Design processes for humans
I recently teamed up with Nick Roder - an experienced Mobile Intensive Care Ambulance (MICA) paramedic (and my uncle) - to give a talk at Agile Australia where we explored what organisations can learn from paramedics about teamwork, collaboration and leadership. We shared how paramedics deal with their unique, complex environment, and how they create a collaborative culture that enables effective teams.
This is the first in a series of four articles, detailing the insights and practical techniques from paramedicine that you can use to help your people do their best work, every day. The other articles in the series are available here:
Why care how paramedics work?
Ambulance Victoria employs close to 6,000 paramedics to provide emergency health care across the state. While the qualifications and capabilities of these paramedics vary, they are all trained to work outside of the hospital environment. This means that they have no defined workplace, limited managerial oversight and they are often remote from support.
And yet their performance is nothing short of remarkable. In 2022 - 2023, they attended over one million incidents, and 95% of patients surveyed reported that their care was good or very good1. I'd wager there's not a business on the planet that wouldn't sell their soul for customer survey scores like that!
So when I learned about this, I got curious. How do they collaborate? How do they deal with the complexity? And can we apply their techniques in organisations to get similar results?
People are our delivery system
The connecting thread between paramedics and organisations is people. In paramedicine, people deliver the care that saves and improves the lives of their patients. And in organisations, people deliver the products and services that create value for the organisation and its customers. In both cases, it's people who are responsible for delivering the outcomes.
So, the question you need to ask yourself is: Does your organisation work with its people or against them?
In my opinion, the answer for many organisations is that they unintentionally work against their people.
I believe that we can learn from paramedicine, adapting the techniques that they use to create high-performing teams. Once we accept that people are our delivery system, we can work with them them by doing the following 4 things:
Design processes for humans
Create a just culture
Foster civil interaction
Flatten the authority gradient
This post explores the first of these: Design processes for humans.
A paramedic's work is unpredictable and complex
Paramedics deal with cases that run the gamut from interhospital patient transfers to accidents to search and rescue. They have complex protocols and procedures which they perform under pressure. They work with people that they may have never met before. And all of this in challenging environments like accident scenes, remote areas or residences with access issues.
In response, paramedics have developed a range of tools that provide a systematic approach, constructed in a way that recognises that they will be deployed in a range of contexts while keeping the needs of patients and paramedics at the centre. In other words, they design processes for the humans who are involved.
Take for example the reference for Chronic Obstructive Lung disease. In its original form, it is a 218 page manual: impossible to memorise and difficult to navigate in an emergency situation. So paramedics distil the information down to a form that can be viewed on a mobile device. Importantly, this is created by people who understand the work and the environment.
Image 1: On the left is the original 218 page reference for Chronic Obstructive Lung Disease. On the right, part of a flowchart that distils the key information paramedics need.
Organisations are unpredictable and complex too
Processes that are not designed for humans, will not be used by humans
Reflect on your organisation for a moment. How many of your processes are closer to the 218 page manual, than to the flowchart that fits on your mobile screen? Do you have processes that aren’t documented? Or are documented but not followed? The insight that I think we should take from paramedicine is that processes that are not designed for humans, will not be used by humans.
A few years ago, I worked with a team that had low morale and was struggling to meet expectations. When I first spoke to them, I learned that timesheets were one of their biggest pain points. While it’s easy to dismiss this as trivial (nobody likes timesheets) I quickly realised that this was a very real problem for them.
Their process went something like this…
A project manager comes to the team with a few dot points describing the requirements and requests an estimate. But “don’t worry, it’s just a high level estimate that we need to get the work approved - we won’t hold you to it” says the project manager. Reluctantly, the team provides the estimate along with a long list of assumptions and caveats. Grateful, the project manager thanks them and scurries off.
Months later, the original conversation long forgotten, the project manager returns to the team with the go ahead on the project. That initial high level estimate has been communicated to stakeholders and is now set in stone. The project manager supplies the team with the timesheet code for the work and reminds them of their original estimate. What’s more, the project manager controls how much time team members can log against each project code. And project managers are KPI’d on keeping their projects on budget.
As a result, timesheets were taking team members an hour or more each week to complete as they negotiated back and forth with project managers and their team leads, causing considerable stress for the team and friction with project managers.
The timesheet process was designed for the Project Management framework, not for the people. So we worked with team members, project managers and the PMO to redesign it from a human perspective. We made it trivial for team members to complete their timesheets, while retaining the necessary reporting rigour.
And the results were immediate. Within a month, the team’s NPS went from -50 to +30 and team members were noticeably more engaged. Redesigning the process for humans made their lives better, and demonstrated that leaders were willing to listen to feedback to continuously improve.
Image 2: Visualisation of team NPS scores before (left) and after (right) the changes to the timesheet process.
What can you do?
Listen to your people
The first thing that I do when I start working with an organisation is talk to as many people as possible. I want to understand their current context, what's working well and where there are opportunities to improve.
This is where I recommend you start too. Talk to your teams. Talk to your people leaders. Talk to your executives. Listen carefully and identify opportunities for improvement. This will be considerably easier if you have a high degree of psychological safety in your organisation, but that's a topic for another post.
Involve the people who do the work
Paramedics understand that the people who understand the work and the environment are the best ones to design the processes. The same applies to organisations. This doesn't mean that you can't support your people, but at the very least you need to involve them.
This could be as simple as asking them their preferences or it could be something more involved like co-design sessions. The critical thing is that you get the perspective of the people who will use the process. They will inevitably have ideas and insights that you will not think of.
Prioritise simplicity
As illustrated with the example of Chronic Obstructive Lung disease, simplifying processes is often key to productivity. When faced with a choice, prioritise creating a simple process that covers 80% of cases over a complex one that covers 100%. Sure, this means that you may need to make some trade-offs, but the alternative is a process that no one uses.
So when you're designing changes to processes, challenge yourself to make them as simple as possible. How could you have fewer steps? Do you really need to involve all of those people in a decision? Where there's ambiguity, what if instead of trying to build answers into the process you simply empowered your people to resolve it themselves?
Continuously improve
This can be hard to accept, but it's highly unlikely that you will get the design of a process right the first time. Even if you somehow manage to get it "perfect", eventually your context will change and the process will need to change too.
A useful technique is to treat process changes as hypotheses. You have an idea for the process changes that you will make and the impact they might have, but you won't know if they have the intended effect until you implement them. So explicitly define the impact you expect and how you will measure it. Strategyzer's Test Card is a useful tool that you can use for this.
And make it easy for your people to continuously improve your processes. Rather than creating one-off improvement projects, foster an environment that encourages your people to continuously try new ways of collaborating.
Conclusion
Designing processes for humans is not a revolutionary idea. In fact, the sentiment is not too far from the first value in the Agile Manifesto - "individuals and interactions over processes and tools". However, I still see many organisations that have processes that aren't designed to support the people who use them. Processes that are designed for the project management framework, or the finance process or for some other long-forgotten reason.
All organisations have constraints that restrict some process design decisions. As a result process design is often a matter of making tradeoffs. It may not always be possible to make the "perfect" process for humans. However, paramedics are proof that prioritising the humans who use the processes is a recipe for success.
So next time you're redesigning a process in your organisation, start by talking to your people. Involve them in the process design. Keep things simple and continuously improve. And most importantly, design the process for humans.
References
1: Ambulance Victoria Annual Report 2022 - 2023, accessed 27 Nov 2024
