How to use data to scare people …

… and how to use data for analytics.

Crisis hit GP surgeries forced to turn away millions of patients

That was the headline on the Royal College of General Practitioners (“RCGP” – UK family physicians) website today. The catastrophic tone was elaborated in The (London) Times: Millions shut out of doctors’ surgeries (paywall).
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The GPs’ alarm was based on data from the GP Patient Survey which is a survey conducted on behalf or the National Health Service (“NHS”) by pollsters Ipsos MORI. The study is conducted by way of a survey questionnaire sent out to selected NHS patients. You can find the survey form here. Ipsos MORI’s careful analysis is here.

Participants were asked to recall their experience of making an appointment last time they wanted to. From this, the GPs have extracted the material for their blog’s lead paragraph.

GP surgeries are so overstretched due to the lack of investment in general practice that in 2015 on more than 51.3m occasions patients in England will be unable to get an appointment to see a GP or nurse when they contact their local practice, according to new research.

Now, this is not analysis. For the avoidance of doubt, the Ipsos MORI report cited above does not suffer from such tendentious framing. The RCGP blog features the following tropes of Langian statistical method.

  • Using emotive language such as “crisis”, “forced” and “turn away”.
  • Stating the cause of the avowed problem, “lack of investment”, without presenting any supporting argument.
  • Quoting an absolute number of affected patients rather than a percentage which would properly capture individual risk.
  • Casually extrapolating to a future round number, over 50 million.
  • Seeking to bolster their position by citing “new research”.
  • Failing to recognise the inevitable biases that beset human descriptions of past events.

Humans are notoriously susceptible to bias in how they recall and report past events. Psychologist Daniel Kahneman has spent a lifetime mapping out the various cognitive biases that afflict our thinking. The Ipsos MORI survey appears to me rigorously designed but no degree of rigour can eliminate the frailties of human memory, especially about an uneventful visit to the GP. An individual is much more likely to recall a frustrating attempt to make an appointment than a straightforward encounter.

Sometimes, such survey data will be the best we can do and will be the least bad guide to action though in itself flawed. As Charles Babbage observed:

Errors using inadequate data are much less than those using no data at all.

Yet the GPs’ use of this external survey data to support their funding campaign looks particularly out of place in this situation. This is a case where there is a better source of evidence. The point is that the problem under investigation lies entirely within the GPs’ own domain. The GPs themselves are in a vastly superior position to collect data on frustrated appointments, within their own practices. Data can be generated at the moment an appointment is sought. Memory biases and patient non-responses can be eliminated. The reasons for any diary difficulties can be recorded as they are encountered. And investigated before the trail has gone cold. Data can be explored within the practice, improvements proposed, gains measured, solutions shared on social media. The RCGP could play the leadership role of aggregating the data and fostering sharing of ideas.

It is only with local data generation that the capability of an appointments system can be assessed. Constraints can be identified, managed and stabilised. It is only when the system is shown to be incapable that a case can be made for investment. And the local data collected is exactly the data needed to make that case. Not only does such data provide a compelling visual narrative of the appointment system’s inability to heal itself but, when supported by rigorous analysis, it liquidates the level of investment and creates its own business case. Rigorous criticism of data inhibits groundless extrapolation. At the very least, local data would have provided some borrowing strength to validate the patient survey.

Looking to external data to support a case when there is better data to be had internally, both to improve now what is in place and to support the business case for new investment, is neither pretty nor effective. And it is not analysis.

Deconstructing Deming VI – Institute training on the job

6. Institute training on the job.

W Edwards Deming Point 6 of Deming’s 14 Points. I think it was this point that made me realise that everybody projects their own anxieties onto Deming’s writings and finds what they want to find there.

Deming elaborates this point further in Out of the Crisis and several distinct positions emerge. I identify nine. In many ways, the slogan Institute training on the job is no very good description of what Deming was seeking to communicate. Not everything sits well under this heading.

“Training”, along with its sagacious uncle, “education” is one of those things that every one can be in favour of. The systems by which the accumulated knowledge of humanity are communicated, criticised and developed are the foundations of civilisation. But like all accepted truths some scrutiny repays the time and effort. Here are the nine topics I identified in Out of the Crisis.

