Regulation isn't the best fix for broken quality

We can’t just blame the politicians and the top executives. 

If we induced the companies that provide our everyday products and services to be ISO 9001 certified (just as they impose these standards on their suppliers), then we might deserve more of the following:

  • Ensuring that the objectives of the organization are linked to customer needs
  • Creating and sustaining shared values, fairness and ethical role models at all levels
  • Establishing trust and eliminating fear
  • Establishing clear responsibility and accountability for managing key activities
  • People freely sharing knowledge and experience
  • People openly discussing problems and issues
  • Evaluating risks, consequences and impacts of activities on all interested parties
  • Understanding the interdependencies between the processes of the system
  • Providing people with training in the methods and tools of continual improvement
  • Ensuring that data and information are sufficiently accurate and reliable
  • Making data accessible to those who need it
  • Analysing data and information using valid methods
  • Establishing relationships that balance short-term gains with long-term considerations
Regulation and policing enters the breach where quality management has broken down.

It’s never too late to say that managing the quality in the first place is much the best remedy, as well as being more cost effective.


Critical purpose

Critical Purpose is a new term to define an approach that emphasises the key deliverables.  On every project there are a small number of critical questions that must be answered if success is to be achieved.  The goal is to isolate these critical success factors and to remove the uncertainties as soon as possible by producing some tangible output that can be dependably validated and indisputably verified. 

Critical Path technique identifies the longest path through a project which defines the shortest possible time to complete the project, according to the estimates of how long each activity will take and the interdependencies between activities.

Critical Chain methodology concentrates on rare resource, thus giving it more of a cost focus.  By planning around the key constraint and reallocating resources, pressure is reduced on bottlenecks.


Critical Purpose will make people think of agile development methods. However, the word agile can conjure up an image of agitation.  The risk is that it over-emphasises reactivity; people may think that if they conceal their intentions, they will be able to make things up as they go along.


Rapid prototyping, risk-based, test-driven, user-centred and team-based are all terms that are used for agile development and each of them emphasises one aspect, whilst in practice the use of one technique makes the others vital. 


If you develop the test plans at the beginning of the project, then you are going to need models and prototypes to test many of the assumptions.  If you build a plan around prototype reviews, then you will need workshops to facilitate the decision making process.  If you focus on risks, then you are going to need the presence of the team and subject matter experts.  If you prioritize the requirments then you need to involve users.  In fact, of course, you need all of these.  It is reassuring to think that if you do one of them, it pulls the others.


‘Critical purpose’ is a term that covers all of these approaches, at least as well as agile because it does not lead people to think that they can decide everything at the last minute, or on their own on their way to work, or without informing anyone of their reasoning. 


The difference between 'Agile' and 'Lean' ?

Here is a point of view:  It's easier to find things in common between 'Lean' and 'Agile' than differences: both work on the basis of small batch sizes that enable you to get early and frequent feedback;  inspect and adapt. Both imply greater 'fitness' (for purpose). 


Broadly, 'agile' management helps you to plan and deliver what is necessary and 'lean' management helps you to identify and remove what is unnecessary; so they are quite complementary. 


'Agile' includs a lot of 'faiths' and 'values' and I don't even think it's entirely encapsulated by the Agile Manifesto.


Probably, all learning-based innovation should be agile and all agile projects includ some learning. 


Meanwhile, you get 'leaner' by removing something unnecessary, like carrying an umbrella when it's not raining, checking your e-mails every 5 minutes, or possibly un-optimised, like travelling to work at the same time as everybody else; although there may always be other risks. 


The main risk in 'agile' is that you might not be good at teamwork and team coordination, but that's also the reason for doing it ! 


So with 'agile' you may have to do quite a lot of experimentation, and 'lean' will help you to make sure that the experiments are worthwhile; quite a synergy then !


Therefore, "Learn to be Lean and Lean towards Agile."


Examples of different kinds of "pivot" for lean start-up

In 'Lean Start-Up' terminology, a “Pivot” is a deliberate adjustment to the basic assumptions about a new product, system, service or process.  Implementing the notion of pivots, a company seeks feedback from existing or potential customers and users, early and often, and uses the feedback to change direction, either marginally or fundamentally.  


