At Ask! restaurant in Durham, where we went on Saturday night with friends, the toilets are more discreet than most.
There are individual cubicles: perfect for capacity planning. This means that, if you think that women will require more cubicles than men, you can allocate more cubicles to women. And they have done exactly this, four allocated women versus two allocated to men.
The reason Why?
There may be lots of reasons why they've decided to provide individual cubicles instead of restrooms; studying toilets is not my favourite activity. But it reminded me how important it is to match your resources (your capacity) to meet your demand.
Too much capacity for the actual demand: the service costs too much, and resources are diverted from some other vital service. If you are a commercial entity, your profitability will suffer. If you are a service for public good, you find yourself unable to provide some other service needed by the community.
Too little capacity: queues develop. Again, if you are commercial, you may lose customers; if you're a service for public good, you may be fined or severely criticised.
A dark art
But capacity planning is something of a dark art. In just about every situation I have worked for public good, the numbers have been relatively small; numbers on the list for surgery (12 lists but effectively 12 queues because it’s difficult to transfer patients between lists on the day); numbers of calls coming in somewhere between 1 and 30 of 45 per hour (reform of urgent care services in London) for example; 2.5 full-time equivalent GPs in the GP practice;.
It only takes one member of staff either way
Getting the planning wrong by one member of staff either way can have a dramatic impact on effectiveness. I've used a Poisson binomial distribution which dramatically demonstrates the benefits of scale; I've used Excel spreadsheets, and I've used the care planning system (CPS) designed by Simon Dodd. When the numbers from different systems converge, you probably have the right answer.
The Commissioner Provider split.
For providers, the benefits are obvious: the surplus of income earners costs allows investment in new ways of doing things, and better service in other areas.
But why is this relevant to the commissioner? We've noticed over the last few years the provider hospitals have an uncanny ability to work round demand management; wherever the commission has put their focus, activity booms in another place. It isn't clear why this is happening, but with payments to acute trusts rising faster than the increase in income to commissioners, and commissioners' income coming to a standstill, it matters! It's the same in social care; the providers have a lot more independence, a lot more autonomy, but the tensions to match supply to demand may be even more acute; and the commissioner can often help.
Second-guessing your provider, and understanding how they work, is important. And now, with the new contracts being written (2010/11 templates now available from the DH website) is the time to look more closely.
It's the right time to take action
We all recognise that resources are limited. We do the best we can with what we have. I believe I can help with the scientific approach, based on my experience in all of these areas. Please feel free to contact me.
What of those toilet cubicles which allow for both sexes - they have a little notice on the outside saying "either"?
They represent a different point of view. If (to take a healthcare example) your staff are trained to do more than one thing, for example to perform both joint surgery and chest surgery, then you can keep them busy all the time regardless of the mix of cases coming to them. The same could apply to someone with skills in both health and social care - instead of two people coming to the house (the personal assistant to get the person up and washed, the nurse to check blood pressure and administer medication) only one comes with skills to do both.
Does this make sense? It sounds ideal!
Not always. There are two reasons why not.
many skills need constant refresh. In order to be an exemplary surgeon in one particular speciality, you need to practice regularly. If you have too many different things that you are able to do, then you may not practice enough in any one of them. For example, nurses trained in treatment of adults have a hard time re-training to become children's nurses, simple because when there's an emergency the rule-of-thumb doses they first learnt and remember first are the doses for adults.
people with multiple skills are often/ always more expensive to train and command higher pay
Multi-use toilet cubicles are great where a restaurant only has room for two or three toilets. Each cubicle takes up more space as it has to contain its own wash basin, brick walls, etc. But where numbers are limited then flexibility is important.
Emergency Care Practitioners (ECPs) are more expensive than paramedics because they are more flexible. In their case, the choice is between two ambulancepeople with a full 1.5ton ambulance and one ECP in a car. Again, with small numbers (1 or two attending the patient), the ECP is cost-effective.
