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Category Archives: Continuous Improvement

Why Process Improvement Is a Never-Ending Job…Thank Goodness

Best Practices, Continuous Improvement, Innovation, Lean Six Sigma, Process Improvement, Sacramento

By Stephen Alfano, PMP, CSM

Ice cream melting. Kids whining. Anger mounting. It’s a Saturday morning in the middle of summer. The lines at the local grocery store registers are six people deep. Patrons have been moving at a glacial pace for the last 10 minutes. Many are complaining to one another. Several have begun to shout out for the store manager. The store manager is not on duty. The shift manager is—so, the bottleneck is her problem. She needs to find another way to move these customers through the queue as quickly as possible or risk seeing dozens of negative (business-killing!) reviews posted on social media. Her job is at stake. If she’s unsuccessful, then the ice cream won’t be the only thing having a meltdown.

Of course, if the shift manager has been trained or has prior experience with this type of process problem, she will undoubtedly follow the store playbook or her gut and get the shoppers on their way in no time. But, what if the store didn’t have a playbook on how to handle this kind of situation? Or what if this was the shift manager’s first day on the job?

This check-out crisis at the corner store might seem a little cliché at first. However, it is a perfect example of a real-world (real-time) business process improvement opportunity, for example…

  • An opportunity where an individual or an organization can take a bad scenario—or “use case”—and turn it into a teaching moment that will drive value for customers;
  • An opportunity that highlights how critical addressing process flow problems are to the success of any business; and
  • Perhaps most important, an opportunity that demonstrates the need for making a plan, doing what the plan prescribes, studying the results or reaction to what was done, and actively identifying and pursuing any changes to the plan to improve the process on a continuous basis.

I like to use the Plan-Do-Study-Act (PDSA) cycle. Known as the Deming Wheel or Deming Cycle—named for Dr. W. Edwards Deming, an American engineer, professor, author, and management consultant—the PDSA is an organized approach to continual learning and improving products, processes, or services.

“If you can’t describe what you are doing as a process, you don’t know what you are doing” ― Dr. W. Edwards Deming

Here’s how the PDSA cycle is applied:

The Plan step starts the cycle:

  1. Establish a goal or outcome.
  2. Formulate a theory or an approach to achieving the desired results.
  3. Define success criteria, including actual activities and products necessary to execute the plan itself.

Then, in the Do step:

  1. The plan is implemented.
  2. Processes are executed.
  3. Products are generated.
  4. Services are delivered.

Next comes the Study step. The results—the outcomes—of the processes, products, and services are monitored and evaluated on their effectiveness and efficiency towards meeting the customers’ expectations and needs. The entire plan is examined: Progress and success are measured as much as problems—and areas for improvement are prioritized.

The Act step brings the cycle back to the planning or drawing table. Here, data and learning gained throughout the process are used to help make informed decisions—or at the very least, adjustments in goals, approaches, and value metrics.

If executed with discipline and intentions to drive continuous improvement, the PDSA cycle can be repeated over and over to the delight of customers and managers alike in any season or business scenario.

For more insight on process improvement, check out these links:

Whether it’s at the ice cream counter or on technical project, this model for process improvement can apply! Do you have questions or comments about Process Improvement or your preferred best practices? Comment below!

About the Author: Stephen Alfano is an Organizational Change Management Consultant and Communications Expert. He has over 30 years of experience leading and managing initiatives for both private and public-sector clients. His résumé includes providing both new business and business process improvement services to Apple, American Express, AT&T, California Department of Transportation, Chevron, Entergy, Levi Strauss & Co., Louisiana Office of Tourism, Mattel, Microsoft, Novell, SONY, Sutter Health, and Wells Fargo. Stephen currently works as an Executive Consultant—PMP®, CSM® with KAI Partners, Inc., providing change management and communications expertise and project management support services on several active contracts.

Using Data and Semantics to Improve Public Sector Services

Continuous Improvement, Data Management, Data Science, Government, Healthcare, Information Technology, Innovation, Innovation in the Public Sector, IT Modernization, Public Sector, Sacramento, Technology

An Interview with Dr. Josh Morgan of SAS


We recently had the opportunity to hear Dr. Josh Morgan, National Director of Behavioral Health and Whole Person Care at software developer SAS, speak at the SAS Institute Inc.’s SAS California Users Forum.

Dr. Morgan spoke about how important semantics and data are to solving complex issues in the areas of health care, homelessness, corrections, the environment, and more.