The pivot allows the business, whether it is a start-up or well-established to try things out, to make minimal investments for maximum information.  For example, do people want to look at the product on the web and buy in the shop, or look at the product in the shop and buy on the web?  These assumptions and what affects them are pretty important.  To what extent are people looking for a product, off the shelf and plug and play, or for a service, with advice, support and training? 


Who knows?  It may only be a small detail in one way or the other that could have significant impact on customer behaviour.   Or it could be something more radical, that would enable you to make a breakthrough in technology, marketing and to amend the whole business model.  For example, what will users want to do on a phone, a tablet, a PC or in the cloud?  The point of a ‘pivot’ is that not only trial and error, but managed learning and revisions, called ‘pivots’ will provide the answers.


Here are some explanations and examples of different types of pivots, inspired by the Eric Ries book “The Lean Start-Up” and also by Osterwalder and Prigneur in their "Business Model Generation" canvas.


(By the way, lean does not mean starved or starving.  It means 'fit for purpose', avoiding the useless in favour of useful work, and working on what customers are prepared to pay you for doing, either sooner than later, rather than making up unnecessary things just to look busy.  If we were all lean at home, for example, we’d have more time to do the things that we really enjoy and less time on chores and fixing mistakes.)


Why is Project Leadership so important ?

(Here you can find an instrument that enables you to assess your leadership preferences).


Importance of project management

Classically, there are two ways to compete in business:

1) By achieving and maintaining low cost and high volume

2) By targeting high value-added and building customer loyalty


The first requirs mastery of production capabilities, whether for a product or a service.  The second involves the ability to constantly innovate in order to meet the needs of current or future customers.  


However, even production capabilities entail improvement of the process, the methods and the tools, if low cost is not to be based entirely upon low labour costs.


Most companies cannot guarantee the lowest labour costs, and therefore need to compete upon some other basis that demands innovation and not mass production only. 


The innovation of products and processes, services and systems, and their development, implementation and development necessitates project leadership skills at all levels, because the effort will be cross-functional and will requir decision making that is strategic, technical, operational and commercial.


Although organisations can squeeze their assets in a production environment over a long period of time, ultimately our economy and our future requir informed and well-instructed teams to innovate frequently and successfully.


Importance of leadership in project management


Companies cannot afford to waste their highly-educated, talented and high potential people resources. Automation, standardisation, routine procedures and high degrees of control are not the right way to release or reward creative brainpower. 


Leaders in the organisation must build a climate that encourages inspiration and aspirations, fuels energy and mitigates stress.  Creative team members flourish when they have a clear view of the end goal, a sense of purpose and cohesion, an organisation that fits the task, access to information and expertise, working tools, mutual support and recognition for their endeavours. 


Leaders need to understand the factors that drive individual and collective motivation.  They need to develop values that sustain trust; responsibility, respect, fairness and integrity. They must remain attentive to particular needs as well as managing the dynamics of the team. 


Leaders demonstrate courage, tenacity and conviction in order to serve the team and to help them to achieve their ambitions; and they demonstrate the values and behaviours that people want to follow and that preserve their credibility.


Without project leadership competencies at executive level, project management levels and amongst the team members themselves, it is highly unlikely that the innovative products and services that our companies and economy requirs will emerge.


There are more opportunities to obtain return on investment by improving project leadership skills than in almost any other part of an enterprise.


Nature and character of leadership in project management


Project leaders ensure that voices are heard throughout the project and especially in the early stages; voice of the customer, of marketing, merchandising, promotion, production, sourcing, human resources, logistics, finance, safety, regulations, etc.


Project leaders are resolute, honest and forthright when communicating information, from the team to decision makers and from decision makers to the team.


Project leaders seek opportunities to make work simpler, more useful, more usable, more effective and also more interesting, knowing that interested people are more productive in creative work. 


