.5650.00
3/99 69.44
Special Cause: A consecutive sequence of 8 or more points on one
side of the medianData
-2
0
2
4
6
8
1 0
1 2
Indiv
idual V
alu
e
Run Chart: A time ordered plot of process data with the MEDIAN drawn in as a reference line.
Goal: Go from 50% to 75%--How are they doing?
% Compliance6/97 44.44 %
41.6750.00
9/97 50.0052.7858.33
12/97 33.3341.6750.00
3/98 69.4469.4466.67
6/98 66.6769.4472.22
9/98 66.6766.6763.89
12/98 69.4455.5650.00
3/99 69.44
Sorted33.3341.6741.6744.4450.0050.0050.0050.0052.7855.5658.3363.8966.6766.6766.6766.6769.4469.4469.4469.4469.4472.22
3/9912/989/986/983/9812/979/976/97
70
60
50
40
30
Month
% C
om
plia
nce
Run Chart for % Chart Audits in Compliance with Guideline
6/97 - 3/99
“Plot the dots!”
[p. 17]
How many meetings?
Arrests Vfib Mo/Year 18 6 6/94 17 8 7/94 15 6 8/94 19 6 9/94 21 6 10/94 21 8 11/94 23 7 12/94 25 7 1/95 21 1 2/95 30 9 3/95 27 8 4/95 24 9 5/95 24 9 6/95 19 2 7/95 14 2 8/95 21 7 9/95 32 5 10/95 19 4 11/95 28 9 12/95 28 10 1/96 28 8 2/96 17 5 3/96 21 7 4/96 24 3 5/96 Tot_Arr Tot_Vfib Period 261 81 6/94-5/95 275 71 6/95-5/96
“We are running a slightly higher number of cardiac arrests per month. The total amount of cardiac arrests has risen from a mean of 21.75 (June 94- May 95), to 22.92 (June 95- May 96). This is an increase in 14 cardiac arrests in the last 12 months.”
Arrests
10
15
20
25
30
35
Jun-
94
Jul-9
4
Aug
-94
Sep
-94
Oct
-94
Nov
-94
Dec
-94
Jan-
95
Feb
-95
Mar
-95
Apr
-95
May
-95
Jun-
95
Jul-9
5
Aug
-95
Sep
-95
Oct
-95
Nov
-95
Dec
-95
Jan-
96
Feb
-96
Mar
-96
Apr
-96
May
-96
Period
Indi
vidu
al V
alue
Why, yes…(275 – 261) does indeed equal 14
“Next we interpreted the data relating to Vfib Cardiac Arrests…This could be significant to our outcome, and…indicates a need for more sophisticated statistical analysis. It was already shown that the number of cardiac arrests has increased by a mean of 1.17 per month. Now we are adding to that increase, a decrease of times we are seeing Vfib as the initial rhythm…This obviously means that over the last year, we have responded to more cardiac arrests and found them in more advanced stages of arrest.”
%Vfib
0
10
20
30
40
50
60
Jun-
94
Jul-9
4
Aug
-94
Sep
-94
Oct
-94
Nov
-94
Dec
-94
Jan-
95
Feb
-95
Mar
-95
Apr
-95
May
-95
Jun-
95
Jul-9
5
Aug
-95
Sep
-95
Oct
-95
Nov
-95
Dec
-95
Jan-
96
Feb
-96
Mar
-96
Apr
-96
May
-96
Period
Indi
vidu
al V
alue Obviously…
TREND?! I think NOT!!!Percentage discharged, admitted or transferred within 4 hours - A&E Type 1+2
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
16
/06
/20
03
to 2
2/0
6/2
00
3
23
/06
/20
03
to 2
9/0
6/2
00
3
30
/06
/20
03
to 0
6/0
7/2
00
3
07
/07
/20
03
to 1
3/0
7/2
00
3
14
/07
/20
03
to 2
0/0
7/2
00
3
21
/07
/20
03
to 2
7/0
7/2
00
3
28
/07
/20
03
to 0
3/0
8/2
00
3
04
/08
/20
03
to 1
0/0
8/2
00
3
11
/08
/20
03
to 1
7/0
8/2
00
3
18
/08
/20
03
to 2
4/0
8/2
00
3
25
/08
/20
03
to 3
1/0
8/2
00
3
01
/09
/20
03
to 0
7/0
9/2
00
3
08
/09
/20
03
to 1
4/0
9/2
00
3
15
/09
/20
03
to 2
1/0
9/2
00
3
22
/09
/20
03
to 2
9/0
9/2
00
3
29
/09
/20
03
to 0
5/1
0/2
00
3
06
/10
/20
03
to 1
2/1
0/2
00
3
13
/10
/20
03
to 1
9/1
0/2
00
3
20
/10
/20
03
to 2
6/1
0/2
00
3
27
/10
/20
03
to 0
2/1
1/2
00
3
03
/11
/20
03
to 0
9/1
1/2
00
3
10
/11
/20
03
to 1
6/1
1/2
00
3
17
/11
/20
03
to 2
3/1
1/2
00
3
24
/11
/20
03
to 3
0/1
1/2
00
3
01
/12
/20
03
to 0
7/1
2/2
00
3
0/1
2/2
00
3 to
14
/12
/20
03
15
/12
/20
03
to 2
1/1
2/2
00
3
22
/12
/20
03
to 2
8/1
2/2
00
3
29
/12
/20
03
to 0
4/0
1/2
00
4
05
/01
/20
04
to 1
1/0
1/2
00
4
12
/01
/20
04
to 1
8/0
1/2
00
4
19
/01
/20
04
to 2
5/0
1/2
00
4
26
/01
/20
04
to 0
1/0
2/2
00
4
02
/02
/20
04
to 0
8/0
2/2
00
4
09
/02
/20
04
to 1
5/0
2/2
00
4
16
/02
/20
04
to 2
2/0
2/2
00
4
23
/02
/20
04
to 2
9/0
2/2
00
4
01
/03
/20
04
to 0
7/0
3/2
00
4
08
/03
/20
04
to 1
4/0
3/2
00
4
15
/03
/20
04
to 2
1/0
3/2
00
4
22
/03
/20
04
to 2
8/0
3/2
00
4
% Total seen < 4 Hours
70.00%
75.00%
80.00%
85.00%
90.00%
95.00%
100.00%
4/6/
2003
4/27
/200
3
5/18
/200
3
6/8/
2003
6/29
/200
3
7/20
/200
3
8/10
/200
3
8/31
/200
3
9/21
/200
3
10/1
2/20
03
11/2
/200
3
11/2
3/20
03
12/1
4/20
03
1/4/
2004
1/25
/200
4
2/15
/200
4
3/7/
2004
3/28
/200
4
Period
Indi
vidu
al V
alue
[p. 20]
“Reduce Accidents 25%!”
