TPS aka Lean Quality Improvement in Healthcare

Buzz words about quality, accountability, pay-for-performance, evidence-based medicine, modernization/automation, workflow optimization, waste reduction, core measures and transparency are heard daily on the campaign trail and in the media. The recent economic crisis has fueled concerns and elevated the urgency of change from a preference to a priority in the minds of Americans.

Everyone wants change for the better, but how we achieve a positive and lasting change is a daunting challenge. Since February I've been working with with RWD Technologies, a firm who advocates of the Toyota Production System (a.k.a. TPS) as the solution of choice to improve quality in health care -- increasing patient safety while reducing costs.

It is no secret that we at RWD Technologies embraced the Toyota Production System (a.k.a. TPS) as the solution of choice a few years ago, sending consultants to Toyota on behalf of Ford Motor company to learn the methodology directly from the source. For more than 15 years, the RWD Lean approach to business process performance has inspired innovation and independence within the culture of organizations at all levels, resulting in long-term, continuous improvement. RWD believes that their approach is one of if not the only systemic solutions proven to enable and empower organizations through a unique, lean approach based on TPS.

As hospitals and healthcare organizations have adopted the RWD TPS solution, they have seen dramatic and profound transformations which have minimized the kinds of “preventable errors” outlined in the new CMS Final Rule while optimizing hospital performance and patient outcomes.

Not only do I see how the collaborative processes has worked for hospitals like St. Luke’s Episcopal Hospital in Houston, Baylor Mediccal and others with each visit, individual hospital workers share their own individual contributions and enhancements.

The process is so continuous, that often, the worker supervisor is hearing about the new enhancement for the first time.

On a recent visit to St. Luke's one worker commented about how she applied the inventory management process to her own surgical team, building on what she’d learned from other surgical teams. TPS truly is a marvel, a human-centric process where every step counts and the process is a continuous journey, not merely a destination. It's been an honor to work with RWD to spread the word of how, in these difficult times, the methods Bell Labs brought to Japan that evolved into the Toyota quality process can make an enormous differences to the lives, health and pocket books of American healthcare.

A common theme

These blogs traverse from alliances to product life cycle management (PLM) to unified communications and customer relationship management. At first glance it would seem that the blog is all over the map!

In reality all of these subjects have a very common theme running through them. Every single one has to do with how people work together and relate together effectively. Technology can (and should) be an enabler in this effort, but in the end all of them come back to the human element.

I'm a mother and as a "mom" I spend time teaching and arbitrating. The skills it takes to be a successful mom are the same to succeed in business: listen to the needs of others. Decide how both sides can "win" and get what they want. Compromise. Learn. Admit when you don't know or are wrong. . .

A while back there was a book entitled "Everything I Know I Learned in Kindergarten." Not me. I learn something new every day! We learn more by watching and listening to others and the day we stop learning is the day we begin to die.

So the key to success, Sandra says, is knowing what you want, continual learning and then listening (respect) for those around you. This ties into all the themes of this blog. Which take me back to alliances and why so many fail.

I've worked on all sides of alliances -- I've acquired companies (M&A), I've run OEM alliances, I've created alliances (ISV, systems integrators and VARs) and I've killed a few relationships, too. Why do some succeed and some fail?

For the very reasons I just stated: companies don't know what they want from the partnership, or they don't communicate what they want to the partner, or the partner doesn't communicate it to them. . . At one Fortune 100 company I stepped into a $20 million alliance that had been struck (prior to my arrival) between the leader in its field and my firm (the leader in our field). The deal had been struck by the CEO of each firm and $10 million annually funded by both sides.

Yet there was not one stipulation to the deal. There was no "goal." There was no criteria for one firm giving the other beta or alpha releases of software for testing pre-release. There was no sales plan in place for joint "go to market" offers. Here we had the thought by executives that these two behemoths should be linked (and they should have been) but absolutely no thought was given to:

1. What did either firm want from the relationship? Sales? Prestige? Linking of products? WHAT?


2. Tactically how were the companies to work together? At an engineering level? Sales? Marketing? HOW?

So many alliances fail because someone, somewhere thinks that it is a "good idea" but none of the structure that would be put in place in any due diligence is done. Are the two companies values complimentary? Are their goals similar? Do they compete in some areas? If so how can they ally well and avoid the areas where they conflict?

