REVIEW and thoughts on: Chronic Condition, Jeffrey Simpson
Working from the hypothesis that “to appreciate where we are, it is worth revisiting how we got here,” this book includes a thorough review of the history of the Canadian Medicare system. This was very instructive to me, although some will be more familiar with these developments. Some of the important elements that stood out for me were:
1 – “Fee-for-service” for providers (specifically doctors) is well baked into the system
2 – Hospitals are a distinct and well-developed part of both the infrastructure and of the system
3 – Even though the Canada Health Act allows non-government service providers, the word “private” complicates any discussion because it conjures up “US-style,” “two tier,” and other terms that garner very emotional responses.
Simpson provides a thoughtful comparison of our system with those of England, Sweden and Australia. This illustrates how no one has a perfect system, but there are systems that perform much better than ours does. He suggests that low public awareness as to the mediocrity of results from the Canadian system (by OECD standards) is a big part of the problem. Maybe people are fine as long as we are not as bad as the US. Politicians certainly benefit from the misperception both in reducing panic of a looming crisis and in hiding any province-to-province comparison that could identify comparative laggards.
According to Simpson, continuing to throw money at the current system is a complete waste of resources and is an admission that funders do not understand the dire situation that we have created. The big thing at stake is what he calls “vertical equity” meaning that the status quo puts an unfair burden on future generations. (He uses “horizontal equity” to describe how the system treats people in terms of access and care at any given time.)
The big recommendations are threefold:
(1) Doctor and nurse unions have to stop being rigid in protecting compensation. Fee-for-service usually means that “how much” you get paid is a function of “how much” you work. Again, there is no clear answer but Simpson relays the challenge of how, for example, reducing wait times leads to rising costs because more patients are being served.
(2) Hospitals need to be allowed to do what they do well, and cease to provide ALC-type services that are both of insufficient quality and of exorbitant cost.
(3) Drug expenses have to come down. He suggests a national drug plan based on CPP.
Each of these avenues takes on a very specific and very powerful interest group: unions, hospital administration and pharmaceutical companies. All tough rows that need to be hoed.
I enjoyed the read, and it got me thinking about how much of the eventual solution will come from strong leadership in small areas that can start some momentum. Actions and results at lower levels can help to build the various beachheads that need to be established for more comprehensive systematic changes to bring sustainability and “vertical” equity.
It’s the mantra of excellence for process engineering and supply chains everywhere: right product, right place, at the right time. How could it not fix all that ails any organization, be they financial problems, customer service problems, quality problems, or any other type of problem? If there were only a broad consensus on the definition of “right,” things would be easier. In instances where “right” is not perfectly clear to all involved, there is an opportunity for a conversation (or negotiation). The adversarial nature of such interactions can cause them to consume more resources than necessary or can mean the conversations never even happen. It is easy to see how these “battles” arise.
Are you picking your battles?
By definition, those working in supply chain are “caught in the middle” between two nodes in the chain. When this idea of “right” becomes a struggle between, for example, consistency and timeliness (e.g. I don’t need it right, I need it on Tuesday), you can make a judgment call as to which of those positions is more “negotiable.” “The boss said Tuesday,” is an understandable piece of evidence to introduce to the consistency camp. But is “Tuesday” reasonable? Is the consequence of missing the deadline worth the consequence of breaking with consistency? That is a conversation that may be difficult to broach, especially if “The Boss” has little time or attention to expend. Engaging rather than accommodating may bring about a more informed decision and direction. A solid base of relationship capital—with all parties—can help move this to a collaborative conversation rather than a battle of “The boss said” vs. “That is crazy!”
Are battles picked for you?
In a competitive environment, whether trying to win business in the marketplace or win resources internally, it is easy to fall into the mindset of a win-lose approach that creates adversaries rather than collaborators. It is worth asking oneself, “Am I the one who is making this adversarial? Can I see it a different way?” It is equally beneficial to ask, “Have we been pitted against each other?” Well-intentioned people may have created a reward system (formal or informal) that sets up the interaction as a zero-sum game. (e.g. on time or on budget?) If you have different measures of success, it is another instance of right vs. right. Is there a common “right” that makes sense to both of you (e.g. customer satisfaction)? If so, you are now allies in engaging to have better measures in place for next time.
