I’m at that age where I have one or more doctors run annual tests to gauge my health. At least once a year, I see my primary care physician, a cardiologist, a pulmonologist, and other assorted  health care providers. They compare my current numbers — height, weight, blood pressure, cholesterol count, and so forth — with the numbers typical of a person of my age and gender, as well as with my historical numbers.

If my numbers are improving or if they’re above average, they let me go for another year with just a light warning to do this, or don’t do that. Now, there’s nothing in the law that says I have to get an annual checkup; it just makes good sense to me to know if I can proceed “as is” or if I need to take some kind of corrective action. Here’s another example: I’m averaging seven years’ ownership per automobile in the time I’ve been driving¹, a fact that I like to think is due to my attention to routine preventive maintenance.

The same is true of my bank accounts and my personal relationships. Regular, careful attention to details helps ensure that very little falls through the cracks.

If it’s important for an individual to routinely measure events and processes and analyze them in light of reasonable expectations and history, isn’t it reasonable to expect that businesses would do the same?

Which begs the question: Is your company measuring its performance? Is it doing something substantial with those measures, like improving its processes? Regardless of whether your company is required by some standard or regulation to measure its progress toward objectives, doesn’t it make good business sense to always look at how you’re doing in comparison with certain reference points (your own past, your goals, competitors’ performance, etc.)?

It’s been proved many times and in many ways: You can’t improve what you don’t measure. Do you agree or disagree?

NOTES

¹The average jumps to over eight and one-half years when I count just the new vehicles I’ve owned.

We were asked this by a reader not long ago, in reference to writing a quality procedure. Exactly what procedure, the reader didn’t say, so I’ll keep my explanation brief and general.

In the policies and procedures we offer on the Bizmanualz web site, we generally include a statement of purpose. That is, what’s the purpose of the procedure outlined in the document? Not only is what you do important — why you do it is just as important.

Again, why am I doing this?

Overall, the purpose of any procedure is to serve as training material. In addition, an important purpose of procedures is to ensure consistency. Procedures are designed to help reduce variation within a given process.

Furthermore, clearly stating the purpose for a procedure helps you gain employee cooperation, or compliance, and it instills in your employees a sense of direction and urgency.

The statement of purpose is a “soft” statement of reasons and goals. Objectives, on the other hand, are about quantifying and measuring. For any of your business processes, you must have measurable objectives. How do you know if your processes are working if you’re not tracking and measuring the results? How do you improve your processes if you don’t establish a baseline, then measure output against the baseline? And, how do you compete effectively if you’re not continually improving?

In short, a procedure’s purpose addresses the “why” and the objectives address “what”, “when”, “how”, and “how much”. The purpose is general, where the objectives are specific.

I hope that helps clarify the issue. If it doesn’t — or if you have a differing opinion — let me know, won’t you? Thanks.

Anyone will tell you it’s impossible to know how well your business is doing if you aren’t taking measurements. Those same people will tell you you have to measure the “right” things.

Yes, it’s just that simple…or so they’d have you believe. How do you know you’re measuring the right things, though?

W. Edwards Deming

W. Edwards Deming was one of the pioneers of management by measurement. Dr. Deming recognized that all processes are flawed — some more than others — and that variation can and does occur at every step in a process. The causes of that variation need to be identified and reduced if product quality is to be improved.

Deming believed that organizations must continually monitor and measure their processes. He taught that process data should be examined by managers to determine the causes of variation, eliminate them, and improve the process. This idea became known as the “Plan-Do-Check-Act” (PDCA) cycle.

The “plan” phase of the cycle is where, among many things, you state the goals you have in mind for the process. What are the expected results? In other words, how do you know the process works if you’re not tracking (measuring) its progress?

Your objectives have to be SMART – specific, measurable, attainable, relevant, and time-bound. If your objectives aren’t all of the above, your best-designed process plan is still doomed to failure.

Specific – Define your objectives in concrete terms (i.e. increase by 50%); fuzzy won’t do.

Measurable – Objectivity is the key here. Weight, time, growth, revenue — these are things we can measure with ease. We can’t measure “goodness”, “attractive”, or “quality” with certainty; they’re all relative (and subjective) terms.

Attainable – Your objectives must be realistic. Perfection is impossible, especially the first time around. No process is 100% efficient — variation will occur. One of your implied objectives is to reduce the variation in your process.

