Showing posts with label triage. Show all posts
Showing posts with label triage. Show all posts

Tuesday, October 2, 2012

Fifty Thousand!

 

I was pleased to discover yesterday that my Sidewise Thinking blog has now hit the 50,000 pageview mark. Last month, there were over 4,300 views, or well over 150 per day.

My first post, "What's SideWise Thinking?", appeared on April 11, 2009. It was an excerpt from the book I was currently working on, Creative Project Management (with Ted Leemann). I've generally put a new post up every Tuesday (with a big gap between July and November 2010), with topics ranging from project and risk management to my two big series on cognitive biases and decision-making disorders.

The most popular piece so far has been "You're Not Being Reasonable," on the rules of reasonable arguing. First published on March 2, 2010, it's gotten over 3,400 page views, helped primarily by a plug from the blog "LessWrong" and a StumbleUpon link.

I don't quite understand why the second most popular post is the 23rd part of my Red Herrings series, "Hume's Guillotine." First published January 24, 2012, it's gotten over 2,200 hits, but I can't find any specific factor driving traffic to that article and that one alone. Next comes "Triage for Project Managers (Part Two)" (February 8, 2011, over 1,700 hits), and "Eyewitness to Murder" (April 13, 2010, with over 1,300). Red herrings strike again with "A Cute Angle (Part 19)" (December 27, 2011, over 1,000 hits).

By comparison, my new blog, Dobson's Improbable History, which has only a little more than a month under its belt, is already exceeding 100 hits per day, with over 3,200 pageviews last month — a much better start.

This is the 149th post I've made to the blog. I made 29 entries in 2009, 31 in 2010, 52 in 2011, and 43 so far this year.

Thanks very much for reading, and I hope you continue to enjoy it.




Tuesday, February 8, 2011

Triage for Project Managers (Part Two)



Our triage process has identified the most difficult and challenging projects, and now it’s time to perform a “deep dive” analysis of project difficulty — the final step in our preliminary analysis. The goal is to make sure we have a deeper understanding of the issues. Our earlier question, “What is the minimum decision and minimum action I must take right now?” is one that we must repeat as we move forward in the project.

Unless you’re staring at an Apollo 13-style deadline, with the clock ticking as CO2 levels rise, the right thing, as innumerable after-school specials have taught us, is to Learn More About It.

Difficulty comes in three dimensions: more complexity, tighter constraints, and less certainty. Of course, a project can have difficulty in more than one dimension, and their various combinations produce even more issues.

Complexity

Complexity can exist in both product and project. Project complexity is measured by such factors as the number of work packages, the number of resources, and the number of interactions and linkages. Product complexity is measured by such factors as the number of components, the number of processes, and the number of production steps. The key word here is numbers. Complexity can be counted.

Tools for managing complexity abound. They’re found in classical project management, systems engineering, logistics management, and financial risk management. A good background in probability is useful.

Constraints

Constraints come in many flavors, not merely the Neapolitan mélange of time, cost, and performance. You must obey applicable legislation, ethical codes, regulations, internal policies and procedures, and the laws of physics. They aren’t all created equal, especially in terms of their impact on an individual project.

A constraint is only a constraint if it limits your project performance choices.  If a regulation, for example, keeps you from doing something you’d otherwise do, it’s a constraint. If breaking the regulation would not help you achieve your project goal, it’s not a constraint, but merely a fact. (We’re not advocating breaking the regulation, of course, but merely classifying it in terms of your project universe.)

Constraints, as we noted, can be tight or loose, flexible or inflexible. A tight, inflexible constraint can make a project extremely difficult or even impossible. A constraint that is equally tight, but has flexibility, is much less serious. Equally, a loose constraint, even if inflexible, still gives you room to maneuver.

There are three fundamental strategies for managing constraints: change them, check assumptions, and come up with creative workarounds.

Uncertainty

How firm is the ground on which your project sits? Some of the factors that govern project uncertainty include the stability and likelihood of identified assumptions, the stability of your stakeholder community, the state of competition, the extent of newness, and the level of risk.

