Another way of looking at healthcare improvement

A personal experience

A friend of mine was diagnosed in Sep 2013 with a tumour next to his lung. He was referred by his hospital to another city hospital for consultation.

He waited until mid-November before contacting his GP who in turn rang the first hospital. It was then discovered that his file was not forwarded to the city hospital until a while later but because he moved to a new property in 2012, he should really be seen by a third hospital. Meanwhile, he waited.

I only discovered his plight in mid-December. Immediately, I assisted him via my contact and managed to secure an appointment for him to see an oncologist from the city hospital. After his appointment the following week, he was told that he needed a scan.

By late December, the letter has not arrived even as Christmas and New Year break are happening. I am wondering from the perspective of harm what has the system done to him in terms of making him wait and whether we could have done something about it? I am thinking whether someone who does not know the health system could have actually waited longer? I am sitting here and working through the degree of physical and psychological harm that is impacting my friend because of the systemic failure?

Reducing harm currently

In New Zealand’s healthcare, quality improvement is seen within the context of some static events. For example, the Health, Quality and Safety Commission (HQSC) reported in its Serious and Sentinel publication of 2013 the following static events: 

From the analysis, it is obvious that ‘Falls’ is indeed a major event responsible for 51.72% of all serious and sentinel events. If we expand the category of ‘Clinical Management Serious Adverse Events’, you will realise that it covers off the other activities like ‘Diagnosis’ and ‘Treatment’[1].

These events tend to be treated as separate, unrelated and, if I may say, siloed. If ‘Falls’ is the largest component, then our challenge is to organise improvement activities around how to reduce falls. We end up treating each event as its own entity or effectively a time-limited, finite project.

Across other industries

However, organisations outside healthcare are learning that it might be better to see them as linked.

Banks, telecommunication and manufacturing companies, for example, are adopting a process approach to looking at improvements, following the Lean principles developed by the renowned Japanese car manufacturer, Toyota and its accompanying Toyota Production System (TPS).

In New Zealand, telecommunication companies like Vodafone and Telecom are strong believers of processes to lead improvement because lean focuses on the customer and what is important to them (value) while attempting to eliminate the aspect of waste. Lean also allows us to track the elements of time and quality (defects) within the system.

Lean process improvement’s fundamental principle lies in the fact that none of us work alone and that we are all part of an overall process. A time/ quality defect is usually a systemic reason rather than a people issue.

In other international healthcare organisations

In healthcare, making improvements through understanding their processes is still in its infancy.

Perhaps the most prominent adopter of LEAN process improvement is Thedacare.Thedacare is the largest healthcare provider and employer in Northeast Wisconsin employing more than 6,100 staff in 43 sites and five hospitals, serving more than 250,000 patients. Thedacare used process management to deliver improvements by reducing defects, improving patient outcomes, eliminating waste and removing unnecessary costs through its unique improvement system, the ThedacareImprovement System (TIS).

John Toussaint, the former CEO who is a pioneer in this journey, has written a well-regarded and easy-to-read healthcare improvement book titled ‘On the Mend’ in 2010.

In an article published by www.mayoclinicproceedings.org[2], ThedaCare clinic reported the following:

• Reduced inpatient total cost of care by 25%
• Improved patient satisfaction to nearly 100% of patients rating their care 5 of 5
• No medication reconciliation errors occurred for patients in hospital units served by care teams that include a pharmacist over the past five years.

Then, there is the Ottawa Hospital (TOH)[3], which became the 2013 winner of the Best Start-Up Business Process Improvement Programme awarded by the Process Excellence Network[4]. TOH set about integrating their processes to technology in order to drive improvement.

Organisations, including some in healthcare, are looking at improvements from a lean flow process perspective.

Strengths of Process Flow

What does process flow offer us that are different?

When we recognise that all organisational activities are arranged as a series of events, we can begin to see the benefits. Toussaint, in his book, On the Mend, shared four advantages as follows:

• It allows us to focus on patients and design care around them
• It identifies value for patient and gets rid of everything else (waste). This ‘waste’ can be defined as the elements of time, $, and poor quality
• It minimises the time to treatment and through the course, and
• It energises the work practices of continuous improvement every day in every area

More than that, it also frees staff to work collaboratively across the organisation, recognising the impact each has in his/ her own area of responsibilities and on another. It gives a chance for everyone to see the ‘big picture’ while not losing sight of the patient as their main focus.