Relevant – While increased efficiency and decreased variation do result in cost savings, not every process can be directly measured in terms of euros, yen, or dollars saved. Make sure the people directly involved with the process can understand the process objectives.

Time-bound – Efficiency is determined by comparing output with various costs, like time and money (e.g., dollars per hour, units produced per minute). Even with pure research and development projects, you don’t have an infinite budget; you have to say, “We need tangible results by ‘x’ date.”

Does any of this ensure you’ll be measuring the right stuff from the outset? Well, no. You’ll actually have to rely on experience and research to help you set objectives the first time through. But, once you have the process in place — you’ve been through the “plan” phase and now you’re “doing” it — you’ll be gathering enough data from your process that you can “check” it and determine if you’re headed in the right direction.

You then “act” on that information and make corrections, if necessary. That’s the surest way to know — keep measuring and comparing as you reiterate the process.

Any questions? Comments?

What are procedures? Procedures are documents that describe business processes. Procedures are one tool we can use to train new and current employees how our processes work, and sometimes we show them how processes interact. Procedures can also help ensure a high degree of consistency in how processes operate and in the results they yield.

From "We Want Our Mummy", Columbia Pictures (1938)

Procedures are also a pain for many companies to write and maintain. Many organizations write procedures with one goal in mind — compliance. Not that there’s anything wrong with that. Either there’s a compelling business reason for you to comply, like a larger organization that says they won’t do business with you unless you comply with a certain standard, such as ISO 9001. Or, there are laws with which you have to comply simply to stay in business (for instance, worker safety and food safety regulations).

Strangely, when compliance is the most important — or the only — goal, companies often forget about their procedures once they’ve implement them. Instead of monitoring and measuring, reviewing, and adjusting their performance — gradually and continually improving the process — they put the Almighty Book of Policies and Procedures in a hallowed place on the shelf and ignore it.

From "vodex.co.uk" site

Why is that? Well, here’s what some companies say about procedures:

• “Writing procedures isn’t our business”
• “It’s a cost center, not a moneymaker”
• “It takes time and money to maintain procedures”

Writing Procedures Isn’t Our Business

It’s true — your customers aren’t buying your internal procedures. What ARE they buying? Yes, they’re purchasing a product…but is it just the product or service they’re buying? Of course not.

Besides paying for goods or services, your customers are paying for the quality of your product, your ability to produce a consistently good product, and/or your ability to act on problems quickly and efficiently. They like the fact that you don’t make excuses — you just fix problems. And how do you do that without implementing effective policies and procedures, like “how to conduct an internal audit” or “how to take corrective action“? You might, if you’re lucky, but luck doesn’t guarantee your customers consistently high-quality results.

Procedure Writing Is a Cost Center

True, it costs you time and money to develop, implement, and maintain procedures. The fact that you have to research, write, review, and approve procedures can appear expensive and time consuming.

But what does it cost you NOT to have procedures? Like we said earlier, effective internal procedures are what help you gain and keep customers. Without the high quality and consistency that procedures help ensure, you risk losing your hard-earned reputation — and your hard-won customers. It’s much easier to keep a satisfied customer than it is to obtain a new one and it’s infinitely easier to keep them than it is to win them back once you’ve disappointed them.

It Takes Time and Money to Maintain Procedures

“Besides”, many companies insist, “our people know what they have to do. They don’t need procedures once they have the proper experience ‘under their belts’.” But how did your employees get that knowledge in the first place? Were they given in-depth training? Was the training consistent? Are they able to build on that knowledge?

Besides, business circumstances change (look at the recession we still seem to be going through). Customers’ needs change over time. Regulations are added all the time — some don’t affect you but others have a great impact on your business. Are you accounting for these types of change in your procedures?

In short, maintaining your procedures will cost you something but not maintaining them will cost your company a great deal more. You run the risk of falling behind your competition, falling to the back end of the technology curve, or falling out of compliance if you’re not looking at your procedures as “living documents”. If you’re not continually looking to improve the way you do things, you run the risk of stunting your company’s growth.

To sum up, you really should develop, implement, and maintain business procedures because it’s just plain good business and not just because somebody’s making you.

What do you think? Can an organization’s growth be held back because of poor or nonexistent procedures?

* * * * * * *

If you find your company is having trouble developing effective, meaningful procedures, check out our full line of business policies and procedures. They’ll make your policies-and-procedures journey easier to start and make it easier for you to stay on the right path.