The difficulty in measuring uncertainty is the extent of the “unknown unknown” universe, the extent to which we don’t even know what it is we don’t know. In the managing assumptions, an equal problem comes in the form of “unknown knowns,” things that we don’t know that we actually do know.

Complex and Tightly Constrained

When complexity meets tight constraints, the value of the formal tools (project management, systems engineering, logistics management) tends to increase, because driving waste out of the system and driving structural efficiency into the system reduces constraint pressure. Formal systems also provide the necessary data structure to back up negotiations to modify constraints as well as to support creative efforts to move past them.

Complex and Uncertain

Uncertainty, on the other hand, undercuts and weakens the tools needed to manage complexity. Formal systems naturally work less well when the necessary data is unavailable or unreliable. The two main tools to manage complexity and uncertainty are risk management to prepare for known possible risks, and contingency reserves (extra time, extra money, optional requirements) to prepare for unknowns.

Watch out as well for uncertainty caused by complex stakeholder interactions and political maneuvering. The trouble-plagued Denver International Airport (DIA) construction project, delivered in 1994 after a $2 billion cost overrun and a year’s delay, was victimized by a constant tug-of-war among stakeholders ranging from city officials to airlines to various business interests.

Cognitive biases interfere here as well. Not only does weak data increase the role of bias in decision-making, uncertainty can also manifest itself in the form of various biases, especially denial.

Tightly Constrained and Uncertain

While tightly constrained and highly uncertain projects may not be impossible, they are often problematic. It may be legitimate to review whether the project should be attempted in the first place. If you go ahead with the project, failure is a significant risk, so plan for damage control in case of catastrophe.

Negotiating changes in the constraints is usually a worthwhile strategy, but the real problem is that projects in this category are often crisis responses. There were plenty of CO2 filters available for the Apollo 13 lunar module; the problem is that they were on Earth. Management freely gave project teams every resource possible — the problem is, that the range of the possible was very narrow indeed.

Complex, Tightly Constrained, Highly Uncertain

The trifecta of project management comes when a project scores high in each of the three dimensions. In 1991, as the Iraqi military retreated from Kuwait, they set fire to 737 oil wells after placing land mines to keep out firefighting crews. The resultant project to put out those fires fit all of our criteria. While money was available in ample amounts, professionals with the unique skills to handle a problem such as this are in short supply.

The time constraint didn’t have a specific date attached to it, but the environmental damage was such that time pressure was enormous. Risk and uncertainty were extremely high. Commentators at the time speculated that it might not even be possible to extinguish the fires in anything less than years. The dimensions of the problem were not clear at the outset.

Maintain an extreme vigil over your risk portfolio. Spend resources on information. Move forward in small steps, and watch for indications that your assumptions need to be modified.


[Part 1 appeared last week.]

Adapted from Creative Project Management: Innovative Project Options to Solve Problems On Time and Under Budget, by Michael Dobson and Ted Leemann; published by McGraw-Hill and copyright © 2010 by The McGraw-Hill Companies; all rights reserved. Used with permission.

Tuesday, February 1, 2011

Triage for Project Managers

The Very Model of a Modern Surgeon-General

In the opening credits for the TV series M*A*S*H, helicopters swoop in low over the hills carrying their precious cargo of gravely wounded soldiers.  Hawkeye Pierce, surgeon-saint in a Hawaiian shirt, leans over one soldier, a serious expression on his face. He quickly assesses the soldier’s condition, signals a waiting nurse, and soon a line of stretchers is carrying the wounded down Helicopter Hill and into surgery.

If you’ve ever waited in a hospital emergency room, you know what triage is. As its pronunciation suggests, triage is a French word, deriving from trier, to sort or select. It’s a formal way to prioritize medical patients based on the severity of their condition.

Both M*A*S*H and triage have their origin in the work of the same man: Baron Dominique-Jean Larrey, MD, surgeon-in-chief to Napoleon’s armies. Napoleon described Larrey as “the worthiest man I ever met,” and there’s some justice to the categorization. He invented the ambulance (inspired by watching Napoleon’s famous “flying artillery” maneuver around the battlefield), and was a pioneer in the enormously complex logistics for providing care in mass-casualty settings. 