How can we make process flow work?

Like Telecom and the bank, we can divide a patient’s events into these discrete parts[5] as follows:        

• Assess and Diagnose
• Consult and Plan
• Admit
• Care,
• Cut (Surgery),
• Stay (Ward),
• Treat
• Discharge or Transfer
• Prevent

The objective is to rally people together to work collaboratively on enhancing that which are valuable while eliminating that which are unnecessary.

Challenge to think differently

Problem solving can be approached at different angle. What ThedaCare has done is to demonstrate to us that there are other ways that we can look at improving safety in patients. Instead of taking the traditional problem solving route, Toyota has shown us another approach and ThedaCare has adapted Toyota’s lean for their use.

Rolf Smith[6] highlighted seven levels of change as follows:

LEVEL 1:	Effectiveness	DOING the right things
LEVEL 2:	Efficiency	DOING things right
LEVEL 3:	Improving	DOING things better
LEVEL 4:	Cutting	Stopping DOING things
LEVEL 5:	Copying	DOING things other people are doing
LEVEL 6:	Different	DOING things no one else is doing
LEVEL 7:	Impossible	DOING things that can't be done

In New Zealand, this approach towards looking at improving safety in healthcare would be at Level 6 but it would be a Level 5 in America because a few healthcare organisations have already began the journey.

Borrowing ideas across industry and from Toyota is not new. Boeing, the global leader in aircraft manufacturing did that too for its main money earner, its 737. Where once the 737 was produced by bringing workers to the plane, it has reversed the journey to bring the plane to its workers through the ingenuous use of a conveyor belt – a flow approach.

It was a Level 5 in the car industry but a Level 6 in aircraft manufacturing. The result was astronomical as follows:

• Reduced assembly time from 22 days to 11 days
• Reduced WIP inventory by 50%
• Reduced number of crane lifts - from 8,000 crane lifts/ month to 3 crane lifts/ airplane
• Up production to 47 planes per month

Coming back to my personal experience

It is mid-January 2014 and my friend is yet to receive his appointment to get his scan done[7]. I have been involved in improvement for years – from newspapers, to telecommunication, and then banking. I have seen the benefits as well as carried out some end-to-end process projects using Lean.

It identifies waste and value to a customer quickly. It advocates collaboration between members in that process. After seeing what happened to my friend, I believe that Lean would provide better value to make improvement.

Sensei888
4 Feb. 14

Don't give a man a fish .... Teach him to fish ....

“The best problem solvers are the people doing the job because they are closest to the issues. The important thing is training them on a set of tools to use.”

Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.

Everyone can be trained to fish. In the last illustration, I demonstrated this through a group of delivery riders. Here is yet another example to motivate you.

Gathering statistics need not be difficult if people know what they are looking for. A case study is attached here although the real numbers have been manipulated to protect the ‘innocent’.

This case study involves a HR Admin department that was trying to reduce its errors in Employment Contracts and also the time that it was taking to turnaround the contracts. The errors had legal implications. So, getting the contracts right was very important.

If you need more information, post a comment here.

I Became a Kaizen Advocate

In the late 1970s, Singapore was going through her growth pains. The country was economically advancing but her productivity was lagging behind. Singapore was highly dependent on manufacturing but finding that finding the extra worker was getting more and more difficult. There had to be a better way.

Japan, meanwhile, was accelerating her growth. Despite the setbacks of World War 2, Japan had, by then, surged ahead of her Western counterparts and was becoming a superpower in the world economy. In a short span of 30 years after World War 2, Japan had accumulated a record trade surplus and foreign exchange reserves to become the world’s second strongest economy after the U.S.

As part of Singapore’s ‘Learn from Japan’ campaign, the then Prime Minister of Singapore, Lee Kuan Yew, visited Japan. He came away totally fired up with how Japanese workers went about solving their day-to-day problems. On his return, he directed the Government to start a statutory board, the National Productivity Board (currently called Spring Singapore), with the sole aim of raising workers’ productivity (getting more done with the same or lesser number of people).