1. People don’t spend enough on training because the benefits do not show on the balance sheet

This was one of Deming’s targets behind his sixth point. It reiterates a common theme of his. It goes back to the criticisms of Hayes and Abernathy that managers were incapable of understanding their own business. Without such understanding, a manager would lack a narrative to envision the future material rewards of current spending. Cash movements showed on the profit and loss account. The spending became merely an overhead to be attacked so as to enhance the current picture of performance projected by the accounts, the visible figures.

I have considered Hayes and Abernathy’s analysis elsewhere. Whatever the conditions of the early 1980s in the US, I think today’s global marketplace is a very different arena. Organisations vie to invest in their people, as this recent Forbes article shows (though the author can’t spell “bellwether”). True, the article confirms that development spending falls in a recession but cash flow and the availability of working capital are real constraints on a business and have to be managed. Once optimism returns, training spend takes off.

But as US satirist P J O’Rourke observed:

Getting people to give vast amounts of money when there’s no firm idea what that money will do is like throwing maidens down a well. It’s an appeal to magic. And the results are likely to be as stupid and disappointing as the results of magic usually are.

The tragedy of so many corporations is that training budgets are set and value measured on how much money is spent, in the idealistic but sentimental belief that training is an inherent good and that rewards will inevitably flow to those who have faith.

The reality is that it is only within a system of rigorous goal deployment that local training objectives can be identified so as to serve corporate strategy. Only then can training be designed to serve those objectives and only then can training’s value be measured.

2. Root Cause Analysis

The other arena in which the word “training” is guaranteed to turn up is during Root Cause Analysis. It is a moral certainty that somebody will volunteer it somewhere on the Ishikawa diagram. “To stop this happening again, let’s repeat the training.”

Yet, failure of training can never be the root cause of a problem or defect. Such an assertion yields too readily to the question Why did lack of training cause the failure?. The Why? question exposes that there was something the training was supposed to do. It could be that the root cause is readily identified and training put in place as a solution. But, the question could expose that, whatever the perceived past failures in training, the root cause, that the training would have purportedly addressed, remains obscure. Forget worrying about training until the root cause is identified within the system.

In any event, training will seldom be the best way of eliminating a problem. Redesign of the system will always be the first thing to consider.

3. Train managers and new employees

Uncontroversial but I think Deming overstated businesses’ failure to appreciate this.

4. Managers need to understand the company

Uncontroversial but I think Deming overstated businesses’ failure to appreciate this.

5. Managers need to understand variation

So much of Deming’s approach was about rigorous criticism of business data and the diligent separation of signal and noise. Those are topics that certainly have greater salience than a quarter of a century ago. Nate Silver has done much to awaken appetites for statistical thinking and the Six Sigma discipline has alerted the many to the wealth of available tools and techniques. Despite that, I am unpersuaded that genuine statistical literacy and numeracy (both are important) are any more common now than in the days of the first IBM PC.

Deming’s banner headline here is Institute training on the job. I think the point sits uncomfortably. I would have imagined that it is business schools and not employers who should apply their energies to developing and promoting quantitative skills in executives. One of the distractions that has beset industrial statistics is its propensity to create a variety of vernacular approaches with conflicting vocabularies and competing champion priorities: Taguchi methods, Six Sigma, SPC, Shainin, … . The situation is aggravated by the differential enthusiasms between corporations for the individual brands. Even within a single strand such as Six Sigma there is a frustrating variety of nomenclature, content and emphasis.

It’s not training on the job that’s needed. It is the academic industry here that is failing to provide what business needs.

6. Recognise that people learn in different ways

Of this I remain unpersuaded. I do not believe that people learn to drive motor cars in different ways. It can’t be done from theory alone. It can’t be done by writing a song about it. it comes from a subtle interaction of experience and direction. Some people learn without the direction, perhaps because they watch Nelly (see below).

Many have found a resonance between Deming’s point and the Theory of Multiple Intelligences. I fear this has distracted from some of the important themes in business education. As far as I can see, the theory has no real empirical support. Professor John White of the University of London, Institute of Education has firmly debunked the idea (Howard Gardner : the myth of Multiple Intelligences).