We were particularly taken with Dr. Morgan’s insights on how we define things can determine how we review and analyze them. He emphasized that the way we speak about a problem influences how we look at it and address it. (Spoiler: Below, Dr. Morgan shares a great story about how changing semantics in a public outreach and engagement program led to improvements to the public agency’s services.)

After hearing Dr. Morgan speak, we wanted to learn more about the work he does and his passion for improving whole person care and for helping solve complex issues. Today we’re thrilled to share this interview with Dr. Josh Morgan!

KAI Partners, Inc.: What is your profession/day-to-day work?

Dr. Morgan: I’m a licensed psychologist currently working as the National Director of Behavioral Health and Whole Person Care at SAS. I provide consultation to agencies on how to identify a more complete, accurate picture of community need as well as the impact of services, ideally from a more holistic perspective.

KAIP: How did you get into this field?

Dr. Morgan: I was planning to become a film director originally, but wanted to more directly help people, so I pursued psychology (after exploring multiple other fields). My doctoral program emphasized strengths-based, person-centered work that also acknowledged the role of systems and structures in our lives (versus an individual in isolation). But when I started working full-time in the field, I got frustrated by all the things we weren’t allowed to do because it’s not a covered benefit or not in policy. Our health world is focused very much on reducing symptoms and just on the individual. I made the move into the analytics/evaluation side as a way to use data to advocate for better services, systems, structures, and policies.

KAIP: What is your favorite part about your work and why?

Dr. Morgan: There are two parts. The core meaning of my work is in helping advocate for more whole person care across the country. On a more practical level, I love getting to see the creativity of people around the country in doing so much with so little and finding answers to complex questions despite barriers. I really have fun being presented with policy and evaluation questions and figuring out ways to answer them and even enhance them with more complete, accurate information.

KAIP: Why do you do what you do/what inspires you?

Dr. Morgan: Making a difference in our policies, systems, and structures so more people get the care they need in a holistic way.

KAIP: How does data and semantics inform your work and how you approach problems?

Dr. Morgan: My dissertation was qualitative (on exemplar Muslim and Christian interfaith peacemakers), so I’ve long been a skeptic of quantitative data’s ability to represent human experiences and true outcomes. However, I’ve increasingly recognized we live in a quantitative world, and discrete numbers are really helpful for telling a story of broad impact. It’s easy to complain about the metrics we currently have, but I decided it was better to get a seat at the table and influence the metrics to push for more whole person, strengths-based indicators and data rather than just have it all imposed upon me.

This is core to a lot of my work, finding ways to be creative in meeting required, symptom-focused metrics while contributing more contextual information to tell a more complete, accurate story. I had a great team when I was the Chief of Behavioral Health Informatics at the San Bernardino County Department of Behavioral Health, and we found ways of even using claims data to get a more complete story!

In that role, I got to present at the SAS Analytics Experience conference and discovered text analytics and natural language processing. I talked the ear off the product manager because it brought me back to my grad school days with my dissertation and some computation linguistics work we did. Advances in technology are helping unlock narrative and qualitative data which, especially in behavioral health, is so rich and gives an opportunity to give an even more whole person perspective.

We can explore more robust mixed-methods designs by leveraging technology to present both quantitative and qualitative data. That’s truly more whole person analytics!

KAIP: Can you explain the intersection of data and semantics in the public sector, and why it matters?

Dr. Morgan: First, we need to remember that data is a very inclusive term. People usually think about structured, quantitative information when they hear the word data, but all information is data. This interview is data. Semantics usually refers to narratives, language, and other qualitative data. As my dissertation was qualitative, I deeply value and appreciate the richness that can be found in semantics. There’s human nuance that just cannot be captured in a quantitative way. Further, when we talk about things like health equity and civic engagement in the public sector, the voice of the consumer, the citizen, the patient, etc., is of paramount importance. Wouldn’t it be great to literally gain insights from the voices our public agencies serve?

The public sector is also unique in that it is the only institution that is truly responsible for all lives and making our communities better holistically. All other private entities have sub-segments, geographies, or populations.

Public agencies cross all industries. Therefore, there is a unique ability to gain a true whole person view into the community that no other institution can really gain.

In this way, though, I believe public agencies have a responsibility to get as complete a view as possible, meaning both quantitative and qualitative data.

KAIP: Can you give an example of using data and semantics to create policy and drive change in the public sector?