1989
1990
1989
1990
129630
7
6
5
4
3
2
1
0
Month
# Acciden
ts
"Year-Over-Year" Plot of Accident Data
24211815129630
7
6
5
4
3
2
1
0
Month# Acciden
ts
"Trend" Analysis for Accident Data
1/89 - 12/90
Not Valid!
("Trend" of 4.173 to 2.243)
8 months are lower than previous year
Reduction is 46.2% !
45 one year…32 the next…25 % reduction achieved?
[p. 18]
Goals a la Dilbert
Boss:– Our goal this year is ZERO disabling
injuries.
– Last year our goal was 25 disabling injuries; however, in retrospect, that was a mistake…
– We had to injure nine employees to meet the goal
Safety Data
24211815129630
7
6
5
4
3
2
1
0
Month
# A
ccid
ents
Run Chart for Accident Data
1/89 - 12/90
(Median = 3)
“Plot the dots!”
Need “common cause” strategy
Statistics on the number of accidents does not improve the number of accidents
You cannot treat data points individually or “dissect” an accident individually
You cannot compare two points– % change, “too big” a change…
It does NOT mean that the current performance is
“acceptable”!
Event
Type A B C D E F Total
1 0 0 1 0 2 1 4
2 1 0 0 0 1 0 2
3 0 16 1 0 2 0 19
4 0 0 0 0 1 0 1
5 2 1 3 1 4 2 13
6 0 0 0 0 3 0 3
27
28 (less than 6 each)
29
Totals 6 19 7 3 35 7 77
Unit
Matrix of Adverse Events
SHA name 30-Mar-03 6-Apr-03 13-Apr-03 20-Apr-03 27-Apr-03 4-May-03 11-May-03 18-May-03 25-May-03 1-Jun-03Avon, Gloucestershire & Wiltshire 89.7% 85.1% 83.9% 85.1% 85.2% 84.9% 85.7% 85.5% 85.3% 85.2%Bedfordshire and Hertfordshire 93.1% 89.1% 88.0% 84.9% 84.3% 85.4% 85.7% 86.8% 87.8% 85.3%Birmingham and the Black Country 91.8% 85.4% 84.9% 85.8% 85.6% 84.8% 88.7% 88.3% 86.7% 87.5%Cheshire & Merseyside 95.2% 90.1% 88.5% 87.3% 87.0% 85.7% 88.1% 88.0% 87.9% 87.6%County Durham & Tees Valley 94.8% 96.4% 94.7% 94.6% 92.2% 93.9% 95.5% 94.3% 92.0% 94.2%Cumbria & Lancashire 91.7% 91.6% 92.1% 93.0% 92.0% 92.7% 93.6% 93.5% 92.6% 91.9%Dorset & Somerset 93.8% 91.2% 89.7% 92.3% 91.5% 91.5% 89.7% 93.2% 90.9% 92.8%Essex 93.8% 90.8% 91.2% 91.1% 91.5% 90.3% 92.3% 89.9% 91.1% 90.5%Greater Manchester 94.7% 91.0% 90.7% 88.8% 89.5% 90.0% 90.8% 92.6% 91.1% 89.8%Hampshire and Isle of Wight 90.6% 83.5% 84.3% 81.4% 84.0% 82.3% 81.7% 82.8% 80.8% 79.7%Kent and Medway 88.1% 90.1% 89.5% 89.6% 87.6% 86.0% 91.0% 92.2% 89.3% 87.4%Leicestershire, Northamptonshire & Rutland 86.1% 73.3% 72.2% 74.7% 74.0% 72.8% 77.4% 75.9% 78.4% 73.0%Norfolk, Suffolk and Cambridgeshire 93.6% 88.4% 86.6% 86.0% 85.8% 87.9% 87.6% 87.3% 85.9% 86.0%North and East Yorkshire and Northern Lincolnshire 94.2% 92.7% 93.3% 92.4% 91.7% 90.0% 91.5% 91.7% 90.7% 92.0%North Central London 93.7% 83.7% 86.6% 84.4% 86.1% 84.9% 84.9% 85.4% 85.1% 83.9%North East London 93.7% 84.4% 80.8% 79.7% 78.8% 78.8% 81.9% 81.6% 79.6% 80.1%North West London 94.6% 86.7% 86.2% 86.4% 83.7% 83.1% 81.9% 82.2% 81.4% 82.6%Northumberland, Tyne and Wear 94.1% 92.5% 91.5% 92.0% 90.0% 90.1% 92.4% 92.7% 92.6% 92.1%Shropshire and Staffordshire 95.4% 88.0% 89.0% 84.0% 85.6% 83.9% 84.2% 85.8% 87.4% 83.0%South East London 96.1% 89.7% 90.9% 91.5% 89.0% 88.7% 89.2% 90.0% 88.9% 89.2%South West London 95.5% 80.5% 83.4% 81.4% 80.6% 81.9% 82.0% 81.0% 80.1% 