So…
The “right” actions and initiatives can come from many places, but those originating from a supply chain function may carry the risk of being seen as a hindrance and not a help. It takes a deft appreciation of the overriding narrative to understand which actions will be most effective and what conversations (up, down and across) will enable implementation with the least amount of resistance.
One big advantage of supply chain is the end-to-end view that this discipline affords. In his novel The Ground Beneath Her Feet, Salman Rushdie recounts, “The only people that see the whole picture are those who step out of the frame.” We are all in a frame, but I think that those in supply chain have one of the wider ones going. This can help them see the more wide-reaching “right” way to do things. Sensitivity and skills in collaborating will help.
THIS ORIGINALLY APPEARED IN THE NEWSLETTER FOR THE CANADIAN SUPPLY CHAIN SECTOR COUNCIL – Oct. 2011.
The monthly mailer from APICS brought my attention to a panel hosted by SAP at the end of September that touched on how supply-chain related activities can lead to business sustainability and, more importantly, can reduce risk. One of the comments on the website of the original article suggests that this is not “new news,” and goes on to share the commentator’s own presentation from 8 years prior conveying a similar risk-reduction message.
I concur that stating “It’s not about going green, it’s about making money and minimizing risk” smacks of motherhood, but the clarification this from a strategy level will quickly become a negotiation about trade-offs involved. For simplicity sake, let’s look at an industry that makes no pretense in the “doing good” department: contraband cigarettes.
Tom Blackwell’s recent series in the National Post exposes a picture of a complex supply chain and the risks taken on by some of the parties. Beyond the tobacco farmers as suppliers of raw materials, the industry needs paper and filters. Suppliers would be smart to engage their buyers in a discussion in order to fully understand the risk and return trade-offs. The discussion should address the risks involved with supplying illegal factories, apparently located on First Nation reserves. The balance of risks (of being associated with a contraband industry) with return (of additional sales) can become a business decision beyond its ethical implications.
You can see how this becomes an internal negotiation, as well, and provides an opportunity to clarify what is acceptable by multiple measures (e.g. what do we mean by sustainable, ethical or other measures?). Avoiding these negotiations leaves a larger degree of risk than necessary. If/when a crisis breaks regarding untoward supplier relationships, the communications and public affairs department may be stuck with: “We never bothered to ask” as a defense. This may not be acceptable to stakeholders on grounds ranging from ethics to stock price.
Gaps between “doing” and “saying” create risks that need to be acknowledged, and then managed and reduced. Treating these situations as a collaborative negotiation (internally and externally) can assist in this process. Not every industry operates in such proximity to ethical and legal risks. Nonetheless, the approach is similar. Sustainable business can offer some common ground from which to build a conversation/negotiation about shared value. A first step is to identify the different aspects of sustainability and how they are prioritized. It will be worth the effort.
Earlier here, I introduced AUTHORITY, EXPERTISE and INFORMATION as dimensions to consider in determining if and why to collaborate with different parties. Importantly, this decision is driven by what you need from other parties and not whether or not you like them. For context, let’s say we are addressing complex supply chain relations that directly affect the sustainability—economic, environmental and societal—of today’s business models.
The net/net of the earlier column was, if you have all three of these elements, collaboration is optional.
THE “2 out of 3” SCENARIOS
#1 – No AUTHORITY – Sell the idea
The extent of simultaneously moving parts in most business functions creates a situation where those managing the work cannot be familiar with all the intricacies. Having information and expertise usually means that you can see the consequences of a decision (e.g. “No, we can’t just ship in larger quantities to make sure we meet demand; the expense and risk of housing inventory in that particular location is prohibitive.”).
