Walter Reed - Getting to the Root Cause

Have you noticed that most people in the public sphere today use buzzwords that correspond to what would be bullet points on paper?   The words are familiar so you think you know what they are talking about but the buzzwords are actually  codespeak.  The buzzwords stands for a set of ideas or concepts, so you really have no idea what they are talking about even though you think you do.  You make up your own definition to what the words mean according to your life experience.
Yesterday, as I was listening to the hearings on the problems at Walter Reed Hospital, I kept hearing the buzzwords of TQM.  TQM stands for Total Quality Management.  It is a set of ideas that constitute a management model.  Theoretically, it's supposed to improve management to achieve maximum productivity, least cost and optimum customer service. 
Without question, the failures at Walter Reed were a failure of leadership.  And that failure of leadership is directly attributable to 'Total Quality Management'.  Were it not for the consequences to our wounded soldiers and their families, it would be funny.  In fact, Scott Adams made a career out of describing a TQM workplace with his cartoon strip,  Dilbert.   

So where did the idea for Total Quality Management come from?  The literature says that it came from the Japanese.  I do believe the concept was tested in Japan, but I think the ideas actually originated at RAND Corporation.
"For nearly 60 years, the RAND Corporation has pursued its non profit mission by conducting research on important and complicated problems.  Initially, RAND (the name of which is a contraction of the term research and development) focused on issues of national security. Eventually, RAND expanded its intellectual reserves to offer insight into other areas, such as business, education, health, law and science.

RAND's tradition of problem-solving continues to this day. RAND conducts research and provides analysis to address challenges that face the United States and the world.  Today, RAND emphasizes several areas of research that reflect the changing nature of a global society..."


Systems Analysis

The words to focus on are 'systems analysis' because the concept of Total Quality Management at its root, is a model of on-going analysis for self-perpetuating improvement of process. 

If I asked you to apply the concept of what I just said to a real world situation, would you be able to do it?   I don't know what the odds are, but I know they are very slim indeed.  It probably sends your mind into a brain loop - a condition that occurs when the concepts are too large to be solved and you end up in the ozone of thought.

Enough of the esoterica. Now I'll try to explain what I'm talking about using the job of a Computer Systems Analyst as the example.  

The job of a Computer Systems Analyst is too look at processes in the workplace for the purpose of trying to streamline them for efficiency and improvement of performance.  It's easiest to understand if you take a step back to the early days of automation - when most processes were paper-driven and labor intensive.   For example, consider a simplified version of a typical process in a manufacturing plant:

Purchase orders were received in the mail (or were called in) from a customer.  The purchase order forms were multipart.  They listed all of the items the customer wanted to purchase.  One part of the form would go to the warehouse for item picking and shipment, one part would go to accounts receivable and one part would go to the production department.  Accounts receivable would receive the form but they would have to hold it until the other part was processed.  That process included the warehouse picking and packing the items for shipment, producing a bill of lading, and then shipping the items.  At that point, the warehouse copy and the bill of lading would be sent to the accounts receivable department for billing.  The production copy was used by the production manager to plan his production because he needs lead time to purchase raw materials and to make the products that they sell so he needs order volume purchase pattern information. 

The Systems Analyst would map the paper flow and design a solution that automated it to the extent possible at the time. In the first iterations of automation, the purchase order would be keypunched and reports would be produced for everybody involved in the process - and they would work from the reports rather than the forms.   This cut down on the paper flow and made everybody more efficient. 

Looking at the processes and analyzing the paper flow did not make the Systems Analyst an expert in the functions.  Their expertise was in being able to look at the processes and to improve the flow - not to invent the flow and not to disrupt the flow.  That is an important distinction to make.   The expertise of the Systems Analyst is in logical thinking and organization, and quick absorption and summation of the process at the highest level possible to re-engineer it.  The ability to do it is a talent unique unto itself - greatly under-appreciated I might add.  

I'm going to digress for a minute to tell you a story.  After growing up and living in the West for my entire life, I moved to Manhattan.  On my first full day in the city, I don't remember where my husband was headed to but we still had the car and he had some place to go so he dropped me off at Grand Central where I was to catch the subway to get to my job interview.   It was a peak commute hour - around 8:30 in the morning.  I found my way into a huge area alive with activity.  There literally thousands of people, swirling around me on their way to work or home or school, where ever, buying tickets, buying flowers, selling newspapers, talking, laughing, scowling, moving.  It must have been sensory overload for me because I froze and just stood there for a moment and the thought came to me that in this city, you really needed to have a firm grasp on who you are and what you are doing because if you don't, everybody here will take a piece of you until there is no more. 

The relevance of this story is that Grand Central at commute times appears to be total chaos but it really isn't.  There is an order - a system to everything that is happening there.  Each person there is engaged in one of the processes that comprises the system of their life.  The subway system is one of the nodes in the process of the system of their life.   Now scroll back up and look again at the RAND diagram of nodes.   That's the way that RAND looks at the world.  Everything is a system. The problem is that the people who work at RAND are brilliant and they are trying to solve societal problems - but they don't live in the real world.  They live in a world of true genius trying to design solutions for people who are not.

Process of Analysis

Going back to the example of the early days of automation, the way that Systems Analysts did their job was that they would take investigative trips along the paper path to find out who handled the paper and what they did with it and why.  Each person that handled the paper - was a node in the paper flow.

The people would be invited to a meeting in which the analyst would find out from each, what they did with the paper.  The purpose of having all the people in the path at the same meeting was both for efficiency and to ensure that everybody was speaking the same language and that no intermediate processes were missed.  The process could then be documented for the purposes of increasing efficiency through automation.     

This is the method by which big systems are designed - or should be designed.  Consider the Alaska Marine Highway Ferry Reservations System as an example.  You have entire departments of people involved in functions that you have to analyze in a drill down fashion in order to design a computer system to serve the needs of all the people doing the actual work that makes the Ferry System work.  For example, you have the passenger terminals, tour operators, the people who plan the sailings,  the call center that takes phone reservations, the maintenance of the ships and capacities, the people who load the ships, etc. 

With that in mind, consider now that we enter the age of the PC and peer networks.   In that world, the people who plan sailings can have their own little network and their own system.  The passenger terminal people can have their own network and their own software.   The problem obviously is that while each entity in a system can have their own computer world - in order for the Marine Highway to work as a whole functioning system, all of the little nodes must be coordinated to work together as a whole system.

What RAND attempted to do with the TQM management philosophy was to try and turn everybody into an analyst who wears two hats - being both the person who does the function and the analyst who looks at the process as a whole.  The thinking is that re-engineering for quality and efficiency would be perpetual. Everybody is part of a team - and nobody is in charge because everybody is in charge.  Everybody has the responsibility but nobody has the authority.   

As if that weren't bad enough, because they knew that the people who actually knew how to do the jobs - the 'on the ground' experts would balk at the concept, part of the implementation plan for the philosophy was to get rid of those people who object to the new management idea.   In effect, they got rid of the true experts leaving a bunch of very confused, average workers with no real idea of what is expected of them and without management to tell them. 

With that as background, listen again to the hearing of what went wrong at Walter Reed.  You'll hear that it was a failure of leadership.  And now that you know the philosophy of  TQM, you'll understand why it went wrong.  TQM doesn't work - and it will never work because it makes a fundamental error in the understanding of human capacity and organization.  In the human society, you can't get rid of leaders and you can't get rid of experts.  And the fact that RAND even tried is indicative of how far out into the ozone they have gotten with their 'future thinking' and how unfortunate it is for us that we have evolved to such a fascist state that they are leading the parade.