80.3%South West Peninsula 95.7% 90.9% 90.1% 89.5% 89.4% 89.1% 92.5% 92.8% 88.6% 90.1%South Yorkshire 95.1% 86.6% 85.4% 86.0% 84.8% 86.0% 87.9% 91.0% 89.9% 87.7%Surrey and Sussex 88.4% 84.4% 85.0% 85.7% 84.3% 83.7% 83.4% 85.0% 83.7% 83.5%Thames Valley 83.2% 80.3% 80.0% 79.2% 81.4% 78.4% 80.4% 83.7% 81.7% 79.6%Trent 93.1% 87.7% 88.6% 88.1% 88.1% 87.4% 89.2% 90.0% 87.4% 86.2%West Midlands South 93.7% 89.1% 92.0% 91.6% 88.5% 87.9% 89.3% 89.5% 91.8% 94.3%West Yorkshire 93.6% 90.8% 90.2% 90.1% 91.8% 90.7% 90.1% 91.7% 89.7% 89.8%England total 92.9% 87.8% 87.6% 87.1% 86.7% 86.3% 87.5% 88.1% 87.1% 86.7%
“Red…Amber…Green…” RUBBISH!
[p. 20]
West 93.6%90.8%90.2%90.1%91.8%90.7%90.1%91.7%89.7%89.8%88.5%91.0%89.7%91.1%90.1%90.1%91.1%90.8%91.4%91.9%
Region 28
87.00%
88.00%
89.00%
90.00%
91.00%
92.00%
93.00%
94.00%
30-M
ar-0
3
6-Ap
r-03
13-A
pr-0
3
20-A
pr-0
3
27-A
pr-0
3
4-M
ay-0
3
11-M
ay-0
3
18-M
ay-0
3
25-M
ay-0
3
1-Ju
n-03
8-Ju
n-03
15-J
un-0
3
22-J
un-0
3
29-J
un-0
3
6-Ju
l-03
13-J
ul-0
3
20-J
ul-0
3
27-J
ul-0
3
3-Au
g-03
10-A
ug-0
3
Indi
vidu
al V
alue
“What about those 3 consecutive yellow months?!?!”
What about them…?
Don’t abdicate just yet!!!
The math is so simple, it would astound you
Region 28
87.00%
88.00%
89.00%
90.00%
91.00%
92.00%
93.00%
94.00%
95.00%30
-Mar
-03
6-Ap
r-03
13-A
pr-0
3
20-A
pr-0
3
27-A
pr-0
3
4-M
ay-0
3
11-M
ay-0
3
18-M
ay-0
3
25-M
ay-0
3
1-Ju
n-03
8-Ju
n-03
15-J
un-0
3
22-J
un-0
3
29-J
un-0
3
6-Ju
l-03
13-J
ul-0
3
20-J
ul-0
3
27-J
ul-0
3
3-Au
g-03
10-A
ug-0
3
Indi
vidu
al V
alue
Special Cause Flag
Current performance: 90.7% [87.6 – 93.8]
Two consecutive weeks can differ by 3.9
The process tells you what these number are![Sorry if you don’t “like” them]
Transition to More “Advanced” Skills
From:– Colors & Faces & Drawing circles
To:– Counting up to “8”– Subtracting two numbers– Sorting a list of numbers– Asking better questions!– Change organisational conversations
around data– Reacting appropriately to variation
What would you do with data like this NOW?
10
73
10
10
8
12
8
6
7
13
6
9
3
10
2
9
12
5
0
5
10
15
20
25
30
35
40
2001-02 2002-03 2003-04 2004-05 2005-06
MRSA Bacteraemia 2001-02 to 2005-06
Q4Q3
Q2Q1
[p. 19]
“Plot the dots!” Quarterly MRSA Bacteraemias
02468
101214161820
Q! 2
001
Q2
Q3
Q4
Q1
2002 Q
2
Q3
Q4
Q1
2003 Q
2
Q3
Q4
Q1
2004 Q
2
Q3
Q4
Q1
2005 Q
2
Q3
Period
Indi
vidu
al V
alue
Quarterly MRSA Bacteraemias
0
2
4
6
8
10
12
14
16
18
20
Q! 2
001
Q2
Q3
Q4
Q1
2002 Q2
Q3
Q4
Q1
2003 Q2
Q3
Q4
Q1
2004 Q2
Q3
Q4
Q1
2005 Q2
Q3
Period
Indi
vidu
al V
alue
Special Cause Flag
Quarter-to-quarterdifference: < 10
Looking at “complaints” as a process: perfectly
designed… Total Complaints
0
10
20
30
40
50
Feb-
02
Apr-0
2
Jun-
02
Aug-
02
Oct
-02
Dec
-02
Feb-
03
Apr-0
3
Jun-
03
Aug-
03
Oct
-03
Dec
-03
Feb-
04
Apr-0
4
Jun-
04
Aug-
04
Oct
-04
Dec
-04
Period
Indi
vidu
al V
alue
% within 20 days
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
Feb-
02
Apr-0
2
Jun-
02
Aug-
02
Oct
-02
Dec
-02
Feb-
03
Apr-0
3
Jun-
03
Aug-
03
Oct
-03
Dec
-03
Feb-
04
Apr-0
4
Jun-
04
Aug-
04
Oct
-04
Dec
-04
Period
Indi
vidu
al V
alue
“It is what it is!” …“Plot the dots!”