Project leaders organize the working environment in a way that respects differences in motivations and priorities that allow people to contribute in different ways.


Project leaders develop a distinctive style that nevertheless takes account of the realities of individual performance, strengths and weaknesses when working in a team.


How to develop a sense of leadership at all levels ?


A project leader may be inclined to a style that is more or less relational, process-driven, ideas-centred or action-oriented.


Relational-centred leadership skills are those that are sensitive and supportive of people


Process-focused leadership skills entail the structuring of change and communication management


Ideas-driven leadership interprets situations and integrates perspectives


Action-oriented leadership shows the way and pursues results with determination


No person can be equally strong in all areas; but the art of leadership is about developing the right balance; the woman or man of the moment.


Scope-Time-Cost or Quality-Time-Cost ?

The triple constraint is a cornerstone of project management.  However, even if you look hard for it in the PMBoK (Project Management Body of Knowledge) you will not be able to find it.   And if you use a search engine, you will find different versions, the favourites being scope – time – cost or quality – time – cost.  


Other versions contain resources, risk, performance, and more, making it a hexagon, or perhaps a tetrahedron. Ultimately, the exact form of the so-called ‘triple constraint’ is less important than the fact that there are trade-offs.


This is not a theoretical reflection, but a consideration about what could happen in practice.  In fact, it all depends upon the definition of quality.  Either the most suitable scope-time-cost combination determines quality, or the quality-time-cost equilibrium defines scope.


If quality is defined in terms of customer satisfaction and meeting or exceeding customer expectations (as per ISO) then quality embraces time and cost, as well as scope.  If quality is about compliance with a specification of requirments within budget and on time, then scope covers quality, time and cost.


To satisfy a customer is not to produce a perfect product, but late and over-priced, or to produce the wrong product before the deadline, but cheaply, or the right product on time but at a price no-one can afford.  To satisfy a specification of requirments that has been misconceived, or misunderstood, by some of the partners, is not a successful outcome even when it is contractually irreproachable.


An impact on scope, for example, either more or fewer requirments will almost certainly have some kind of impact on the time taken, which will knock on to cost. The inverse is not necessarily true.   Prices or exchange rates, for example, can change without any commensurate impact to the schedule, whilst the schedule can slip without modifying scope.


The main reason that leads me to prefer the scope-time-cost triangle is because higher quality does not always imply higher cost.  Sometimes, fewer features give a better fit with the customer need, whilst also costing less.  Indeed, cheap and quick may be the customer preference, as in many low cost products, rather than waiting for features that provide little added value to the core product.


There are products where cost is embedded as the essence of ‘quality’.  It would be entirely inappropriate to suggest an expensive ‘low-cost’ air fare, ‘economy’ car or ‘budget hotel’.


Similarly, there are products for which even the slightest degree of lateness would invalidate any notion of quality: a late ticket for the cup final, today's newspaper delivered 3 days late, a perfect weather forceast (to tell you that it rained yesterday), a gift late for an anniversary. 


Here is another version of the triple constraint: Triple constraint

A more extensive reflection on the "critical triple constraint" and the ways in which projects can be managed according to the priorities established between scope, time and cost also introduces the idea of "critical purpose".


Can inspiration be ‘managed’ ?

As a LinkedIn survey of July 2013 summarizes: “We get major inspiration hits when we are expressing ourselves, becoming more self-aware and pushing ourselves to achieve new levels of capability. Both requir a ton of self-expression, self-awareness and growth to succeed.”


The LinkedIn survey reveals that we actually become more inspired with age.  This is an inspiring thought in itself, because in a sense it means that we all grow as we age. Amongst the most inspiring professions are those that deal with the arts, education and helping others to realize their potential.


And “If you want to be inspired consistently in your career, you need to find ways to constantly grow and help others do the same. It is that simple and that hard.”