For many companies, it’s that time of year — time for year-end performance reviews. Time to see if we can find our performance reviews from last year, or head over to Human Resources to get a copy. For managers, time to dust off the performance reviews from last year and see if anything’s changed.

If you’re like most of us, you haven’t kept a daily diary of your accomplishments, so you have to construct an account of the last 12 months from long-buried memories in just a few days. You don’t bother listing your close calls, almosts, and never-weres — you need to put a positive spin on your year.

You might go into the review feeling you did a “more-than-adequate” job, even if you can’t quantify it exactly. Then again, you might approach the review with a sense of foreboding. You’re not well prepared. Maybe you feel like you’re going to get slammed. Maybe you wish the shoe were on the other foot. Maybe you wish everybody would just forget about it.

The performance review, as most of us know it, is a broken process. Lately, there appears to be a groundswell of support for the idea of doing away with performance reviews. According to an article in a recent Wall Street Journal, many HR professionals are “frustrated that managers don’t have the courage” to give constructive feedback.

In an interview from July, 2010, UCLA business professor Samuel Culbert said that performance reviews should be dispensed with altogether because annual reviews don’t promote candid discussions about problems in the workplace or their potential solutions.

Going back to 2006, the Harvard Business School’s “Working Knowledge” page ran an article by James Heskett, one of the HBS faculty, in which he called into question the main objective of performance reviews. Professor Heskett asked, “Is (the objective) to weed out poor performers? To recognize the so-called A players? To provide the basis for compensation decisions?” He concluded that we don’t do a good job of establishing or communicating objectives.

W. Edwards Deming, one of the gods of quality, called the performance review one of the “deadly diseases of management“. You’re not going to find a much stronger indictment than that.

It’s been a few years since I’ve had a formalized performance review. The manager in question got much more out of the typical performance review because he always had the performance of the group in mind. He linked my performance to that of my teammates, which helped create and maintain a team ethos.

Unfortunately, his type of performance review wasn’t the norm. Too often, the performance review is an exercise with no apparent purpose, except to satisfy a regulatory requirement or follow a decades-old policy. We go through the motions but don’t accomplish anything. By conducting performance reviews the way we do, we miss so many opportunities for improvement.

We all deserve better from this “process”.

* * * * * * *

I’m currently conducting a performance review poll on LinkedIn. Please drop in (it’ll only take 10 seconds, if that) and register your opinion. Or, post a comment below.

What do you think? Do performance reviews work for your company or your group? Or, do you think the performance review should’ve been retired with the mechanical adding machine and green eyeshades?

* * * * * * *

REFERENCES

• Light, Joe, “Human Resource Executives Say Reviews Are Off the Mark”, Wall Street Journal (Nov 7 2010) – http://online.wsj.com/article/SB10001424052748704405704575596723632340284.html
• NPR Staff, “Annual Job Review Is ‘Total Baloney,’ Expert Says”, NPR-dot-org (Jul 8 2010) – http://www.npr.org/templates/story/story.php?storyId=128362511
• Heskett, Jim, “What’s to Be Done About Performance Reviews?”, HBS Working Knowledge (Nov 27 2006) – http://hbswk.hbs.edu/item/5563.html
• “Management’s Five Deadly Diseases – a Conversation with Dr. W. Edwards Deming”, Encyclopedia Brittanica Educational Corporation , 1984 – http://www.youtube.com/watch?v=ehMAwIHGN0Y. (Video is approx. 15 minutes long.)

FURTHER READING

• Peralta, Eyder, “Top 10 Performance Review Euphemisms”, NPR-dot-org (Nov 9 2010) – http://www.npr.org/blogs/thetwo-way/2010/11/09/131189907/top-ten-performance-review-euphemisms

Chris Anderson, Managing Director of Bizmanualz, recently posted on the Top 10 Quality Gurus. Those of us in the quality disciplines all know about these people: Shewhart, Deming, Juran, Crosby, Ishikawa, Taguchi, and many others laid a solid foundation for quality practices in the 21st century and beyond. Some of us, I’m sure, can recite ISO 9001 from memory, but memorizing the minutiae isn’t as important as “getting it” — applying the principles of quality to our business and personal lives.