Total Complaints
0
10
20
30
40
50
Feb-
02
Apr-0
2
Jun-
02
Aug-
02
Oct
-02
Dec
-02
Feb-
03
Apr-0
3
Jun-
03
Aug-
03
Oct
-03
Dec
-03
Feb-
04
Apr-0
4
Jun-
04
Aug-
04
Oct
-04
Dec
-04
Period
Indi
vidu
al V
alue
Special Cause Flag
Month-to-month difference: < 24
Need a common cause strategy!
“We made a difference!”
0
2
4
6
8
10
12
14
16
1 2 3 4 5 6 7 8 9 101112131415161718
0
200
400
600
800
1000
1200
1400
# Infections
#Patients
Infection Rate
-0.5
0
0.5
1
1.5
2
2.51 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Month
Infe
cctio
n R
ate
Really?
Budgets, too!
Actual FTE
Budget FTE
0 5 10 15 20 25
102
107
112
Pay Period
FT
E
Plot of FTE Performance Vs. Budget
2007 Resolutions: Weight and… Budget?—Jan/Feb 2007http://www.qualitydigest.com/jan07/departments/spc_guide.shtml http://www.qualitydigest.com/feb07/departments/spc_guide.shtml
[p. 24]
FTE
95
100
105
110
115
1201/
18/9
8
2/15
/98
3/15
/98
4/12
/98
5/10
/98
6/7/
98
7/5/
98
8/2/
98
8/30
/98
9/27
/98
10/2
5/98
11/2
2/98
12/2
0/98
1/17
/99
2/14
/99
Period
Indi
vidu
al V
alue
Variance from Budget
-15
-10
-5
0
5
10
1/18
/98
2/15
/98
3/15
/98
4/12
/98
5/10
/98
6/7/
98
7/5/
98
8/2/
98
8/30
/98
9/27
/98
10/2
5/98
11/2
2/98
12/2
0/98
Period
Indi
vidu
al V
alue
Do you REALLY need those meetings every 2 weeks?!
FTE
95
100
105
110
115
120
1/18
/199
8
2/15
/199
8
3/15
/199
8
4/12
/199
8
5/10
/199
8
6/7/
1998
7/5/
1998
8/2/
1998
8/30
/199
8
9/27
/199
8
10/2
5/19
98
11/2
2/19
98
12/2
0/19
98
1/17
/199
9
2/14
/199
9
Period
Variance from Budget
-15
-10
-5
0
5
10
1/18
/98
2/15
/98
3/15
/98
4/12
/98
5/10
/98
6/7/
98
7/5/
98
8/2/
98
8/30
/98
9/27
/98
10/2
5/98
11/2
2/98
12/2
0/98
Period
Indi
vidu
al V
alue
Special Cause Flag
Link to Balanced Scorecard
All hospital incident rate
0.016
0.018
0.02
0.022
0.024
0.026
0.028
0.03
Jul-0
4
Sep-
04
Nov
-04
Jan-
05
Mar
-05
May
-05
Jul-0
5
Sep-
05
Nov
-05
Jan-
06
Mar
-06
May
-06
Jul-0
6
Sep-
06
Nov
-06
Jan-
07
Period
Indi
vidu
al V
alue
Special Cause Flag
Complaint rate per admission
0.00200
0.00400
0.00600
0.00800
0.01000
0.01200Ju
l-03
Nov-
Mar
-
Jul-0
4
Nov-
Mar
-
Jul-0
5
Nov-
Mar
-
Jul-0
6
Nov-
Pressure Ulcer Rate
-0.0001
0
0.0001
0.0002
0.0003
0.0004
0.0005
0.0006
Jul-0
3
Nov-
Mar
-
Jul-0
4
Nov-
Mar
-
Jul-0
5
Nov-
Mar
-
Jul-0
6
Nov-
Total Falls
-5
0
5
10
15
Jul-0
3
Nov-
Mar
-
Jul-0
4
Nov-
Mar
-
Jul-0
5
Nov-
Mar
-
Jul-0
6
Nov-
Bacteraemia rate
0
0.0005
0.001
0.0015
0.002
0.0025
0.003
Jul-0
3
Nov-
Mar
-
Jul-0
4
Nov-
Mar
-
Jul-0
5
Nov-
Mar
-
Jul-0
6
Nov-
All Hosp_Med_err_rate
0.0005
0.001
0.0015
0.002
0.0025
0.003Ju
l-03
Nov-
Mar
-
Jul-0
4
Nov-
Mar
-
Jul-0
5
Nov-
Mar
-
Jul-0
6
Nov-
All hospital incident rate
0.016