Dr. Morgan: When I was with the San Bernardino County Department of Behavioral Health, we developed a program to conduct outreach and engagement with “resistant, non-compliant” people. One of our evaluation metrics was pretty basic, looking at counts of outpatient utilization pre and post engagement. The first time my team ran the numbers, we showed dozens of visits in the year before engagement. But these were supposed to be those who weren’t in treatment because they were called “resistant and non-compliant.” Digging into the data a little more, we found the nature of the services was overwhelmingly crisis visits and assessments (often multiple assessments with different providers). People who are repeatedly seeking assessments and even crisis visits within a 12-month period are really hard to classify as “resistant.”

This started a conversation internally about whether our language in describing people was accurate in the first place. Then we were able to gain more context from the stories of the consumers served and the care coordination staff who engaged with these folks and even went to appointments with the consumers. Plus, we had focus groups and other narrative stories.

These stories (i.e., semantic data) gave context and insight into the quantitative data we saw, shedding light on the ways our system can be challenging to engage with. It started changing our semantics in describing people in need. No longer did we see these folks as “resistant and non-complaint,” but rather desiring help and facing legitimate barriers to care. That also led to quality improvement policy work to change our system to be more accessible. These insights are also helpful in larger policy conversations about how to engage the harder to reach, high utilization, and expensive populations. It may not be that the consumers need to change as much as the systems aimed to help them need to change.

KAIP: What questions should we ask ourselves to make sure we approach/analyze data in the right way?

Dr. Morgan: Who are we not including in the data? Who are we not including in the interpretation process? In the many conversations around biased algorithms and AI ethics, there’s increasing recognition that we can unintentionally have biased data and results by the absence of some populations. We may not be able to include everyone but attempting to do so is a start. It is critical that we are very clear and intentional about who is included and not included and that we are sure to avoid generalizing results to excluded populations.

What questions am I not asking? Too often I find agencies, especially in the public sector and health, not asking questions because we don’t know how to find the answer. Often this is because of a lack of data or a lack of a data platform to truly unlock insights.

I think people have more helpful data than they realize. There are ways to be creative in answering questions.

It may not be perfect, but proxies can be really helpful in getting at certain ideas. Just because you may not have a perfect methodology or result doesn’t mean you can’t do something to start getting at the information. You can caveat any results so they are not over-interpreted, but starting to explore the questions we stop asking helps get us to more whole person perspectives.

KAIP: How should data be used to inform and drive decision-makers, policies, etc.? How should it not be used?

Dr. Morgan: Data should be the start of the story and conversation and not the end. Some people approach results as the end-all-be-all, but interpretation and application is key. Stakeholder engagement in this interpretation process can gain additional insights and conversations that may not have otherwise occurred if we took data at face value. Data doesn’t just inform decisions and policies; it brings us all together to build dialogue and more compassion for each other by having greater insights into context.

We also need to be careful about “perfect” methodology. A danger in a lot of policymaking and decision-maker requests for data is a default to an academic-like approach. I teach on the side and have published, so I love the academic world. However, laboratory research often doesn’t translate to the messy real-life world, especially in health and particularly in public sector health and social services. I’ve seen a lot of evaluation projects and data initiatives stall because there was any level of data quality challenges or an inability to achieve extreme rigor in statistical significance. We don’t want to dismiss rigor, of course, but when we look at trends across populations, numbers don’t have to be perfect. I use the example of suicide rates and opioid use and deaths. They’re both broadly recognized as undercounts because of the way they’re underreported. But we can still tell when there’s a problem or a trend in a good or a bad direction. Don’t wait for data perfection to start using the data and even starting policy conversations!

Thank you, Dr. Morgan, for your fascinating insights on using data to public policy and public services. Now, for a little fun and games…

KAIP: What was the last show you binge-watched or what is your favorite podcast?

Dr. Morgan: Star Trek Discovery. I grew up on The Next Generation and wore a Star Trek uniform for my fourth-grade school picture, so I’m a long-time Trekker. I watched this series and then thought after Season 2 that my wife would like it, so we just binged both seasons in time for San Diego Comic Con! 🖖

KAIP: What are your favorite productivity or life tips/hacks?

Dr. Morgan: Mindfulness. I was exposed to this more deeply in my clinical work during an intensive training in Dialectical Behavior Therapy (DBT) when I led a program for adolescent self-injury. As I’ve done intro trainings on mindfulness and DBT, I’ve shared many of the mindfulness principles that have been more helpful in my personal life than in my clinical work!

