In the Real World: Talk to Stakeholders

Our local hospital has a national reputation as a high-quality institution. If you know anything about healthcare, you understand how valuable that is. High patient satisfaction ratings mean more federal (and sometimes state) dollars. Happier patient stakeholders mean more referrals and more revenue. In healthcare, quality isn’t just a buzzword.
But getting into the hospital is like gaining access to Fort Knox. I understand the need for security, but it adds a good 10 minutes to a visit. The main lobby is always crowded and confused; if you go in that way, bring your patience too.

The Problem

Patient Parking SignMy husband requires a monthly medical treatment. We park at a back door, in a small lot designed to serve out-patients who need access to the few departments nearby. Otherwise, it’s a long, long walk from the bustle of the main lobby. It’s also a convenient shortcut for vendors servicing medical equipment
Getting in and out is quick and easy and the security guards are great: they get to know you and greet you with a smile. I don’t know how they stay so cheerful, because there is no shelter from the elements. Even in good weather, strong winds blow around a nearby corner. It gets brutally hot in the summer, miserably damp and cold in the winter. The equipment they need to look up names and print ID tags never works—it wasn’t designed to be used outside.
We asked about the situation as one guard wrote out our nametags by hand on a “Hello My Name Is” label. The hospital refused to invest any money in an adequate guard station. It was only a back door and not as busy as the main lobby. Why bother?
Unfortunately, bad people recognized an opportunity. They began to sneak in. The staff had problems with unwanted guests trying to steal drugs and equipment, or harass patients. It was getting out of hand.

The Solution Worked—Until It Didn’t

Russian guardsHospital security implemented a solution. They installed a camera and intercom system. To get in, you buzzed the security office. They examined you through the camera, asked you to hold up your ID, and then let you in or sent you around to the main lobby. But the hospital was unwilling to invest in a good camera and visitors were unprotected from the elements. Most of the time the guard who answered the call couldn’t clearly see visitor’s faces, much less read the proffered ID card. Many were sent to the madhouse in the main lobby.
A lot of the patients who use that door are in poor health. Walking around the building is difficult, even if you’re agile. Having to go to the front strained parking attendants and volunteers, held up medical procedures, delayed equipment repairs, reduced the number of patients the departments could treat in a day, and, as a result, reduced revenue while increasing costs. Worse, stakeholders were irritated to the point of irrationality. It risked impacting the patient satisfaction scores.
That got everyone’s attention.

Who Needs Stakeholders?

vault lockFrustrated by all the complaints, hospital security went for the cheap-and-easy solution: lock the back door. Grant access only to staff with access badges.  That was it, problem solved. 
Oh, and don’t tell anyone that’s what you’re doing. 
You can see where this is going.

Well, That Didn’t Work Either

Not only did it make things even worse, it caused a number of unforeseen problems. The hospital added temporary staff to answer the increased volume of complaints. Because many patients couldn’t walk from the main lobby to the back of the hospital, more volunteers were needed to push them in wheelchairs. But the volunteers didn’t return the wheelchairs when they were done, so the hospital had to purchase more wheelchairs—and find more people to return the wheelchairs to the main lobby.  Meanwhile, the wheelchairs were starting to pile up in corridors and waiting areas. (I thought the hospital looked like the set of “Dr. Who.”)
Vendors were delayed further in getting to their repair appointments. Expensive medical equipment sat unused—and not generating revenue—even longer than before. To keep patient satisfaction scores up, a small nation’s budget in Starbuck’s gift cards were sent out acknowledging the inconvenience and thanking everyone for their patience
Staff schedules were upended because patients and vendors were delayed. Not only did that cost the hospital more money in overtime, it also meant staff was upset. To their credit, they didn’t take it out on patients, though managers sure got an earful.

