Losing quality: How much are companies really sacrificing?

In tumor removal, a doctor must be highly trained in histology to be able to identify how deeply cancer cells exist without inflicting too much harm on healthy tissue [1]. With the increasing popularity of organizations beginning to implement lean six sigma techniques, a similar need for identification has begun to arise: After what point do we begin to stop cutting waste and start cutting quality?

The following image is from the Integrated Enterprise Excellence Volume III Improvement Project Execution: A Management and Black Belt Guide for Going Beyond Lean Six Sigma and the Balanced Scorecard [2]:

The iceberg analogy is appropriate in illustrating the unrealized potential dangers and losses from implementing blanket waste management techniques without understanding full impact on a company’s processes. Process improvement companies, due to the nature of their industry, often only focus on success in immediate savings rather than considering future costs and lost returns. A process improvement team can not only provide lots of immediate savings, but also many unanticipated costs once they have left a company to fend for themselves.

Worse than unrealized costs, often in companies it is not the implementation of the new protocols and techniques. but rather than continued utilization after the consultants have left. This summer, I had the opportunity to visit a few radiology centers as a part of my summer internship where we were studying the usage of a specific medical software designed to increase quality of patient records and medical billing procedures in health systems. However, as we continued to speak to different customers, we found that after the point of implementation, many radiation technologists started to revert back to their old ways of information and data entry to save time or if they were not being trained properly. Illustrated below is a chart detailing a study tracking process improvement technique implementation at a company:

The chart depicts the natural tendency of employees to follow new guidelines for a short ramp-up period and then return to original practices which can be much more dangerous after “waste” management has been put into place [3]. In a hospital where certain practices have been implemented to allow nurses to see more patients, and then the amount of nurses on staff has been cut – if nurses return to their original patterns the hospital is suffering an even more critical loss to patient care than before.

When considering returns to natural behavior and unmitigated risks in lean management and process improvement, is there a way to factor them in to process improvement techniques?

Would process improvement companies be better suited continuing using their current practices and it should be the company’s responsibility to account for these possibilities? Or, would they benefit from doing more in-depth, company specific process improvement cost analysis and strategic “check-ins” and re-training at companies where they have been hired?

References

[1] http://www.fhcrc.org/en/diseases/featured-researchers/olson-jim.html

[2] http://www.qualitymag.com/blogs/14-quality-blog/post/92109-cost-of-quality-and-lean-six-sigma-projects

[3] http://online.wsj.com/news/articles/SB10001424052748703298004574457471313938130