When over efficiency means less productivity

I was, at first, speechless when I heard about an NHS friend who spend part of her work days perched on the edge of another colleague's desk because there wasn't enough space for her to work. I hadn't heard about the Government Policy, introduced in 2011 that for administrative areas, there should be only 8 desks provided for 10 people - this is called Agility working. Huh?

You can read about this cost saving exercise here: https://www.gov.uk/government/news/government-property-strategy-cuts-millions-in-costs If you want to see the NHS business case document on how it is built into cases then you can find this here (item 23): www.england.nhs.uk/wp-content/.../11/five-cse-bus-mod-chck-lst.docx 

Now I am all for cost saving and inefficiencies but there's something not working if someone is trying to do their job balancing their laptop on the corner of a desk, wires trailing, knees wrapped round edges etc. Apart from anything it's not respectful.  I'd not put up with it, but then, even in the administrative areas of the NHS, there's fear and concern for jobs.

[sigh]

I've not blogged for a while. I was waiting until I had something I really wanted to say.  I think it's time to speak out and to speak up. So I'm going to start doing just that.

On being productive

I thought I'd start 2013 reading around the topic of productivity at work.  I was looking for new ideas and testing my own assumptions. After a fair amount of reading, this is where I ended up.




General principles

• Productivity means different things to different people
• Learning styles matter; so there's no point in promoting one method as the best - it needs to fit the style of the person, and their workplace. People who shout about a specific system are those who discovered something so perfect that works for them - this doesn't mean it will work for everyone else
• A home office and freelance lifestyle is not the same as a 9-5 office job

What I do already, that works for me, that I will continue

• When I am with a client I do only that client's business; I stay present (and this means being organised, not doing email etc)
• Don't do work email after 5pm on a Friday and before 7am on a Monday. I've learnt that even if I've been away for a week, I can get through it all in a couple of hours on Monday morning
• Don't accept paid work on a Monday. This means I don't travel on a Sunday (which is important to me). It also means I have Monday to get sorted, do admin, meet my Mum for lunch, go to the Post Office, read a book, research papers etc.
• When I'm in my home office I try to do one task before turning on the computer (filing, reading a paper, tidying up), then one task before opening my email (designing an agenda, writing ppt or paper).
• Use lists. I have a "lab book" which usually has all my lists in it but I have been using the Allen Getitdone app which syncs my lists across PC, iPad, smartphone. I'm not entirely certain I like it but will keep trying it for another 3 months. I do like the way you can send emails to it, then schedule working with them.
• Work with my energy. I'm a morning person. I know I do very little between 11:30 and 2:30 pm so I don't bother any more. I go for a walk or lie on the sofa and read a book.
• I don't try to work while I travel. The results are never good. So I sleep, relax and read. This does mean I need to put preparation time into my diary. I've always felt that preparing while travelling is not giving the work my proper attention.
• Finally, my favourite productivity technique is the Pomodoro method. You work (set timer) for 25 mins, then take a 5 minute break - and repeat. Do one thing in the 25mins (like this blog post). After a few repeats, take a 15 minute break.  I divide my productive time into these 25 minute blocks. And have 3 of them during the day for doign my email.  You can download a Chrome Pomodoro extension to be the timekeeper.

What new ideas I got from my reading

• not so much new as a reminder - exercise is good for me. So I shall put in the diary.
• turn off the Twitter alerts!!

Book Review: Crucial Conversations by Patterson, Grenny, Mcmillan & Switzler

This book has the subtitle "Tools for talking when the stakes are high" and I found there was not a single page that disappointed me. Part way reading through the book I thought this is all common sense, and of course a lot of it is. However, the authors are showing and telling in an extremely compelling manner that you just can't help going "aha", oh-yes", "of course" every few minutes. My copy is full of notes, highlighter marks and pages turned over.

So what's the meat in the book?

At its heart is a dialogue model which is about me and the other and how we each act, feel, tell a story and see/hear. In our dialgue we are aiming to create a pool of shared meaning and there are a number of factors that impact this, such as safety, and silence (withdrawing, avoiding, masking) and violence (controlling, attacking, labelling). All this sounds cold in this description, what brings this book alive is the way the authors develop the model with the use of various tools and stories. It's impossible to read it anot feel connected yet at the same time feel empowered to do something about your next high stakes conversation.


You can download book chapters and sample MP3 audio from http://www.vitalsmarts.com/books_more.aspx . There is also the stress test to discover your style under stress.

Book Review: Time Traps by Todd Duncan

You can't manage time but you can manage your thoughts, actions and tasks - that is the underlying premise of this powerful book. I read the book a couple of years ago and in a rare moment, I decided to read it again as I found I was often using the mantra of its premise and was seeking to find more ways to satisfy my desire to get a grip on the slippery slope of the balance between time and tasks.

