Does Process Matter?
The difference between life and death
Atul Gawande is an internationally recognised surgeon. When he was asked by the World Health Organisation to help reduce death rates from surgery, he realised that his usual tactics weren’t going to get him very far.
Improving outcomes in healthcare is generally achieved by improving staff training, greater skill specialisation or better technology.
But modern operating theatres are already staffed with highly trained, specialist staff who use advanced medical technology. So, Dr Gawande started looking at how other high-risk organisations manage the problem of safety.
Gawande looked at how sky-scrapers were constructed and how airlines make sure planes fly safely. It was while working with the lead safety engineer from Boeing he observed that Boeing used something which medicine did not: checklists.
In critical life or death situations or to avoid getting into those difficulties in the first place, Boeing use checklists to make sure that safety critical checks, actions and decisions are taken when needed.
Dr Gawande realised that the equivalent did not exist in medicine so he set about designing a checklist that could be used before and during surgical operations. This checklist contained 19 items and took operating teams 2 minutes to complete. It was tested in 8 hospitals from Tanzania to Seattle to see what would happen.
The results were startling. Complications from surgery fell by one third. Death rates fell by nearly half. As Dr Gawande says himself these were staggering results which were many times more effective than the introduction of any new drug.
Simple, well designed processes can have a profound effect.
Here’s the link to an extract from Dr Gawande’s TED talk if you’d like to learn more. He’s an engaging speaker and the video is worth 6 minutes of your time:
Life is increasingly complicated
Gawande’s observation – that the world is becoming more complicated as knowledge increases – is a trend that is only set to continue and accelerate. More complexity demands greater role specialisation as the sum of all the tasks required for success stretch beyond the capability of any one individual. As outcomes depend more on teams than individuals, the co-ordination of the members and resources within a team becomes ever more vital. And that is the purpose of process. For a team of individual specialists to be successful, all the pieces of that team and the interactions between them need to be successful. Process is the glue between the pieces that helps ensure the success of the whole team.
What Makes a Good Process?
At its most basic, a process is simple – it’s a series of actions or steps taken in order to achieve a particular end. It can be anything from a recipe to make your favourite food to a pre-flight safety checklist to make sure the plane in which you are flying doesn’t crash.
Although Dr Gawande’s example is more about risk management than the process for how to conduct an operation, the principle and the effect is the same.
Good process definition provides 5 main benefits:
- It clarifies purpose: what’s the intended outcome and why?
- It specifies method: how do we do it?
- It provides decision making criteria.
- It creates context by giving you a view of the system.
- It gives a starting point for continuous improvement: either to capture a better way of doing something or to reduce errors.
Processes in service businesses tend to be very poorly defined. Definition is either entirely absent or performed at too low a level: 25 page Visio documents where it’s impossible to get an overview of what’s going on and why.
Build the Big Picture First
The good news is you don’t have to embark on a massive programme of mapping every process in detail to start realising the benefits of process management.
Processes are best defined in a hierarchy from the top down and should only be defined as far as needed – where the potential benefit or risk justifies the expense of doing it.
Begin at the highest level to specify the major processes within the lifecycle of your customers. In a typical service business this will be made up of processes like:
- Acquire New Customers,
- Service Customers,
- Retain Customers and
- Close Account.
These are your level 1 processes.
Then break each level 1 process down into the 3 to 7 steps needed to accomplish it. For example, Acquire New Customers might be made up of:
- Identify Prospects,
- Send Marketing Material,
- Process Applications,
- Set-up new account.
This is level 2.
Then take each of those activities and break them down in the 3 to 7 steps required to accomplish them to give you level 3.
Notice that each of these levels only involves defining chunks / components of activity. We’re defining what is done, not how it’s done. It’s only when you’ve got to this level that you would start to think about detailed process mapping (Level 4) and operational procedures (Level 5) which describe how to carry out a particular process.
Level 1,2 and 3 are all about defining the process components and how they inter-relate. This is often referred to as a Process Architecture: it’s the big picture summary of all of the processes an operation undertakes.
Even at this level, a well-defined process architecture provides a number of important benefits for your operation:
- It creates context by giving everyone in the organisation a view of the whole operational system.
- It gives you a common language for how the organisation works.
- It provides a basis of defining effective measures: once you know what the component processes are, you’re in a good position to define the measures which tell you how well each process is being performed.
- Provides a framework for error trapping – the ability to systematically tag errors to the process which caused them.
- Becomes the organisational structure for all your detailed process mapping.
Summary
Process matters – simple procedures can have profoundly positive results as Dr Gawande’s surgery checklist demonstrates. They work because as the world becomes ever more complicated, job roles become more specialised to accommodate the extra complexity and successful outcomes depend more on teams than individuals. Process is the means to co-ordinate the individual members and resources within each team and most importantly, the interactions between them. It’s the glue that ensures team success.
To get the benefits of this it’s important to begin with the big picture first.
In future posts, we’ll look at how you can define processes for your own operation and some of the design principles involved.
Measurement