Monday, August 01, 2005

Value Stream Management, Specify Value

The first step in Lean Thinking is to specify value: What will our whole process from the legislative appropriation through the client create, and what that should cost. At this step, original and comprehensive thinking are crucial. For example, in our system, we often treat the service provided as the outcome. I suspect that we think this way, because in our system, the service is, in fact, the last compensated part of the process. Sometimes assigning a value to the service doesn't seem like such a good idea in case someone compares the cost, but this is why we try to fix stuff.

I would suggest that in the system design, value is creatively and well described. We say that the system exists so that people with developmental disabilities can choose and experience lives similar to their non-disabled peers as fully integrated members of their community. To this we add health, safety and dignity at least in interactions with the participants in the system. This isn't very specific, but it is humane, measurable, creative and comprehensive. The current specification in statute of what that should cost is "whatever it takes" which may be unsettling to many taxpayers and politicians but it won't be me pushing for a hard number. It may be useful, however, that if Lean Thinking settles in that some rationale for costs may actually be useful in providing better lives to clients.

So we have three pieces of our value specification:
1. The outcome of the system is that people with developmental disabilities will live in a manner of their own choosing a life equivalent to that of a non-disabled peer as an integrated member of their community.
2. The client's experience of the system will be dignified, attentive and safe.
3. It will cost whatever necessary to meet the first two value propositions and no more.

That looks pretty specific to me, although we can debate how often those propositions are really carried out. I would contend that everywhere in this system that we are not conscientiously specifying value the implied value specification is this:
1. The outcome of the system is that people receive services of their choosing.
2. The client's experience with the system will comply with Regional Center policies and state regulations.
3. Costs will be in line with those incurred by other clients deemed similar.

So, I would say the system is relatively successful in specifying value but wholly unsuccessful in remembering or communicating the specification.


Anonymous said...

Amazing how self determination, DDS budgeting to Regional Centers....or God forbid, clients' well being goes quiet after government and agencies received THEIR budget.
Our children, however in the RC service delivery are still suffering daily at the hands of administrators" directives to the case management staff.
It is amazing that even in the seven RCs in LA County that a client does/does not get services based solely upon where they live rather than their developmental needs. Can we fix this? Does anyone of authority really recognize the consistent inconsistency in this arcane service delivery model?
Or just care?
Or has Sacramento employed young consultants who have taught decison makers to cop an attitude of--Whatever
Community activists,parents, and professionals who care....the sound of one hand clapping is deafening
How about No mas/no more cuts until the system corrects itself?

Shirazi said...

Ask me what is the worth of your words? They are worth life because they teach so much.

Doug said...

Anonymous, I've had that very conversation before and I'm trying to figure out how to approach it politically with the State. If you read the POS Study II, it was really obvious and no-one except John Shea and I commented on that. The services provided should fit the need of the client, not the other way around. We're backwards. Thanks for your comment.

Shirazi, you are really terrific. Why not join the fun at Waking Ambrose? Your friend Marwa shows up from time to time and your friend Doug is there daily.

Shirazi said...

Thanks for the invitation. I am at Waking Ambrose now?

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