The book is written with sales in mind though I didn't find this detracted at all from my personal context and I expect anyone who deals with many interactions with others will find it helpful.

The author talks the reader through a number of traps. The first is the identity trap. This is how when time is monopolised by our work we become our work - and thus how important it is to rethink time, to rebalance as part of regaining our personal identity. Secondly there is the organisation trap where the author suggests that most sales people are disorganised, out of control and say they lack the time to catch up. Well, that sound like a lot of the stories I hear from many people! And what I say sometimes as well!!! He suggests learning to stop all unnecessary tasks before they steal time, admit legitimate tasks onto your list of things to do, and make sure you know the difference between necessary and productive tasks. Then take action and assess how you're doing.

He also talks about the Yes trap, and then how to say No, or sacrifice more sales for the benefit of others. He has some interesting things to describe on the value of saying no. Then there is the Control Trap and the issues of letting go and learning to delegate. The technology trap should be familiar to those caught by their email, and for sale people he discusses the Quota trap. And if you're not trapped out yet, there is also the Failure Trap and the Party Trap.

I know this book changed how I felt about time and the management of it the first time I read it and certainly, the second time around, I was reminded to take some more detailed action steps.

Go to here http://www.timetrapsbook.com/ to download a chapter or to carry out the self assessment on the eight traps.

Book Review: NO! How one simple word can transform your life, by Jana Kemp

This makes a change from all the "Yes, you can" books! It's basically about getting over the fear of saying now and taking control of any circumstance without negative consequences. A critical aspect as you might imagine is tone of voice and the author words hard to ensure we understand that it's critical we get this right - not too fast, too harsh and to make sure we choos the right words when we do mean it. It is also key to stick to your decision when you've make it.

Kemp has a model called the POWER of No which has an acronym from POWER: Purpose, options, when, emotional ties and rights/responsibilities. She suggests that using this acronym will help us to make a yes / no decision based on the right issues at the time. For me I find it a lot to think about when considering a yes/ no response online, though I suppose you get better at it with practice.

In essence the decision prcess goes like this
- think about the purpose and context of the decision
- what option do you have? What resources are available?
- when is it due? What is the deadline and can you meet it?
- be realistic about the emotional ties
- consider your rights and responsibilities

I'll be trying out some "No's"....

Book Review: The 29% Solution by Misner & Donovan

How can you improve your networking skills so you become one of the 29% of people who are separated from the rest of the world by six degrees? After explaining that we are not all connected to everyone by six degrees and that it takes some work to be in that position, this books provides a 52 week guide to achieving this.

Here are the week by week headings (it is worth reading the book to understand the detail underlying each one):
1. Set networking goals
2. Make time to network
3. Profile your preferred client
4. Recruit your word-of-mouth marketing team
5. Give to others first
6. Create a network relationship database
7. Master the top 10 traits of an effective networker (these include positive attitude, trustworthiness, good listening skills, helpfulness, timely response etc)
8. Diversify your contacts
9. Meet the right people
10. Reconnect with people from the past
11. Talk to your family
12. Break out of your "cave-like" routine
13. Participate in a web networking group
14. Become a centre of influence (develop magnetism)
15. Go the extra mile; be value-added
16. Become a catalyst who makes things happen
17. Find a networking partner to help accountability
18. Volunteer visibly
19. Send thank you cards
20. Follow up today
21. Be available 24/7
22. Create catalyst events beyond the workplace
23. Have purposeful meetings
24. Make first impressions count
25. Seek out a referral networking group
26. Join a Chamber of Commerce
27. Sponsor events
28. Host a purposeful event
29. Ask questions of others
30. Talk about benefits not features
31. Comunicate your business succinctly
32. Speak about your business
33. Leverage your business card
34. Give high-value presentations
35. Create an informative newsletter
36. Write press releases
37. Write your own identity
38. Ask for written testimonials
39. Share your success stories
40. Write your own personal introduction
41. Blow your own trumpet (or toot your own horn if you're in the USA!)
42. Ask for feedback
43. Adopt a host mentality at functions
44. Use the law of reciprocity
45. Write a letter of support
46. Ask for referrals
47. Read the paper with the intent to discover referrals
48. Conquer your public speaking fear
49. Become the hub of a power team
50. Become a networking mentor
51. Recruit an advisory board for your business
52. Commit to lifelong learning

(I've tweaked the wordings on the list a bit to suit my own understanding.)