An A&E department has many more staff and many more patients. There may be a case for a multi-disciplinary team, ie where individual staff are specialists in specific skills rather than generalists, and patients need to be referred to the most appropriate individual.
Workforce design is an art form. That is, a specialist skill that relies on more than academic study, that relies on a deep understanding; a willingness to look at alternatives and quantify them and pick the best and second best (3 Ps and 2 Ws - Predicted, Possible, Preferred, Wildcard negative, Wildcard Positive); but principally that relies on experience and knowledge.
In a previous blog, I looked at some of the tools available for group collaboration, using the Internet. We concluded that for a team of admin staff in a GP surgery, Producteev.com was the best tool. It is simple to use, colourful, and much better for assigning tasks than using Outlook. But it has some severe limitations.
I'm a freelance consultant, when I'm not at the GP surgery. For my purposes, I need something with more structure than Producteev.com. Yes, I also want to be able to share my work. I want to be able to set up small collaboration groups with all sorts of different people:
I also needed much more structure; milestones, for example, and projects with a defined beginning, middle, and end. And don't forget, this is just for me – this doesn't even take into account what a small or large team spread across the world would require.
Producteev.com is just a task list, and you usually don't see anything shared with you unless it is directly assigned to you. This has advantages for workflow, because it keeps your task list empty. But it has disadvantages, because someone working on a number of different projects, like me, has to look in different places (the different workspaces) in order to find all of the tasks that are urgent today. There's also a cost of having more than one collaboration with – I have to pay a subscription for each separate group. With the subscription running at $20 per month, this could work out expensive.
Oh the joys of getting sidetracked by following a bit of research! What I'd overlooked in my previous articles was that Google, and Google apps, are just made for collaboration. Many of the apps available within Google (written, managed, and sold by many different companies) are collaboration apps, and many of them have a free version which is quite sufficient for my testing purposes. Running a search for “project management” brings up a whole range of integrated products, and running a search for “collaboration” brings up many of the same ones.
The last piece of research taught me something very valuable: narrow your range of options down as fast as you can, so that you can put a reasonable in-depth study on to the final few options.
Google apps offers an excellent way to narrow down the selection. You can sort by "highest-rated" (the ones that people using them have awarded the most stars to), and you can sort by "most popular" (the ones most often downloaded). Obviously, plenty of people have done this before me, because most of the "most popular" are also the "highest-rated"! A good start!
Producteev was in there. So were a lot of other products, which are examined in some depth. The one that caught my fancy is called "manymoon.com".
I installed it, and invited some people from the GP surgery to join one of my collaboration groups. They ignored the invitations, because they came from somewhere with a silly name – why do people give such silly names to products? I invited people at Skills for People, and my brother, to join other collaboration groups, and they joined. I now use it for my collaboration groups, and my tasks, and the surgery has decided not to pursue Producteev.com beyond the 30 day trial period, so I'm going to switch them over to Manymoon.

Manymoon is designed to put the collaborative working. It is also designed to multiple projects. This means that I can have independent collaboration groups on each project, instead of on each workspace (as in Producteev.com). This is great, because the collaboration group can see all the documents associated with the project (held in Google docs), the milestones, their own tasks and everyone’s tasks. They can see what’s going on, and see what part they play (I find this vital to getting people motivated). They can add to, edit, and complete different tasks – whereas in Producteev.com, only the creator of the task and the person to whom it was assigned could make any changes (this means that if one of the staff went off sick, we could find their tasks but we couldn't update them until that person had returned).
Another very important difference is that documents attached to a task in Manymoon.com are actually only linked back to the original document in Google docs. This means we have one master copy in Google docs, attached to any number of different tasks. This is potentially a dealbreaker against Producteev. If you attach an actual copy of the document to a task, there is a real danger that you end up with lots of copies of the same document, each with different edits made, and people can't understand why the changes they made aren't reflected in the final document.