Quality is one of the keys to success in any discipline. Though we may use different terminology, it’s clear who gets quality. There are people who get it, who successfully apply the tenets of quality to what they do in life — people who make everyone around them better without having to know a thing about Six Sigma, ISO 9001, or Lean. Some examples are:

1. Yogi Berra, “It ain’t over ’til it’s over.” How many of us have been through a grueling project — like working toward ISO 9001 certification — and, once we reached our goal, said, “Now that we have that out of the way…”? Once your quality management system has been certified, it ain’t over.  There’s no such thing as the perfect QMS — that’s why a major goal is to keep improving. Yogi kept improving his game, all right. You know how many other MLB players have 10 World Series rings?  Zero.

2. Ichiro Suzuki, “In baseball, even the best hitters fail seven of ten times and of those seven failures, there are different reasons why”. Ichiro was referring to a time-honored measure of success in baseball, the .300 batting average. Ichiro has batted over .300 every year he’s been in the American major league. Between Japan and the U.S., he could retire with over 4,000 hits, a plateau only two before him (Cobb and Rose) have reached.

3. Jackie Robinson. “Thinking about the things that happened, I don’t know any other ball player who could have done what he did. To be able to hit with everybody yelling (racial slurs) at him. He had to block all that out, block out everything but this ball that is coming in at a hundred miles an hour. To do what he did has got to be the most tremendous thing I’ve ever seen in sports.” Shortstop and Dodgers’ teammate Harold “Pee Wee” Reese, on Jackie. Enough said.

4. Archie Moore, “If I don’t get off the mat, I’ll lose the fight.” In 234 recorded boxing matches over a span of 30 years, the Old Mongoose won nearly 200, 145 by knockout! He also failed to win more than 30 of his matches. Mr. Moore even won a light-heavyweight match at age 50! Archie Moore personified dedication and dogged persistence, qualities that separate winners from also-rans in business, too.

5. Steven Spielberg. “All of us every single year, we’re a different person. I don’t think we’re the same person all our lives.” Has there been a better expression of the concept of change. Always thinking, always moving forward — that’s why Spielberg is considered one of the best ever at his craft.

6. Miles Davis. “Do not fear mistakes…there are none.” Miles was one of the most innovative composers and arrangers of jazz, a musical genre known for innovation. He was continually reinventing what he did and staying at the forefront, from cool jazz to fusion. Nearly every one of Miles’s albums, from the 1940′s “Birth of the Cool” to the 1980′s “Aura”, represented a landmark in the progression of music.

7. “Dizzy” Gillespie. “I always try to teach by example and not force my ideas on a young musician.” Known as one of the founding fathers of bebop, Dizzy was also a proponent of Afro-Cuban music, decades before “world music” became popular. Never content to rest on his laurels, he was still inventing new ways of expressing himself through music at the time of his death.

8. Wayne Gretzky. “You miss a hundred percent of the shots you don’t take.” The Great One’s career shot percentage was a mere 17.6%; to put it another way, he missed over 82% of the time. Still, Gretzky holds every single-season and career scoring record in the history of the National Hockey League. Just goes to show that you don’t get anywhere by standing around and waiting for something to happen.

9. James Madison. “The truth is that all men having power ought to be mistrusted.” Madison felt power ought to be distributed among the people, so he (and many nameless others) developed the U.S. Constitution to assure a balance of power. They had the foresight — the vision — to craft a document which is still the model for sound government more than two centuries later.

10. Dwight D. Eisenhower. “You don’t lead by hitting people over the head. That’s assault, not leadership.” Field Marshal Montgomery, thought not to be one of Ike’s biggest fans, once said, “He has the power of drawing the hearts of men toward him as a magnet attracts the bit of metal. He merely has to smile at you, and you trust him at once.” That’s saying a lot when someone who doesn’t care for you still respects your abilities.

Of course this isn’t the definitive list of The Top 10 Leaders Not in Quality. I don’t believe any of them ever thought they were perfect, which is why they continually worked on improving themselves. These are ten people who represented quality in what they did or how they lived. They’re living evidence that quality is all around us.

Not every quality guru is in the field of quality. Who represents quality to you? Why? Are they people you know personally?

It was nearly a year ago that the Bizmanualz Quality Management System (QMS) was certified to the ISO 9001:2008 standard by Platinum Registration.

Nearly a year has passed since that ISO certification audit and, as required, Platinum returned last week to conduct a surveillance audit of our QMS. That is, they reviewed our quality documentation and records to verify that we were in compliance with ISO 9001 and our QMS is healthy.