Alliances can be hugely successful -- but the only way they are is when your company first realizes what it wants from alliances and then puts a plan in place (a tactical plan) that it can follow in each potential alliance. Years ago I created a template I call my "PEF" (partner evaluation form). Before we even proceed to the first face to face meeting we must complete this document which asks these questions from BOTH company's perspectives. The end goal here is success for both firms -- and if you fail to plan you, plan to fail.

Unified Communications and the Contact Center

First we went from Call Centers which were either inbound or outbound (e.g. you were calling someone or they were calling you). Then we moved to "contact" centers where the thought was that customers could communicate with your company over the phone (call center) or email -- or maybe even via "live chat" over the internet.

Contact, whether by keyboard or voice!

The problem is that most contact centers didn't spring up instantly (like the goddess Athena who was born full grown out of the head of her dad, Zeus). Most start small and grow -- or we wind up with multiple call centers in various places (including India or China) that use different technologies. Some happened through mergers, some just over time. We have silos of information. Islands floating off by themselves.

All of these islands of contact points (distributed call centers, email, live chat, etc.) were put in place to reduce costs and yet still give decent customer service. To further complicate our global customer base we also have employees who telecommute or live in various cities.

How can all this complexity be unified? How can we simplify?

For one we make all these multiple points of communications (voice, email, fax, live chat) available from one point. When a customer (or employee) reaches out they make one connection and find the end point they need. No more phone tag. No more voice mails left on office phones and cell phones and punching "0" in the hopes of finding a live person who can help.

No more "let me transfer" you and getting disconnected.

Unified Communications brings the promise of true customer service at both reduced costs and high satisfaction.

Let me give a live example from my own life. A major credit card company (who shall remain nameless) has the world's worst call center. When calling in one is first faced with IVR hades. Push "1" for this "2" for that, and oh please enter for 17 digit credit card number and expiration date. . .and what was your mother's maiden name again???

By the time one reaches a human being (IF one reaches a live human being) the frustration level is high. The first agent invariably does NOT have your credit card number or mom's name so you have to repeat the exercise. Invariably again this agent cannot help you but must transfer you to another department.

Many times in this "transfer" I have been disconnected and have to start the entire misery again. Oh, yes, one can try to do this over the internet but the interface is clumsy and results in much the same result.

Assuming one does get transferred one must again repeat the information. It is the lucky person indeed who does not face a third transfer! This credit card company is so poorly IT challenged that they were unable to give me a record of a charge and suggested I call the retailer for it! This after being transferred numerous times only to be told they didn't have the very basic tools of their own business!

Now envision this contact center if it had unified communications. If you are a VIP you might have a direct connection in to a specific workgroup, but if not one can bypass the IVR rapidly and get to a live agent who has in front of them your information (on one of many CRM applications). That one person should have access to any and all information, but just in case they do need to transfer you they can see visually who is available and they can stay on the line with you as they hand off the call with the new agent.

COMMUNICATIONS. Not frustration! In this example my credit card record would have been emailed, faxed or snail mailed to be automatically. None of this is future and none of it is unrealistic. It is all available today and I dare say the credit card company in question would have saved considerable money considering the number of agents who handled (or mishandled) my call.

Internet Marketing -- at home at work and on your cell phone

July 2007 McKinsey published a report on how companies are marketing online.

The results are intriguing.

Although most savvy companies are using some form of online marketing (about 2/3rd per the report) online and offline marketing are often separate and non-communicative. Doesn't that seem odd in light of the whole "clicks and mortar" concept of combining the power of the internet with good old fashioned outlets?

A major reason for the disconnect is the old "silos of information" problem we're so familiar with. The systems that run traditional businesses don't have the necessary capabilities for Wiki, Blogs, viral marketing, etc. Even with today's sophisticated CRM software solutions that allow a prospective customer entry via the Internet, "click to chat", call center, email, fax, etc. most companies haven't implemented that technology -- let alone the next step that ties the Internet itself to their back end ERP or industry specific applications (such as HIS in health-care, BSS in Telecom, etc.).