The approach here is to “sell” the right idea. If you have fostered a degree of “benefit of the doubt” with the “authority” figure, this can be very easy. If the relationship is not there yet, this will demand a thorough understanding of that person’s interests, and a savvy ability to tell them what they need to hear. This is the realm of persuasion and communication skills. In my view, it is the responsibility of our informed experts to get these ideas through.
#2 – No INFORMATION – Help me help you
The final scene in the Cohen Brother’s movie “Burn After Reading” illustrates this situation perfectly (and hilariously), but in real life these interactions can horribly frustrating. Picture a situation whereby you are a competent cook and you have the authority to make whatever you want for dinner. Yet your question “what do we have in the house?” is met with either:
1 – “Well, there is a lot of stuff in the house,” OR,
2 – A detailed list of “everything” in the house.
The fog created by the audience’s lack of expertise can thicken if they are at all intimidated by the degree of authority. These situations are quick to break down completely (e.g. “we’ll eat out tonight!” or “just let me in the kitchen to see for myself!”) The overriding “help me help you” desire can—time and patience permitting—also take the form of tolerating the lengthy list and taking what is useful.
#3 – No EXPERTISE – Hand over the authority
This is the flip side of “No AUTHORITY” and demands a large degree of comfort with the lack of expertise. But, no, this doesn’t mean abdicating completely! Those in authority are tasked with taking a wider look at things, so, to use our first example, they understand the trade-offs involved with running short on supply (e.g. disappointed customers), as well as the trade-offs involved with keeping more inventory (e.g. higher costs and risks). Taking all into account, they can arrive that the decision that does the “best” for the organization.
The interesting part here is the word “best,” which should come down to strategic priorities for sustaining business success, rather than “best” for specific segments of the company (short-term profitability) or individuals (least headache potential). With the necessary separation of expertise and authority, such strategic priorities need to be very clear. A colleague of mine and I consult with organizations to align such strategic priorities with elements of the triple bottomline (profit, planet and people) and to leverage those in engaging with various stakeholder groups. The ensuing conversations, though tough, are well worth having in preparation for evaluating such trade-offs.
If there was any danger of your supply chain getting dull, this can certainly spice things up nicely.
What kind of person are you: Competitive? Big-picture thinker? Assertive? Conciliator? Other?
Such tags tend to promise clarity, but bring in a bundle of behaviours and attitudes that may or may not relate. When these words find themselves describing quadrants or supporting wider groupings on a personality test, you almost need a glossary to explain the context (and the particular bundle).
I run into this with my working descriptions for negotiation strategies.
A couple of semantic challenges are:
- Even if you are not “a competitive person,” you can still pick a strategy of “competing” in a certain situation;
- It can make strategic business sense to “accommodate” the needs of others and you don’t have to be weak-kneed to do it;
- Collaborating with a party does not mean agreeing with them all the time, and you don’t have to be “nice” to do it.
I will suggest that collaboration is a default for supply chain initiatives, given that the relationships (internal and external) have to be maintained over a period of time and that, in today’s competitive (semantics again!) environment, there is no room for compromising the returns on time and dollars spent.
So do you have to collaborate all the time on everything? Not at all.
Before giving you the model, let me give you this:
Glossary of Terms
Information: Results, data, examples and findings that may help in determining a superior course of action.
Expertise: Orientation, experience and training that enable one to see relevant implications of a decision prior to its implementation.
Authority: Structural or informal power to direct the actions of others, coupled with accountability for the consequences of a decision.
If you have all three, there is no need to collaborate. Why would you? You have all the information you need, you know what is important for the decision, and your sphere of responsibility allows you to “make the call.”
This doesn’t mean that you have to be obvious about “going it alone,” but engaging others would be strictly for relationship-building. You will decide if this is worth the effort.
Tune in next month for an elaboration on what to do when you have “two out of three” (which “ain’t bad,” according to Meatloaf).
THIS ARTICLE FIRST APPEARED IN THE AUGUST NEWSLETTER FOR THE CANADIAN SUPPLY CHAIN SECTOR COUNCIL.
