(If you have trouble printing this page, you can save the document and print from any word processor:   Under the "File" Menu, select "Save As," "Format:Text," and a location on your computer for the document."

Rx ID:
Overall Comments on Team Responses

Written by Judge Rob Foshay




It was a great experience.

As I see it, there were four major issues in the case:

  1. Change management to the model of optimizing simultaneously to maximize patient care and minimize cost. Within that, a number of specific issues, especially trust of management, team development and integration of technology.

  2. Specific need to develop a legally defensible assurance of correct operation of the RBA, coupled with a need to develop an agreed-upon criterion of correct operation.

  3. Focus of RoboMedic on the machine rather than its benefits, leading in turn to a general failure to address the integration issues through machine design (e.g., failure to build in a UPS or an EPSS or training mode) and integration support.

  4. PR problem, of which the lawsuit is only the most extreme example.


    None of the teams got all four problems. Many of the teams got three out of the four, but failed to weight them for criticality and cost. Attention to risk managment and direct and indirect costs was minimal in most of the solutions, leading to some wildly impractical and budget-blowing solution strategies. It was particularly astonishing to me that none of the teams asked if there was a performance problem with machine operation (they all took the lab's assertion that there was not at face value--no one questioned the acceptability of the documented rejection and recalibration rates, and most teams did not recommend an analysis of error causes), and they accepted management's preconception that the need was for training! Regardless of what they say, management NEVER wants training (except in regulatory situations where the regulations are written in terms of number of hours of training); management wants the assurance of performance!

    Also, none of the teams adequately addressed the problem of how to present the recommendations to management. The basic problem is that management thinks they have a simple need to assure correct operation of the RBA, easily fixed by a little bit of training. Coming back with a recommendation for a huge systemic fix to the entire change management problem simply won't sell on the basis of the RBA problem alone. If presented as done in most of these documents, there's a high probability that management would reject the whole needs assessment, turn to RoboMedic and tell them to come up with a cheap fix to the perceived training need. Only one of the teams even attempted to explain the problem and solution in the TQM jargon management seems to support.

    Also, only a few of the proposals included any kind of risk management strategy such as use of a pilot team, phased implementation, prioritized intervention strategy options with attached costs and risks, etc. The majority of proposals took an all-or-none strategy for an intervention which exceeds the perceived size of the problem and the ability of the 4-person training office to implement with available resources. Management would almost certainly reject swallowing such a big pill at once, and might even reject the idea as a clumsy attempt at empire building by the trainers. If, by some miracle, management did buy the proposal, the training office would certainly fail in its implementation. How 'bout an implementation strategy that makes it likely that the training office will still be around for "Round 2"?

    P.S. -- I doubt that anyone who built her reputation on an EPSS would be looking for a constructivist solution!

    It was a lot of fun! Thanks for inviting me!




Return
Click here to
return to the top
of this page