7. Don’t rely on watch Nelly

After my academic and vocational training as a lawyer, I followed a senior barrister around for six months, then slightly less closely for another six months. I also went to court and sat behind barristers in their first few years of practice so that I could smell what I would be doing a few months later.

It was important. So was the academic study and so was the classroom vocational training. It comes back to understanding how the training is supposed to achieve its objectives and designing learning from that standpoint.

8. Be inflexible as to work standards

This is tremendously dangerous advice for anybody lacking statistical literacy and numeracy (both).

I will come back to this but it embraces some of my earlier postings on process discipline.

9. Teach customer needs

This is the gem. Employee engagement is a popular concern. Employees who have no sight of how their job impacts the customer, who pays their wages, will soon see the process discipline that is essential to operational excellence as arbitrary and vexatious. Their mindfulness and diligence cannot but be affected by the expectation that they can operate in a cognitive vacuum.

Walter Shewhart famously observed that Data have no meaning apart from their context. By extension, continual re-orientation to the Voice of the Customer gives meaning to structure, process and procedure on the shop floor; it resolves ambiguity as to method in favour of the end-user; it fosters extrinsic, rather than intrinsic, motivation; and it sets the external standard by which conduct and alignment to the business will be judged and governed.

The Productivity Paradox

File:City of London skyline at dusk.jpgThis last week saw a further report from the Bank of England that UK productivity has fallen inexplicably behind the nation’s aspirations. There is a compelling picture of the development of productivity over time on the Office of National Statistics (“ONS”) website here.

There is general puzzlement, and disquiet, among UK economists as to why productivity is not improving. It seems to suggest that cutting the costs of production is not at the top of UK business agendas. It’s true that there are other important things to worry about: design and redesign of products and services, reputation, customer experience, workplace engagement, safety and sustainability.

But I suspect that there is nothing more important than productivity. It is only by learning how to do more with less that resources can be freed up to develop novel income streams. Even on matters of safety and environment, it is the efficient organisation that finds the resources to take those matters seriously.

The road to increased productivity is well mapped out. The continual improvement of the alignment between the Voice of the Process and the Voice of the Customer, by the means of diligent criticism of historical data is an open secret.

Bang! UK Passport Office hits the kerb

Her Majesty's Passport OfficeThe UK’s Passport Office is in difficulties. They have a backlog that is resulting in customers’ passport applications being delayed. This is not a mere internal procedural inconvenience. The public has noticed the problem and started complaining. Emergency measures are being put in place to deal with the backlog. Politicians have become involved and are looking over their shoulders at their careers.

It is a typical organisational mess. There is a problem. Resources are thrown at it. Personalities wager their reputations. Any hero able to solve the problem will be feted and rewarded. There will be blame and punishment. Solutions will involve huge cost. The costs will be passed on to the customer because, in the end, there is no one else to pay.

A suggestion for investigation

From the outside, it is impossible to know the realities of what has caused the problem at HM Passport Office. However, I think I can respectfully and tentatively suggest some questions to ask in any inquiry as to how the mess occurred.

  • Had any surprising variation in passport processing occurred before the crisis hit?
  • If so, what action, if any, was taken?
  • Why was the action ineffective?
  • If no surprising variation was observed, were the managers measuring “upstream” indicators of process performance in addition to mere volumes?
  • Was historic data routinely interrogated to find signals among the noise?
  • If signals were only observed once it was too late to protect the customer, was the issuing process only marginally capable?

“Managing the passport issuing process on historical data is like …”

… trying to drive a car by watching the line in the rear-view mirror.

Myron Tribus

And, of course, that is what HM Passport Office and every manager has to do. There is only historical data. There is no data on the future. You cannot see out of the windscreen of the organisational SUV. Management is about subjecting the historic experience base to continual, rigorous statistical criticism to separate signal from noise. It is about having a good rear view mirror.

A properly managed, capable process will operate reliably, well within customer expectations. In process management terms, the Voice of the Process will be reliably aligned with the Voice of the Customer.

Forever improving the capability of the process gives it the elbow room or “rattle space” within which signals can occur that the customer never perceives. Those signals could represent changes in customer behaviour, problems within the organisation, or external events that have an impact. But the fact that they are unnoticed by the customer does not mean those signals are unimportant or can be neglected. It is by taking action to investigate those signals when they are detected, and by making necessary adjustments to work processes, that a future crisis can be averted.