Manymoon will be a real challenge. The interface is a typical project management interface, with lots of extra information besides a simple list of tasks, such as links to show you the projects/ milestones/ documents/ project members etc. This is bound to confuse people.
We keep all our documents on our S:\drive. Nothing that would have tasks associated with it would have any confidential content, so they could be hosted on Google Docs, but we would then have to make a special effort to move many of the key documents to Google Docs, and remember that the master copy was on Google Docs, not on the S:\drive.
Manymoon.com fulfils a purpose for me, So much so, that I have bought the premium subscription, which gives me a few extra features that I will find useful, and a whole lot of extra features that a tiny business like mine won’t use for at least a few months. What I do get is a bullet-proof environment which does exactly what I need for my day-to-day work, in planning projects and executing them, and in collaborating with different groups of people to deliver work for them, and with associates. Whether I can convert the Luddites in the GP surgery is another matter.
Primary health care, and in particular GP surgeries, are in the middle of some of the most dramatic changes in 60 years. We're faced with uncertainty, with falling incomes and rising demand, and we've made a commitment to make sure that we provide the best healthcare to the patients of our surgery. We have to innovate, we have to deliver new services, but we have to keep the basic service is going.
In my one day per week, I run the audits to check how things are going, and the reports to make sure we get paid on what we do (without income we can’t pay the staff for the hours they do on services. It’s a sad fact of life that GP surgeries are independent businesses and nobody bails them out if they spend too much). I need information to compile these audits and reports, and I need information to redesign services or create new ones (such as numbers of patients affected, amount we spend on sending patients into hospital to determine whether we can invest in a new diagnosis machine, etc). I need to get staff together to discuss the best way to approach a problem, and they are just too busy and practical to take time out to meet up and discuss something that is only an idea.
At the moment we have ideas, but they often don't get done:
We’ve created a mini-industry (no pun intended) of extra work trying to manage tasks: each team leader uses a different system to remember what tasks they requested or have been asked for
I thought there must be a better way.
The king of Getting Things Done is David Allen (author of the book by the same name, known affectionately as GTD). His method is based on keeping a single comprehensive task list, so it is out of your head and you can get on with the job in hand. The examples given are usually trivial, but it can be made to work in a shared environment.
Project Management is an alternative approach; with defined objectives, defined milestones and the tasks to achieve those milestones.
We need a hybrid – GTD is about day-to-day tasks, but we also need a sense of purpose to create innovation.
I plugged these two concepts into Google and went looking for my solution on the Web. I also want a solution which is web-based because that means we don’t have to set it up or maintain it, and we don’t break the rules on our outsourced IT support.
A search for Getting Things Done reveals a number of web-based shared task lists which claim to comply. I investigated the following:
ActiveCollab; GetItDoneapp; GoalsOnTrack; Gyronix Result Manager for MindManager; Jello-dashboard.net; Nozbe; Producteev; Propel’r; Remember the Milk; TaskAnyone; TaskMerlin; Taskmind Web; Toodledo; Vitalist; Voo2do;
A similar search for Project Management revealed these as the main contenders:
Basecamp; Nirvana; Zoho Projects;
The next thing to do was make sense of these results:
On the previous page I outlined the problem that I was facing: improving productivity and innovating with an already busy team.
I went through each of these tools are at their ability to fulfil our requirements – how expensive are they,what technologies they use and support (do they support smart phones for example), and what features they have. I didn't know exactly what I was looking for the start, so I found I had to go through the list twice, and try out a couple, to work out what would work best.
Of course we couldn't try out every single product.
first pass through identified a number of results from the Google search which didn't really exist. They automatically scored zero. I also excluded all products that were really only designed for one person rather than a team – after all, the point was to improve collaboration.
|
Single user No product available Still in Beta |
0 |
|
Not strong on collaboration |
1-3 |
|
Good product for our purposes, if pricey |
4 |
|
Selected best products to research in depth |
5 |
in the above scoring table, you will see that some scored for, and some scored five. There are a lot of excellent products out there, but some of them come at a price. What do you get this price? Ease of use, ease of setup, extra features that we can't find a use for, and the ability to scale for staff of thousands (which we don't have).