The thread that I try to weave through most what I do (including my writing in this space) is that communication can be strategic on the smallest (micro) levels. By strategic, I mean trying to get the most for the least. By communication, I mean storytelling through writing, talking or meeting with people. Sample supply-chain related stories (aka – agendas) include: sharing the upside of the switch to centralized purchasing, understanding why a process is not working in practice, or encouraging diverse groups to share all their information.
Some ears may be deaf to these storylines, but there are three things that I think can help you be more strategic in telling your story (even to the metaphorical hard of hearing).
Three enablers of strategic storylines
1 – Seed the idea
Communication works on networks social, informal, or otherwise. People may pay more attention to things that are being discussed. Favourable discussion can lead to: “everyone is talking about how good this is, so it must be good.”
Deferring judgment, I bring you the social media example of the “tweet sheet,” which is, under one definition, a list of “key messages” that you send to your friends so they can independently “tweet” your messages to their networks and beyond.
Judgmental note: I was gobsmacked when I heard this. Isn’t social media supposed to be this bastion of authenticity? Everyone has an agenda!
The ethical discussion is beyond the scope of this column. Seeding ideas is one way to tell a story. You may be able to plant seeds in ways that fit with your way of operating.
2 – Use what’s there
Again, I draw from a marketing discipline. A consultant relayed the story of working with a producer of breakfast cereal: “One of the things that kept coming up was the stat that a cereal box is read X number of times. Finally someone decided to capitalize on that real estate!” Similar rational sits behind using the cleverly placed ads on bathroom walls.
Where are people looking already? Does the company newsletter attract eyes? Is there a place where people tend to wait (e.g. outside a particular directors office)?
Again, be wary of the line between “clever and subtle” and “overt and cheesy.” Best to keep well on the former side.
3 – Question the change
I was in a discussion last month that questioned the entire premise of “buy-in.” The logic being that, looking back at theories of motivation, people won’t do what they don’t want to do. (I was in a discussion yesterday where a client had recently realized that “power” was the answer.)
Asking the “what if” question of yourself gives you what you need to go forward. So, what if we can’t centralize all purchasing? What if we can’t get reliable information from sales? The steepness of the downside may illustrate how much effort you put into this.
==
My secret hope is that everyone makes their case well, and the result is actions and directions that serve the best interests of all involved. (My “best” includes a good dose of sustainability.) I will get you my “tweet sheet” and cereal box decals, if you want to help get this message out. Of course, we all realize that much of this could be (1) happening already, and (2) impossible to achieve. More of 1 will put me out of business, and I haven’t “bought into” 2 just yet.
THIS ORIGINALLY APPEARED IN THE MAY NEWSLETTER ON supplychaincanada.org
Let’s grant Francois Houle (Univ of Ottawa) his presumed wish to go back in time to before he hit send on the e-mail warning to Ann Coulter this week. We will weigh the decision based on some negotiation theory.
First up are M. Houle’s interests, including the overriding objective of the school. (e.g. promote constructive educational dialogue). Determining the latter will be a conversation given the published University “mission” statement, which is not clear enough to be workable.
Taking the overall goal into account with other interests (e.g. increase Ottawa U’s global reputation: mission accomplished on that one!) M. Houle would ask himself if bringing Ann Coulter to the university serves his purposes without compromising the overall goal. (There are some serious assumptions made before ticking “yes” to this, but let’s make them.)
M. Houle them selects between different negotiation strategies based on (1 or X-axis) the importance of demonstrable outcomes, and (2 or y-axis) the importance of the ongoing relationship with the other party. This becomes a 2×2 grid, across the axes of “low” to “high” for each dimension; the strategies are AVOID (low and low), ACCOMMODATE (relationship trumps outcome), COMPETE (outcome trumps relationship) and COLLABORATE (high and high). To oversimplify, we will call the single demonstrable outcome “a safe campus event” and the relationship is, obviously, with Ann Coulter and by association.
