The majority of this post will be devoted to the title matter, of why metrics are important. The rest of the post will be attributed to why deficiencies in a system can overwhelm and cause disproportionate damage to a system.
Why Metrics are Important
What I’ve learned by working in a manufacturing environment is the continued proliferation of data driven results is driving productivities higher and higher. One specific KPI that is often used is the number of parts made or services delivered per hour. A simple metric that lets you judge very quickly how much money a company (or person) can make. When you break a process down in steps (Hi Control Plan), it’s also a metric that allows one to understand an end-to-end process and see where the gate in a process exists. This can drive down process cycle times and allow for throughput into a process to be maximized. Remember throughput being maximized.
For when services are delivered, you can scan geographic zones and quickly find out where the quantity is most demanded and where demand may be weak. You can see similarities into how services are delivered, but you can also very quickly see how services delineate in different regions. It is easy to identify KPIs and observe how KPIs differ. This may be the result of differing political conditions, skillset concentration, foreign relations between countries or other variables, but generally in a country, conditions should be standardized. This is to say no matter if I open up a plant in Mississauga or Inuvik, the costs should be the same, so the services that I deliver should not differ much region to region. Now that we’ve kind of created a baseline for nations, what about if external stressors within a country caused services to be a delivered a certain way. Let’s say in the non competitive areas, regions which have slower growth and sparser populations (e.g. Nunavut), services are delivered with services technicians who don’t really have to focus on payment of a mortgage as one of their principal payments. It’s not a stressors in the noncompetitive region day-to-day lives, since this stressor does not exist (or is limited) where they live. I would argue a definite advantage, since we’re talking about finding a place to live, not picking out strawberries. Also if the money stressor is minimized on people, who knows how the service they deliver might evolve. Again this is something that could be better understood with additional (or any) KPI supervision. If you think about your healthcare & how sometimes you don’t feel like the doctor has listened to you (or spent the full 1 hr of a physical with you even though they charge the province for a full hr), I feel this kind of exercise would be an appropriate root cause to see if your doctor has acted in an efficient manner. These complaints are all symptomatic of a broken system and the only way to fix a broken system is through the implementation of a formal QMS. A formal QMS allows you to define customer needs and document tailor made skills that serve that need so that costs are not wasted (or hidden). A short term fix could be increased vigilence when it comes to dealing with doctors, however this will not solve many of the inherent inefficiencies in the Canadian way of delivering medical care. Many will give the excuses that, ‘well doctoring is such a specialized skill and that’s the reason there’s a skills shortage’. But Cuba did it, and they have some of the lowest healthcare costs in the Western World & guess what? Hospitals there are ISO 9001 certified. Now I haven’t been able to view any audit specifications, or control/risk documents so I’m only going by the sentence on their website, but they’re QMS certified so it is an interesting coincidence.
The point of this article, is that when optimizing processes, I can see a quick dashboard of relevant KPIs to ensure service standardization. The reason I mentioned throughput maximization above was because that can point out any service abnormalities. For example, if doctors with a mortgage and substantial debt, have higher throughputs, is that because they’re spending less time on clients or because of a different reason? If you incorrectly identify an unrealistic baseline throughput this could act as an additional stressor, cutting the quality of canadian healthcare.
However we will never be able to define this grey area without the work and we haven’t done the work as of yet. The introduction of a QMS would allow for cost transparency and eventually cost feedback into the process of delivering medical care. This is where I’m going to state, I love my Canadian healthcare and certain aspect of it (as summarized by Ralph Nader. But costs are going up, and to be ignorant of costs is setting the Canadian public down the path for failure – and if not failure, then longer wait times and less options. No analysis is done to ensure sustainability or cost effectiveness (or at least public papers). It seems like the only analysis I ever see thrown around is how Canadians (& nearly every other country with socialized medicine) pay significantly less for healthcare compared to the USA. But as someone with a background in Data Analysis, I always question a single stat that is supposed to summarize everything. For example, simple questions like, does that include R&D spending towards healthcare as well? Do the exact same services cost more or less in the USA? Questions like these.
The rest of this article, I will discuss failure and what happens when something small fails in a big system. To think about idea, I’m going to illustrate eating food in a way you probably haven’t thought of before. The concept is general enough that it can be applied to any process with subprocesses that interrelate. If one of the subprocesses fails to work, then it can put excess load on other subsystem components and cause them to fail prematurely.
Think about when you eat and chew your food to a sufficiently ‘mushy level’. Your body performs best when it is focused on one task at a time. Meaning, if you chew your food slowly and allow the food to enter your stomach little by little, your body can extract maximum nutrition from the food because your body first focuses on chewing, then transporting the food down your throat into your stomach then the rest of the digestion process. You might actually end up feeling more full from less food by this means as well. But if you don’t chew your food properly, then this one habit can end up having long term debilitating effects. You can end up overeating and over the course of many years this can put excess strain on everything from your esophagus to your colon. This is because the body now has to act more to digest the food because the work centre responsible for mushing the food (mouth) did not do its job. This can cause early failure of ‘other’ subsystem components because they were forced to do the work they weren’t designed to do. This exact phenomenon can be present in company documentation and also in government service documentation as well. It’s frustrating to see inefficiencies in a government service that you see present as a service recipient, however since the system doesn’t account for this potential feedback, the system will never get better. The system also does not account for visibility of continuous improvement exercises but that is a step 2 behind setting up a formal QMS.