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News from PDSS Inc.
"Leading the Future in Product Development" 
November 2010- Vol 3, Issue 11
In This Issue
Problem Prevention: Updates to the PDSS Model
Problem Prevention at a Medical Practice
Book: The Checklist Manifesto
Greetings!  
During the past year, Skip Creveling (President of PDSS) has been refining PDSS' Problem Prevention model, as well as inviting several professionals to apply it. Read on for some of the results! 

Have a Happy Thanksgiving!

-Carol
Problem Prevention: Updates to the PDSS Model 

During the year since PDSS' Problem Prevention steps were outlined in this newsletter, Skip Creveling, President of PDSS Inc., has been refining and clarifying the problem prevention model, in preparation for publishing a book on the subject. Among other enhancements to the model, two steps have been added to the six steps originally presented in the October and November 2009 issues of this newsletter.

The previous steps were written as:

1.   Plan and rank tasks of the prevention project

2.   Define Potential Problems

3.   Document and evaluate the root causes

4.   Define preventive actions

5.   Define contingency actions

6.   Re-use learning

The updated model now has 8 steps:

1.   Define the specific actions that make up the flow of tasks you want to accomplish

2.   Identify and document potential problems within and across the flow of tasks

3.   Identify, document and analyze root causes of the potential problems

4.   Define the risk profile of each of the potential problems *NEW*

5.   Design and apply preventive actions

6.   Design and activate contingency actions

7.   Design and activate corrective actions for when we get blindsided *NEW*

8.   Document and re-use lessons learned

New step #4: Define the risk profile of each of the potential problems

Defining the risk associated with each potential problem includes answering these three questions:

1.   What is the likelihood of the potential problem actually occurring?

2.   What can be measured to detect the early onset of the problem? 

3.   What is the severity of the problem's impact if we do nothing to stop it from occurring?

Each of these contributors to our risk profile can be assessed on a scale of 1 to 10 and used to quantify their magnitude. These risk numbers are called the Preventive Priority Number (PPN) and the Contingent Priority Number (CPN). Risk is calculated separately for preventive and contingent actions so they can be directly compared.

This exercise will clarify the risk associated with applying prevention versus contingent action. Contingent action is often favored due to cost. Monitoring for leading indicators is often cheaper than outright preventive action, but this step will help determine which to pursue.

During step #4, we only consider potential problems we can anticipate. What about problems we can't foresee or that blind-side us? The problem prevention model now addresses that with the new step #7.

New Step #7: Design and activate corrective actions for when we get blind-sided

The goal here is to be prepared much as a fire department or ambulance service. Fire fighters and emergency responders are well prepared to apply corrective actions once an emergency is detected. A fire has started or an accident has happened and the pre-planned reaction to such "surprises" is ready to be used. In modern business there is a well-known set of steps to correct problems called Lean Six Sigma (LSS), also known as the D-M-A-I-C (pronounced Dee-may-ick) process, as follows:

1.   Define the problem now that it has been discovered

2.   Measure the process in which the problem has occurred

3.   Analyze the data for root causes of the problem

4.   Improve the process such that the problem is corrected at the level of its root causes

5.   Control the process so that the problem cannot resurface without being detected

Happily, many of the tools and best practices for problem solving are easily adapted for use in problem prevention. If you are trained as a Green Belt, Black Belt or Master Black Belt in LSS you know most, if not all, of the tools and best practices needed for problem prevention. We recommend LSS; it is globally recognized for its problem-solving effectiveness. With respect to problem prevention, however, the key is that using LSS means the problem has already occurred and was not prevented!

Problem Prevention at a Medical Practice
U of R Medical Center Logo 

To illustrate the applicability of problem prevention across many environments, Mr. Creveling has invited several professionals to apply the problem prevention methodology in their daily work and in turn, write about their experience to contribute to the book. Invited are a medical doctor, professor, CEO, attorney and a business manager.

As a result, PDSS' problem prevention methodology and tool set has been studied and will soon be adopted by Rochester, NY surgeon Dr. Louis Eichel at his medical practice. Dr. Eichel is also a Clinical Assistant Professor in the urology department at the University of Rochester Medical Center. Dr. Eichel presented the problem prevention methodology in the context of a physician's daily work of patient treatment and surgery to an audience of about 30 medical professionals and students at the University of Rochester Medical Center this past October.

His talk illustrated the use of process maps, swim lane diagrams, brainstorming, and fishbone and noise diagrams in several examples, including initial patient consultation and surgery.

Surprisingly, problem prevention is not typically taught to medical students, nor is it deliberately practiced by most medical professionals. Dr. Eichel and his partners are enthusiastic about learning and practicing problem prevention as a means to improved health outcomes. Dr. Eichel cited the Physician Quality Reporting Initiative (PQRI) and the certification and maintenance of certification required by specialty boards as further incentive to pay attention to this valuable tool.  Wouldn't we all like to know our doctors have problem prevention at top of mind when they are treating or operating on us or our loved ones!

Book: The Checklist Manifesto
 

The Checklist ManifestoThe Checklist Manifesto by Atul Gawande is one of the books recommended by Skip Creveling and Dr. Eichel. This excellent book about problem prevention is reviewed by Malcolm Gladwell as follows (from Amazon.com website):

"Gawande begins by making a distinction between errors of ignorance (mistakes we make because we don't know enough), and errors of ineptitude (mistakes we made because we don't make proper use of what we know). Failure in the modern world, he writes, is really about the second of these errors, and he walks us through a series of examples from medicine showing how the routine tasks of surgeons have now become so incredibly complicated that mistakes of one kind or another are virtually inevitable: it's just too easy for an otherwise competent doctor to miss a step, or forget to ask a key question or, in the stress and pressure of the moment, to fail to plan properly for every eventuality. Gawande then visits with pilots and the people who build skyscrapers and comes back with a solution. Experts need checklists--literally--written guides that walk them through the key steps in any complex procedure. In the last section of the book, Gawande shows how his research team has taken this idea, developed a safe surgery checklist, and applied it around the world, with staggering success."

Note that a paperback version of this book will be issued in early January 2011.

Is there a topic you'd like us to write about? Have a question? We appreciate your feedback and suggestions! Simply "reply-to" this email. Thank you!
 
Sincerely,
Carol Biesemeyer
Business Manager and Newsletter Editor
Product Development Systems & Solutions Inc.
About PDSS Inc.
Product Development Systems & Solutions (PDSS) Inc.  is a professional services firm dedicated to assisting companies that design and manufacture complex products.  We help our clients accelerate their organic growth and achieve sustainable competitive advantage through functional excellence in product development and product line management.
 
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