Big Data needs a Big Lever

While the rest of the world is focused on volume, velocity and variety, Big Data has a real challenge that is larger than distributed storage and processing and larger than sources and types of data. It has a problem I’ll call the Big Lever. Put another way, “What do you do once you think you’ve engineered something meaningful? How will you pull the ‘business lever’?

Big Lever

Without the Big Lever, there’s significant risk to Big Data projects that put too much time and focus on the latest whiz bang technology and not enough on the end-to-end ecosystem that supports business value. Not surprising when you consider that the non-whiz bang isn’t exciting or trending on twitter.

The parts of the ecosystem at risk of being ignored include:

  • People – Have we staffed and trained the people necessary to keep a system running once up? Do we have people scheduled to work when the solution needs support? Who will be adversely affected by new ways of doing business?
  • Process – Is the organization geared up to use better or new information differently? Have we looked at what work will change? Will we put new information in the hands of a Marketing group that hasn’t decided what to do about it? Do we have a plan for what to do when things don’t work as planned?
  • Systems -  Can the network scale to handle data movements? Do we have a way to keep data ‘fresh’ and reliable? Do we have ways to modify the solution as necessary? Do we know the triggers?
  • Security- Have we made sure that users of a Big Data solution don’t gain access to data they wouldn’t have otherwise had? What is our strategy if this happens?

Each of these is a significant part of a solution whether you call it Big Data or Data Analytics and can’t be ignored.

John West of Fabless Labs puts it well in 10 Gotchas of Big Data. In the fun and excitement of new technologies, there are lots of traditional ways of managing change that can’t be forgotten.

When the answer is Small Data

Big Data is advertised as the secret to unlocking actionable intelligence. Collecting and sifting through vast amounts of data finds the patterns that change everything. But is elusive ‘data in combination’ the answer that we should expect from analytics? Not necessarily.

More and more often, crunching large amounts of data gets to the opposite result: The answer to many questions is found in far less data than expected. Looking at what’s being answered by large-scale analytics today, the patterns that are emerging often show surprising results like:

  • A clothing retailer discovers that fit matters more than color, or vice versa
  • A wine recommendation engine proves that color matters more than most other attributes, but only when a customer is an occasional wine drinker
  • Only the three most recent transactions show a customer’s preferences and not their composite shopping history

Does that mean that Big Data itself is an overreaching goal for organizations? No. To understand that few factors matter, large data sets need to be created and analyzed. A Small Data answer still requires validation through data that often has velocity, volume and variety. Knowing for sure that Small Data is the answer is just as tricky, and maybe more so.

If we’re not careful, assuming complexity can blind us to the fact that simplicity is the real answer.

The key to today’s Big Data capabilities is to have an open mind and be ready for the answer that you don’t expect.

Intervention While The Patient Is Still Healthy

The following was first published on The TIBCO Blog.

In a previous article, Healthcare: You can’t improve what you can’t measure, we took a look at the Toyota Production System in Healthcare.

Going beyond Lean and TPS,  new-to-healthcare technology brings significant disruption to the traditional healthcare technology market for one simple reason, laid out in a recent article in TechCrunch, Money Ball for Medicine – Business Models for Healthcare: “By definition, the legacy HealthIT vendors have optimized their solutions around the legacy reimbursement and delivery models that have created the hyperinflation in healthcare crushing family, business, and government budgets.”

Lean and Six Sigma techniques, data analytics, business events and process technology will be used to break the reimbursement model and its attendant software norms.

This is a veritable sea change. What was locked into paper records is now being captured for the first time in electronic medical records (EMRs). By itself, this is simply shifting from paper to an electronic record. That won’t be enough. Smart healthcare will go further and manage many data sources simultaneously. It will be able to sort through this new avalanche of data to find the information, often a combination of data from multiple systems, which can predict problems and allow for intervention before an expensive crisis occurs. This borrows from the way banks detect credit card fraud and is easily applied to avoiding healthcare mistakes and intervening early.