I sorted these products in order of their attractiveness to us (score, as in table above). One of each type (task manager following GTD methodology, and project management) scores five i.e. we look at it in more detail.
|
Product |
Price |
Where does it run? |
Access in other ways |
Notes |
Collaborate score |
|
$20/month (unlimited users)= $220/yr (£170) |
Web |
iPhone & Android |
Task lists with tags which approximates to projects. Tendency to become cluttered as every assigned task becomes a separate task and tasks out in the future are also visible |
5 |
|
|
$99/yr (unlimited users – other options including time tracking and billing also available) |
Web |
Use a simplified Mobile web interface |
Zoho is a powerful suite and Projects is good at getting things done, by highlighting what is dependent on what and keeping status reports. Doesn’t include tags and context, and may be project centric |
5 |
|
|
$249 to buy, $99/year after purchase (£150 + £60/yr) |
Local server (we’d have to set it up) |
We’d have to set this up – not sure |
Considered one of the best solutions for collaborative working, but requires technical knowledge to set it up |
4 |
|
|
$49/month (unlimited users but only 35 projects) = $600/yr |
Web |
Various tools, extremely widely supported |
Very project centric. Not easy to tell if it is easy to run multiple projects at once, ie to give a list of to-dos across all projects. It looks as though we need to work the Basecamp way for best results |
4 |
|
|
$39/yr/person; for 20 people $780 = £500 |
Web |
iPhone, Android; Can also collaborate through email |
Hides tasks which are not due |
4 |
|
|
20 users = €49.95/mo ie €600 (£550) per year |
Web |
iPhone, Android, paper |
Seems to be second best known after Producteev (though that may just depend on the review articles I read). Very good user interface |
5 |
|
|
Gyronix Result Manager for MindManager |
$285 per person |
Desktop |
No |
Works with MindManager, which in turn works with Project Management software and allows collaboration |
3 |
|
€12/user/month. For 20 users = €2,880 (approx. £2500) |
Web |
Also desktop (Adobe AIR) and iPhone |
Projects appear to be an afterthought, and tags are personal. The web page makes interesting reading though |
3 |
|
|
$49.90/mo (Checklist+TaskAnyone combo), for 20 users that’s approx. $12,000/ £7,500 |
Web |
Don’t know |
Web site not explicit, though collaboration on projects looks like an afterthought |
2 |
|
|
Free, more features with Pro $14.95/user/yr (20 users $300 =£200) |
Web |
Paper (special printed lists), iPhone, Android |
Use Folders (like projects), subtasks (hidden within a task to save “busyness” – pro account only), tags, contexts. Not quite as robust collaboration tools as others |
2 |
|
|
$49/yr, for 20 users $1000 £750 |
Web |
iPHone, Smartphone |
The standard for GTD, but not strong on collaboration |
2 |
|
|
$99/yr, id $2000/ £1500 |
Runs on server |
Don’t know |
Focussed on capturing tasks. Not strong on collaboration |
1 |
|
|
Free |
Web |
|
Collaboration features aren’t particularly well developed |
1 |
|
|
single person setting goals. $5/mo |
web |
Haven’t investigated |
Thought to be very good for life goals – includes Vision Boards etc |
0 |
|
|
Free – Outlook add-in |
Works with Outlook |
Desktop |
Applies GTD principles to Outlook |
0 |
|
|
Still in beta |
Web |
Web interface for smartphone |
Still in beta |
0 |
|
|
Not available yet |
Web |
Promises smartphone access |
Too many promises, not enough product |
0 |
|
|
Single person lists – usually free |
Web |
Smartphone access for Pro account $25 |
Best known task list product, though it isn’t clear how the collaboration works and it isn’t really designed around a project interface – we need projects |
0 |
Helping busy teams to be both more productive, and more innovative will require collaboration, which means we need to know where discussions happening, and how to access the results. We need to focus, so that what is important gets done, and what is not important is identified and ignored.