So many companies have sophisticated "front end" marketing for their Internet presence -- SMS coupons to the cell phone for example -- but the back end is a little chaotic and highly manual.

Today when most people think of Internet marketing (if they think of it at all) they picture email SPAM and banner adds that may be linked to previous sites they've visited.

Thought leaders have long been blogging (hey, you're one of them -- you are reading this!) and using SEO (search engine optimization) to try and get their websites higher up on the coveted search engines like Google, Yahoo, Microsoft Live Search, etc.

We've moved from purely informational websites and B2C or B2B (business to consumer and business to business) to massively multi-player game sites (like World of Warcraft or Disney's ToonTown) and social networks (like FaceBook and MySpace).

Virtual worlds are the next phase past social networks. The are multi-dimensional sites where users can interact with each other in a cross between IM (instant messaging) and social networking.

Podcasts and ad hoc Webinars are another new marketing venue where the information is multimedia and folks can watch them online or download them. These can take the form of demos and infomercials and can be a very effective form of online advertising.

We've barely scratched the surface -- how about Wikis (like Wikipedia where anyone can contribute content) or Widgets (if you have Vista you probably have widgets showing the time or the stock market) and web services that do the work of making it all seem like magic. . .

Everyone seems to agree that online marketing is important and here to stay. 83% (per the McKinsey report) are using it for service management and 44% for pricing. The real trick here is to decide which form of online marketing makes the most sense for your company. To do that you must decide what your goal is (driving sales, improved customer satisfaction, leads, etc.) and then examining not only the various forms we've discussed here but which best suits your business model.

Everything old is new again -- VoiceCon

VoiceCon is the big telephony convention. It is underway in Orlando -- just next door to DisneyWorld. The location seems somehow ironic. Just as Disney is expert and re-inventing itself one sees "old" players insisting that they are new and improved.

But everything new is old again -- and the reverse is also true.

Along with Voice over Internet Protocol (VoIP) and going "green" we have the even more secure networking vendors -- and the biggest buzz of all? Why, Unified Communications of course!

UC (as it is known to its friends) is focused on making people "reachable" where ever they are -- on one device. These days the average person has an office phone, a cell phone, a home phone, corporate email, personal email, an instant messenger (or two) and probably more I've forgotten to mention. I seem to recall a statistic that said the average American has seven (yes, 7) ways to be reached.

So we are forever checking multiple places and playing "phone tag" ad naseum. The promise of UC is that we can identify "where" we are and UC will let those we want to find us find us. (Those we try to avoid may still wind up in voice mail heaven). In UC verbage this is called "presence awareness."

In other words big brother (UC) knows where you are. This is your "presence."

At VoiceCon Avaya introduced their Intelligent Presence Server which they say takes UC another step forward -- not just presence awareness, but presence information across multiple sources.

Nortel's big pitch at VoiceCon is based on "mobile" UC. Siemens has had this for awhile-- your office phone number is the one number given out and it can be routed to any device -- including your PC or your cell phone. Nortel is tying the idea of UC with FMC (fixed mobile convergence) so that when you are at your office you don't pay the cell phone company for minutes -- your call is switched to a WiFi connection.

The problem here isn't the technology but the cell phone companies who (for the most part) won't allow phones that can be FMC capable on their networks. They aren't dumb and they don't want to lose the 30-50% of network revenue that goes away with FMC.

Still, that is Nortel's pitch.

Cisco announced enhancements to its CCVP® professional-level certification. Why no big announcements like Nortel or Avaya? Hey, they don't have to. Cisco is the leader in Unified Communications by far - with 50,000 Cisco Unified Communications customers worldwide and more than 70 percent of all Fortune 500 companies using their UC offer.

Product Management Goes "Hi Tech" with PLM

For many years I was a product manager at Bell Labs. We used three ring binders, ISO 9000 (and then 9001) standards to ensure quality and a lot of Microsoft Excel(TM) and Microsoft Project(TM) worksheets.