In day to day work, the understanding is that performance = competency * effort.  However, this is not the same with activities that involve invention and innovation.  Increasing the rate of effort does not necessarily produce more ideas.  In fact, it may have the opposite effect by raising the levels of stress and anxiety.  Scientific studies have demonstrated how rewards can actually harm the inspiration that drives creative performance.      * (See below)


Creative ideas that have the potential to develop into discoveries, inventions and innovations are correlated with other factors, and one of the most important is definitely inspiration.   But what is inspiration exactly?  First, what is ‘inspiration’ in terms of a dictionary definition?


Putting aside the ‘divine’, and staying in the human domain, definitions includ:

  • the action or power of moving the intellect or emotions (to a high level of feeling or activity)
  • the agent or source of influence or stimulation, such as a flash of inspiration that prompts action

It is recognised that inspiration typically comes from a state of being or experience, that we may be able to anticipate and recognise, such as deep relaxation and meditation, nature or art, human behaviour and uplifting stories, and again the sudden flash of an insight that can arise from a new perspective, piece of information, knowledge or understanding.


Openness to experience precedes inspiration.  People when inspired experience more clarity and awareness. And at the same time we may feel more relaxed and confident, as if anything might be possible and the obstacles seem less imposing or constraining.


The feeling of achievement can fuel inspiration as well as being the result of inspiration.  Even small accomplishments can trigger inspiration and thus make inspiration a virtuous circle.


From a semantic point of view, there are conditions that are conducive to inspiration, that create a feeling of transcendence, tranquillity, transparency, transmutation and transversal thinking.  The “trans” gives the idea of crossing, connecting, blending, and becoming something else through contact with something harmonizing, elevating, and educational or enriching.


From a philosophical viewpoint there is also the sense of synergy and synchronisation, the feeling of oneness and wholeness when things feel complete, fitting, adapted, suitable and appropriate; somehow circular and cyclic, or otherwise expansive and infinite; the sense that the whole is greater than the sum of the parts and beyond the scope of understanding, the feeling that the potential to develop wisdom is perhaps endless.


Furthermore, inspiration can repose upon internal sensations of equilibrium, equanimity, but also can engender excitement, agitation, nervous tension, exuberance and even euphoria.  And these feelings can move one way or the other to release inspiration; thus, we are confounded by a contradiction between reassuring continuity, but also the stimulation that comes from change. 


Ultimately, therefore is a hormonal reason underlying inspiration.  Thus, apparently, inspiration could have a purely physical as well as a purely psychological substance.  Psychologically, under hypnosis and with suggestion we can attain a sensation of inspiration.  Physically, the hormone dopamine drives the feeling of satisfaction and accomplishment we obtain from achieving an objective.  The hormone serotonin contributes to feelings of well-being, inner-contentment and well-being, whilst oxytocin is associated with sentiments of trust and attachment. 


Consequentially, and realistically, ‘managing’ inspiration must have implications for the quality of work and for work quality, because it is a basic and intrinsic part of the human experience.  We feel better, we work better and we produce better results in creative tasks when we are inspired.


What message can we take away as managers, organizers and leaders?

  1. Inspiration can create emotions of exuberance and euphoria, whilst organizations are wary of emotion, preferring logical analysis, cool-headed decisions and rationality in action.  Use words such as passion that has positive connotations and make sure that it has meaning, by accepting that passion is made up both of moments of inspiration, and of desperation.  
  2. Be understanding and supportive about the rhythms, the changes in energy levels; be prepared to mitigate the troughs and to smooth the progress and turbulence over the high peaks.
  3. Recognize that different people have different sources and patterns of motivation; in general action-oriented, relation-supporting, ideas-centred or process-driven, but more specifically according to moods, values, lifestyle situation, habits and experience.
  4. In further detail, in which situations are people most like to be inspired; start of the day or end of the day, inside or outside, in the city or in the country, amongst people or solo, and for what kind of task or circumstance?
  5. Be conscious that inspiration is aspiration, not perspiration; in other words inspiration is “pulled” by dreams and ambitions, by vision and by passion, and not “pushed” by punishment or “forced” by monetary rewards without the feeling of self-realization and attainment.
  6. Create an environment that is attractive, aesthetic, stimulating or relaxing depending upon the kind of inspiration which you would like to create.  Ensure that meetings and shared work areas enable, rather than discourage inspiration.
  7. The best way to find out what inspires people could be to ask them.  Then you can help them to realize their aspirations, by appealing to their intrinsic passion and motivations.