One of the primary drivers was the introduction of Quality Control Circles (QCC), a structured team based problem solving approach that quite literally changed the way that Singaporeans and Singapore-based corporations operated. It did not matter whether it was a manufacturing business or a service outfit, the Singapore Government incentivised all staff to be trained on the QCC concept. In effect, it became a national 'indoctrination' programme on productivity or, in organisation speak, it was organisational development at a national level. Quite cool really!

QCC is very much the precursor of Kaizen. While Kaizen is a philosophy, QCC is the nut and bolt in problem-solving. It was THE original U.S. problem solving methodology adopted by the Japanese. Everything about QCC is based on facts and numbers. Little was left to assumption. If they were unsure of the facts, the staff would gather the relevant data and test it.

I became a Kaizen Advocate in the mid-1990s. I was trained in both QCC and QCC facilitation. I led a QCC team consisting of mid-managers and later became a QCC judge as well as taking on the role of the Productivity Manager of the newspaper company that I worked for.

What changed my perspective was seeing how such perceived ‘difficult’ statistical tools could be taught and used by frontline staff, some of whom only had 3 years of education. The project that had the most impact on me was seeing a group of courier motorbike riders resolving their problem – Difficulties in finding proper parking place within the Central Business District (CBD).

These riders had to collect and deliver advertising bromides, unheard of in current internet days, to the ad agencies in the city. However, the city has no designated free parking area. The council had a ‘charge all’ mandate, that is, if these riders did not park in the right spots, they would be fined and quite costly too. And it would not be practical to pay for parking since their roles would require them to move around substantially.

So, they formed a team to resolve this problem. They quantified their current parking habits over a three-week period and identified 3 main places to park their motorbikes as follows:

• Back lane (illegal but safe),
• Side of building (unsafe), and
• Front of building (definitely unsafe).

They found that they had to park 233 times over that period using the above options.

They then examined the root causes using the Fishbone diagram and found that a critical root cause was because riders were not sure of where the possible ‘legal’ parking spots were.

Included in their examination, they revisited the current modus operandi and devised countermeasures for each option, together with action statements. Here is their list of countermeasures:

Subsequently, they implemented their course of action and collected a 3-week 'After' data. This time, the team found that they had managed to reduce their problems to 102 incidents parking illegally, that is a more than 50% reduction from 233 cases.

I am convinced, more than ever, that basic statistical techniques can be taught. When I think of the education qualification of a typical manufacturing worker in South East Asia, I am emboldened.

If we believe in our people, raise the expectation bar, and provide the correct training and environment, everyone can problem-solving systematically using the QCC (Kaizen) approach.

You may say, "I have been there, done that". Having seen it done, it is really not that difficult.

Hold Your Horses!

We love problems. It gives us a chance to showcase our abilities in finding solutions. And when we have resolved the issue, we do all love a nice beer around the BBQ to rejoice. After all, it is a job well done, a pat on the back, and a time of celebration, that is until the next problem happens.

When a problem is identified, many of us think we know the solution. Some of the fortunate ones in authority may simply define a project to resolve the perceived ‘problem’. We start engaging a team of people. We may even assign a project or a programme manager, depending on the size of the project, to turn the solution into a reality. If we are in government, we might even birth an entire ministry. Whether it is the Agile methodology or ‘Waterfall’ strategy for project management, or the formation of a department, the horse has bolted.

But what if we are solving the ‘wrong’ problem? What if solving that ‘problem’ result in giving us a less-than-optimal solution? What if the ‘real’ problem remains while the illusion of resolution sits comfortably with everyone? Heaven forbid, but is it possible at all that such a case might exist even among well meaning and capable managers of businesses?

Let me illustrate with a real problem. I was working for an outsourced business partner of New Zealand Telecom. The company was having a problem meeting its call centre service level as it was unable to find sufficient staff to man the phones. Ringing-in customers were made to wait for a long time on the phone. Telecom was unimpressed. The outsourced partner needed to increase its manpower level to meet the call targets. But in a tight labour market, Human Resources was running out of solution. I was approached to offer more avenues.