I’m happy to say we passed the ISO 9001 surveillance audit. We didn’t get through the audit completely blemish-free, but that’s to be expected. (In fact, I’d be rather suspicious of an auditor if he/she didn’t identify something that needed improvement.)

Your registrar should find opportunities for improvement. Your QMS isn’t expected to be perfect. No matter how long you’re in business, you will never do things perfectly. That’s why continual improvement (clause 8.5) is in the international quality standard.

“Don’t worry about perfection. You’ll never achieve it.”
(Salvador Dali, 1904-1989)

Our ISO auditor did identify a few “issues”. If her concerns had been serious enough – if, for example, we didn’t have a quality manual, as clause 4.2.1(b) requires — she would be correct in writing major or minor findings. We’d be required to address those concerns…those findings…in a timely manner or risk losing our certification.

However, our ISO auditor identified several “statements of fact” (also called “observations”), which aren’t nearly as serious. We could ignore observations, which are a way of saying “you’re in compliance, so you don’t have to do anything.” Instead, we’ll use the auditor’s statements of fact to improve our QMS further.

You see, merely passing an audit isn’t good enough. Posting “ISO 9001 Certified” on your office wall, your stationery, and your product means nothing if you don’t back that term with action. If you don’t, your customers will see right through you.

That’s why customer satisfaction (clause 8.2.1) is a key requirement of the quality standard. In fact, you could argue customer satisfaction is the KEY requirement, and few would differ with you.

In the coming days, we’ll use the auditor’s statements to improve our system. And throughout the coming year, we’ll be doing a number of other things to continually improve our QMS. We have another surveillance audit in about a year from now and a recertification audit in 2012. We also have customers to take care of.

The Moral of the Story: Always practice the quality you preach and you’ll be ready for anything at any time. Right? Do you disagree?

I got a piece of spam today from “The Warrior Sales Academy”.  Two things immediately popped into my head.  One, they’re trivializing the unpleasant but sometimes necessary things soldiers do.  (You want to be a “warrior”?  Really?)

Two, we’re not in the Dark Ages.  Conciliation is preferable to confrontation.  Collaboration trumps the “pillage and plunder” mindset.  Selling is first and foremost about establishing – then building – healthy relationships.   What value do you give them in return for the money they give you?  Are you offering greater value than your competitors?  Are you always looking to improve?

Look at the quality management system process model, as depicted in ISO 9001:2008 (figure 1).  See where the customer is?

Here, the customer is the alpha and omega of the quality management system.  Organizations that implement quality management systems ensure customer satisfaction — they meet the customer’s requirements, and then some.

Contrast the ISO process model with the warrior process model (Figure 2):

Do you really expect to get – and keep – customers when you go after them like barbarians on Rome?  Look at what clause 1.1(b) of ISO 9001 says:

“This (standard) specifies requirements for a quality management system where an organization…aims to enhance customer satisfaction through the effective application of the system, including processes for continual improvement of the system and the assurance of conformity to customer and applicable statutory and regulatory requirements.”

Seems pretty simple but as the saying goes, “If it was that simple, everyone would be doing it.”

So, what are you?  A warrior, or a builder?  If you’re not having any luck as a warrior, it’s probably time to take the ISO 9001 approach.

There are seven common Quality Tools you can use to understand and improve processes during a process improvement event.   Each tool helps you identify sources of variation and aids in the analysis, documentation, and organization of the information, which leads to process improvement. 

