Capability Maturity

The term Capability maturity refers to degree to which the management of an organization has control of processes, employees and outcomes of the organization.

An organization at the highest level of optimization is continually improving its methods to improve the outcomes for its customers thru management decisions based on metrics and active optimization of the processes.

5: Capable – the process is quantitatively managed in accordance with agreed-upon metrics. The process is being systematically improved through observation, measurement and corrective actions.

4: Efficient – process management includes deliberate process optimization/improvement. The process is fully understood, reason prevails.

3: Repeatable the process is documented sufficiently such that repeating the same steps provides predictable results. Experiments can be performed.

2: Definedthe process is defined and confirmed but outcomes are still not completely confirmed. Science is recognized and takes hold.

1: Initial: Process undocumented, ad hoc, uncontrolled and reactive. A chaotic, unstable environment. Heroics, star performers rule

The following 4 negative stages are not part of the recognized CMM but will be experienced by any manager tasked with changing a culture. Originally noted by Capt. Tom Schorsch USAF.

0 Negligent: Lip service to processes, lacks will or effort. Tends to abandon procedures in favor of crash programs. Extreme heroics.

-1 Obstructive: Ineffective processes that obstruct work are implemented with rigor. Adherence to process is the measure of success.

-2 Contemptuous: Measures of activity replace measures of productivity, often portrayed as “agility.” Poor results are blamed on factors outside the organization’s control.

-3 Undermining: working to downplay and sabotage the efforts of those working towards improved capability. Common in larger departmentalized organizations that compete for scarce resources.

Example: Doctors engagement

Thee are countless examples of where an organization is on the capability maturity model, the physicians engagement is a good place to look. When compared to the rubric it clearly is operating at the initial or lower level. Once again the most gifted, empathetic, best trained doctor has to operate in a process driven environment, this is a reflection of the management not the people being managed. The individual doctors are being hampered by the workplace they are required to work under.

The following document compares a few of the required commitments the doctor must make with the commitments that a capably mature organization would make. The objective here is looking for evidence of capability maturity.

The Gods of management

In management theory Gods of Management by Charles Handy is required reading. Handy presents an organizational paradigm using powerful historical and visual support. His work causes you to examine the order within organizations while compelling you to identify personal organizational preferences.

Their is a large body of research into the Capability Model for hospitals, most of it over complicating a very simple concept. This you would expect from an academic oriented organization like a hospital or worse a teaching hospital.

CMM for hospitals

The challenge for an expert patient

I am an expert in Capability maturity of organizations, by training, through experience and 40 years in the field. Why could I just not trust the doctors? Why did I have to look into things on my own, because intuitively I could tell it was out of control. But I was so sick I could do nothing about it, my uremic brain, fatigue and mental confusion could not articulate the terror i was feeling because of what I was seeing.

The irony of course is that because my transplant to date is a success, my uremic brain is no more and I am aware enough to criticize the process that saved my life. I find it ironic and worthy of notice. The hospital does in fact do what they say they will do, its just they do the wrong things.

The leader is the one who climbs the tallest tree, surveys the entire situation, and yells, ‘Wrong jungle!’ …
Busy, efficient producers and managers often respond … ‘Shut up! We’re making progress!’ Stephen Covey (1932 – 2012)

Yes I got a kidney and I am off dialysis! Thank you! God Bless you!

But you did it by giving me an increased risk of PTLD and NHL. And then as I slowly emerged from my Uremic brain and I started to investigate what happened to me and found that mismatched EBV serology was a well known and very risky procedure, you obfuscated, ignored me, belittled me, misrepresented the risk and finally made me feel “ghosted”. From all this I was depressed, frightened and confused.

The turning point was the kind caring concern of one nurse (who shall go nameless, I have seen a bureaucracy attack their own), who asked me a simple question; “what was I trying to accomplish” and then >>BAM<< a lightening bolt, my training kicked in and I was no longer confused. I was trying to do what I always did, help an organization be more effective. I saw it then for the first time, and I could articulate my concerns.

My anxiety was an unconscious revulsion to the confusion of a chaotic organization..

In a capable organization their would be a process, a deviation from the process would be flagged, an analysis would be done, the results would be documented, if the change did not work, a corrective action.

The organization learns, the process improves, it is not about a mistake on a doctors watch, its is about doctors collaborating to define an evolving process and ensuring the technicians, technologists and colleagues are all playing from the same, up to date, scientifically validated playbook.

Everyone learns, the hospital learns, the process improves, a mistake is made once and not again. If the process was successful a positive metric. You learn.

None of that ever happened in my case.

Thank you for listening.

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