As a rule, inspired people have more desire to master work and are less competitive.  Inspired people aspire towards higher performance, beyond ordinary achievement, as well as achievements that are more creative an uplifting than routine and mundane.   And if people are able to be inspired and to manage their inspiration, with or without outside help, then it promotes their well-being.


*  Quite evidently ‘inspiration’ is not the same as what we understand by ‘motivation’; although the theory of motivation inclines us to believe that many people misunderstand the application of motivation.   Suffice to say, that studies, such as the marshmallow challenge demonstrate the extent to which there are internal ‘motivators’, including inspirations and aspirations, and there are external  ‘de-motivators’, which are basically due to the absence of a necessity, such as sustenance and reward or recognition. 

The field of motivation is one area where the theory ought to be more respected, because it is much more practical and useful in practice than the various misconceptions and ideologies that people develop about motivation.  i.e. If you pour cash down throats, it doesn’t stoke innovation, it chokes it.  (It can even encourage the wrong kind of innovation, the one that invents the numbers.)

Try our motivation exercise to explore the phenomenon of motivation in project teams. 


Sure and Safe? AgilePM and SAFe

AgilePM is a project management framework for agile projects launched to enable project managers to adopt a mature, scalable, corporate-strength agile approach within their organisations.  SAFe (Scaled Agile Framework) is presented as an “interactive knowledge base for implementing agile practices at enterprise level”. 


For me, the critical next question for agile projects is about getting top management involvement for projects of high strategic importance; i.e. projects that have significant impact on the future of the organisation. In my experience, strategic decisions in agile projects are being made day-to-day with regard to technologies and customers, whilst unfortunately top managers stand outside the process.

Teams are “empowered”, allegedly (because often without budgetary power), but this does not mean that top managers should be absent. In my opinion, in a highly strategic project they should be available when the situation demands, which may even be in the middle of a ‘timebox’ (i.e. in principle, a ‘sprint‘ does not allow this.)

The philosophy expressed in the '41 things you need to know" is ‘centralized strategy’ with ‘local execution’. But, how does top management participate in ‘local execution’? Think of the way that a Jobs, Gates, Dyson, Bezos or Chanel participates in strategic projects. Give them room and space, but serve, hearten or embolden the team when needed. (Don’t stifle them, but give them oxygen.)

Scrum outlines a ‘Product Owner’ role and I expect SAFe to outline the ‘Product Manager’ role. However, these are often delegated way below the top management level of decision. Given the importance of decisions that will be made during the often turbulent life cycle of an agile project, governance for a ‘strategic’ project must be in the executive suite. How many ‘Product Managers' sit on the board of directors?

I can see the ingredients for top management presence through the ‘Visionary role’ and the guidelines for using the business case in APMG's AgilePM/DSDM,and in the detail of Robert Cooper’s ‘Stage Gates’ (gates with teeth), in design and product development such as Ulrich and Eppinger’s strategic engineering approach via the ‘contract book’, and in ‘design thinking’ in general, and in the IIBA's BABOK. I cannot see it explicitly in Lean for production, but in Eric Ries's Lean Start-Up, via the 'pivots' and 'actionable metrics'. I can also see it as part of stakeholder management in PMI's PMBOK and in APMG's PRINCE2’s exception reporting structure, and in the ‘Sponsor’ role acting as ‘executive champion’, present in all of the afore-mentioned approaches.

For me AgilePM is one way to wrap all of this stuff together and to integrate top management in critical decision making on agile projects of high strategic significance.  


If you look at the annual “Agile Tends & Benchmark Report” produced by SwissQ, a consultancy specialising in information technologies and testing practices, on page 4, you can find a maturity curve which shows Scrum approaching post-maturity and DSDM in the introduction phase of the life cycle.


