Wednesday, August 22, 2012


I haven't been motivated to write in a while, and this blog comes from a different direction.  My dad is currently in a sub-acute rehab facility (nursing home) as the result of a relatively minor fall that broke his ankle. What's been happening there got me thinking about processes in business.

One of the things that all really successful businesses have in common is that they all have well developed processes that work.  The typical business will have many many processes, some very simple, some quite complex.  When companies don't have processes, or don't follow the ones they have, the results can be chaos.  So let's examine a typical process, in this case one in a rehab facility.

Patients invariably arrive at a rehab facility in an ambulance, from a hospital or maybe an acute rehab.  When they arrive, whether they can walk or not every patient gets a wheel chair at the front door.  So in a rehab with say 135 beds there would probably be upwards of 150 wheelchairs.  They come in different sizes and types too.  Some are lower and narrower for small patients, while others are wide and heavily built for large patients.  Some have anti-tip wheels on back, others have footrests.  In any event, as a patient you are about to meet a wheelchair, maybe for the first time in your life.  For many patients you are about to become very familiar with that chair, maybe for many weeks or even months.  Suffice it to say that chair is pretty important to your quality of life.

So dad arrives at the rehab by ambulance, from an acute rehab, and gets a wheelchair.  He's there because his ankle is in a boot with a break that is healing very slowly.  I notice right away that the wheels on his chair are worn down so much that the floor is covered in chunks of rubber, and the brakes don't work well.  Of course I am really concerned that the chair could move during transfers and he could take another fall.  So I ask about him getting another chair, and the next day when I visit he has a different chair.  The wheels are much better, but one brake doesn't work at all, it's missing parts!  So again I ask for a different chair.  When I return dad is upset because they gave him a big wide heavy chair for a very large person, and he can't even turn around without backing it out into the hallway!  So this time I actually talk to the social worker about his chair, and the poor state of the past three.  He apologizes profusely and promises to have the head of rehab, responsible for wheelchairs, look into the situation. That evening I visit, and as promised dad has another chair.  On one side the brake doesn't touch the wheel, on the other it is nearly falling off and has been repaired with parts that clearly don't belong on a wheel chair!  The next morning I meet with the social worker who introduces me to the head of rehab, and she tells me the chair problem is solved.  So I suggest we go look at it.  When she sees the broken chair she tells me someone must have swapped it out last night. However I have pictures from last night showing otherwise.

Now there is a mad rush to get dad an acceptable chair.  I decide to wait around.  While I am waiting I inspect other wheelchairs.  The patient dad shares a room with has a wheel that wobbles two inches side to side and the chair is hard to push and pulls badly to one side.  The guy has been using this chair for three months!  Another chair has brakes that don't touch either wheel.  Another has a front caster tilted to one side about 3/4 inch.  While I am waiting I over hear a conversation about dad's wheelchair.  Someone says they are going to get a chair and parts from 'the shed' to build dad a chair.  They tell me it will be awhile so I leave.  Dad calls at 5:00 PM to tell me he's been stuck in bed all day because he doesn't have a chair. At 6:00 PM he calls again to report they found his chair.  I'm expecting Frankenchair. Built  of miss-matched parts, from the corpses of long dead chairs in the shed!  I am pleasantly surprised to find dad sitting in a brand new wheelchair, with the tags still on it.

Problem solved right?  Let me see if I understand the situation.  It takes 5 attempts to find just one acceptable wheelchair, and buying one new chair solves the problem?  What happened to the first four?  I'm betting that they met the next ambulance and patient at the door, still broken!  By now it should be clear that what is really broken here is a process.  As it happens, a relative is in charge of maintenance at another facility owned by the same company.  So I ask him how it works there.

He tells me:
1. When a patient leaves housekeeping grabs the wheelchair as part of cleaning up the room, cleans it up and delivers it to the returned wheelchair pool.
2. Maintenance inspects the chair and if it is in good condition transfers it to the available wheelchair pool.  If it is bad it gets moved into the maintenance shop, where it is repaired or scrapped.  Repairs are done by a mechanic skilled in that kind of thing, not a nurse or rehab person.
3. Incoming patients get a chair from the available wheelchair pool.

Pretty simple isn't it?  Seems almost too simple, yet it works.  Processes though, even simple ones can be hard to start, and maintain.  If you don't have a process at the beginning there is lots of Inertia (see previous blog) keeping you doing what you are doing even when it doesn't work. It can be difficult to keep them working too.  If you aren't training everyone about the processes you use, they will slowly disappear.  Even tougher is how to keep a process that works from morphing into one that doesn't.  Somebody makes a tiny little change, or forgets a step, and everyone follows merrily along the wrong path.  Interestingly I noted that the rehab facility had a shelf full of binders at each nurses station marked 'Corporate Policies' I'm betting that at this facility there is a policy on wheelchairs, and it isn't being followed.

So what about at your company?  When you see something being done wrong.  Is there a process for what is being done?  Does the process you have in place work, or is everyone circumventing it?  Is everyone trained in the process?  Are they following the process?  A good step to fixing this situation is to simply sit down and write out on paper how the process should work.  I like to do this in indented outline form. I am often surprised at how 'simple' really isn't.  Often I come to the bleated realization that the correct process involves a lot more steps than everyone realizes.  Other times the sheer complexity of the process on paper can lead you to breaking it down into simpler processes that are easier to understand and implement.