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Adding Steps to Simplify

September 14, 2009

A Peaceful RoadBy John Munce, Deployment Executive, The Tatham Group

We process types often talk about simplifying processes. We’re on a relentless march to find the value-add step and then perform only that step. There can be a rallying cry for a team: Take out steps! Cut rework! Take out checking! Build in quality! Find the absolute minimum number of steps! Less is more!

But sometimes simplifying the process means adding in a step. It can seem unnecessary, even irrational.

My friend Ann is a process type and fierce project manager who’s dying of pancreatic cancer. When I went to see her the other day, she launched into a process critique of end-of-life health care. The medical establishment came off with a strong B. One item in particular fascinated her.

A nurse from hospice had come for the introductory visit. There was lots of chatting and information sharing. The nurse inspected the house and talked with my friend about whether she would want a hospital bed or other special equipment. Then she presented The Gift.

The Gift is a special assortment of meds that is standard for all hospice patients. They include morphine as a painkiller, for example. The package of drugs is in a colored plastic container about the size of a couple of pounds of butter. It’s called The Gift because it brings blessed relief in the middle of the night when there is an onrush of pain or vomiting. Ann’s friends who have been through hospice all told her that it truly was a gift.

Ann began thinking aloud about where best to put it. By the bed? On the dresser? In the bathroom with the other meds? There were many choices.

The nurse said, “It goes in the refrigerator.”

“Oh, it needs to be kept cool?”

“Not at all.”

“Then I can keep it in the bedroom, if I want, right?”

“No. It goes in the refrigerator.”

Ann was surprised. Why would we keep it in the refrigerator, if it doesn’t need to be kept cool? That’s irrational. It’s unnecessary.

“We keep it in the refrigerator so everyone involved can find it.”

The nurse went on to say that every house has a refrigerator and it is easy to find for even first time visitors. One word can direct any helper to the right place. In the middle of the night, Ann or her caregiver know immediately where to find the drugs. There’s no fumbling around the bedroom, like there had been the week before for Ann’s caregiver. Even more importantly, any hospice nurse arriving at any time knows where to look without instruction or delay.

Ann was very excited by the process insight. Hospice had redefined which process they were working in. It was not the “Store Medications” process. They were designing the “Bring Help Fast” process.

The customer is Ann and what she needs is relief when she’s in distress. Getting medications are the value-add step. For the caregiver providing the relief, knowing where to find the meds is as important as knowing how to deliver them. Given that many different people may participate in the process, and that homes and bedrooms can be arranged many different ways, locating the meds can be a problem. So the process designers thought about what storage place would make the process work the fastest for the customer every time the process runs.

Ann finished her story by pointing out the moral. “Sometimes an unnecessary step is required to make the process work the best.”

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