Page 5 reveals that in the survey: “54% of all agile projects fail because of difficulties reconciling the business philosophy with agile values”.  “Scrum projects remain islands that are largely self-organized” and only “17.9% use ‘definition of ready’ opposed to 62.1% using ‘definition of done’”.


42.2% of statistics are invented of course.  Nevertheless, for me the significance is in the roles. Test consultants recommend an ‘embedded tester’, which is entrenched in DSDM.   Scrum insists repeatedly upon the independence of the team from management interference and the role of the Product Owner being to “serve the customer”.    (Yep: important to know what the words ‘serve’ and ‘customer’ should mean  ;-)


SAFe describes the role of Product Manager in a way which implies top-down management.   The Product Manager “communicates the vision” to the team and “maintains the product roadmap”.  In essence this role is “typically an active member of the extended Portfolio Management Team, where they participate in decision-making about the key economic drivers for future releases”.


In DSDM, the Business Visionary “defines the business vision”, promotes translation of the vision into working practice, monitors progress in line with the business vision, communicates and promotes the vision to all interested parties, etc.  This is potentially a much more pro-active and high-level role. 


For me, these are key points:  A ‘strategic’ project can give reason to ‘pivot’ the business vision.  A strategic agile project may requir frequent re-focusing of the vision during the project.  Vision clarification entails active dialogue, trust and understanding between the development team (technology) and the business (market).  “Defines the business vision” should allow participation and encourage ownership. 


All partners in this crafting and shaping of the business vision must learn to understand the language, not only of the technology (agile and whatever), but of the business. 


The Scrum team spirit

Do you like stories? In the story about the traveller, the stone-cutter, the stonemason and the cathedral builder, I feel the Scrum teams are like the stonemason, fearful to be turned back into stone-cutters, at a glance from the sponsor or the project manager, where we would have them become cathedral-builders.


A Scrum team may say: “Just tell us what you want, share your priorities and we’ll build it for you; don’t tell us how we should work.” It’s not asking very much and it’s a condemnation of much modern management that expectations are so low.

However, we could offer much more. “This is why we need the work, for which we are accountable; if you can help us with our priorities, you decide how the work will be done.” Providing that the Scrum team show interest in why the work must, should and could be done, it’s up to them how they want to ‘scrum’.


Management stories can be fascinating: At the time of the great cathedrals and other constructions, skilled gang leaders throughout the land; the master masons, architects, carpenters (still ‘maître d’oeuvre’ in French) and the ‘master builders’ like on the great ships (still ‘maîtrise d’ouvrage’ ). The members of the team were later called 'compagnons' in the 'compagnonnage' movement.

These artisans and freemen, staunchly resisting the influence of the church and the aristocracy, created a sense of mystery and ritual. Gradually they edged towards cult-like behaviors, that some trace back to the crusades.

At the end of the 19th and early 20th centuries modern scientific management practices, traceable arguably to Henri Fayol, created the idea of the professional manager. Interestingly, Gantt is often described as a ‘disciple’ of FW Taylor. Given that agile methods can get cast by some as a cult and when innovation teams invest in ‘mindfulness’, we need to keep our feet on the ground and our heads in the real world.  


Bridges or Cathedrals?

There is a familiar discussion in project management forums about the problems of IT projects, and why information technology projects cannot be more like construction projects.


First of all, I'm not convinced that the Standish Report and other statistics account adequately for projects that are stopped early.  If you start a project and stop it the next day, is that a failure or a success?  If you stop it after 20% of the work and save 80%, is the project a success or a failure?  Was US Airways flight 1549 landed by Sullenberger on the Hudson a failure or a success?  When your flight gets cancelled due to weather conditions, do you count it as a failure? 


People often tell me that IT projects should be built like bridges.  Check how many bridges have the same 'too-thin gusset plates' as in the collapsed I-35W Mississippi River bridge.  Did the contractor enjoy the rewards?  Henceforth, if future bridges are built more like agile IT projects, there will be more early testing and early prototyping (for example to test the design of the gusset plates) - design of experiments, conjoint analysis, stress loads, ease of assembly, ease of maintenance, risk factors - using physical modelling and computer-aided design - more cooperative and informed decision-making, less nonsense.  There will be fewer costly, disastrous and fatal bridge designs.  And future failed projects will be corrected, or stopped.  Will that be failure or success?  Then maybe we will be building cathedrals, not bridges.  