The Point Is…

Talk to your stakeholders. Start by investigating the following questions for yourself, then check your understanding with your stakeholders.
  • What problem are you really solving? People were sneaking into the hospital through a back door. The real problem: Security guards weren’t equipped to work effectively. (A little root cause analysis would have sussed this out.)
  • Why does the problem need solving? Bad people were trying to gain access to drugs, equipment, and patients. Yup, that’s a good reason to fix the problem!
  • Who is impacted by the problem? Bad people, sure; but also security guards, out-patients, volunteers, parking attendants, staff, and vendors—stakeholders no one thought about.
  • How would your stakeholders solve the problem? Locking the back door seemed like the simplest, easiest solution. Who doesn’t love simple and easy?
A better solution: Invest in a weatherproof station and equipment to protect the guards, help them do their jobs, and make them more comfortable. Yes, it cost money in the short run. But the solutions that were implemented turned out to have a much larger impact on costs, revenues, quality and customer satisfaction.
  • How will you measure results? Clear indicators catch problems in the making. In this case, the solution eliminated security problems at the back door and meant the guards could be reallocated elsewhere. (Yay! Problem solved!) But the unintended consequences were more costly by far–and weren’t uncovered until much later. Oh, and in all the confusion, more bad people were getting past the guards at the main lobby. (Boo! Hiss!)
A final note: By the end of the first week, the back door was reopened and smiling guards were once again greeting us. It turns out cranky out-patients are a force to be reckoned with.

In the Real World: Agree On How to Organize Things

I love my honey, I really do. He’s a fabulous organizer; without him, our home would look considerably messier than it does. (He and I disagree: his “mess” is my “comfortable.” Right there we have a problem: we lack a shared vocabulary. More on that in another post.) When he’s bored, he’ll re-organize the garage, the bookcases, the closets and the kitchen. He’s a dream that way.  Mostly I appreciate his considerable efforts to bring order to our lives. He doesn’t organize things like I do—he’s an engineer, for one thing. He takes any mess personally. But one man’s entropy is another woman’s pile, or stash, or clothes closet. Or kitchen.

Don’t Touch My Toolbox

ToolboxWe’ve already had the “don’t touch my toolbox” conversation.  I could find things in my toolbox, but he couldn’t. We agreed that was his domain, so he took it over. I don’t mind; toolboxes aren’t all that big and his system is obvious if counter-intuitive to me. He applied the same rigorous logic to the junk drawer in the kitchen. It is now organized to within an inch of its life and has been renamed the “utility drawer.” I get reprimanded if I slip and call it the “junk drawer.”  I can’t find anything in it but he’s usually around to ask, so I live with it. Then he oh-so-helpfully organized another of my toolboxes, the drawer of cooking utensils under the range top.  I was making pancakes one morning, happily ignorant that the organizational elf had paid a visit when I wasn’t looking. Time to flip the pancakes. The spatula was not where it should be. Now mind you, I have several specialized spatulas: one for pancakes and hamburgers, one for fish, one for eggs. Different shapes and sizes, slotted or not, each specific to its purpose. I’d have settled for any spatula at that point—the pancakes were starting to burn. Couldn’t find any of them. Shouted for the engineer, who was reorganizing his closet again. Somewhat offended, he showed me his new system. This, he proclaimed, would make my life easier. He opened another drawer entirely. Et violá! There were my missing spatulas—and everything else I hadn’t thought to look for—organized by material (wood, plastic/silicon, metal), color and size.

No, Really. Don’t Touch My Toolbox

He ate burnt pancakes for breakfast and we had our second “don’t touch my toolbox” conversation. I tried to explain wood/plastic/metal + color is not how I look for tools. I failed. (it wasn’t logical. Thank you, Mr. Spock.) I got his attention when I said he’d be eating a lot more burned meals if he messed with my tools. I thought we’d gotten that resolved until I decided to make a stew that called for fennel. I could have sworn I had fennel, but I didn’t see it in the spice drawer. I bought a bottle and opened the spice drawer to put it away. That’s when I noticed things looked suspicious: bottles, boxes, and cans were organized by material (glass, metal, plastic), color and size. The organizational elf had struck again. As I reorganized, I realized we had four bottles of fennel, three of cinnamon, no salt (turns out that was stashed in another cabinet across the kitchen), no cumin (a staple in my kitchen), and a bottle of mace I thought I’d thrown out years ago.

The Point Is…

Build a common vocabulary.

  • Get stakeholders involved. Understand their perspective. Cook in their kitchen—understand why the spatulas are where they are and the spices organized the way they are. And know that every stakeholder, like every cook, is different.
  • Clarify vocabulary. Get definitions. These will often conflict. My microplane is my honey’s rasp; my French rolling pin is his wooden peg. Have you ever asked Sales, Marketing, Operations, Customer Service, Accounting, and HR to define a customer? It’s an interesting conversation.
  • Document what you learn. Build a dictionary if you need to. Agree to disagree. Note differences and conflicts. Publish/share it across your project.

Meanwhile, I’m looking for more recipes to use up the fennel and cinnamon.