While the customer is unaffected, the problem can be thoroughly investigated, solutions considered calmly and alternative remedies tested. Because the problem is invisible to the outside world there will be no sense of panic, political pressure, cash-flow deficit, reputational damage or destruction of employee engagement. The matter can be addressed soundly and privately.

Continual statistical analysis is the “rear view mirror”. It gives an historical picture as to how well the Voice of the Process emulates the Voice of the Customer. Coupled with a “roadmap” of the business, some supportive data from the “speedometer” and a little basic numeracy, the “rear view mirror” enables sensible predictions to be made about the near future.

Without that historical data, properly presented on live process behaviour charts to provide running statistical insight, then there is no rear view mirror. That is when the only business guidance is the Bang! when the organisation hits the kerb.

It looks like that is what happened at HM Passport Office. Everything was fine until the customers started complaining to the press. Bang! That’s how it looks to the customer and that is the only reality that counts.

#Bang!youhitthekerb

Deconstructing Deming V – Improve constantly and forever

5. Improve constantly and forever the system of production and service, to improve quality and productivity, and thus constantly decrease costs.

W Edwards Deming Point 5 of Deming’s 14 Points. Surely about this there can be no controversy.

Improvement means reducing operating costs, enhancing customer value, and developing flexibility and agility. Improvement means constantly diminishing the misalignment between the Voice of the Process and the Voice of the Customer.

The UK awaits fresh productivity statistics next month but the figures up to the end of 2013 make sobering reading. UK productivity has been in miserable decline since 2008. In response to tightening of demand, failures of liquidity, absence of safe investment alternatives, rises in taxation and straightened cash flows, the aggregate response of industry has been a decline in human efficiency.

The reasons this has happened are no doubt complex. The paradox remains that it is improvement in productivity that grows sustainable rewards, captures markets and releases working capital for new ventures. At first sight it appears the answer to all the ills of a recession.

How will you know?

In their seminal model for improving productivity, Thomas Nolan and Lloyd Provost posed the question:

How will you know when a change is an improvement?

It is such a simple questions but it is too seldom asked and I suspect that itself is a major barrier to improvement.

We are beset by human induced change, by government and by business managers. The essential discipline is critically to question whether such change results in an improvement. It is an unpopular question. Nobody who champions a particular change wants to be proved wrong, or confronted with a marginal improvement that fails to live up to an extravagant promise.

Business measurement is mandated in the modern corporation. Businesses, governments, organisations abound with KPIs, metrics, “Big Ys”, results measures … and often a distracting argument over what to call them. There is no lack of numbers for answering the question. We are constantly assured that we now have the Big Data whose absence frustrated past strategy.

The habitual analytic tool in old-style businesses was what Don Wheeler mischievously named the executive time series, two numbers, one larger (or smaller) than the other, selected to show movement in the desired direction. That is, as Scottish folklorist Andrew Lang put it:

… using statistics in the same way that a drunk uses lamp-posts — for support rather than illumination.

It is a moral certainty that no two measurements will yield the same number. One will be larger than the other. It will be easy to select two to support any pet project or theory.

Building a persuasive case that improvement has happened firstly requires a rigorously constructed baseline. Without an objective description of the historical experience base, claims as to improvement are simply speculative.

And beyond that, what the executive time series cannot do is distinguish signal from noise. It cannot help because the answer to the question When will you know …? is When there is a signal in the data. That can only be answered with the diligent and rigorous use of process behaviour charts.

At the top of this page is a “RearView” tab. Without the trenchant and determined use of process behaviour charts there is not even a white line in the rear view mirror. The only signal will come from the “bang” when we hit the kerb.

What to improve

Deming’s further message was that it was every process that was to be improved, not simply those whose customer was the end consumer. Many processes have internal customers with their own voice. Processes of management of human resources, maintenance and accounting can all have a critical impact on organisation performance. They must keep on getting better too.

Being held to account is never comfortable but neither is the realisation that we have surrendered control of assets without the means of knowing when such assets are incrementally put to increasingly efficient, effective and agile use.

We need louder demands of “Show me!”