I outlined the problem, and then I compared the various solutions we found.
We identified two front-runners for our purposes – Producteev.com which is an easy-to-use delegated task list, and Zoho Projects, a low-cost Web based project management tool, and part of a major suite of business productivity tools.
Producteev.com is extremely easy to set up. You just type in a series of tasks, and assign labels which, in GTD fashion, allocate the tasks into the equivalent of small projects. Anybody using the system can see all the tasks, and in particular the ones assigned for them to take action on (of course it is possible to restrict which tasks people can see, if that is necessary), but its key advantage is that the tasks allocated to a person are listed in date and priority order so that the most important things get done first.
Even with a very long list of tasks (i.e., so they are out of your head) it's very easy to see what needs doing and get it done. This is proved to be a massive productivity boost – Joseph and I can discuss our priorities and check the duplicate requests before assigning tasks to staff, and we can attach notes and files for clarity. When staff have a moment, whether I'm in the building or not, they can add their comments; and comments are all kept in one place (attached to the task) in case anyone needs to backtrack.
When we need input from each professional group within the GP practice, we can assign a series of tasks, and quickly see who has responded and who hasn't; no more wading through e-mails; no more asking each other whether someone responded to the wrong person. It is cut out nearly all the wait, especially since Joseph and I are hardly ever in the same building at the same time.
Producteev.com has a free account allowing two users, which means we can try it out between us without making a commitment.
Zoho Projects has a free account allowing only one project, but Unlimited users, which is also fine for working out if the software will do what we need.
Since most of our work is the day-to-day running of the practice, it was quite difficult to get Zoho projects set up. We created a series of milestones – things that have to be completed by a certain date. Within each milestone, we created task lists: buckets with the name to hold all of the tasks created. Then within a task list, we could start creating the individual tasks and allocating them to people. This means that before you can start creating tasks (probably the first thing on your mind), you need to work out what you are trying to do (and perhaps this is a good thing!).
The video is included because you need it to understand the concept.
Zoho is extremely structured, almost to the point of irritation.
You can assign a date for completion of an individual task, and that affects its position on the list. But it is difficult to tie a group of tasks together (other than with the tag) or put them in context. Also, it doesn't implement full GTD methodology – it doesn't have a "context" tag which would allow me for example to see "I've got an hour of uninterrupted time – what is the best use of that time?". If I have uninterrupted time, I'd like to fill this hour with things that need concentration, rather than urgent phone calls which I can do from anywhere, even in the car.
Of course both of these (overall aims, and working in an environment other than the office) are less relevant to the admin staff who want to know what we want, clearly and precisely, so that they can just do it and hand it back. Producteev.com is great because it's very easy to use, very easy to start using, and very visual. And there's an iPhone app (for Joseph), and an android app (for me).
It shows all the tasks assigned to a person sorted by their task list rather than by their priority or date of completion. This means you can quickly have two or three screens of tasks, and not be sure where to start without looking through all of them.
On the other hand, all documents and discussions are attached to a deadline, which makes it much easier to keep track of a lot of different tasks going on and to see all of the tasks in context – this means that everybody can come back with better ways of ultimately achieving what we want, because they can see where we're going.
It's not quite as pretty as the more expensive web Project Management product basecamp, but it has some extra features, such as dependency between tasks (this is not well implemented – there's no visual representation).
Ease-of-use won out in the end.
Project management, done by Zoho projects has some really big advantages for a small business, or medium-sized team, like us. But asking the staff to get to grips with the project management concepts, when most of their work is simply answering the phone and booking appointments, didn't make sense.
Task management, and maintaining discussion areas and document repositories has worked out better for them and us. Productivity improvement still have to be estimated.
Perhaps we'll have another go next year.