If you know the Sir John Egan report, "Rethinking Construction", please convince me that it isn't aligned with agile thinking.  


How to Design Patient Information Leaflets for Real Life Patients

How could we reduce the attrition rate in clinical trials?


“We have thousands of clinical experts and they’ve been working for years on this problem.” 


Well perhaps this is symptomatic of the fact that we are looking in the wrong place.


Sometimes the answers are staring us right in the face; sometimes the solution is even too obvious to receive much attention. 


There are well-worn and tried and tested ways of doing things, and it’s difficult to question these or even to simply conceive of things differently.


The way that the patient is treated is so important for the way the patient feels, improves, and recovers.


But a patient who fails to fully comprehend what is written in the instruction leaflet, or loses interest, or forgets, or misunderstands is a patient who may be lost to the trial, and also be lost to good health.


Whilst the science of medicine works through consent and ethics, it also includs communication and empathy. In fact, for practitioners of alternative medicines this can often be their only channel, and yet it can have such a potent effect.  

Legitimate channels of communication includ the doctor – patient relationship, which can take many forms between considerate and direct, structured and animated.  Ethical channels includ press articles and frameworks for advertising and sales.


The leaflet and the labelling are two of the primary channels of communication.  The guidelines that exist for packaging are a good example of how to communicate information effectively.  Yet many of these guidelines are rarely applied in the spirit of good communication, even if the letter of the regulations is applied.


Regulations underline the importance of making information difficult to misinterpret, difficult to ignore, whilst easy to read, easy to understand, and as intuitive and natural for human comprehension as possible.  This is about design: design of the packaging, the labelling and the leaflet that serve to provide the best results.


Amongst the recommendations in the European Commission “Guideline on the Readability of the Labelling and Package Leaflet of Medicinal Products for Human Use” are found information on the type size and font, design and layout if the information, headings, prints colour, syntax, style, use of symbols and pictograms and special considerations for sight impairment.  Some of the highlights:


-          “Symbols and pictograms are useful providing the meaning is clear and the size of the graphic makes it clearly legible. They should only be used to aid navigation, clarify or highlight certain aspects of the text and should not replace the actual text.”

-          “Characters may be printed in one or several colours allowing them to be clearly distinguished from the background.  A different type size or colour is one way of making headings or other important information clearly recognizable.”

-          “The package leaflet is intended for the patient/user.  If the package leaflet is well designed and clearly worded, this maximises the number of people who can use the information, including older children and adolescents, those with poor literary skills and those with some degree of sight loss.  Companies are encouraged to seek advice from specialists in information design when devising their house style for the packaging leaflet to ensure that the design facilitates navigation and access to information.”


These guidelines become even more important in an era of electronic communication to a wider and larger sample of the patient population.


It is obvious from reading the text that it is not just a question of the letter of the guidelines, the clauses of the regulations or the chapters of the law.  It’s more about the spirit of the regulations than the letters on the page. 


Quite simply it is just good design practice to make text, and especially critical medical advice, easy to understand.  It is not enough for the leaflet to be understood only by medics with a PHD; it has to be understood by the patient and those who should not be patients.  


And this principle can be carried forward into so many other areas of the patient experience that is also governed by regulation.  A little more empathic design and a little less bureaucracy good go a long way towards better health care and better return in efforts. 


Measuring Work Accomplishment

We measure the progress towards a specific delivery defined in a work package and identified by a milestone. The delivery is the goal and the progress measured is the progress towards that goal.


Inevitably there are controls, checks, inspections, tests, validation and verification which guarantee that the right work has been done, to specification, without unacceptable problems, in the right place and in the right quantity: useful, usable and used.