0.018
0.02
0.022
0.024
0.026
0.028
0.03
Jul-0
3
Nov-
Mar
-
Jul-0
4
Nov-
Mar
-
Jul-0
5
Nov-
Mar
-
Jul-0
6
Nov-
H1_Med_err_rate
0
0.001
0.002
0.003
0.004
0.005
0.006
0.007
0.008
Jul-0
3
Oct-0
3
Jan-
04
Apr-0
4
Jul-0
4
Oct-0
4
Jan-
05
Apr-0
5
Jul-0
5
Oct-0
5
Jan-
06
Apr-0
6
Jul-0
6
Oct-0
6
Jan-
07
H2_med_err_rate
0
0.001
0.002
0.003
0.004
0.005
0.006
0.007
0.008
Jul-0
3
Oct-0
3
Jan-
04
Apr-0
4
Jul-0
4
Oct-0
4
Jan-
05
Apr-0
5
Jul-0
5
Oct-0
5
Jan-
06
Apr-0
6
Jul-0
6
Oct-0
6
Jan-
07H3_med_err_rate
0
0.001
0.002
0.003
0.004
0.005
0.006
0.007
0.008
Jul-0
3
Oct-0
3
Jan-
04
Apr-0
4
Jul-0
4
Oct-0
4
Jan-
05
Apr-0
5
Jul-0
5
Oct-0
5
Jan-
06
Apr-0
6
Jul-0
6
Oct-0
6
Jan-
07
H4_med_err_rate
0
0.001
0.002
0.003
0.004
0.005
0.006
0.007
0.008
Jul-0
3
Oct-0
3
Jan-
04
Apr-0
4
Jul-0
4
Oct-0
4
Jan-
05
Apr-0
5
Jul-0
5
Oct-0
5
Jan-
06
Apr-0
6
Jul-0
6
Oct-0
6
Jan-
07
H5_med_err_rate
0
0.001
0.002
0.003
0.004
0.005
0.006
0.007
0.008
Jul-0
3
Oct-0
3
Jan-
04
Apr-0
4
Jul-0
4
Oct-0
4
Jan-
05
Apr-0
5
Jul-0
5
Oct-0
5
Jan-
06
Apr-0
6
Jul-0
6
Oct-0
6
Jan-
07
H6_Med_err_rate
0
0.001
0.002
0.003
0.004
0.005
0.006
0.007
0.008
Jul-0
3
Oct-0
3
Jan-
04
Apr-0
4
Jul-0
4
Oct-0
4
Jan-
05
Apr-0
5
Jul-0
5
Oct-0
5
Jan-
06
Apr-0
6
Jul-0
6
Oct-0
6
Jan-
07
All Hosp_Med_err_rate
0
0.001
0.002
0.003
0.004
0.005
0.006
0.007
0.008
Jul-0
3
Oct-0
3
Jan-
04
Apr-0
4
Jul-0
4
Oct-0
4
Jan-
05
Apr-0
5
Jul-0
5
Oct-0
5
Jan-
06
Apr-0
6
Jul-0
6
Oct-0
6
Jan-
07
This…?
Kent and Medway K&M 98.4% 96.7% 98.4% 97.3% 96.9% 96.4% County Durham & Tees Valley CDTV 96.7% 95.6% 96.5% 96.3% 94.7% 96.4%Trent Trent 96.7% 95.3% 96.7% 95.5% 94.0% 96.6%Shropshire & Staffordshire SASHA 97.9% 97.1% 98.1% 97.3% 97.5% 96.6% Hampshire & the Isle of Wight H&IOW 96.6% 95.9% 96.0% 96.7% 95.1% 96.7%West Midlands South WMS 97.0% 96.4% 97.6% 97.4% 96.1% 96.7%Bedfordshire & Hertfordshire Beds&Herts 96.6% 96.0% 96.7% 96.4% 95.2% 96.8%Leicestershire. Northamptonshire & RutlandLNR 96.3% 96.2% 97.3% 96.9% 95.6% 96.8%Birmingham & the Black Country BBC 96.8% 95.8% 96.4% 96.6% 94.7% 96.9%Surrey & Sussex Sy&Sx 96.7% 96.7% 96.7% 97.0% 95.9% 97.5%Greater Manchester GM 96.7% 96.7% 96.5% 96.6% 95.9% 97.6%Cumbria & Lancashire C&L 98.0% 97.7% 98.1% 97.9% 97.7% 97.8%South West Peninsula SWP 97.2% 97.8% 97.2% 98.0% 97.8% 97.8% Avon. Gloucestershire & Wiltshire AG&W 96.8% 97.0% 96.4% 97.2% 96.2% 97.8%Norfolk. Suffolk & Cambridgeshire NSC 97.2% 97.7% 97.6% 98.0% 97.4% 98.1%
Indicator Trust Status A&E Cancer Crit Care Medicine O&G Paeds SR&T Surgery T&O
IP Activity J J J J J K J K J JOP Activity J L K K K K J J J JA&E 4 hr Wait L LIP >6 months L J J J J J J J K LOp > 13 weeks L J J K J J J K K L
…or this?
