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Value Definition and the Danger of Obsessing over Waste Removal

Feb 14
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 - from the January 2013 meeting of the Operational Excellence Society - London Chapter

January's meeting of The Operational Excellence Society's London Chapter was another well attended event with some excellent debate around assumptions of value. It really gave me (the relative newcomer, and one of the few lay members) a new perspective on the definition, whilst reinforcing some of the more basic tenets of Operational Excellence

We're all taught that value is maximised through the reduction of the 7 'wastes' (good old TIMWOOD, got to love him!), but Ketan Varia (Director of "kinetik solutions") has more to say on this. His insight on this matter comes from his work in the UK healthcare sector where he has worked towards designing Operational Excellence for various NHS Trusts and their facilities.

Part of this work focussed on a strategy to reduce the numbers of complaints made and in addressing these one must fathom out what is important to various stakeholders. However, in doing so we can fall foul of assumptive actions/decisions when looking at the various interested parties. So to get around such problems Ketan used the Kano model adapted for the NHS situation. In doing so we lose one aspect of it (which may be termed 'Reverse Quality effects' - where different parties perceive the product/service in different ways due to more or less desire for more or less highly developed attributes), but this is entirely justified because the NHS is, and always has been, a 'one size fits all' service. So, at least to the seasoned research-quality professional (myself in former years), this is not a matter for concern.

Ketan moved us to think about the important factors relative to those with an interest in the NHS: Trusts and external stakeholders (including patients), and boiled it down to 4 main areas:

  • Basic Requirements: what must be must be, poor performance will not be tolerated - analogy: would you get on a plane if the chances of failure were 1%? Probably not!
  • Satisfying features: customer/stakeholder satisfaction should be in line with what is available; and (almost intuitively) 'more is better' when more means better performance and thus better satisfaction!
  • Attractive features - features perceived as having disproportionately high value; can cause disproportionately high satisfaction. Examples were extra services at hospitals e.g. specific illness related add-ons with no direct extra cost to the end user and facilities which were not essential (e.g. cafes, coffee shops, newsagents, etc. ) but still viewed as exceptionally highly desirable.
  • Indifferents: Elements which, once examined, the service user is found not to hold in high or low esteem.

In addition to the above, it must always be remembered that available resources and stakeholder expectation will influence the achievability of the above 4 factors.

A lot has been mentioned about stakeholders so far - and we come to two simplified groups: 1. Patients and 2. the NHS/Trusts/wider organisation. In considering these, what is important to one will not necessarily be important to the other, and there is a careful balancing act needed in actioning any potential solution. Ketan finds that the assessment of values and satisfaction held assumptions, not least of infinite resources (this was naturally drawn from the style of questioning used which, while greatly simplifying the amount of thought needed to answer the questions, did nothing to acknowledge that resources are forever limited - an immutable economic fact in itself). This pitfall needed removing as the classic 1 - 10 style of value-based information capture (e.g. “On a scale of 1 - 10 what score would you give the quality of care you received on your visit today - not an actual example, but one which gives you the idea) does nothing to capture the more subjective or qualitative aspects involved in assessing what is ‘valuable’, in this case, to Patients.

In assessing value, we can get stuck on removing waste and becoming ever more efficient, but in doing so we also run the risk of ignoring what is important to stakeholders and must never forget the adage of listening to the voice of the customer, but more importantly we must do so in a way which not only quickly and efficiently captures the response, but which also accurately reflects the values and opinions of the customer as regards aspects of the product/service which are important to that customer! If we ignore this, we run the risk of losing customer confidence through not addressing subjective values accurately and efficiently. If we fail, we fail not only the individual patient, but also society at large and run the risk of further, more widespread fallout.

I look forward to more debate and interesting topics next time!

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