One example is the principle of effectiveness. I can get stuck in considering what’s right or wrong and delay decisions. When I frame things in terms of effectiveness, it helps reconsider what the long-term goals of the work are and what will practically get us/me there. When I remember to be mindful in this way, I can get unstuck pretty quickly.

KAIP: What are your favorite digital tools/apps?

Dr. Morgan: I travel a lot, so I love my headphones. To the point of mindfulness above, I’ve enjoyed the 10% Happier app as a way to dive deeper into meditation approaches and principles in a scientific way. I also just started subscribing to Calm. It includes a lot of music tracks that are great for flights or even just focusing (or relaxing for sleep). The free chair massages in some airports are a great way to spend some layovers!

Pocket is a great app to collect articles I don’t want to read immediately and then read (often on a plane). I use Evernote for a variety of personal notes and OneNote for my work notes, especially since it synchronizes across my devices. I have an electronic notepad that I can easily take photos of in OneNote and have them on my desktop later.

I also rely on the Associated Press app for news alerts and catching up on the day’s happenings. Although reading the news in bed isn’t the best way to mindfully prepare for sleep…

KAIP: What is your favorite professional book and why?

Dr. Morgan: Tribal Leadership was a book I was exposed to during a leadership course. Its principles have stuck with me, as it talks about corporate and personal culture and values in a new way that can help identify congruency with your own values and challenge where you and your company are. It helps reshape ideas about competition. In the highest stage of development, we’re not focused on “winning” over someone else (meaning they lose), but rather, we’re going to compete with major human problems, like poverty, cancer, homelessness, etc. Winning isn’t about another company, but about moving our world forward. This book helped me evaluate SAS as an employer and was a reason I took a job with SAS—the whole Data for Good initiative is focused on these higher ideals, and we are actually able to make a difference in our world across industries!

KAI Partners is committed to helping find solutions and improvements in our community—we know this is imperative to achieving a stronger, more resilient Sacramento—and we are excited that Dr. Morgan shares this passion with us!

About Dr. Josh Morgan: As SAS’ National Director of Behavioral Health and Whole Person Care, Dr. Josh Morgan helps health agencies use data and analytics to support a person-centered approach to improving health outcomes. A licensed psychologist, Dr. Morgan was previously San Bernardino County Department of Behavioral Health’s Chief of Behavioral Health Informatics. His clinical work includes adolescent self-injury, partial hospitalization, and intensive outpatient programs, psychiatric inpatient units and university counseling centers. Dr. Morgan earned his Bachelor of Arts in Religious Studies from the University of California, Berkeley, and a PsyD (Doctor of Psychology) in Clinical Psychology with an emphasis in Family Psychology from Azusa Pacific University and is trained in Dialectical Behavior Therapy.

Bonus reading: Here are a few articles by Dr. Morgan that we found compelling:

Improving the User Experience with Product Management

Agile, Certified Scrum Product Owner (CSPO), Certified ScrumMaster (CSM), Continuous Improvement, Healthcare, Innovation, Innovation in the Public Sector, IT Modernization, Process Improvement, Product Management, Project Management, Project Management Professional (PMP), Public Sector, Sacramento, Scrum, Technology, Waterfall

By Jamie Spagner, PMP, CSM, CSPO

As a PMP, I have nearly a decade of traditional project management experience. I’ve worked on several projects and helped implement solutions into production using the standard waterfall methodology. With a very scripted plan, traditional projects have pre-defined scope and a definitive end.

Something I’ve recently started to work on is Product Management. In my current role, I am helping to plan the modernization efforts for a legacy system in the health care industry. The idea of Product Management is a relatively new concept for the public sector—it shifts the traditional way of thinking and is less prescriptive and more flexible.

You may be wondering how Product Management works, so I wanted to share my thoughts on Product Management in general, as well as some of its challenges.

  1. Product Management doesn’t stop. Product Management is customer-driven by nature—there is no fixed schedule or end date by which to release a product or system. Features are continuously added or tweaked to make the system or product function better for the end-user.
  2. Product Management is centered around the Agile approach. (Also true of some traditional projects.) Teams are self-motivated to determine how and when they’ll do the work. Product Management is not done in a vacuum—the development of the product is still structured using typical scrum tools like daily stand-ups and sprint planning.
  3. Product Management is not perfect. As with any new way of doing things, implementing a Product Management approach is not without its challenges. The idea of a product never being truly “finished”—because the product is continually improved to make sure it meets and exceeds customer needs—can be a tough concept.
  4. Product Management requires buy-in. Product Management often requires a culture change, as well. Coaching of executives and leadership is common—instead of directing their team, leaders should empower their teams to self-organize.
  5. Reporting Product Management’s progress. Another challenge of Product Management is reporting and being able to show progress against a plan. Since these are inherently waterfall tasks, there is a challenge in how to measure and show progress with a continuous process like Product Management. I believe using the tools of Agile can help in reporting and measurement. Developing a product roadmap, building a backlog, holding daily standup meetings, and overall accountability—you should trust in the agile process to develop and improve a great product.