1. Flowcharts, or Process Maps, visually represent relationships among the activities and tasks that make up a process.   They are typically used at the beginning of a process improvement event; you describe process events, timing, and frequencies at the highest level and work downward.  At high levels, process maps help you understand process complexity.  At lower levels, they help you analyze and improve the process.
2. Ishikawa, Fishbone, or Cause & Effect Diagrams visually represent the causes of a problem – or effect – and help you determine the ultimate source of the problem — the root cause.  (This tool is called a “fishbone” diagram because of its appearance; Ishikawa was its inventor.)   The cause-and-effect diagram is used at the beginning of root cause analysis, to organize the causes of a problem (people, methods, equipment, materials, measurement, and environment) and prioritize them.
3. Data Checklists, check sheets, or recording tables are matrices designed to assist in the tallying, recording, and analysis of test results or event occurrences.  They are utilized in production to count defects and collect process data, which you analyze to identify opportunities for improvement.
4. The Pareto chart is named after Vilfredo Pareto, who came up with the Pareto Principle (or the “80/20 rule”), which says that 20% of the factors account for 80% of potential problems.  The Pareto chart ranks defects, causes, or data from the most significant to the least significant, in descending order.  Pareto charts help you separate the “vital few” from the “trivial many”.  They are typically used during process improvement analysis, to understand where to focus improvement for the greatest impact.
5. Histograms consist of vertical bars, side-by-side, that depict frequency distributions within tables of numbers and can help you understand data relationships over time (e.g., the familiar “bell curve”).  Histograms are generally used during process improvement analysis.
6. Scatter charts display relationships between dependent (predicted) and independent (prediction) variables.  They are used during hypothesis testing, to determine if there is a correlation between two variables and how strong the correlation is.  Less scattering indicates stronger correlation.
7. The control chart is a type of statistical process control tool.  Process performance is plotted over time against upper and lower control limits; this helps you readily identify process variations and enables determination of special cause and common cause variation.  Control charts are used during production, or after process improvement implementations, to ensure that processes are within control limits, or “in control”.

To achieve the best results, start by (1) drawing up a process map, so you understand the process flow.  Next, (2) analyze the process flows for the primary causes of problems and develop your cause-effect diagram.  Then, (3) collect data using check sheets and (4) plot your data using a Pareto chart and/or (5) a histogram.  Next, (6) determine the relationship of various variables in your cause-effect chain using a scatter chart.  Once you have solved your problem, (7) use a control chart to ensure that the process is staying within process control limits — demonstrate process control.

The Seven Quality Tools

To summarize, using these seven quality tools:

1. Flowcharts or Process Maps;
2. Ishikawa, Fishbone, or Cause & Effect Diagrams;
3. Data Checklists, check sheets, or recording tables;
4. Pareto Charts;
5. Histograms;
6. Scatter plots; and
7. Control Charts (SPC)…

…especially in combination, will help you improve your processes and achieve your objectives.

At Bizmanualz, process improvement — internal and external — is one of our main objectives.

Many of us in the USA and elsewhere are aware of the need for significant improvement in many aspects of the health care process — providing and insuring, for example.  In a recent blog post about the US Healthcare Problem, we presented a case for using the ISO 9001 standard to drive health care process improvement.  Now, we’ll look at ”lean” and how it pertains health care.

The concept of “lean” was developed for production environments (see the Toyota Production System) but with a few modifications, it applies to services as well.  In either case, Lean considers the use of resources for goals other than “creating value for the customer” to be waste and such wastes should be eliminated.

From the customer’s perspective, value describes an item or a service they’re willing to pay for.  Lean is sometimes said to be about “creating more value with less work”; in reality, it’s about “maximizing value while minimizing waste”.  And though people can’t seem to agree on much of anything in the health care “debate”, one thing we should all be able to agree on is that there’s plenty of inefficiency throughout the health care system.

Bicheno and Holweg (in their book, “Lean Toolbox”), describe seven service wastes:

1. Delay – customers waiting for a service;
2. Duplication — having to reenter data, repeat details on forms, copy information across, or answer queries from several sources within the same organization;
3. Unnecessary Movement — having to get in line several times, lack of a “one-stop” service encounter, etc.;
4. Unclear Communication – wastes of seeking clarification, confusion over product or service use, wasting time finding a location that may result in misuse or duplication;
5. Incorrect inventory — being out-of-stock, unable to get exactly what was required, substitute products or services, or not having the right provider available;
6. Opportunity lost to retain or win customers – failure to establish rapport, ignoring customers, unfriendliness, and rudeness; and
7. Errors in the service transaction — product defects in the product-service bundle, lost or damaged goods (famously, the airman who was supposed to have his gallbladder removed but had his lower limbs amputated).

As providers and as customers, we’ve seen these wastes…far too many times.  We need to remove as many of these wastes as possible and improve the process.  That’s where Lean can help, and many health care providers are already implementing Lean and other process improvement tools and techniques.

We need to take Lean, ISO 9001, and other tools deeper into the entire process of providing health care — more providers and insurers — if we’re going to make things better and make the improvements last.  The answer is certainly not going to be found in new legislation (see #4, above).

Now, shall we – at long last — begin?