Digital technology also underpins the collaboration necessary for cross-network accountable care described by Seattle Children’s Dr. Jeffries in Healthcare, You Can’t Improve What You Don’t Measure. The rise of social media means that what has progressed from paper to fax to email is now moving to enterprise social networks as the most secure and effective way to draw together the patient and a network of healthcare providers, or to connect health insurance to healthcare delivery. While reform was designed to reward cooperation, Medicare, Medicaid and insurers have the power to incent this to continue, even without legislation.

As Dr. Howard Landa, Chief Medical Information Officer at Alameda County Medical Center, and Association of Medical Directors of Information Systems President calls it, “…looking at the entire population and their health rather than focusing on the provision of clinical care.” Landa forecasts that, “…clinical decision support will extend beyond alerts and reminders to presenting information in a more efficient, timely and usable manner so that we can do the right things with the right information in the right moments that matter.”

Beyond technology, there have historically been limited methods for advances in process, treatment or technology in one healthcare organization to be readily compared, understood, and adopted elsewhere. Analytics performed for both improvement projects and patient care need to be “attached” to standardized healthcare work. This has been done in other industries through the use of frameworks like ITIL for information technology, SCOR for supply chain management and APQC’s PCF for enterprise-level process management. A healthcare framework is the key ingredient for communication. Responding to this, the latest requirements put out by the Federal Government’s National Coordinator, Dr. Farzad Mostashari, make it clear that collaboration must be available across organizational boundaries.

“The framework opens the door to process improvement, a structure for social conversations, and managing metrics and events. The organizations that understand this will be the leaders of the future,” says APQC’s Executive Director of Research Services Ron Webb. Webb is actively engaging healthcare professionals to bring about such a framework.

All of these changes go far beyond legislated reform and relate more to the healthcare dynamics that, as Dr. Landa says, “…are driven by an aging population, provider shortages and a burning need to align payment with quality.” Digitization is the reality of healthcare that has little to do with politics.

Are Your Employees Drivers or Victims of Process Innovations?

The following was first published on the Harvard Business Review.

To stay competitive, organizations need to continually find opportunities for innovation in key processes such as customer service and product development, and adoption of a new process almost always requires the implementation of new information technology. In his 1990 classic HBR article “Reengineering Work: Don’t Automate, Obliterate,” Michael Hammer argued that IT must drive radical process innovation.

Unfortunately, this creates two problems. First, as Hammer argued, these large investments in new IT systems tend to deliver disappointing results, largely because companies tend to use technology to mechanize old ways of doing business. That is, they leave the existing processes intact and use computers simply to speed them up, rather than redesign them from scratch.

Second, they don’t take enough advantage of the innovative abilities of their people themselves. Employees often feel victimized rather than energized by the changes. They’re subjected to retraining, and they have to radically alter their routines, often in ways that they don’t think will work as well. Hammer nonetheless argued for using the power of information technology to redesign a cross-functional process, then deal with the people issues. Though many workers will resist a new process imposed on them, competitive demands need to override resistance. I heard him say, “We will carry the wounded but shoot the stragglers.”

Front-line employees driving change

Hammer’s thinking was very powerful, but I’d challenge that last point. The best way to solve both of these problems — and make innovation efforts stick — is not to impose a new process or technology system, but rather have front-line employees drive the change. You’ll get fewer stragglers, and end up with better ideas — ideas that come from the people who do the work every day and see the most glaring problems. Avoiding a new technology may not be an option, but it shouldn’t come first.

Look at ING, a leading bank in the Netherlands, which sets about process improvement by first getting its employees to recommend changes, ideally in short iterations and with frequent feedback loops, to avoid depleting people’s energy and to decrease the likelihood of going too far down the wrong path.

David Bogaerts and Jael Schuyer are process improvement experts in ING’s IT and operations group. They say their projects are more successful when they follow the sequence of people, then process, then technology. “If you automate too quickly, you don’t find out what the front-line people need,” they explained to me recently. “We stay with manual workflows longer than others. Until you have a clear idea of what people need, you may automate workarounds and waste. For example, we worked with people in our Automating Department to improve their processes (using “Lean” and “Agile” methods), and we are now looking at technology to further improve the processes in ways that will revolutionize them.”