24211815129630
7
6
5
4
3
2
1
0
Month
# A
ccid
ents
Run Chart for Accident Data
1/89 - 12/90
(Median = 3)
Region 28
87.00%
88.00%
89.00%
90.00%
91.00%
92.00%
93.00%
94.00%
95.00%
30-M
ar-0
3
6-Ap
r-03
13-A
pr-0
3
20-A
pr-0
3
27-A
pr-0
3
4-M
ay-0
3
11-M
ay-0
3
18-M
ay-0
3
25-M
ay-0
3
1-Ju
n-03
8-Ju
n-03
15-J
un-0
3
22-J
un-0
3
29-J
un-0
3
6-Ju
l-03
13-J
ul-0
3
20-J
ul-0
3
27-J
ul-0
3
3-Au
g-03
10-A
ug-0
3
Indi
vidu
al V
alue
Special Cause Flag
%Vfib
0
10
20
30
40
50
60
Jun-
94
Jul-9
4
Aug
-94
Sep
-94
Oct
-94
Nov
-94
Dec
-94
Jan-
95
Feb
-95
Mar
-95
Apr
-95
May
-95
Jun-
95
Jul-9
5
Aug
-95
Sep
-95
Oct
-95
Nov
-95
Dec
-95
Jan-
96
Feb
-96
Mar
-96
Apr
-96
May
-96
Period
Indi
vidu
al V
alue
% C-Sections -- Adjusted for "Shift"
8
10
12
14
16
18
20
22
24
Jan-
95
Apr-9
5
Jul-9
5
Oct
-95
Jan-
96
Apr-9
6
Jul-9
6
Oct
-96
Jan-
97
Apr-9
7
Jul-9
7
Oct
-97
Jan-
98
Apr-9
8
Jul-9
8
Oct
-98
Period
Indi
vidu
al V
alue
Special Cause Flag
% Total seen < 4 Hours
70.00%
75.00%
80.00%
85.00%
90.00%
95.00%
100.00%
4/6/
2003
4/27
/200
3
5/18
/200
3
6/8/
2003
6/29
/200
3
7/20
/200
3
8/10
/200
3
8/31
/200
3
9/21
/200
3
10/1
2/20
03
11/2
/200
3
11/2
3/20
03
12/1
4/20
03
1/4/
2004
1/25
/200
4
2/15
/200
4
3/7/
2004
3/28
/200
4
Period
Indi
vidu
al V
alue
Special Cause Flag
TRUE STORY
An exec in NZ gave my “plot the dots” macro to an outspoken male nurse, who spoke up at a meeting…
“I just plotted the dots…
…and you don’t know jacks__t!”
Where is the “time” for quality improvement going to come
from? 50% reduction in monthly senior management meeting time– 80% reduction in monthly corporate
financial reports Eliminating up to one hour each day of
managerial review of unimportant data– 60% reduction in daily pounds of published
performance reports (“Backup data”) Other benefits
– Making the vision and values real to employees
– Tracking progress toward achieving the vision and living the values
Linking Performance to Strategy
WHAT are we going to do? WHOM will we do it for? WHY should patients come here? WHERE will we place our emphasis in
products and markets? Core: HOW are we going to bring about
the WHAT, WHO, WHY, and WHERE?– Systems and structures
Not “measures,” but “management”
“Are we doing the right things right?”
A total measurement system– Not an “unbalanced rubbish heap” of
operational measures A PROCESS for converting the data
into intelligent (and appropriate) action at the appropriate level
A hidden benefit…
Coming up with a good solid set of metrics and actually using it to manage will save thousands of hours of time wasted reviewing charts and graphs in meetings and reading reports on statistics that do not really matter…Armies of employees do nothing but collect, summarize, and report data. Armies of managers and technical professionals spend time reviewing these data and attempting to pull out something meaningful from the mass of charts they receive each week… Mark Graham Brown
Break
--Read Peter Block article pp. 5-7
--Informally discuss pp. 5-7 with your colleagues
--What about “demotivators”? P. 7
--Fill out & score assessment on Page 8
21st Century “Leadership”—A Blinding Flash of the Obvious: Isn’t it about time?
Part 2: Some “cultural” issues
Davis BalestracciDavis BalestracciHarmony Consulting, LLC
Phone: +207 – 899-0962
e-mail: [email protected]
Web Site: www.dbharmony.com
Fill out & score Page 8 assessment
Process
Tools
Tech/Adminformation
Only the tip of the iceberg
p. 9
But this is EVERY process needing improvement…or it wouldn’t need
improvement
…AND people are “dancing as fast as they can”…And they’re CRANKY! [ whyiseveryonesocranky.com ]
**Your current processes are perfectly designed to get the
results you are already getting…and will continue to get
Organisational results
Tolerated organisational behaviours– Unlock cultural handcuffs
Tolerated individual behaviours
“Perfectly designed” Current processes: Perfectly designed
to consume over 100% of people’s time,– It’s amazing how much waste can be
disguised as useful work, No one ever puts “culture change” on a
“To Do” list, Logic never convinced anyone of
anything, and only logicians use it as a source of income,
In other words:“Change would be so easy if it weren’t for all the people!”
