The fishbone sticks in the throat

Hospital A followup

Welcome to this blog. It stems from a class I teach in communication technology at the University of St. Thomas in St. Paul, Minn.

Last Thursday the "students" did an exercise in problem solving that used the fishbone diagram invented by Professor Kaoru
Ishikawa of Tokyo University. I say "students" cautiously because the people in this class, all business professionals, teach me more than I teach them. It was a difficult assignment, but not too far removed from the real world.

The biggest difficulty was in not having deep, intimate knowledge of Hospital A’s systems. Hospital A is a fictional composite of several real hospitals.

The class textbook (Bouwman, Harry, et. al. Information and Communication Technology in Organizations: Adoption, Implementation, Use and Effects) stresses in Chapter 4 that in the process of adopting new technology, “not much is certain even with regard to the ‘objective’ factors of technology and economy (costs and benefits): technological developements take place at a breathtaking pace, and it is extremely complicated to determine which technologies are essential. … In short, the decision whether or not to adopt a certain ICT application is based on rational considerations only to a limited extent, depending to a large degreeon intuition and experience — and perhaps even coincidence” (page 74).

Given this, the Deming idea that the most important numbers are unknowable becomes more clear. Anything solution to this problem will be proposed without knowing how many lives will be saved, how employee costs will be reduced, how time will be saved.

Here are some things I observed about the class as it went about the exercise:

• In their groups, the students concentrated to a large extent on the people involved: doctors, nurses, housekeeping. The human element is obvioulsy important, maybe most important. As a question for further thought, What would be the ideal membership for a real-life study group from Hospital A? But people are just one part of the system. Another way to look at this problem is as one of quality control across the entire system. I went partially through the fishbone chart exercise on my own, and the results are in the image below.
• Halfway through the exercise, playing the part of the hospital administrator, I announced that I had become enthralled with RFID technology during a convention in Las Vegas. The annoyance factor on the part of the students was obvious. My goal was to emulate the pushy, clueless kind of boss I’ve worked for in many of my past jobs, and apparently I succeeded. But I’ve also learned two things: The boss isn’t always wrong, and when I’ve chosen to ignore the boss, I’ve done so at my own peril.

CLICK ON THE IMAGE TO ENLARGE

This last item addresses a crucial aspect of Deming’s methods: If any task, such as in this exercise, is given over to a group of employees, managers must commit themselves beforehand to allowing the group to work independently. Even tougher is that the managers must promise resources to implement solutions (within reason, of course).

The class also tried to incorporate the Five Whys method invented by Toyota Founder Kiichiro Toyoda’s father Sakichi. This was less successful perhaps because asking why, always a valuable process, requires that intimate knowledge of the system Deming insists we must have.

The main take-away is the method. As we heard from one class member who has been part of such a group, these methods can be an effective way of focusing a group on the real problems and causes.