1

2 PRACTICALITIES OF PANEL SITE MANAGEMENT: How to Maximize Value for MoneyProf Dr. Ali Jawa MD (USA), MPH (USA), FACE (USA), FRCP (London), MIVM (Europe) Diplomate ABIM and ABIM-Endocrinology and Diabetes Diplomate American Board of Physician Nutrition Specialists Adjunct Professor of Endocrinology, SZABMU, PIMS, Islamabad, Pakistan

3 What is the Value Equation?Bang! Function Satisfaction of needs Cost Use of Resources $$$

4 VM is a style of management dedicated toValue Management VM is a style of management dedicated to motivating people developing skills & promoting synergies and innovation ….with the aim of maximizing the overall performance of an organization

5 What is Value Management?Complete framework for business improvement Typical Benefits: costs Ratio > 10:1 => frequently > 100 :1 Key elements: Creative teamwork involving key employees & stakeholders Project Planning via the VM “Work plan” or job plan” Integrates a wide range of tools and techniques Function analysis to improve services, projects, processes & products: What it is purpose? How is it currently being delivered? How can we improve it?

6 Date Value Management Source Org.A Brief History of VM Date Value Management Source Org. 1947 Value analysis L.D. Miles GE 1954 Value engineering W.D. Leggett US Navy 1950s Customer Value Analysis T.J. Snodgrass GE 1950s Value Control (Benchmarking) R.L Bartlett GE 1963s F.A.S.T. Analysis C.W. Bytheway Univac 1960s Comparative Value Analysis Various Various 1970s Organizational Value Management Various Various 1970s Lean Operations Various Various 1997 BS EN 1325: 1997 Vm, VA, FA Vocab Various BS+ EN 2000 BS EN 12973:2000 value mgt. Various BS+ EN Value Management is used worldwide by leading Organizations to maximize Value for money.

7 What is Value Management? Organizational challenges Value managementFunctional Disciplines: Corporate strategy Competitive Strategy Marketing/ Sales Public Policy Operational Management Organizational Behavior Performance Metrics Finance ICT Program Management Others…… Improvement Frameworks: Learn Mfg. & Service Operations Balanced Scorecard Business Re-engineering Six sigma ISO 9001 Investors in people Charter Mark Business Excellence Model Prince 2/ PMBOK Portfolio Management Other…… Complete framework for organizational problem solving

8 Phases: Emphasis of Project:VM Adds Value throughout the Life cycle of a typical Organizational Project Phases: Emphasis of Project: Concept Investing The Issue Design Develop The Optimum Solution Built Minimize Built Cost Communication Getting The Asset To Run Efficiently Operate & Review Optimizing Org & Processes Decommission Maximizing Residual Value

9 Value Management is like screwdriver tool set:SWOT-TOWS PEST/LE (STEEPLE) The 5 Whys? Ratio Analysis and Benchmarking Cause & Effect Diagrams ( Ishikawa or Fishbone) Function Diagrams Interrelationship Diagrams Stakeholder Analysis using RACI Numerous Change Management Models Process Mapping /Value Stream Mapping Systems Thinking Using Excel for Ratio Analysis & Charts: Run charts / Control Charts Radar Charts Other Charts Others…

10 SWOT-TOWS Value Management is like screwdriver tool set:PEST/LE (STEEPLE) The 5 Whys? Ratio Analysis and Benchmarking Cause & Effect Diagrams ( Ishikawa or Fishbone) Function Diagrams

11 SWOT-TOWS Analysis (Strengths, weaknesses, opportunities & Threats)SWOT is often unfocused & ineffective at an organizational level but can result in some insights TOWS work much better (identify each threat/opportunity and then review the organization's strength and weaknesses against each of them) SWOT-TOWS can also be useful for: Reviewing functions identified in Function diagramming Evaluating options from the creative stage Overall, we find function diagramming more effective than SWOT-TOWS but the two can be used together

12 SWOT-TOWS Analysis WILCARESTRENGTH: Efficient WEAKNESS: Not a hospital (referrals, procedures) OPPORTUNITIES: Develop relationships with hospitals, Strengthen SOPs THREATS: Foreign policy changes (immigration)

13 PEST/LE (STEEPLE) Value Management is like screwdriver tool set:SWOT-TOWS PEST/LE (STEEPLE) The 5 Whys? Ratio Analysis and Benchmarking Cause & Effect Diagrams ( Ishikawa or Fishbone) Function Diagrams

14 PEST=>PESTLE=>STEEPLE AnalysisPolitical Issues: Economic Issues: Social Issues: Technological Issues: Legal Issues: Environmental Issues Ethical Issues: Other Issues:

15 PEST=>PESTLE=>STEEPLE Analysis WILCAREPolitical Issues: Foreign policy Country-specific immigration laws Economic Issues: Consumables (vaccines, test kits) price Taxation on Medical Exams Social Issues: Extra accompanying family members Technological Issues: Better and smarter softwares / equipments Legal Issues: Healthcare facility registrations/compliance Environmental Issues Reduce paper use Ethical Issues: Vaccination (when verbally notified but no documentation) Other Issues: Industry specific taxation

16 The 5 Whys? Value Management is like screwdriver tool set:SWOT-TOWS PEST/LE (STEEPLE) The 5 Whys? Ratio Analysis and Benchmarking Cause & Effect Diagrams ( Ishikawa or Fishbone) Function Diagrams

17 Consider asking the question why? Five times, e.g.The 5 Whys? Consider asking the question why? Five times, e.g. Q1- Why is the service performing poorly? A1. Because the staff turnover is high Q2- Why is the staff turnover is high? A2. Because morale is low Q3- Why the morale is low? A3. Because the Management is poor Q4- Why the Management is poor? A4. Because Management does not make the staff feel valued. Q5- Why Management does not make the staff feel valued? A5. because Management lack skills & need training is this area

18 Ratio Analysis and BenchmarkingValue Management is like screwdriver tool set: SWOT-TOWS PEST/LE (STEEPLE) The 5 Whys? Ratio Analysis and Benchmarking Cause & Effect Diagrams ( Ishikawa or Fishbone) Function Diagrams

19 RATIO ANALYSIS AND BENCHMARKINGRatio analysis allows an organization’s performance to be benchmarked against its peers/best in class This identifies opportunities for improvement Examples of ratios include: Output per Employee Cost per Employee Absenteeism per Employee Staff Turnover per Employee Most Performance Indicators Others

20 Cause & Effect Diagrams ( Ishikawa or Fishbone)Value Management is like screwdriver tool set: SWOT-TOWS PEST/LE (STEEPLE) The 5 Whys? Ratio Analysis and Benchmarking Cause & Effect Diagrams ( Ishikawa or Fishbone) Function Diagrams

21 Cause and Effect Diagram: (aka The Ishikawa or Fishbone Diagram)

22 Cause and Effect Diagram:Use to explore potential or real causes (or inputs) that result in a single effect (or output). Causes are arranged according to their level of importance or detail, resulting in a depiction of relationships and hierarchy of events Use the following categories of causes as a guide: Equipment, policies, procedures and people (for admin & services) Manpower, methods, material, and machinery (for manufacturing) This can help identify root causes, identify areas where there may be problems, and compare the relative importance of different causes.

23 Cause and Effect Diagram (aka The Ishikawa or Fishbone Diagram)Team agrees on the effect or problem statement before beginning. For each node, research/brainstorm its causes, Add to diagram. Be succinct. Pursue each line of causality back to its root cause – use The 5 Whys? Consider grafting relatively empty branches onto others. Consider splitting up overcrowded branches. Consider which root causes should merit further investigation.

24 Function Diagrams Value Management is like screwdriver tool set:SWOT-TOWS PEST/LE (STEEPLE) The 5 Whys? Ratio Analysis and Benchmarking Cause & Effect Diagrams ( Ishikawa or Fishbone) Function Diagrams

25 You can use this to identify each step in a business process.Types of function Task or primary functions (there can be more than one) Secondary functions: Utility functions - essential secondary functions Supportive functions - desirable secondary functions Esteem functions – prestige or decorative elements Undesirable functions – noise or pollutions You can use this to identify each step in a business process.

26 What is the Value Equation?Bang! Function Satisfaction of needs Cost Use of Resources $$$

27 What is special about VM – Function AnalysisA function can describe any activity performed in the delivery of product, service, project or business process A function can also describe any benefit delivered as part of a product, service, project or business process/ Functions are expressed as “Verb noun” pairs => ideally an active verb plus a measurable noun Functions create or destroy value What Are the functions of a…..

28 FUNCTION DIAGRAMS (aka FAST {Function Analysis Systems Technique} Diagrams)

29 Developing a Function DiagramTeam brainstorms functions (verb – noun) onto flip chart Copy the function onto the bottom of post-its Tape 2 sheets of flip chart paper side by side Assemble the logic (using the How ----> <---- why test) Remove redundant/ repeated functions Draw lines joining the functions Number the functions Cost the functions

30 What do you need to conduct a Function Diagram for your Panel Site?2 Flip Chart Sheets One black think nib marker A pack of yellow post its Scotch tape…… …..and your staff!!

