Embrace Complexity

People often study a problem hoping to improve the situation by organizing and ‘simplifying’ it. That is not my vision for Aging in Place 2.0.  There are too many elements, services, interventions, design solutions, tools and personal needs to think that ‘simplify’ will organize them. Instead we must bring the power of technology to create dynamic streams in and out of people’s chosen homes.  This is not ‘one size fits all’. This is custom. In AiP2.0 I refer to this as ‘symmetrical’. That refers to the management of changing human needs in balance with the right resources at the right time. Aging in Place 2.0 is about Embracing the Complexity.

Though some folks may squawk at comparing human needs and dignity to manufacturing the analogy to Japanese style “Just in Time” manufacturing is appropriate. “In short, the Just-in-Time inventory system focus is having “the right material, at the right time, at the right place, and in the exact amount”-Ryan Grabosky” (Wikipedia)

How is this system adapted for Aging in Place 2.0? Compare our current housing and care to the historical US manufacturing approach. In Just in Time manufacturing “Inventory is seen as incurring costs, or waste, instead of adding and storing value, contrary to traditional accounting.” These may may not be the exact words, but most senior living arrangements boast “everything you may need is available to you at all times”.  This is represented by a list of available services and activities. It is not too hard to see this warehousing of capabilities as the waste ‘Just in time” eliminates.

To carry the analogy further, the system of monitoring workflow, quality and parts is complex. Just in Time uses technology flags and communication channels to keep things flowing. It endows all workers with responsibility for the product, empowering them to stop production if things are not going just right.

We can see how these are reasonable goals for senior housing and care – each worker is responsible for doing their job well and reporting things that are not right. Workers are charged with responding to the real time actual situation in front of them, not just putting in time or doing their job. This has the the ring of client centered, client focused care that responds to the real time changing needs in the home and in the life of the client. That is what we all strive for, isn’t it?

My experience in the construction industry can illustrate how technology is used to embrace complexity to accomplish custom. When I started, builders would almost never customize a new residence when they were building a whole lot of them. The line (and cost) between production and custom builders was hard and inviolate. Customization, or choices, could not be communicated. Now, with spreadsheets, smart phones, and I daresay even more with the I-pad, it is not hard for builders to give clients choices- wall colors, cabinets, counters and even floor plans. The builder uses the technology to embrace rather than shun the complexity, improving the customer experience.

Now the big IF. Can We step up to the challenge of choice, respect and dignity for our senior housing and care clients? Can we embrace the complexity, use available technology and improve the customer experience? Hey folks! If builders can do it, why can’t senior housing and care providers?

So here lies our opportunity, to adopt the characteristics of responsive, organized and dynamic lean service* and lean manufacturing sectors to use the best possible suppliers and technologies to ensure dignity and economy for our older citizens in the home of their choice. That is the vision and challenge of Aging in Place 2.0.

*Glance through these ‘service wastes’ and see if they don’t remind you of senior housing and health care in general (Think of how many times you say the same things and fill out essentially similar forms every time you see a doctor or visit a clinic):

The service wastes

The original seven wastes (Muda (Japanese term)) were defined by Taiichi Ohno, the father of the Toyota Production System. These wastes have been often been redefined to better fit new organisations, industries, or external pressures.

One redefinition of these wastes for service operations by Bicheno and Holweg (2009) is as follows:

• 1. Delay on the part of customers waiting for service, for delivery, in queues, for response, not arriving as promised. The customer’s time may seem free to the provider, but when she takes custom elsewhere the pain begins.
• 2. Duplication. Having to re-enter data, repeat details on forms, copy information across, answer queries from several sources within the same organisation.
• 3. Unnecessary Movement. Queuing several times, lack of one-stop, poor ergonomics in the service encounter.
• 4. Unclear communication, and the wastes of seeking clarification, confusion over product or service use, wasting time finding a location that may result in misuse or duplication.
• 5. Incorrect inventory. Being out-of-stock, unable to get exactly what was required, substitute products or services.
• 6. An opportunity lost to retain or win customers, a failure to establish rapport, ignoring customers, unfriendliness, and rudeness.
• 7. Errors in the service transaction, product defects in the product-service bundle, lost or damaged goods.