Personal feedback processes
Relationships
Perceptions & Feelings:CULTURE
The Real Challenge
Issues of :
Cooperation
Support
Collaboration
Individual Mindsets
But there’s NO escaping it…
"When we are dealing with people, let us remember we are not dealing with creatures of logic. We are dealing with creatures of emotion, creatures bustling with prejudices and motivated by pride and vanity.“
— Dale Carnegie, personal effectiveness pioneer and author
Culture change and Individual change
Awareness Breakthrough in knowledge Choosing a breakthrough in
thinking Breakthrough in behaviour
Experiences Beliefs Actions Results
(E1) (B1) (A1) (R1)
E1 + B1 + A1 = Culture (C1)
A deceptively simple model:For individual & organisationalbehaviours
p. 10
R1
A1
B1
E1
R2
A2
B2
E2
New results will require new “beliefs”
As an organisation AND…
As individuals
Culture change and Individual change
Awareness Breakthrough in knowledge Choosing a breakthrough in
thinking Breakthrough in behaviour
– Changed “belief system” telegraphs through observed behaviour
Breakthrough in Thinking
Conscious realisation that current behaviours / actions will not produce long term desired results
Usually precipitated by a visceral reaction – Morris Massey calls these Significant
Emotional Events– Can you make a conscious choice to
“move through it”…and grow?
Breakthrough in Behavior
Changed belief system Growth:
– Consciously examining one’ beliefs– Recognising ones that aren’t working– Choosing to replace them with
healthier beliefs for long term success…and inner peace
Goes beyond describing A2
How do YOU create experiences to motivate the beliefs to drive the right actions that will achieve desired organisational results? AND…
• How do YOU stop recreating experiences (or perceptions of E1) that reinforce old beliefs that drive unwanted actions and produce undesired results?
New executive “B2”…
Given: People HATE being changed!
“Those darn humans…
God bless ‘em!”
The Cultural Transformation Mantra:
“Most human problems are permanent.”--Peter Block
Humans thrive on predictability
“Culture” will eat your best intentions for lunch!People fear retribution from “the tribe”
What they say (“Stated reason”) may not necessarily be what they really mean (“Real reason”)Juran: Managerial Breakthrough
So: “How do I have to
change to get people to
want to change?”
GIVEN reaction: “I agree with what you’re doing. Everyone (else) needs to change.”
Key E2—Led by Executives
ZERO tolerance for “blame”– See Clemmer paragraph p. 4– Go to www.clemmer.net and sign up
for his “Improvement Points” No whingeing allowed…to go
(gently) unchallenged (QBQ!) Data Sanity— “Plot the dots!”
VERY important… R2 business results must be
CLEARLY defined
Or…
“Those darn humans!” WILL continue to produce R1!
Is the sharing of these R2 results just an E1 experience? (“Here we go again!”)
“But this time, we mean it!” (E1 ?)
“Those darn humans!” If You are confused, THEY are
confused If YOU are clear, THEY will act
confused– Interpret R2 through B1 and “tweak”
R1– “Stated” reason (Why they can’t) vs.
“Real” reason• People HATE being changed!
– No consequences (E1)? “STONEWALL!”
– If YOU don’t “walk the talk” you are DEAD in the water!
R1
A1
B1
E1
R2
A2
B2
E2
New results will require new “beliefs”
As an organisation AND…
As individuals
What would “Dr. Johnson” need to do?
“Davis, I come in…I see patients…I go home.”
Personal feedback processes
Relationships
Perceptions & Feelings:CULTURE
EVERY good book on culture
Feedback…
…LOTS of it!
Individual Mindsets
Ah…but those “bloody humans”…
Three managerial “mantras”
How do I change to get the culture to want to volunteer to change?
“Those bloody humans……God bless ‘em!”
As my BEST mentor once told me:“Think of it all as entertainment.”
Integrating quality into the culture
signaling commitment, communicating the new values, peer-coaching each other, coaching the organisational culture, creating a culture of accountability, depersonalising the inevitable resistance, exposing and managing the resistance for
true results. periodic development and follow-up for
individual and team coaching.
One more piece of advice Strong reactions are NEVER for the
reasons we think!– The person/group PERCEIVES what
you are proposing as a threat– The “stated” reasons are not the
“real” reasons– It has NOTHING to do with you
Another needed skill: Insulate your “hot buttons”
Emotional Intelligence Can I recognise what’s going on inside
me? Can I manage it maturely? Can I channel this emotion appropriately
(towards R2)? Can I recognise this process in other
people? Can I manage this process in other
people…– For purposes of organisational success (R2)?– With genuine concern for their individual
success?
E2: New feedback“The behaviour you just exhibited at the meeting will help neither the organisation’s success [R2] nor your personal success. Help me understand what was going on [i.e., the strong reaction] so we can move forward.”
NO judgment
R1
A1
B1
E1
R2
A2
B2
E2
Experiences Beliefs Actions Results
(E1) (B1) (A1) (R1)
Remember: It ALL goes back to this
E1 + B1 + A1 = Culture (C1)
EVERY Interaction Creates Culture
What is tolerated creates culture
The process is “perfectly designed” to produce ‘victim’ behaviour
1. “You can visit ‘pity city,’ but you can’t live there!”
2. “Lack of…” is never an option!
3. “If I can’t change a situation, I may have to change the way I
think about it.”
What was your score? > 40?
Not “victimitis virus,” but PESSIMISM PLAGUE!
30-40? (Most of you)“Disgustingly normal”…but workable
11-29? Poised to make MAJOR progress
10? “Inoculation” has taken hold!– How would it feel to work in a ‘10’?
GENTLY Confront via the “QBQ!” [ www.qbq.com ] “Lack of…” is never acceptable
as a barrier, Restate the issue via a question
beginning with the word “What” or “How,” [Never “Who…”, “Why…”, or “When…”]
Include the word “I,” [NOT “We”]
Focus the question on ACTION.”
Manager / Executive Response
“What will it take from me to help you succeed?”