I decided to take a different approach by looking at the problem through an analogy; I treated incoming calls as water and asked myself what I would do if it was a case of a heavy deluge. By so doing, I reframed the problem from “How do we find more people to man the phones?” to “How do we drain away the heavy call volume?” In so doing, my solutions became quite different from the original plan which was to look for more avenues for manpower. Instead, I started to look at the possibility of making use of the Interactive Voice Response system (the thing that people hear when they are waiting on the phone). I explored the option of using the internet to redirecting callers to find their own solutions. I reviewed alternatives available to get call centre representatives to help reduce the number of incoming calls.

In a short period of intense work, we were able to resolve our problems that looked insurmountable at the beginning; we simply practiced problem reframing.

Problem reframing is possibly the most important job of a leader. Leaders are expected to create reality for the organisation. To reframe a problem is to change what people consider as important or pay attention to. Because all solutions flow out from the way that we ‘frame a problem’, the ability to use this skill is so critical to all that we do, especially so if one is a leader.

Problem reframing is practiced my politicians, marketers, and managers alike. We may recognise this as ‘spin’ in politics but it is a powerful tool. Consider the case of the late US President Ronald Reagan, who when his opponent Walter Mondale commented that Reagan was probably too old for the position simply responded that he did not think age should be an issue and he had no intention of making an issue of his ‘opponent’s youth and inexperience.’ In one comment, he reframed the question in a way that made sure that age would not be a major factor in the race to be President.

Again, let me demonstrate how reframing can force our minds to work differently. Because of the astronomical demand of the narrow 737 planes, Boeing had to increase the production dramatically.

Airplanes have always been built on the premise of bringing workers to the plane, i.e. keep the work-in-progress (WIP) plane stationary and bring in the workers. After all, a plane is mighty big and how would you move it?

However, car manufacturing is quite different. It is made on a conveyor belt, when the work-in-progress car creeps up to each set of workers located in a ‘station’. The question was, could planes be made like car production? And the production system became a reality.

That reframing resulted in the following reduction:

• Assembly time from 22 to 11 days,
• WIP inventory by 50%, and
• Number of crane lifts - from 8,000 crane lifts per month to less than 100 crane lifts per month (3 crane lifts per plane).

It allows its production to grow astronomically and it is projected to deliver 38 planes per month by end of 2012 (Production as of June 2011 was 31.5 planes). If they did not reframe the problem, it would be a mighty achievement even if assembly time had come down to 20 days. But we know that would not solve Boeing’s problem.

Boeing 737 video

 

Problem reframing is a powerful tool. The earlier a problem is reframed, the better it is. Because once a problem definition is accepted, and people start investing their time and effort into how they understand their problem ought to be, it will be far too great a price to pay to change that perception; consider the issues of the politics of time investment.

The message is obvious. Be clear about the problem you are solving. If the problem you have identified is ‘I need a negotiation skills training programme’, get more concrete examples. Go and see and do some analysis.

Don’t fall into the trap of accepting the first problem definition. Try different ways of reframing (NB: There are techniques that help you do so but that is for another time).

Here are four golden keys that I learned:

• All problem definitions are based on assumptions,
• Once a problem is defined and accepted, it is almost impossible to change that view,
• The way we frame our problem determines the way we plan for the solutions,
• Always get your bearings right. That way, you will be sure that you are solving the ‘right’ problem.

As a leader, it is simply too expensive to solve the wrong problem or miss the right solution.

Organisation - A Real Big Elephant

Organisational problems are not the same as individual problems. Organisational problems tend to be more challenging. And herein are some challenges:

• The older the organisation, the more systems and processes they have. And some of them have been around for so long that no one is prepared to take the bold step of removing them. So systems pile on top of systems.
• With technology, we see the increase in computer systems. But for two interacting systems to work, they must be able to communicate with each other via ‘interfaces’. Like bringing together two surfaces, there is a need to make sure that the two are glued properly so that they do not come apart at critical times. Now, the ‘glue’ is the interface and the two surfaces are the relevant computer systems. Depending on whether the two surfaces are made of the same materials, the type of ‘interfaces’ might be quite different.
• Some key systems have been in organisations for many years and no one dare to do anything to it. What if someone ‘breaks’ it?
• Business Analysts, when preparing to write a process in a system, fail to consider all business requirements and ask the key questions, effectively having a less-than-optimal solution in the system and that will require subsequent visits later on.
• Cost of upgrading anything within the system is mighty costly. So, no one wants to do anything because it is in a ‘too costly’ and ‘too hard’ basket.
• The bigger the organisation, the more systems, processes and people are involved. Complexities and management increase.
• For big organisations, those who do the job may not want to document the processes because of inconvenience, not having the skill or simply to protect one’s own job. These people handling the process may determine precisely not to do any process documentation.
• Even if these processes are documented, the organisation may go through restructuring over time, be it a retrenchment, merger or demerger (Think of the merger of city councils as a result of political realignment, e.g. the Auckland City Council). All these make documented processes redundant. In addition, unless they are updated, reviewed and managed regularly these will over time become irrelevant.
• Even if they are documented, there are the issues of finding them and making sure that staff are communicated, trained and updated every time a change takes place. Documents maybe kept in different forms in different places. Now, which is the correct version again?
• Then there are the issues of politics and silos. Organisations are made up of people who are structured by departments. People tend to operate comfortably within their own departments but a ‘product process’ is likely to touch several departments. Each department tends to view only to aim for their own benefits, sometimes forgetting the impact that their actions may have on their other business partners. They do not know what the other department is doing.
• Next, there is the issue of ‘process owners’. If the process is handled by two big divisions, e.g. wholesale and retail, then which division is responsible for the process?
• Culture of ‘empowerment’ can complicate things. ‘Empowerment’ to the point of each department looking after their own areas.
• What about the other ‘people’ aspect of staff turnover and promotion? An organisation that has a high staff turnover will face more problems than others. People do move on and they bring along the organisation’s institutional knowledge in their heads.

I hope by now you see where I am going with. Solving organisational problems is likened to untangling a messed up ball of wool; where would you start? 

Sometimes, it is much easier to begin all over again but, with big and entrenched organisations, it is impossible to do so. The ‘best’ least intrusive long-term solution is to make sure that the discipline of governance, documentation, and review is carried out.

Ever been to an old building that has been well maintained regularly and still spick and span? That is exactly where organisations ought to be when we apply the same level of discipline.

Let me know if you need help.

Call Centre Fundamentals Part 2

Contact Centre - Systems & Technology

The Contact Centre has two main elements of Systems & Technology and Customer Service Representatives (CSR). ‘Systems and Technology’ helps CSRs to perform their function well while at the same time provide data in regard to the contact centre’s performance.

The key elements under ‘Systems and Technology’ are as follows:

• The Knowledge Bank,
• The Call Management System (Queue Management),
• The Quality Assurance System, and
• The Feedback System.

The Knowledge Bank is the BRAIN of the contact centre. It is a one-stop information centre and, in its perfect state, it contains all processes, with detailed business rules and procedures, to enable CSRs to refer to and do their job consistently (one-way, same way) across the business. It allows CSRs to diagnose a customer’s issue with minimum fuss.

Most good knowledge banks have two main things going for them – they are structured for simplicity using a product life cycle approach and they are managed by specialists whose task is to be gatekeepers of information. It is also the job of the specialists to practice good housekeeping, maintaining and keeping it relevant, current, and accurate.

The Call Management System tracks that CSRs are resolving issues quickly. It provides statistical performance, especially that of customers wait time, i.e. the time that the customer is waiting to be answered. ‘Wait Time’ affects a customer’s perception of the Company.

Software to manage contact centres are plenty but they generally would be tracking data gathered from the phone systems, e.g. how long it takes before a call is answered, how long it takes to do after-call work, time away from phone.

These reports help the contact centre manager to manage its contact centre while, at the same time, monitor critical issues.

The Quality Assurance (QA) System aims to answer the question: How are we doing relative to the basic goals of a contact centre. Quite simply, to answer the questions set out at the front:

1.       Are CSRs diagnosing customers’ queries ACCURATELY?

2.       Are CSRs resolving these queries QUICKLY?, and

3.       Are customers going away with a positive impression of the Company?

Statistics captured in the Call Management System might help us answer Question #2, that is, the speed of completing the call but unless there is someone listening in on that call and understanding how it went, the CSR might just be closing off the call without resolving the query. 