By sending his warning letter to Ann Coulter, M. Houle was executing on a COMPETITIVE strategy, which marks a strategic error. If you can’t have a safe event with her there, don’t invite her (AVOID). If you want to try to work with her to ensure the discourse remains constructive and educational, give her a phone call: dialogue is conducive–and necessary–to collaboration. Competitive tactics (e.g. strongly worded and public letters) invite retribution. Find her response on her blog, in public, for all to see.
Oh, the difference made by little things. Had M. Houle engaged Ms. Coulter in private dialogue and raised his concerns and hopes for, for example, a safe event, this would play out differently and much more positively for the University. Had she not been interested in this kind of discussion and responded in a competitive/combative manner, he could move to “AVOID” and be done with it.
We will never know how receptive Ms. Coulter would have been to such a phone call prior to the event. I wonder if such conversations took place in Calgary. We can’t know, because such discussions are kept necessarily informal and non-public, which is where such collaboration sometimes has it’s best chance.
Cynicism can be a very destructive force, and can be particularly damaging to the trust/goodwill/benefit-of-the-doubt that seems to help collaboration unfold. I might suggest that perceived hypocrisy is the very best fertilizer for those cynical weeds in the collaborative lawn of an intra- on inter-corporate culture.
Claiming hypocrisy appears to be a safe place from which to launch a critical attack. Much of the criticisms of the recent Copenhagen climate summit point to a disconnect between curbing greenhouse emissions and jetting off to global conferences, then taking limousines to the hotel.
Al Gore received the same treatment for living in a mansion.
David Suzuki got it for using a tour bus to move his small entourage around Canada.
On a smaller scale, in the set-up to some client work I did on effective meeting behaviours, the senior manager showed up a few minutes late and then began chastising the lack of respect for people’s time that hampered effectiveness.
In my role as a trainer/instructor, I have an opportunity to instill the importance of “walking the talk” when engaging hostile stakeholder groups, or even members of a cross-functional team. Most of the time clients, students and attendees can’t tell if I actually walk my talk. (Recall the cynical adage: If you can’t do, teach.)
Note: A colleague of mine, who also teaches negotiations found a neat way around the issue: “It’s not how good a negotiator I am; it’s how good are you after I have taught you.”
There are two situations where those watching, I think, have an opportunity to really assess my walk-to-talk ratio.
1 – Training presentation skills: Similar to writing a book on writing skills, leading a training session on “presenting” always makes me feel naked. During one such session, I found the projector frozen (having spent a December night in the trunk of a car). I am certain the audience was quietly thinking, “Wow! What is he going to do now?” and expecting me to have the right answer, (which is get on with the content; you will find the projector works fine once it is warmed up!)
2 – Negotiating grades for a Negotiation class: Students have an option to analyze and strategize their negotiation with me for a final mark in my MBA course. I don’t feel as naked in these situations because of the obvious power imbalance.
Either of these situations provides clear opportunities to spot the “do as I say, not as I do” moments. I can’t say that I have been called out much at all. One gentleman approached me after a training session with a hypocrisy sighting: “You told us you tend to ‘beg forgiveness over ask permission,’ but then you kept asking us if it was OK to move on.”
Hmmm. Needless to say, no “participation” marks were on the line this time.
When under scrutiny, I think that credibility can become very solid very quickly if the talk and walk line up. Authenticity is a strong asset in managing and leading change from any level of an organization. I firmly believe that those under the most scrutiny (from strong out-group camps), have a fighting chance to gain/regain credibility when they “walk their talk” as much as possible. This means that if I am not flawless, I can’t hold you to a flawless standard… that would be hypocritical, which would make you cynical, which limits our ability to collaborate.
No one is bullet proof. It is far too difficult to fake it. Lead with your strengths, and find others to cover your weaknesses.
Late in the semester takes on a degree of urgency for those involved in education on either side of the chalk. Similar to the wind down of a sports season, things count more and time runs short. Not surprisingly, the final project for my negotiations class entails analyzing a real situation to assess strategy and implementation of the parties involved. There is a timeliness and relevance that comes with looking at situations that are currently unfolding, and my classes have been blessed over the last bit:
- Fall 2008 – York University unionized workers strike.