Along with other pioneers such as Florence Nightingale and Major Jonathon Letterman, medical director of the Army of the Potomac under General McClellan, Larrey helped transform the face of military medicine, and as a side note changed the way people think about how to utilize limited resources effectively.

Modern medicine is of surprisingly recent vintage. Even the basic idea of the germ theory of disease (see Semmelweis in the cloud tag to your right) only originated in the first half of the 19th century. Medical care for soldiers was appallingly primitive, and throughout all the wars of history far more soldiers died from disease than from combat. It was not until World War II that a combination of more terrible weapons and greatly improved medical care tipped the balance in the other direction.

Military medicine doesn’t just involve the treatment of wounds. To handle mass battlefield casualties requires an enormously complex logistical and administrative apparatus. It’s not enough to be a good doctor; you also have to be a good project manager.

That’s why the concept of triage is so powerful. There is nothing new about the concept of prioritizing, of course. People have sorted, selected, and chosen for as long as there have been choices to make. But priorities are frequently established by a “best guess” method, rather than through a real and meaningful assessment process. An assessment methodology distinguishes real triage from simple prioritizing.

The Hierarchy of Triage

You don’t need to do triage of any sort if you have a single patient (or project), or if there are plenty of resources to go around to accomplish all the work. But that’s seldom the case. You need to perform triage from two different perspectives: not only for the project or projects for which you are responsible, but also so that you understand your relationship to the projects that may potentially compete for the same resources. Both relative and absolute importance have implications for what you do and how you do it Sometimes, your job is to assert the right of way for your projects; other times the right organizational choice is to yield to others.
Initially, you want to make the minimum necessary decision so you can take the minimum necessary action required right now. (You can always do more later.)

Degree of triage required ranges from basic to advanced depending on what’s at stake and what the issues are. Start with the basic process level, and continue as far along the journey as necessary until not only the current project, but also all the projects in your environment, have been accounted for.

Basic Triage

The first stage of medical triage for mass casualties is to separate the victims into three categories:

1.         Those who are likely to live, regardless of what care they receive
2.         Those who are likely to die, regardless of what care they receive
3.         Those for whom immediate care might make a positive difference in outcome.

In project management, Category 1 projects can be identified by large degrees of freedom in the triple constraints of time, performance, and cost. If the schedule is very flexible, performance requirements are modest, and the budget not at issue, there’s not a lot of project management challenge. We often describe smaller Category 1 projects as “tasks. The difference between a task and a project is, after all, merely perspective. Both have the same fundamental characteristics of “temporary and unique.”

Category 2 projects fall are "operationally impossible," meaning they can't be done under the current conditions and constraints. That's not the same thing as saying they're absolutely impossible, of course. Sometimes, current conditions and constraints can change.

Placing a project in Category 2 isn’t something to take lightly. Signs that a project may be in this category include: over-constrained in terms of budget or time, sky-high performance requirements, and high levels of uncontrollable risk. In such cases, you may abandon the project altogether, or perhaps do the very minimum exploratory activities to confirm your analysis. Of course, you may not be the only person whose opinion counts. If you think it’s a Category 2 project but the boss disagrees, you may have to do it anyway — but it's wise to think about self-protection when things go south.

Each triage determination requires an assessment of the specific current situation. Advances in medicine mean that injuries that once were solidly in Category 2 now enjoy remarkable recovery rates.  Similarly, projects once thought impossible also must be reviewed in light of new technologies and circumstances. Relying on outdated paradigms will result in misclassification with corresponding catastrophic results. While miracles are possible, the best doctors and project managers can do is make an informed situational decision using the most current information and technology to achieve the best result.

Category 3 projects need additional analysis, but they also need action. It is in this category that most projects fall.

[Continued next week]

Adapted from Creative Project Management: Innovative Project Options to Solve Problems On Time and Under Budget, by Michael Dobson and Ted Leemann; published by McGraw-Hill and copyright © 2010 by The McGraw-Hill Companies; all rights reserved. Used with permission.