The hardest part of the job was keeping the status up to date and making sure that all of the members of the team -- both direct and matrixed (e.g. our counterparts in sales, marketing, support, etc.) knew what they needed to know so we could get to market on time and on budget.

Boy have times changed.

Major software players now offer something called PLM (short for Product Lifecycle Management). Lifecycle is the key word here. The software helps any type of product manufacturer (from shoes to NASA's next generation space ship) from idea through design and manufacture, update cycles, service and support needs and even end of life decisions.

Back "in the day" at Bell Labs we worked on a six month cycle -- which included everything from "patch releases" (bug fixes) to major next generation and even the generation beyond it planning that went out at least three years. That isn't easy to do with three ring binders!

PLM promises to do for product development what ERP did for the factory floor and supply chain.

The article "What is PLM?" outlines the advantages companies can expect by using PLM software:

1. Shorter Time to Market


2. Better product quality


3. Reduction in prototyping costs


4. Savings through the re-use of the original data


5. A framework for product optimization


6. Savings in reduction in wastage.


7. Savings through the complete integration of engineering workflows

As an ex-product manager the biggest bang for the buck potential based on my experience is

• faster time to market


• fewer missed dates


• fewer "mis-matches" in PM / stakeholder expectations and engineering


• better quality control

In January of 2008 the Gartner Group released a report entitled "Magic Quadrant for Manufacturing Product Life Cycle Management, 4Q07." where they list Siemens PLM, Dassault Systems, PTC, Autodesk, Oracle and SAP as providers of PLM software.

Siemens (formerly UGS) is rated the highest. Oracle acquired Agile (if you've heard of Agile). Gartner dropped Infor because their revenue was too low this past year -- but if you are just learning about the various options you might want to consider looking at them.

In these economic times where the stock market is fluctuating and we may be heading for a recession any tool that can help you cut costs while getting to market faster PLM should definitely been on your radar to consider.

Leaders in CRM Analytics

I'm a former NCR Teradata employee having run development of a number of their industry specific CRM "starter kits." Teradata is used by some of the biggest, most successful companies around to track their profitability and keep an eye on the bottom line. Wal-Mart was one of the first to recognize the value of figuring out what sold well in different locations and how quickly things sold. Wal-Mart took the concept of JIT (just in time inventory) from manufacturing to retail -- and Teradata was the tool that let them do it.

These days the world works in multi-channels -- retail, wholesale, brick & mortar and click & mortar. So targeting what you want to sell now needs a clear understanding of your own market value proposition. To do this you need to know the market segment that fits your value prop and the customers who populate that segment. Again this is where analytic tools like Teradata can crunch data and turn it into information that not only tells who who buys what -- but what other market segments and propsect profiles fit that target as well.

All this is a preamble to a new study by the Gartner Group on multichannel campaign management. They've determined that the leaders in this market (no surprise here) are Teradata, SAS and Unica. The one surprise is that Siebel (always a wannabe in analytics with a weak offer) is now a contender.

This information is from Gartner's " Magic Quadrant for Multi-Channel Campaign Management, 1Q 07." Gartner uses a box split into four blocks (2 up and 2 down) to graphically give their POV on who is a leader, a contender, slipping behind, etc. Gartner Group is one of the leading high tech analyst companies around these days having bought Datapro, Dataquest and a few others along the way. From Gartner's report:

“Leaders consistently out-perform in overall campaign management performance for basic and advanced campaign management , as well as for integration with e-marketin. . .Leaders have high market visibility, high market penetration, strong market momentum and a strategic vision for growing the campaign management business.”

Some up and comers named in the report include Aprimo, Alterian and Eloqua.

If you are looking at marketing automation (and if you are doing any marketing at all it is crazy not to -- you are just gambling and guessing without analyzing the success of your campaigns) then consider looking at the companies mentioned by Gartner. Microsoft Dynamics CRM has also announced a BI component so if you are on the small side you can still get analytical information without spending a fortune.