Most popular posts on the Spread Good Practice blog

Here is the list of the most popular posts on this blog for the last 6 months.  If I'd had to guess I'd not have guessed these - nothing like a good bit of measurement to separate fact from opinion!

Model 2: data, information, knowledge, wisdom 22 Dec 2010, 1 comment 640 Pageviews

The quickest way to spread scale up change 21 Jul 2010 484 Pageviews

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Productivity 8: Where to find ideas for improving productivity in the NHS

This is the 8th in a series of Productivity notes by Sarah Fraser. So where do we find the "no-brainer" ideas for improving productivity in healthcare.

There is no need to start from scratch if you're looking to improve productivity in your organisation, team, ward or practice.  Many have gone before you and many have spent time writing up their experiences so you can learn from their efforts.

This is where I start looking:

1. NHS Library (or any other academic library). DO some proper searches. I do feel that starting on productivity initiatives without doing a couple of hours research is shortsighted.  Google is not enough..
2. NHS Institute for Innovation and Improvement; for NHS England there is a lot of information available.  Scotland and Wales I know have similar organisations who gather and share productivity and improvement information. The same is true for most countries which have a public sector health system
3. The Institute for Healthcare Improvement has a great deal of case studies and resources freely available

If I find nothing in the above then I will find another topic to work on. There is so much to learn from what others are doing that can make the productivity process easier that it doesn't feel worth being the one person who decides to design a research project instead of getting on with the change process.

If you have any favourite place to look for productivity ideas then please add a comment to this post.

Productivity 7: How replicable is productivity?

This is the seventh in a series of productivity notes by Sarah Fraser.  If one organisation or region is classified as productive, can we make generalised statements that the rest of the organisation or nation can implement the same and be as productive?

A new report by York University is making big claims.

"The NHS could cut expenditure by £3.2billion without reducing the number of patients treated if all parts of the country were as productive as the South West, according to a report published today by the Centre for Health Economics at the University of York."

The report has many maybe's and possibly's as to whether the rest of the NHS could see the same cost savings if they performed like the South West Region.  I have no doubt the SW is producing excellent care. My concern is headlines like this paper produces sets unrealistic expectations on others. The delivery of healthcare is significantly contextual in its nature. Services all over the country reflect the complex make up of the areas they serve. The report summary on their website states:

"South West may also benefit from a more stable workforce, vacancy rates for non-medical staff being well below the national average. Lower productivity in the hospital and community sectors may be because more work is undertaken in primary care."

I believe this is enough uncertainty to warrant being very cautious about ratcheting up national numbers. Additionally, there is significant use of the "average" in this report. I am not convinced that averaging data and using the average as a measure is a good one for healthcare. As I pointed out in my earlier Productivity note, there is a big difference between accuracy and precision; basically, it is possible for there to be little variation across the regions (precision) but they are all delivering the wrong solution (accuracy).

Like all theories, this research is helpful to a degree (mostly in applying judgement) and like all theories, needs to be treated with a pinch of salt. If you are going to quote the headline £32billion on the stage then make sure you've read and understand the limitations of the report.

(To those who read the previous Productivity note about definitions - productivity is defined in this research report as output / input - how much output you get for the inputs...)

Productive 6: Are Patients Productive?

This is the sixth note in the the Productivity series by Sarah Fraser. You can find the earlier notes here.

Mark Russell commented on the first in this series and he got me thinking. Healthcare is different from being a consumer of say a car dealership. We know that. We can learn from techniques used in industry and we can apply them to our services to gain some benefits.  But I wonder whether we are too focused on programs such as Lean, or too focused on seeing the patient as someone with whom we need to engage?

The car dealership or company with be thinking about their customers constantly. It feels to me they spend time in empathy mode, figuring out how to make things easier for the customer. This ease translates into more sales (yes, I know I am reducing an entire academic discipline into two sentences.) They may even run focus groups.

When it comes to patients and productivity I am thinking the relationship is more than one of engagement. As a patient I am not seeking to be engaged with my local healthcare providers. I am expecting the provision to help me be a productive member of society. This means, for example, I don't' want to take an entire day off work so I can have an 8 minute blood test. Equally, I am prepared to to help the providers be productive by being an efficient and responsible patient - but I may need help to do so. If I have a chronic disease, then help me learn how best to manage it so everyone benefits from this productivity.

When the patient's interface with the provider is not productive for either party, then we have work to do.

Productivity 5: What do we mean by "Productive"?

This is the fifth in the Productivity Series by Sarah Fraser. If you want to sign up to receive updates in your email inbox or your Reader (your choice) then go to the Blog and click on the Subscribe button.

