| I was fascinated, reading in this morning’s newspaper (“Standaard”) an article about autonomous employees at Nyrstar. In this zinc factory, workers have increased their productivity up to 30% in certain processes. The secret: no hierarchy, as little as possible pre-determined structure and rules and a lot of encouragement to find out for themselves what works best. Read the (Dutch) article HERE (Source: © De Standaard 28 September 2015) Nyrstar
Obviously, the gain by 30% is not universal. Certain manufacturing processes are automated and people mainly supervise. But as soon as the output depends more on personal interventions, free thinking and acting not only speeds things up. It also avoids waste of time. And energy goes up, while frustration and disagreement disappear. A messy process
When things go wrong employees stop blaming it on the brass or on other services lagging behind. They know it depends on themselves to call and find out – together – how to get the show back on the road. Servicing of machines and repairs typically go smoother; often breakdowns are simply avoided, since people feel responsible to call in somebody even before machines or the supply chain break down. At Nyrstar the boss is called Fred (not “director” anymore). Staff and personnel work together in “improvement teams”, where anything and everything can be put on the table. At first glance it seems a messy approach, but it’s bloody efficient. Coming in early or staying a little later is not an issue anymore, since results are counted, rather than hours. (Remember last book: ‘why do we count the hours we work, instead of the output we generate ?’) Flexibility, a polyvalent approach and taking as much responsibility as possible is encouraged. Errors can be made, as long as one learns and improves the overall process every time. Action Plan eHealth
The last couple of months we have been working on the revision of the Belgian eHealth Action Plan 2013-2018. Two years ago the original plan was written by a mixed group of some 300 representatives from all stakeholder groups (doctors, nurses, hospitals, pharmacists, administrations, authorities…). Everybody was invited to contribute to the plan and could write portions of the final text. Although a lot has been executed, governance and monitoring could be improved. And over the last two years we have learned why some things slowly start working and others don’t. Getting eHealth on track is mostly mental change management. The IT part is not really rocket science. Just before the summer we repeated the process during seven working sessions. This time we were ‘only’ 200, but the end result is a much more detailed plan, containing dozens of very specific, SMART-defined actions. Mental switches to be turned
The speed with which the plan is (re)written has always surprised most traditional professional representatives. They are used to long and slow official consultations in an abundant number of committees, where every intervention is prepared and every word and comma in the text counts. The output is most of the time either an ugly compromise or a top-down dictate. It takes some mental throwing of switches to get used to the collaborative approach where a large group of mixed stakeholders throw all their issues on the table and try to figure out together how to solve them. Some participants quickly understood that everybody had to win, when they wrote themselves a proposal for a solution, put it on the table and amended it on the fly, while the discussion was going on. With a little sense of synthesis one could distil a workable solution after a good discussion, not only taking into account one’s own interests, but also those of the (majority of the) others. Speed beats perfection
The result that lies on the table is not written in stone. It is an excellent guideline, that will help project leaders and stakeholders to know where they should go in the next 3 to 4 years. Hopefully the execution will be as collaborative a process as the conception of the (re)written plan has been. Of course, it’s all about finding the right balance between sticking to the vision and the (general) objectives and at the same time allowing flexibility in working out the right solutions. But that’s another mental switch people have to flip: learning to take responsibility ‘as good as you can’, without fear for repercussions. In a network you achieve things together; therefore you (only) have a common reasonability to achieve the best possible output. “Speed beats perfection”. I still remember that ‘new limit’ from Peter Hinssens’ ‘The New Normal’. It is entirely valid here and doesn’t mean you don’t mind quality. It’s about not seeking perfection before you start, since that will bring you in a state of constant ‘ wait to start till we make it even better. Rather go for: “plan, act, evaluate”… and start the cycle all over again. With improvements from the things you have learned in the mean time. Chronic Care Redesign
While the Action Plan eHealth is an exercise in ‘autonomous net-working’ that is already underway, a second major program is picking up speed: a federal project, seeking a number of regional pilot projects aiming to locally redesign chronic care, based on the Triple Aim. The first calls for candidates to coach and steer the project were expected before September 15th. In the next couple of months the real call for projects will probably be launched. This project is one of the most ambitious I have ever seen, certainly in Belgium. It will not only require to apply all the lessons learned in smaller scale pilots that were subsidised in recent years; we must also expect to apply approaches like the ones that re-energised Nyrstar and other companies. Locked in a solid grid
Probably a lot of healthcare workers and institutions are working so hard, with their nose on the steering wheel, that they haven’t had the opportunity to see how others have restructured their way of working. Care and reimbursement of care is locked in a solid grid of rules, regulations and traditions that will be hard to break. Resistance to change will be immense and most of the stakeholders might even deny that there is a need to change the healthcare paradigm and –model. Reading about a zinc factory where people have thrown the traditional system of organising their work overboard to find efficiency and job satisfaction, might help to ease some stiffness of mind or resistance to change. Dirk BROECKX – 28 September 2015 | 
