Quality and Innovation

Jim Collins, author of Built to Last (2004) and Good to Great (2001), released a new compendium of his research this fall entitled Great by Choice: Uncertainty, Chaos, and Luck – Why Some Thrive Despite Them All. I was pleasantly surprised to discover that these authors have also stumbled upon the importance of quality consciousness – awareness, alignment, and selectively focused attention! These are the keys to developing a highly successful “ten-X” (10X) organization (one that outperforms its industry index by at least ten times, especially during times of great volatility in the business environment).

Collins and his co-author, Morten Hansen, don’t call it quality consciousness, though – they call it “Level 5 Ambition.” And Level 5 Ambition consists of three traits: fanatic discipline, empirical creativity, and productive paranoia. Each of these traits demonstrates one or more aspects of quality consciousness. Here’s how (using excerpts from p. 35 and 36 of the book):

Fanatic discipline: 10Xers display extreme consistency of action – consistency with values, goals, performance standards, and methods. They are utterly relentless, monomaniacal, unbending in their focus on their quests [emphasis added].

Consistency of action is enabled by awareness of quality standards, and unrelenting attention towards achieving them.

Empirical creativity: When faced with uncertainty, 10Xers do not look primarily to other people, conventional wisdom, authority figures, or peers for direction; they look primarily to empirical evidence. They rely upon direct observation, practical experimentation, and direct engagement with tangible evidence. They make their bold, creative moves from a sound empirical base.

By aligning the actions of an organization and its players with what the evidence shows will work, everyone is more confident and able to engage fully in the pursuit of shared goals. A data-driven approach, familiar to anyone who understands quality improvement practice, allows an organization to test its ideas on a smaller scale before committing to major changes.

Productive paranoia: 10Xers maintain hypervigilance, staying highly attuned to threats and changes in their environment, even when – especially when – all’s going well. They assume conditions will turn against them, at perhaps the worst possible moment. They channel their fear and worry into action, preparing, developing contingency plans, building buffers, and maintaining large margins of safety.

Hypervigilance is heightened awareness of the external environment, even during times of peace and productivity. The aspect of productive paranoia that I think is most instructive, however, is that it involves a choice of where to focus your attention: instead of harboring worry and panic about what might happen, the productively paranoid manager will focus on understanding failure modes, developing contingency plans, identifying backup strategies, and planning to branch off on alternative paths, if necessary. The attention is purposefully and positively diverted from unproductive emotions (worry and panic) to productive emotions (the positive feelings associated with being prepared).

Even though nearly 40% of the end of the book is an “Epilogue” containing more detail about Collins and Hansen’s research methodology and results, this is still a very substantial read, and one with very practical advice for businesses aiming to succeed through a challenging economy. My graduate students in technology management enjoyed it too.

Point 1: Transparency in business and in government means that you know what’s going on (or can find out). You have access to information about the organization’s processes and results, it is clearly presented, and it is understandable. It is difficult, if not impossible, to understand accountability when transparency does not exist. In the emerging ISO 26000 standard for social responsibility, both transparency and accountability are important.

Point 2: In data management, we struggle with the concept of provenance: how to track what happened to your data at every step of its journey – from being collected, to being operated upon by a host of processes and algorithms, to being evaluated, analyzed and visualized.

McClatchy reports today that the U.S. government is having problems with both. In “Where did that bank bailout go? Watchdogs aren’t entirely sure”, Chris Adams describes the murkiness of the issue:

Although hundreds of well-trained eyes are watching over the $700 billion that Congress last year decided to spend bailing out the nation’s financial sector, it’s still difficult to answer some of the most basic questions about where the money went.

Despite a new oversight panel, a new special inspector general, the existing Government Accountability Office and eight other inspectors general, those charged with minding the store say they don’t have all the weapons they need. Ten months into the Troubled Asset Relief Program, some members of Congress say that some oversight of bailout dollars has been so lacking that it’s essentially worthless.

Bottom line: achieving transparency requires successfully managing provenance. But in the case of the bailout, are transparency problems an information technology issue, or a policy issue?