31 14:05

32 14:21

33 14:36

34 14:50

35 15:07

36

37 What do you need to conduct a Function Diagram for your Panel Site?TOTAL COST $ 1.52 !!! 2 Flip Chart Sheets One black think nib marker A pack of yellow post its Scotch tape…… …..and your staff!!

38 Function Diagrams SummaryFunction diagramming is very powerful analytical tool There is an art to effective function diagramming Practice is a key to improving skills Try testing the function diagram on a 3rd party Function diagrams lie at the heart of value management

39 Competitive Strategy- Porter’s 5 Force ModelThreat of New Entrants, e.g. Entry ease/barriers Geographical factors Incumbents resistance New entry strategy Routes to market Bargaining Power of Suppliers, e.g. Brand reputation Geographical coverage Product/service level quality Relationship with customers Bidding processes/capabilities Rivalry Among Existing Competitors, e.g. Number and size of firms Industry size and trend Fixed/variable cost bases Product/service range Differentiation strategy Bargaining Power of Buyers, e.g. Buyer choice Buyers size/number Change cost/frequency Product/service importance Volumes, JIT scheduling Threat of Substitute Product or Services, e.g. New technology Alternative price/quality Market distribution changes Fashion and trends Legislative effects

40 Why Are Function Diagrams Useful?Break down management problems into ‘bit sized’ chunks Provide a view of an organization from many perspectives: Top down ‘macro view of policy/ strategy, structure, material, etc. Bottom up ‘micro’ view of discreet components Stakeholder perspectives Can be used on products, services, project & processes Provides a shared understanding of a projects’ functions by: The project team Customers and users Other stakeholders Provides an agenda to drive effective brainstorming

41 GOING LEAN…..

42 What is the Value Equation?Bang! Function Satisfaction of needs Cost Use of Resources $$$

43 The Underlying PrincipleActivity = Work +Waste Imagine looking at a business operation through “waste goggles”

44 Preferred Approach To LeanSystems thinking view of the enterprise: Voice of the customer-what creates & destroys value? Customer pull/cycle time-Takt time Identify and eliminate waste in serving the customer Value stream mapping the business process: Map current business process 7 wastes within business processes Workplace ergonomics -5S Mistake proofing-poke yoke Single minute exchange of die (SMED)-fast change-over Pulling it all together…..

45 System thinking view of the enterpriseWhat are we in business for? Who are our key stakeholders? How do we create value for each of them ? Shareholder value Efficient public services How do we create value for us? Be efficient (i.e. lean) Better than competitors Differentiate our service Without a strategic view, management could solve the wrong problem

46 What creates value for the ‘customer’?Customer value is very situational. consider: Car servicing Call center user Car manufacturer Patients Governments Other… The key to success is to capture the ‘voice of the customer’

47 Customer ‘Pull through’- Takt Time (1)Waste can be minimized by producing only when customer demand pull the product or service through. This frequently has a natural ‘drum beat’ or cycle time. Although a useful idea in principle, the supply chain needs to be sufficiently ‘pump primed’ or there is a risk of waste through stock-outs. In practice, not all lean organization practice true customer pull. Many take a hybrid approach.

48 Customer ‘Pull Through’-Takt Time (2)Many manufacturing & service operations have a natural ‘drum beat’ or cycle time to synchronize activities, e.g. Formula 1 car servicing McDonalds restaurants Operating on a patient Medical examination of applicants Many manufacturing & service operations have no ‘cycle time’ e.g. Bespoke products and services Consultancy activities Other example…

49 Customer ‘Pull Through’- Takt Time (3)Using takt time has a number of benefits: Products/services move along a line, so bottleneck are easily identified when the product does not move in time. Workstations that don’t operate reliably are identified. Takt time should leave only the time needed to perform the actual value added work. Increased productivity Identify ‘takt time ‘ if it exists and then plan all lean activities around it.

50 Seven Kinds Of Waste Lean focuses on reducing the seven kind of waste:Waste Manufacturing Services Over-Production Y Y(Capacity) Waiting time Y Y Motion Y Y Transportation Y Y Processing Y Y Inventory Y Y Scrap/Rework Y Y Any Wastes missing from the above list?