“How can I help you make that happen?”
Support their risk
“Lack of time” is not an option…for either party!
Another B2
“Lack of time” = Lack of PRIORITY
Let’s stop here for some dialogue
Issues– Data sanity– Cultural change– Emotional Intelligence– Changing views of Leadership– Where is the “time” going to come from?
Have I answered the questions on p. 13
Major steps to transformation 1. Top management awareness and
education See quality improvement as a strategy for
learning and Improvement Establish focus and context…and CLEAR
results– Vision, values and purpose– 3 to 5 strategic initiatives that cascade– Follow-up…follow-up…follow-up
Learn and apply:– Process thinking– Problem-solving tools– Statistical thinking– QBQ!
2. Build a critical mass 25-30% of management demonstrating
their commitment to quality– Promotions reflect commitment to quality
20-30% of organisation educated in quality philosophy
10-20% of organisation trained in basic tools for quality improvement
1-2% of organisation trained in advanced tools
ZERO tolerance for:– Blame– ‘Victim’ behaviour
3. Achieving a quality culture All employees educated in basic quality
improvement tools and philosophy Use of data is integrated and statistically
based Feedback is an integral part of
organisational culture, is NON-judgmental and based entirely on: • Commitment to people’s success• Addressing behaviours seen as inconsistent with:
• Organisational success• Individual success
Suppliers heavily involved Improvement initiatives are given top
priority at executive meetings
4. Ways of life Customer orientation Continuous improvement Elimination of waste Prevention, not detection Reduction of variation Statistical thinking and use of data Adherence to best-known methods Use of best available tools Respect for people and their knowledge Results-based feedback: Emotionally
intelligent culture
Quality permeates design efforts Reorganisation around key
products/services and markets Quality improvement process is
institutionalised and self-sustaining Totally consistent management
practices 50% + are trained in advanced tools
5. World-class quality
What’s it going to take? Assessments pp. 14-15: Ongoing
“homework” [B2 “team” beliefs]– QBQ! peer feedback– Dealing with “demotivators” [p. 7]
Culture’s “responsibility”: pp. 5-6– B2 beliefs that are “expectations”– QBQ! “feedback”
www.clemmer.net– Sign up for his “Improvement Points”
Supplementary Material
Page 23: Useful references– Quality AND Culture change
Pages 24-25: Tabulation of Davis’s Quality Digest columns
Massey’s R-E-S-U-L-T-S [p. 12] R espect [Everyone is ALREADY doing the best
he/she knows how] E mpathy [Developing a sensitivity to other people's
perceptions] S canning [Where are the situational/environmental
“land mines”?] U nity [Continually identifying and respecting
the needs of the business] L ove [Sincere commitment to colleagues'
success] T ruth / T rust [The honest expression of feelings]
– “If you can't talk about it, you can't fix it…Period!“– "If you don't trust the people, you make them untrustworthy."
[Wing (1986)] S elf - awareness**
– "I and I alone am responsible for the values I bring to work, the behaviours they make me exhibit, their effects on people's beliefs about me, and the consequences of my behaviour."
Studer’s “Nine Principles” Commit to Excellence Measure the Important Things Build a Culture Around Service Create and Develop Leaders Focus on Employee Satisfaction Build Individual Accountability Align Behaviors with Goals and Values Communicate at All Levels Recognize and Reward Success
– From Hardwiring Excellence [Quint Studer]– www.studergroup.com
Unconscious business [p. 11] Repeating the same patterns and problems over and
over again Not identifying themselves as the source of those
patterns and problems. Spending a lot of time ignoring or recycling the patterns Expending considerable energy trying to prove
somebody else is to blame. Getting defensive in situations where enlightenment
could be sought Not talking about feelings directly Carrying secrets not yet shared with the relevant person Thinking of themselves as victims, and
– Going back and forth between thinking of others as perpetrators or fellow victims.
– Arguing from the Victim Position, casting others as Perpetrators.
– Resolving arguments by often joining others in being Fellow Victims.
Not expressing their full creativity and having a variety of excellent reasons why they're not doing so.
Seven “Root Causes” Placing budgetary considerations ahead of
quality, [“Costs” vs. “the four Cs”] Placing schedule considerations ahead of
quality, [Arbitrary goals & deadlines] Placing political considerations ahead of
quality, [Manipulation for personal gain] Being arrogant, [“I have nothing to learn”] Lacking fundamental knowledge, research
or education, [Deep knowledge of QI] Pervasively believing in entitlement,
[Need for “Employee Manifesto”] Autocratic leadership behaviors, resulting
in "endullment” rather than empowerment.[“Learned helplessness”]
“I suffer simultaneously from
amnesia and déjà vu. I have
the feeling that I keep
forgetting the same thing over
and over again.”
--Steven Wright
Conscious business If a pattern or problem repeats itself, we
look for the source of the pattern in ourselves.
We commit to learning instead of defensiveness in toxic interactions
We become skilled at thanking people and the universe for giving us feedback, instead of punishing them.
We make conscious commitments and hold scrupulously to those commitments
We make Practical Magic happen
Anger vs. Passion: A new “belief”
Yes, indeed, GET MAD… …but use it to focus your
PASSION for improvement! Emotional Intelligence:
Focus emotion into pursuit of a desirable goalHow do YOU motivate an inherently resistant culture to do this?
“If we’re actually trying to do the wrong thing, the only reason we may be saved from disaster is
because we are doing it badly.”
--David Kerridge