Today’s Washington Post has an article by Minnesota senator Tim Pawlenty on the effective design of national health care reform, entitled “To Fix Health Care, Follow the States”. He argues that the federal government should model its initiatives after successful state-based systems that link outcomes to value:

In Minnesota, our state employee health-care plan has demonstrated incredible results by linking outcomes to value. State employees in Minnesota can choose any clinic available to them in the health-care network they’ve selected. However, individuals who use more costly and less-efficient clinics are required to pay more out-of-pocket.

Not surprisingly, informed health-care consumers vote wisely with their feet and their wallets. Employees overwhelmingly selected providers who deliver higher quality and lower costs as a result of getting things right the first time. The payoff is straightforward: For two of the past five years, we’ve had zero percent premium increases in the state employee insurance plan.

Minnesota has also implemented an innovative program called QCARE, for Quality Care and Rewarding Excellence. QCARE identifies quality measures, sets aggressive outcome targets for providers, makes comparable measures transparent to the public and changes the payment system to reward quality rather than quantity. We must stop paying based on the number of procedures and start paying based on results.

Pawlenty also notes that healthcare reform should not focus solely on access to health care, but also the cost and quality of the service – that is, the value that is delivered. The Malcolm Baldrige National Quality Award (MBNQA) Criteria for Performance Excellence provides a framework that has been tailored over 20 years by a huge collaboration of experts to help business, industry and the government better solve this kind of “wicked problem”. The Minnesota solution sounds like it has applied concepts very similar – if not identical – to those presented by the Baldrige Criteria.

When will the government employ the successful problem-solving frameworks it has developed itself (e.g. MBNQA) to solve its most pressing problems?

Today’s Op-Ed section in the Washington Post has a piece by Philip K. Howard called “Health Reform’s Taboo Topic”. The problem?

Health-care reform is bogged down because none of the bills before Congress deals with the staggering waste of the current system, estimated to be $700 billion to $1 trillion annually. The waste flows from a culture of health care in which every incentive is to do more — that’s how doctors make money and that’s how they protect themselves from lawsuits.

The article goes on to talk about “defensive medicine,” the practice of ordering tons of diagnostic tests to refine a diagnosis or a treatment plan for the purpose of avoiding malpractice suits. Howard suggests that physicians are cultured into this way of doing business as a defense against potential risks and potential malpractice cases – he even mentions one case where a doctor reacted to a lawsuit by changing his behavior in favor of defensive medicine. A solution, however, is possible:

Containing costs, as Rep. Jim Cooper (D-Tenn.) noted on “Face the Nation” recently, requires overhauling the culture of health-care delivery. Incentives need to be realigned. That requires a legal framework that, instead of encouraging waste, encourages doctors to focus on what’s really needed. One pillar in a new legal framework is a system of justice that is trusted to reliably distinguish between good care and bad care. Reliable justice would protect doctors against unreasonable claims and would expeditiously compensate injured patients. The key is reliability.

The culture of a system – in this case the U.S. health care system – influences the behavior of individuals within the system. This behavior can be waste-producing. When it is, we need to look towards the cultural influences or the structure of the incentives that drive that behavior, and examine ways to address the root cause(s).

It reminds me of the requirements gathering phase of a software development project. Stakeholders spend hours trying to hash out what functions and behavior they expect from their software, and how reliable they want it to be. It is always a challenge to avoid designing the system (that is, how it will look or act) when the essence of what you need to know is what the system needs to do.

I see evidence in the growing national healthcare debate that many people have opinions on the design of the system (e.g. who gets coverage, how pre-existing conditions are handled, how much it costs, who pays), whereas most citizens and Congressmen aren’t even touching the requirements for a successful system (e.g. what scenarios it should support, what behaviors it should provide incentives for, or its reliability/requirements for how much waste the system can and should generate).

In my opinion, one requirement for a successful health care system is that it provides incentives for you to remain healthy and stay out of doctors’ offices and hospitals. A tax credit for a health Body Mass Index (BMI), or maybe lower interest rates? I’d go for that… it would even stimulate me to boost the economy a little more by buying rollerblades or something.