ING acknowledges that it has occasionally neglected to engage workers adequately, with disappointing results. “In the case of a workflow management software project, we bought the tool and told people to use it,” Bogaerts and Schuyer said. “It was technology first, then process, then people, and it didn’t work very well.”

Enterprise implementations

No doubt new technology systems can help bring about dramatic process improvements, no matter how much employees howl about the change. Yet organizations that implement an enterprise system (ERP, CRM, SCM, etc.) frequently underestimate the costs of front-line resistance. The systems force people to change the way they work, and while they eventually adapt, most implementations are delayed, operations suffer temporarily, and revenue can take a hit, as at Hershey Foods and Lumber Liquidators.

Why not tap into their expertise instead of dragging them along? Your investments will be better spent, and your workforce is much more likely to buy into the whole thing. As Bogaerts and Schuyer said to me, when workers identify improvements in their jobs, a new computer system appears as an opportunity to eliminate waste and better serve customers, not as a threat.

Engaging workers as drivers of process changes may seem like it’s slowing things down, particularly in implementing a revolutionary enterprise system. But what’s your alternative? You either pay upfront and get worker ownership and sustainability of changes, or you pay later to get buy-in and overcome resistance. The ride is much smoother when you can have your workers be drivers, not passengers.

Questions: How have you seen organizations use IT to drive process innovation? Were front-line people the drivers or the victims?

The fun of not knowing the answer

The best part of the current startup landscape is that we have no way of knowing what will and won’t work. In fact, the situation is the same for established organizations. Between social, mobile, cloud and an Internet that now reaches billions of people, there is enormous change on the horizon.

We know from recent history that seemingly crazy ideas will break through and what seems like a safe bet will go nowhere. That’s the beauty and terror of the rapid changes we’re seeing.

Given this uncertainly, how does a small startup go from ‘nowhere’ to ‘now here’? (Love Guru reference for non-movie-buffs) How does an established company shift to meet a changing world?

Stay nimble

The first idea can often be just the precursor to the breakthrough. Look no further than Flickr, which set out to create a way to photo share as part of gaming. What they stumbled upon with photo sharing dwarfed the original plan in both creativity and financial value. What matters most about this story is that the founders were willing to see the market for their ‘accidental product’ and change gears and course.

Nimble companies change direction when the cues dictate.

Fail fast, fail cheaply

The ability to get to a great idea can require several attempts at products or services that may not work out. There are countless stories of inventors who found success on their 10,000th attempt, but that’s not the point. Get ideas out quickly and as painlessly as possible so that the good one comes to the surface sooner. The longer an idea takes to develop, the more costly and higher risk it becomes. We cherish the things that have taken our biggest investment, our ‘babies’, which can easily blind us to whether that investment was a good idea or not.

While on the topic…reward those who fail fast and don’t punish willingness to try out an idea. You’d be getting rid of your innovators.

Focus on the important things

What matters most is that the idea has market value and that you have the people to realize the vision. To that end, build a smart, creative team and avoid turnover. The longer you work to solve a problem together, the better you’ll get at it. The team will become experts at moving an idea from inception to market and will get faster and better each time.

Unless you’re one of the few who has unlimited funding (and therefore, time) and a first, perfectly conceived idea, your moves will need to follow these patterns to be successful.

Sure, there’s lots more advice about how to create or change your business. I would argue that this is the core of the problem…this is the hard stuff.

A BPM playbook for the Last Mile

Making process ‘stick’ is a real challenge facing process management initiatives. Most BPM professionals try to solve the problem in a similar way…they create the Playbook, the Electronic SOP or the Emergency SOP. Each is a flawed answer to the challenge but could look like progress.

Years ago, before the triumph of  mobile phones, there was the concept in telecommunications of the Last Mile, “the final leg of delivering connectivity from a communications provider to a customer.”  The last mile was the challenge that the call seemed “almost there” but was, in fact, missing a particularly  important piece. It was, in fact, missing the single most important piece.