Milestones often release some value that can be recognized and paid for by a customer. The work effort is not always directly related to the value.  First of all there is the risk to take into account.  Design, preparation and foundations are work packages that may not take a long time, but they can reduce the risks significantly.


Secondly and quite simply, the customer’s perception of value does not always align with the work effort or cost.  Information is one example.  It may be cheap to give and valuable to receive a piece of information, or vice versa. It’s worth checking frequently what gives the value to the customer – i.e. via prioritizing – in order to adjust the effort proportionately, if realistic and appropriate.


With some work packages a control, a check or a test does not mean very much.  Either the work has been 100% completed or not, but there are no intermediate milestones.  The work must be accepted at the end, when you can say that it is 100% complete:  0/100


This seems unfair on the party executing the work.  After all they have accomplished work that has only gets recognized and paid for right at the end.  They may demand 20% down payment at the beginning and the balance at the end: 20/80.   Similarly on internal work packages, you may choose to account for 20% of work accomplishment at the start.


If you decide instead to count 50% of the work accomplishment at the beginning and 50% at the end of a work package, it looks and sounds over generous, but it feels right when you are working well. There is an incentive to start the work, and you are over-estimating the earned value of the work for the first part of the job (and remembering to value its importance). In the second half of the task you are underestimating the work that’s been done from halfway until completion, when you earn the remaining 50%:  50/50.


The notion of level of effort is for those work packages where it would be more difficult to assess value, because the value depends upon something else (i.e. Quality management and testing).  Also, when your progress is evaluated according to the hours worked, this is a kind of level of effort. You make the assumption that value depends upon the quantity, volume, weight, interfaces connected, functions tested, documents processed; meters of pipe implemented, instruments calibrated or some other measure that you are managing.


Always focus on the goals, and determine how success will be measured. If my document is a business proposal to a customer, then perhaps the management summary and cost breakdown are worth 80% of the whole value.  Therefore that’s maybe where I invest my effort.  If producing a slide presentation of a business investment, then better spend time on the benefits and the graphics; if it’s a design document, then the clarity of the drawings and the supporting statistics; if a requirments specification, then the exhaustivity and the ability to obtain agreement; if a publicity poster, then the slogan; if a document to be translated, then the quality of the sample and the final edit, and so on.


Three stories about value:


* A motorist takes the car, with a knocking sound, to be repaired at a garage. The garage mechanic listens a moment, and then smacks the engine with a hammer and the knocking stops.   “That will be 100 Euros.”  “100 Euros for hitting my car with a hammer?”  “Actually, it’s 1 Euro for hitting the engine and 99 for knowing where to hit”.  This is actually more effective than saying, “It’s worth much more than 100 to you sir”.  The motorist is paying for competency and reliability.


* It was said that Picasso always knew his worth and how to get the recognition his art deserved.  Certainly, his conviction was a factor in influencing the market.  The story goes that once in a restaurant, when asked to pay the bill, he offered instead to draw a sketch on a napkin.  (Real artists don’t carry money.)   The restaurant owner is delighted and asks him to sign the sketch.  Picasso’s answer: “I’m buying a meal, not the restaurant.” (Or why not a chain of restaurants?)  J.M.W. Turner would add a blob of red paint to a small boat in the middle of a painting and blast the competition out of the sea.  But many other artists fail to sell work that only becomes commercially successful when they have passed away.


* Michael Faraday was a philosopher, chemist and physicist who pioneered many discoveries and inventions, including an electromagnetic motor.  When asked by the Prime Minister, William Gladstone, of “Of what possible use can this be”, Faraday’s reply is a model of exemplary stakeholder management. “One day, Sir, you will be able to tax it.”  Incidentally, it is said that Albert Einstein used to keep photos of three scientists in his office: Isaac Newton, James Clerk Maxwell and Michael Faraday. 


Therefore, when asked about a change to engineering product, a business-minded person might say, “If we could make this change would you pay for it?”  “A shop assistant might say, “Would you tell your friends about it?”  In the simplest of words, “What’s the value?”  


Metanaction.com : Ian Stokes, Project Leader and Advisor

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