Public Health and Process Improvement
The Public Health story relates to the maturity of societies. Mature societies focus on entire populations (upper right). I'll use "organizations" from here on, but the term applies in almost all human activity. The difference is in the definition of population.
Here's how to read the chart:
- More mature organizations operate at the top level, with minimal slips to the lower left
- More individuals (people, projects) are affected on the right, fewer on the left
- The cycle goes: upper right/upper left/lower left/lower right. Expense and damage increase as the cycle progresses
- The idea is to invest early with well-designed programs to avoid moving to the next box in the cycle
Primary Intervention
The least overall expense and the least damage occurs where we have vaccinations to prevent disease, take actions to prevent breeding of mosquitoes that spread everything from West Nile Virus in the US to Malaria and Dengue Fever in the less developed world, or have programs to promote abstinence from unprotected sex, etc.
Organizational data developed from such programs include coverage, specific infections addressed, etc. This data is reviewed regularly to determine if programs should be changed or replaced, or if new ones should be developed.
Secondary Intervention
Even in mature organizations, some infections (or defects, or whatever) occur. Screening programs detect infections as early as possible when it may be possible to treat the individual, and when actions can be taken to prevent spreading of the infection.
The set of tests taken at an annual physical is an example in medical terms. In the business world, examples include periodic project reviews scheduled according to policy.
Organizational data developed from secondary intervention provides the organization with guidance on the effectiveness of prevention programs and on the incidence (new occurrence) of various conditions. The organization uses this information to make improvements--but only if there are clearly stated reporting requirements, as well as clear direction for use of the reported data.
Tertiary Intervention
Cut (surgery), burn (radiation), poison (chemotherapy)
If we get to this point, at least one individual is in severe trouble. The best outcome is to continue with some limitation. An example in the IT world would be a project that has significant cost overruns. The major options are to shut down the project or to invest in remedial actions and take corrective actions in management.
In less mature organizations, more individuals will reach this point. There is more disease in countries or regions where the public health infrastructure is less developed. There are more troubled projects IT and engineering organizations where the process infrastructure is less developed. The overall cost in human and dollar terms is far greater than the cost to organizations that refuse to invest in infrastructure, citing short-term expense issues and ignoring long-term cost.
Crisis (Chaos)
We don't want to get here. The graphic represents management with a parachute. We have examples of failed states (Afghanistan, Sierra Leone) and of places where rampant disease is leading towards state failure (Zambia). Enron gives us a fine example of setting the wrong policies in the upper right, corrupting the oversight mechanisms in the upper left, hiding damaged individuals in step 3, leading to step 4. Anyone who has spent time in the corporate world can cite less extreme examples.
The story on the upper right quadrant
I used the mosquito in this quadrant based on the example of dengue hemorrhagic fever (DHF) in Ban Pao, Thailand (for more details on Ban Pao and my time there, follow the navigation bar link at the next level up or click here).
Here's the story: the Thai Ministry of Health (MOH) observed increased incidence of DHF in areas near the borders. Ban Pao is in one of those areas. DHF is spread by mosquitoes. After study and analysis, the MOH determined that the best way to prevent the spread of the disease is to limit exposure to the mosquitoes that carry it--and the best way to limit exposure is to limit mosquitoes.
Unlike the mosquitoes that carry malaria, which are active after dark in rural areas, the mosquitoes that carry DHF are active during the day in inhabited areas. Options such as mass spraying of toxic chemicals are not viable. The MOH program include larvicide in all inhabited areas. Since many of the the inhabited areas are in remote areas, the program required local action and reporting.
In the case of Ban Pao, a village of about 600 people, there is a kingdom-funded Public Health Unit (PHU). The PHU includes a resident M.D., and is responsible for education on health issues in addition to treatment. Each family was responsible for administering larvicide in their homes (quadrant 1). Volunteers inspected the homes regularly and reported to the PHU (quadrant 2). The PHU reported results to the district, which reported to the province, which reported to the MOH.
Ban Pao had 22 cases of DHF in 1999. After implementing the MOH program, the incidence was reduced to 4-5 cases per year. If the program is maintained, incidence should reduce further.
The moral: individual villages may have been able to implement programs to reduce DHF incidence, assuming they had the knowledge and resources to respond. Some of these might have been effective. Far better for the Kingdom of Thailand as a whole to implement a national program.
By providing a policy, a plan that was tracked, supplying training, providing resources, assigning responsibility, managing the data, monitoring adherence, involving relevant stakeholders, and reviewing status at all levels, the Kingdom was able address a significant Public Health problem, reducing financial cost of caring for affected persons and reducing human costs of illness and death.
This is an excellent, true example that is applicable in a variety of contexts.
2005-09-17 17:38:24 -0000