A process is defined as "a series of actions, changes, or functions bringing about a result". In the disciplines of management science and quality management the "process" is a fundamental building block[1], requiring us to pay special attention to its design, implementation and maintenance. In general, the outcome of a well-designed process is reduced variability. For example, when we set up the processes for accounts payable, we expect that our department will submit payments to the appropriate party in the exact time frame specified in the exact amount required. Any variation might be a problem. A lot of variation can bankrupt a company.

But sometimes we find that a process is more art than science, more abstract than logic, and more flexible than specific. Moreover, sometimes the customer desires variation.

This generally doesn't apply to the world of healthcare diagnostics and medical devices. In fact, the industry has made dramatic quality improvements in the past 20 years by standardizing some processes that were previously left (to some degree) to the judgment of the operator. Some examples include performing a cell differential in hematology, interpreting cytology slides, and automating the type and screen test in blood banks. These are examples of macro processes, and for each there are hundreds of micro processes that have been standardized by the lab protocols and automation that we use every day.

So when is a process more art than science? Generally, we look for these conditions to make that determination:

• The inputs to the process are variable

This happens in judgment-based work when the environment is highly dynamic. Sometimes the raw materials are variable so a "craftsman" is needed to make the calls to mold the materials into the product that will bring out the best quality. The construction of musical instruments requires this type of craftsmanship, and within our world of healthcare a prime example is a surgeon: though there are established practices, there are many judgment calls to make in a successful procedure.

• The customer desires / requires variability

In some environments treating each customer in a standardized way will decrease overall effectiveness. In other words, some customers are so different that they each want something different from the process. The hotel and restaurant management environment faces much of this: not everyone will want to eat a sirloin cut, cooked to medium rare. In a Ritz-Carlton, employees are taught an artistic approach to customer service so that they have flexibility in satisfying the demands of each hotel guest.

At Nexus we have worked within both environments and sometimes a combination of both. (Click for full article)