51 Value stream mapping- Used to identify the ‘7 wastes’Over-production Waiting time (queuing, bottlenecks & constraints) Motion (5-S, SMED) Transportation Processing (5-S, IT& manufacturing technology) Inventory (stock, intermediate stores) Scrap/rework (poke yoke, statistical process control)

52 Workplace Ergonomics-5-SActivity Action Detail Sort (seir) Classify items needed for work & clear out anything that not essential Bin what is not needed store what is not regularly needed ‘Red tag’ uncertain items (e.g. vaccines) Straighten (seiton) Organize the working environment Order what is needed according to frequency and sequence of use create a standard layout (e.g. stations) Shine (seiso) Clean the workplace and check equipment Ensure equipment is fit for purpose do preventative maintenance (e.g. IT check) Standardize (seiketsu) Ensure conformity as far as possible Establish the best way to do things make this the standard (e.g. SOPs) Sustain (shitsuke) Revisit the workplace and reapply the above Make it a habit to review regularly (e.g. Quality Audit)

53 Mistake proofing – “poke yoke”Fool-proofing operations by designing processes to avoid human & machine error , e.g. Guards on presses/machine tools Forced field completion on web sites , e.g. Credit card transaction Petrol vs. diesel fillers on vehicle fuel tanks Similar name alerts during medical exam Pregnancy Alert tag

54 Single Minute Exchange Of Die (SMED)What is SMED? Minimizing change-over time Relevant to mfg and services Can make a major difference to value Why use SMED? Minimize turnaround time, e.g. F1, AUS to US Improve agility/ Competitiveness, e.g. Toyota Improve profitability How to apply SMED: Video current process & analysis VM, i.e. benchmarking + creative workshop

55 Key Question During BrainstormingIdentify and eliminate the 7 wastes Sort out the workplace -5S Eliminate as much inventory as economically feasible Constraint theory-any queuing/waiting? Single minute exchange of die (SMED) Fool proofing/mistake proofing (poke yoke) Increase utilization of production capacity, via: Multi-shift working Incentive Specialization Multi-skilling Automation/It/other, e.g. DIP/ Workflow, ERP system, etc.. Eliminate unnecessary or combine functions What does best practice benchmarking tell us? Any supply chain risks, e.g. critical components? Other?

56 High Performance TeamsTeam performance-crucial for getting the best result: Truly innovative world-class solutions to problems Achieving benefits: cost ratios > 10:1 Managing risk / avoiding mistakes Key factors in team management are: Leading team Designing teams Facilitating team One also needs to be practical about it….

57 Key Qualities Needed By A Team LeaderA Passion for the project & willingness to take it on! Effective interpersonal skills: One-to-group (team, customers and stakeholders) One-to one (team, customers and stakeholders) Practical knowledge and understanding of: The problem and its associated issues Value management and other tools & techniques Project management skills Team management and facilitation skills An understanding of the organization's culture: How to make things happen? How to sell proposals? A good dose of common sense + fun! Other?

58 Team Leadership SkillsTeam design: Project strategy (e.g. right terms of reference) Getting the right people on board (i.e. senior mgt) Team selection (composition and size) Internal members external members (facilitators and/ stakeholders) Team functioning Project planning (includes allocating roles & use of resources) Facilitating team processes Motivating team members (can make significant demands on them) Tackling team problems: Dealing with trouble between team members Dealing with a team member(s) who are not performing

59 Team Design Getting The Right People On BoardPeople selected on the basis of hard criteria: Knowledge of the problem & its organizational environment Functional expertise (e.g. customers, users, supplies, etc.) Key stakeholder (e.g. customers, user, supplies, etc.) People selected on the basis of soft criteria: Role types (e.g. creativity, organizational abilities, etc.) Personality types (e.g. ability to function within a team) Motivations (e.g. they are keen to participate) The soft criteria are always important but especially so far large projects.

60 Team leadership Key factorsEstablish a sense of urgency and direction Select team members based on hard and soft criteria First meeting and actions are important Set clear rules of behavior Set immediate performance orientated tasks Challenge the team with fresh facts Use positive feedback, recognition and reward

61 Human Factors That Spoil TeamworkCapacity-lack of: Lack key skills? Lack key knowledge? Attitude- impact of: Axe to grind (personal agenda)? Lazy (may sometimes be polished performers”) (Teflon-nothing sticks to them!) Malevolent? Troubled (temporary or permanent?) Unavailable? Bereaved, over pressurized, unwell, etc.? Difficult/ challenging personalities (e.g. inflexible)? Psychiatric illness? Sometimes you get all of the above!

62 TAKE HOME MESSAGE Value Management primarily deals with performing the desired function with least amount of cost/resources VM principles can easily be applied in our typical panel site settings The key VM methodology is to do a functional analysis of your business Understanding your “customer’s perspective” is key to operational excellence

63 THANK YOU