Since I received a great deal of commentary on my July 7, 2012 blog post, entitled “Who is Your Customer?”, I have decided to blog about the topic some more this week to provide additional clarifying information.
It is the inability to differentiate between the distinct elements of the value stream that leads to poor customer satisfaction in any industry–particularly the service industry. Whether those elements are integrated and performed by one person or distinct and performed by separate individuals is of very little consequence. As a matter of fact, the integration of those processes can sometimes cause the sub-process interfaces to be more obscure. At the end of the day, however, sub-processes must be identified and viewed in terms of their intended outputs and required inputs in order for any holistic process improvement to take place.
In my July 7, 2012 blog post, entitled “Who is Your Customer?”, I presented an example of a surgical procedure to show how the upstream sub-processes of intake, vitals, and surgery preparation all provide outputs that are inputs into the surgeon’s surgery process and demonstrate how the surgeon is, therefore, an internal customer of those upstream sub-processes. Since the patient in this surgical procedure is the hospital’s primary customer and the surgeon’s immediate sub-process customer, the patient is not merely an object, but the entity that validates and the surgeon’s procedure on a sub-process level and the hospital’s services in general at a high level. In other words, a well- or poorly-performed operation cannot be determined unless it is determined by the patient that is undergoing the procedure. Each of the upstream sub-processes, however, delivers no more of an output directly to the patient than does the company that manufactures the surgeon’s latex gloves.
This concept of internal sub-process customers transcends the service industry, the manufacturing industry, and even business in general. It is a concept that governs every process that has ever existed and will ever exist in the universe. How about the human metabolic process that relies on water, food, and other elements to sustain life and growth? Isn’t this process dependent upon the sub-processes of eating and drinking, just to name a couple? In order to improve a process, that process must be dissected and broken down and understood at its respective sub-process steps. Each step must be evaluated based upon its intended outputs and required inputs in order to achieve the intended output. If this natural law of process improvement is not obeyed, there can be no sustainable improvement.
The fact that individuals or organizations may choose to overlook these sub-processes and their interfaces is not evidence that they do not exist and that their significance in the context of process improvement is diminished. A golfer who overlooks the significance of taking the proper stance, getting the proper grip on the club, and creating the proper arc in his or her backswing will most certainly end up with a horrible shot because taking the proper stance, getting the proper grip, and the backswing are all upstream sub-processes that have an input into the downstream “shot” sub-process. And guess what? They are all integrated and performed by the very same individual.
Let’s assume that the hospital in my July 7, 2012 example also has integrated services and that all of the services described (intake, vitals, preparation, and surgery) are all performed by the same individual. Won’t the final outcome still be flawed and fall short of the patient’s expectations if the upstream processes (intake, vitals, and preparation) are not performed correctly and do not yield adequate inputs into the downstream process (surgery)? Moreover, a good argument could be made that since other skilled health care professionals are typically trained to perform each of these specific upstream functions, the likelihood of sub-par outputs from these sub-processes would increase by assigning these functions to a single individual (but that is a separate debate altogether). The bottom line is that whether the sub-processes are integrated or not, process improvement and control can only occur when all of the sub-processes are identified, and the outputs of the upstream sub-processes are validated by the downstream sub-processes that are their internal customers.