So what do we mean when we say we want to be productive or we want our services to be productive? This is something we think we know but until we articulate exactly what we mean, the term is uncertain and ambiguous. What one person understands as productivity may not be the same meaning that another has.

The online dictionary provides a number of definitions and I liked the way it provides similar, related and dissimilar words.

ThesaurusLegend:  Synonyms Related Words Antonyms

Adj.	1.	productive - producing or capable of producing (especially abundantly); "productive farmland"; "his productive years"; "a productive collaboration" creative, originative - having the ability or power to create; "a creative imagination" fertile - capable of reproducing fruitful - productive or conducive to producing in abundance; "be fruitful and multiply" profitable - yielding material gain or profit; "profitable speculation on the stock market" successful - having succeeded or being marked by a favorable outcome; "a successful architect"; "a successful business venture" unproductive - not producing or capable of producing; "elimination of high-cost or unproductive industries"
	2.	productive - having the ability to produce or originate; "generative power"; "generative forces" generative
	3.	productive - yielding positive results successful - having succeeded or being marked by a favorable outcome; "a successful architect"; "a successful business venture"
	4.	productive - marked by great fruitfulness; "fertile farmland"; "a fat land"; "a productive vineyard"; "rich soil" fertile, rich, fat fruitful - productive or conducive to producing in abundance; "be fruitful and multiply"

Based on WordNet 3.0, Farlex clipart collection. © 2003-2008 Princeton University, Farlex Inc.

Using the above I came up with a number of questions to ask myself and others who claim to be working on increasing productivity:

1. If being productive can be defined as the capability to reproduce I wonder what productive spread is? I think it is about how efficiently we adopt and implement best practises, but that may not be the all of it.
2. If being productive is about abundance, how can we shift our mindset to one where we aim to use and create abundance rather than to streamline, cut and destroy services? How much impact can a mindset shift make?
3. If being productive is about yielding positive results, I wonder for whom these results are? How do we manage the differing expectations of different stakeholders?

How do you define "productive"?

Productivity 4: Leaders need to be productive

This is the fourth in the Productivity series by Sarah Fraser. Is is possible to have a productive organisation if the leader is not productive?

This short video by Patrick Collins focuses on how leaders can use the 80:20 rule to ensure they focus on what matters and what provides the value you provide as a leader.



If you think you know the 80:20 rule, then I challenge you to watch this video and test whether you put it into action.

Productivity 3: Productivity is more than a process

This the the third in a series of Productivity notes by Sarah Fraser. Productivity is more than a process.

New and improved policies can impact the design and implementation of efficiencies. For example, new recruitment, pension, appraisal and similar policy changes can impact processes not only in the short term but also long term. I do think that policy improvements are a necessary condition for many other efficiencies to be put into place.

Clinical productivity is often conceived as as "how hard are we sweating out clinical assets". Another way of looking at this is to see clinical productivity as the most up to date and best practice clinical methods being used. For example, continuing to carry our surgical procedures that are no longer proven to be effective is not productive.

Process productivity is the most familiar aspect of efficiency chasing in healthcare. Largely based on the principles of Lean (or reduced and less focused use of Lean) it is helpful but not enough to meet the healthcare challenges for the next 2 - 5 years.

Productivity 2: Reduced variation is not enough

This is the second in a series of productivity notes. Reducing variation is only part of the productivity process.

Reorganising processes so they are precise and prediction is helpful but not enough. In the diagram, the red dots are hitting the target in a predictable way. However, while they may be precise, they are not accurate. The green dots, with less precision, are more accurately placed around the bulls eye.

What I learn from this is the need to

• know the definition and position of the bullseye (what is the purpose of the process being improved)
• measure for accuracy as well as measuring variation
• fix accuracy first, then go for reduced variation

Productivity 1: Operational Efficiencies are not enough

This is a the first in a series of Productivity notes from Sarah Fraser.  Are your productivity projects innovative enough?

Organisations, like the NHS, will need to do more than streamline some processes as part of their cost saving initiatives. Many projects underway are badged as productivity improvement yet mostly they are about basic good management. For example, reducing DNAs (Did Not Attends), improving the Discharge Process, holding less meetings, carrying less stock etc. These are important and help to provide a good base form which to develop more innovative approaches, however, I am concerned few organisations considering gains in productivity through redesign and reconception of processes.

Many managers may feel like they are standing in the equivalent of the Victorian cotton mill with a clipboard in one hand and a stop watch in the other. Yes, it is possible to gain more efficiency from a process. I argue, however, that the leaps in efficiency come from reconceptualising what is being delivered. For example, in many countries for at least a decade, group appointments are available for patients with long term conditions. This is one small example of how rethinking a process can create both an efficiency and an improved patient experience.