Taking Care of Business: Why Context and Need are at Heart of Business Process Design

For those of you who don’t know, my BPM consulting work focuses on the healthcare field. Nowhere is the answer to the question “Why?” more striking and evident. When people begin (and I do mean begin) to think in terms of “Why do we do this?” and “Why do it that way?”, the answers inherently gush with reasons that make you sit up and take note. And nowhere have I paid witness to answers and reasons that are so incomplete as to send shivers up and down my spine. If you’re not sure what I mean, give up an afternoon of your time, sit in your local emergency room and watch how people there do their thing. It’s free, entertaining and the best open source forum for organic, dynamic examples of workflow and process in action.  You won’t be sorry. Mortified at times but certainly not sorry.

From this healthcare standpoint, let me say a few things about context. First of all, if you’re relatively new to BPM, BPR, BPA and all of the other acronyms, you should become aware and fluent in context diagrams. Context models and diagrams allow you to illustrate (simply) understanding of the transactions between stakeholders or entities and the outcomes that are expected as a result. For instance, if a hospital submits a billing to an insurance company, the expected outcome is a payment. These diagrams also take into account indirect interactions. In doing so, they begin to conjure SIPOC diagrams but are different in that they take a very broad Business Process Overview that includes all of the possible stakeholders (direct and indirect) and display – at once – all of the interactions in simple, straight-line fashion.

Business Process Overview – The Bird’s Eye View of Context

By illustrating all of the transactions and expected outcomes possible over an entire array of workflow and activities in a highly simplified diagram, the reader gains immediate insight into the context and the needs of all of the stakeholders (my expected outcome is directly related to my need). This may sound elementary but I promise you that in this highly inter-dependent and inter-connected world, few people grasp and understand the value and relationships involved in the working world they inhabit. Again – from the healthcare field – how many people understand that the answers, information and data they harvest are being used by Immigration, CDC, Public Health, Policy and Legislative, and Insurance officials simultaneously for vastly different reasons?

Taking Care – Taking Heart

When people understand fully the value of their work product, when they can see themselves and their activities in full view of the context, then they grow more intimatley connected to the people and stakeholders they are in exchange with. It isn’t a matter of giving you what you asked for. It  is a matter of helping you satisfy a goal or a need. If I work in a restaurant for example, the meal I serve may be the context for a marriage proposal, a landmark business deal, a birthday or the only respite a couple will get from their hectic schedules. That meal may be what restores patience or hope. If I work in a clinic and I have to enter data today, I may be entering the data that enables an epidemiologist to spot a viral outbreak or I may be entering the data that assures my patient of full and prompt insurance coverage. I may be avoiding a medication error and saving their lives. If it sounds dramatic, context reminds us that  it is.  Take pride in the work you do, my friends.

The Leaning of America: The Case for Small Business Process Management is Unequivocal

As a consultant to small and mid-sized business, non-profits and government agencies (with a particular focus on healthcare), I often engage executives on the merits of BPM. Said executives wonder aloud if their time is well-spent documenting, analyzing and re-engineering work and processes.  The common refrain is that they believe they have bigger fires to fight and that their people simply need to be managed to be more productive. Other excuses involve blaming external factors such as unfair competitors,  legislators, suppliers, and fickle customers.

There’s no doubt that the economy is in terrible shape. All of my clients are struggling. However, the data is incontrovertible: organizations that run lean, slick, flexible processes in every dimension of their operations are doing well compared to their less BPM-savvy peers.

In retail, Wal-Mart is peerless. Japanese and European automakers have survived whilst GM and Chrysler went bankrupt. Amazon continues to disrupt the entire universe of commerce. Kaiser has revolutionized healthcare and health insurance. Tata is helping India’s GDP grow while the institutionalized first-world back-slides. The tech sector as a whole has fared better than most other sectors. The only incongruities are the BPM-centric banks that demonstrated ethics, morals, risk-taking behavior and greed can and will outsmart BPM any day.  While there are many factors at play in the world of business and global economics, it pays to study the common traits among the winners and apply them at home.

Think Small and Lean

It’s simply undeniable that investments of time, energy and money in becoming process-centric will pay off in a number of important ways. It is also a fact that the US economy is a function of small business. Our challenge is not in doing more to demonstrate how swell BPM serves multi-national, multi-billion dollar, multi-tech corporations. There is no question that aerospace and supply-chain giants know what they’re doing.

The great challenge lies in packaging BPM approaches, tools and methodologies in right-size, right-time, right-cost portions for healthcare, social services, job training, housing and other sectors. Government and non-profit organizations are crucial participants in our economy and generally suffer from a lack of process savoir-faire.  This is especially true at the local level. Small government and small business must become process-enabled.

This call to action is all the more reason to simplify and de-code the way we talk about BPM. The more cryptic and foreign something sounds, the more geeky the approach, the less accessible and more expensive it becomes in the minds of government and small business leaders. Similarly, the more BPM is a product of software developers and the more is aimed strictly at automation, the less attractive it becomes. Electronic medical records (EMR) are a terrific example. Software developers sell software in a way devoid of attention to the most basic workflow and implementation issues; 60% of implementations fail; and today a dismal 2% of hospitals and 10% of doctors offices have a fully-functioning EMR in place. No matter how badly our country needs EMR proliferation, if our approach is tinged with greed (which it is), the initiative will stall (which it has). Compare that performance to the spread of VistA (the VA’s answer to open source, simplified solutions to the same problems). VistA is standard across the DoD, VA and many other public health domains today and spreading quickly.

Lean Initiative

True, government, social service, health, and non-profit sectors – who are often smothered under the weight of social and economic pressures in ways you and I can’t relate to – need to modernize, get lean and automate. However, so long as the architects of change speak a foreign language and offer up expensive software solutions, progress will be glacial. I propose that this country needs a Lean Agenda as much as it needs a Green Agenda. Frankly, we need lean to get to green. But it has to happen in all sectors, fields, industries and domains. And in order for that to happen BPM ambassadors need to come back to Earth and engage people in a multi-cultural fashion. We should all be painfully aware that big business relies upon small business and affordable health and social services. Unhealthy, unemployed, uninsured, homeless and penniless people make lousy customers. Get real.