Product Management is starting to be used more widely in public sector technology and innovation endeavors because it focuses on the people, processes, and technology. Product Management is a team effort to make sure a product thrives and meets the needs of the end-user community it supports.

Have you used a Product Management approach before? How is it working for you? Leave a comment and let us know!

About Jamie: Jamie Spagner is an Executive Consultant for KAI Partners, where she works as a Project Manager for a public sector health care client. She graduated from California State University, Sacramento with the Bachelor’s Degree in Communication Studies/Public Relations. She is a loving mother of a teenage son named Wyatt. In her spare time, she enjoys shopping, spending time with family/close friends, and working out.

Why Successful Meetings Start with Stakeholder Management

Best Practices, Communications, Continuous Improvement, Employee Engagement, Managing/Leadership, Project Management, Sacramento, Team Building

By Stephen Alfano, PMP®, CSM®

Raise your hand if you’ve ever been in a meeting that was derailed by a dominating or distracting stakeholder. Now, concentrate on that scenario: Do you remember how you reacted to the meeting going off track?

If you attended the meeting as a secondary stakeholder—in a role like a union representative or a regulator not tied directly to an outcome of the meeting—the event probably made you feel a bit confused or at the very least a little uncomfortable for the person running the meeting.

However, if you were a primary stakeholder—accountable for a project or an outcome tied to the meeting—you might remember feeling like you witnessed a total train wreck.

Regardless of your takeaway, I’ll wager that everyone—except the stakeholder at the center of the disruption—left that meeting shaking their head wondering why someone (anyone!) didn’t anticipate that the meeting might be at risk of being derailed. Better still, I’ll double my wager that the root cause of the derailment comes from insufficient insight and analysis on the stakeholder in question. In other words, I’ll bet the house that the meeting would have stayed on track with Stakeholder Management on the scene.

Stakeholder Management is an essential component in the delivery of business processes or activities.

Stakeholder Management identifies the needs of vested participants and helps rank (arrange and prioritize) their power, interest, and influence levels in context to one another and in alignment with the overarching strategic goals and objectives of the organization, program, or project driving the delivery.

That’s why a project owner or manager with a Stakeholder Management Plan in hand can anticipate and approach disruptive stakeholder behavior quickly and effectively—especially in a meeting.

The key to effective Stakeholder Management comes from a continuous, laser-like focus on the significant interactions between and impact on people—playing roles as individuals, inside groups, or within organizations.

Maintaining a high level of awareness and engagement with stakeholders to assess, analyze, and then align their needs and expectations—often referred to as providing “care and feeding” throughout the delivery lifecycle—is a demanding job.

It’s a job that requires masterful interpersonal skills like leadership, motivation, and active listening, as well as proven project management skills like risk management, negotiating, and critical thinking.

Of course, there are many other skills involved in stakeholder management that I could list here, but I wouldn’t want to get off track. 😉

For more insight on running successful meetings, check out these links:

How to Run a More Effective Meeting
https://www.nytimes.com/guides/business/how-to-run-an-effective-meeting

Five principles for getting more done as a team
https://slackhq.com/run-effective-meetings

7 Ingredients for Effective Team Meetings, Distilled from Two Years of Torture
https://blog.hubstaff.com/effective-team-meetings/

Do you have questions or comments regarding Stakeholder Management including best practices? Submit them in the form below!

About the Author: Stephen Alfano is an Organizational Change Management Consultant and Communications Expert. He has over 30 years of experience leading and managing internal and external marketing initiatives for both private and public-sector clients. His résumé includes providing both new business and business process improvement services to Apple, American Express, AT&T, California Department of Transportation, Chevron, Entergy, Levi Strauss & Co., Louisiana Office of Tourism, Mattel, Microsoft, Novell, SONY, Sutter Health, and Wells Fargo. Stephen currently works as an Executive Consultant—PMP®, CSM® with KAI Partners, Inc., providing change management and communications expertise and project management support services on several active contracts.

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