Convergent evolution

BPM has the very same problem nearly everywhere. Enormous resources are invested getting to the point where processes are agreed upon and ready for use by the employees. But how to truly affect the organization and get things done in new and better ways? This is a very real challenge that confronts all organizations at some point in their ‘process lifetimes’.

At a recent APQC conference, I heard organization after organization talk about attempts to take various process initiatives to the masses. Each had eerily similar ways of ‘packaging’ their results for consumption, but each fell short of the Last Mile. Just the fact that each arrived at the need to ‘sell’ a package was a great example of convergent evolution, getting to a similar result despite different starting points.

‘Unsuccess’

Getting to the same place was not validation of their success. In fact, getting to that spot without having the Last Mile figured out is the opposite. What each needed was the delivery mechanism that kept process owned, current and relevant to roles and functions in their organization. Without that, orphaned and stale information was going to be quickly ignored in favor of “the way things have always been done.” While they all seemed on the verge of the big process payoff, each was far from successful at changing the way business was done.

There are no shortcuts for the Last Mile. Organizations need a centralized way to own, store, amend and communicate process. Employees need to have a role-based view of their world that also provides contextual references for getting the job done. They need to trust the system is accurate and intelligent.

What methods or tools are you using to deliver your processes to the last mile?

Healthcare, your process is your product

Processes are how work gets done. They are a series of activities that convert an input into an output for the customer or next stage of work. Healthcare is fundamentally a service industry with processes as its product. Because efficiency has never mattered in a fee-for-service world, healthcare is overripe with opportunities to innovate.

Innovation through rigor

Most people think of innovation in terms of products:  Apple, Google, etc. We always hear about those game changing product launches that corner a market. While there are still plenty of innovations to be had for new treatment modalities and groundbreaking therapies, healthcare organizations are primed and ready to see major shifts in organizational performance by innovating their processes. What we, at APQC, refer to as innovation through rigor.

Some of the best representations of these principles come from the Toyota Production Systems (TPS), or the Toyota Way. The basic principles of TPS go to the core of what healthcare has purported for years and drive straight to the center of why many healthcare organization were created in the first place. The principles of TPS are:

  • Continuous improvement
  • Respect for people
  • A long-term philosophy
  • Belief the right process will produce the right result
  • Developing your people and your partners adds value to the organization
  • Continuously solving root problems drives organizational learning

When I read through this list, I am amazed at the parallels I see to the mission and purpose of the healthcare organizations I’ve been a part of over the last 20 years. Why, then, is there a disconnect between most healthcare organizations and the concepts of continuous process improvement.

Binary focus

It comes down to a singular, binary focus of many organizations. Healthcare organizations tend to focus all their energy serving the patient. Now, before you lambast me, let me explain.

I’m NOT promoting that the patient shouldn’t be a key focus of any healthcare organization…far from it. It should be the central focus; it is why you the organization was created. I’ve found that some healthcare organizations (and many non-healthcare organizations) take on a hero’s mentality to serve the patient at all costs, which ultimately leads to very convoluted and at times unsuccessful approaches to serving patients. The exact opposite of what they have intended.

Instead of thinking about how to treat THIS patient the right way, the organizations innovating through process are figuring out how the treat ALL patients the right way. Thus creating an organization innovating patient care through the way they work with patients, not just the technology, treatment, or modalities they apply to a single patient.

Falling short

When I look at the principles of process innovation noted above, I think healthcare respects people, does focus on long-term solutions, and focuses on developing people. I think they tend to fall short on their continuous improvement focus, focusing on how they work vs. who they work on, and stepping back to understand and solving their root process problems.

We’re already seeing examples of the use of continuous process improvement and process innovation within healthcare at organizations like Virginia Mason, ThedaCare, and others. They are able to apply these process innovation principles to impact the real outcome for all patients, showing us all that it isn’t an either/or problem. Stronger, more innovative processes will result in better patient outcomes, better financials, better HCAHPS scores, or whatever process outcome you choose to measure. The key is taking a more holistic, process approach vs. a binary vies creating tradeoffs between the care of patients and other outcomes such as financials or patient satisfaction. That is not a place any organization wants to find itself.