In his weekly radio address, President Obama announced today a renewed intent to cut wasteful spending, and the upcoming announcement of even more decisive cuts. He also noted the appointment of Jeffrey Zients, a former executive and Director of Sirius XM, as the Obama Administration’s Chief Performance Officer. His official title will be deputy director for management of the Office of Management and Budget. Zients replaces Nancy Killefer, who rescinded her nomination in March.

There have been criticisms of Obama’s handling of the budget so far. For example, critics bristle at the thought that Obama approved the fiscal year 2009 budget with earmarks (this is covered in an article by George Stephanopoulos on March 1, “Obama Will Sign Omnibus Despite Earmark Pledge”). But the fiscal year 2009 budget – executed in March 2009 – is retroactive. It is intended to cover operations of the government and all government-funded agencies (including research facilities, and university-driven research and development) from October 1, 2008 through September 30, 2009. Failure to pass that budget would have meant a swift and immediate crisis, catalyzing a domino effect of layoffs in the highly specialized industries. This could have a nontrivial and long-reaching impact on national competitiveness by depressing not only technological innovation, but also by cutting off practical opportunities for university students and researchers to contribute to innovation as they receive mentorship and training.

More about Zients from the White House Blog:

Zients has twenty years of business experience as a CEO, management consultant and entrepreneur with a deep understanding of business strategy, process reengineering and financial management. He served as CEO and Chairman of the Advisory Board Company and Chairman of the Corporate Executive Board. These firms are leading providers of performance benchmarks and best practices across a wide range of industries.  Currently, he is the Founder and Managing Partner of Portfolio Logic, an investment firm focused primarily on business and healthcare service companies.

AIG is falling. Bailouts are flying. All of the rules of business have changed, and the seismic shift is both electrifying and frightening. But there are opportunities to be embraced, and many of them are summed up in this article entitled “Why Small Companies Will Win in This Economy“. Here is my favorite part, a veritable mantra for the 2010′s:

Small is the new big. Sustainable is the new growth. Trust is the new competitive advantage.

Thanks to Betsey Merkel (Twitter: @betseymerkel) who initially Tweeted this. And thanks to Valdis Krebs (Twitter: @valdiskrebs) without whom I wouldn’t have seen Betsey’s insightful retweets and started following her too.

Today around midday, Ron DuPlain (Twitter: @rduplain) asked me if I wanted to catch lunch with him and Michael Davis (Twitter: @yellowfish_md). Only thing is, I don’t know Michael Davis. Don’t worry, Ron said, he’s a cool and interesting guy and you’ll probably find out you have a lot of business and professional interests in common. Ron is a great conversationalist so I knew I would be safe – if I had nothing to say, he’d cover for me! So I tagged along.

Turns out I had a great time – Michael is indeed an interesting guy, and shared stories about his business, Yellowfish and his pursuit of a mobile lifestyle while homeschooling 3 kids – something I decided to call the “Urban Amish” way of life after I found out more about it. (Oh, and the secret codes on wine labels that can serve as quality measures.) Just listening to his perspective on things, and his ideas over lunch, I was able to get some different ideas about stuff I was working on at work.

And that’s when I got the Million Dollar Idea. Wouldn’t it be great if there was a “business dating service” for technical people? You could sign up, take the eHarmony-like survey, and every so often (as often as you said you’d like to, on your questionnaire) go out to lunch with 1, 2 or 3 randomly chosen technical people in your area with similar interests. As part of your mutual interview, you could figure out if you shared philosophies, or approaches to problem solving, or interests. It would be like Twitter, only in person, and only for an occasional lunch. If you find out you are “professionally compatible” you could choose to do business together, or refer your new contacts to people who need their services. This might also be a boon for job-seekers in a down economy.

And it doesn’t have to stop there – if you ran this kind of company, whose role was to form connections between people and set up lunch dates – you could also get sponsorships from lunch places. They might be able to give you coupons for a free coffee or appetizer with your lunch, just to bring in business. Or maybe they’d have other ideas for helping you bring more people into their lunch venues.

I’m not likely to work on this business idea myself anytime soon, but I would definitely be a customer if there was a service like this. There may actually be services like this already, but there are none here in Central Virginia that I’m aware of. However, I would be glad to support anyone who wants to start up this kind of business. (If you read this idea and end up starting a service, let me know! It would be nice to know the idea actually went somewhere.)