Note: Neither Schulich (business) or Osgoode (law) were affected directly. All appreciated the irony of crossing a picket line to teach a class on Negotiating.
- Winter 2009 – Auto sector woes, which were welcome in the fall, continue.
Note: There is also a nice little transit strike in Ottawa.
- Summer 2009 – Toronto City outdoor and daycare workers strike
Note: Toronto City Counsellor Karen Stintz guest shared perspectives on this in class this semester.
- Fall 2009 – Cable companies and TV broadcasters
Note: Just in time for Fall 2009, CRTC Chair Konrad Von Finckenstein chastised the disputing cable and broadcasting companies with:
“You need each other; I don’t understand why you can’t negotiate.”
A final report gift, just in time for Christmas.
- Winter 2010 – Community College Teachers vs. Management
Note: As an instructor at Humber I was able to vote in this one. Who on Earth thinks that teaching is a profession in which to get rich?!
The thread through all of these situations appears to be “reacting to a business model that’s under strain.” Whether its wage dissatisfaction or margin envy, those involved, who really do need each other, would do well to hear Von Finckenstein’s words.
Complex situations? Requiring new approaches? This will ring familiar to those working in supply chain. Collaboration is easy to talk about and, theoretically, we can see the opportunity for creating/protecting value. The work comes in effectively executing on that mindset to address real challenges.
The competitive reaction appears to be automatic, especially if we are taking away things that people have “always had” (e.g. banked sick days) or have come to expect (3 – 5% year-on-year wage increase). The rightful target for competitive behaviour is often outside this relationship.
This means that even though it makes perfect sense to implement your cost-saving initiative, if someone is losing something, expect some push back. Positioning energy toward understanding the problem (hopefully a shared problem) is the most effective interaction. No situation is too small for a strategic look, which could start conversations toward some fixes.
Earlier this month, I attended a talk at Schulich Business School where Operations Management faculty and PhD students played host to Dr. Kevin Hendricks from Wilfred Laurier University. As is often the case, we began with introductions; the audience was small enough for us to go quickly around the room of students, who were largely looking for research tips. Describing my connection (negotiations instructor) and my interest (helping positive change take hold), I got the sense that people in the room asked themselves “What is he doing here?” I was very clearly “outside” this particular group. It’s not the first—and certainly not the last—time that will happen.
You don’t have to spend too long with me before I start on about in-groups and out-groups. A fundamental belief of mine is that value-producing collaboration requires better communication across traditional divides (e.g. between the two groups). It can, however, be uncomfortable to spend time across a divide (as I can attest from some of the discussion involving research methods).
The set-up for Dr. Hendricks talk peaked my interest: “Many senior executives simply don’t understand the importance and value created by a well-performing supply chain.” His premise was that the best way to “prove” that companies should actively invest in pre-empting supply chain failures was to look at the stock price drop that followed a reported inventory “incident.” (For the truly peaked, click here.)
The take-away for the students was, as I understood it, that many of the traditional statistical methods (presumably familiar to these PhD students) are useless when looking at such incidents. There are other ways to inject the necessary rigour into the study, and this was the focus of much of his talk.
Perhaps a kindred spirit, I am certain that Dr. Hendricks does well in speaking to “practitioner” audiences, and clearly conveyed the importance getting this message out to other parts of organizations. Pre-emptive arguments that require investment are always difficult. Making the case to “senior management” may be easier with studies and findings he and others produce.
According to Hendricks, the majority of practitioners who take interest in this work do so because of such a failure and, conceivably, a drop in shareholder value in their recent past. This means that practitioners can simply wait for “an incident” to occur. Direct experience has a way of persuading.
THIS APPEARS IN THE MONTHLY NEWSLETTER FOR THE CANADIAN SUPPLY CHAIN SECTOR COUNCIL (supplychaincanada.org)
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