Hence, implicit to the QA system is a need for specialists to be involved in listening and independently assessing the performance of that call. A good QA practice follows these guidelines:

• Set Performance Service Standards,
• Train CSRs on these Service Standards (in order to calibrate organisational expectations with the individual/ CSR),
• Monitor adherence to Service Standards (that include both verbal and visual),
• Provide feedback to Management and CSRs,
• Review and update Performance Service Standards in line with rising customer expectations (via feedback from customers, CSRs, the industry),
• Provide feedback to Recruitment so that the hiring requirements are altered.

The concept is that Service Standards are met not once but repeatedly so that they eventually become part and parcel of the centre, or effectively they become the culture of the place.

Finally, there is the Feedback System. This is over and above the QA system because it is intended to provide ‘real-time’ information to address ‘real-time’ issues. Sometimes, a contact centre uses an online survey within the system. Other time, the contact centre might have a Ops team to track real-time issues. Effectively, a contact centre must create a triage system to manage real-time issues quickly while balancing the BAU activities.

All these systems should feedback into the Capability Team so that they are aware of ongoing training essentials.

Contact Centre – The CSR

The CSR is the most important person for the contact centre. Technology and Systems help the CSR to perform his/ her tasks but s/he is the company representative and, hence, the real face of the company.  There are TWO Cs that the CSR must possess:

• Competencies – that is, the technical, product, and customer-service knowledge and skills that the person possesses in order for them to perform their role proficiently, and
• Commitment – that is, the readiness of the CSR to adhere to a scheduled plan in taking calls.

Going back to the fundamentals of a contact centre is critical. Now, I might be a bit longwinded but let us refresh our goals:

• To diagnose a customer’s issue accurately,
• To resolve it quickly, and
• To convey a positive impression of the Company to the Customer.

At a contact centre’s level, to ‘resolve issues quickly’ is dependent upon the number of CSRs available at any one time to take calls. This is the concept of ‘The Power of One’ where each CSR is scheduled to be present is present to take the calls. Really, what it means is that there must be the RIGHT number of the RIGHT people in the RIGHT place at the RIGHT time that will make the difference. While forecasting for the right number of people is important, it is just as critical for CSRs to adhere to their planned schedule; ‘adherence’ is a most important requirement for a CSR in a contact centre. ‘Adherence’ is a big part of ‘Commitment’ as failure to adhere will directly impact on the availability of CSRs to take calls. ‘Commitment’ impacts on unpredictable ‘shrinkage’, ‘shrinkage’ being the amount of time lost due to things relating to vacation, breaks, lunch, holidays, sick leave, and training.

‘Competencies’ is a function of many things but the big ones being Training and the Knowledge Bank (in supplying the right information at the right time).

In effect, a competent and committed CSR is someone who achieves a sound answering time, provides consistently good customer service, identifies the customer’s issue quickly and resolves it within one single interaction.

In Summary

Why are contact centres so popular these days? Contact centres primarily exist because customers do contact an organization from time to time.

Whether we are buying something, or changing some account details, or resolving an issue, we are likely to call rather than visit a Company.

But because a Company cannot afford to have a person sitting on the telephone just to answer to OUR query, we have a contact centre scenario.

Looking at it as a Service Triangle, we may now include as seen below:

To a Company, we can convert the above into the following, that is, answer a Customer:

• A set of ACCEPTABLE SERVICE MEASUREMENTS that have been identified and agreed to by the Company,
• In a manner that provides you with a relevant PLANNED SERVICE EXPERIENCE, and
• One that results in meeting all your queries within the same single call. The term used in call centre is that of ‘FIRST CALL RESOLUTION’.

What Do You Have In Your Hands!!!

In the early 1920s, Dick Drew created the masking tape to meet the need of the auto paint shops. Most of us could have stopped there because the sales for masking tape were substantial. Not Dick. Instead, he wondered what else he could do with the masking tape technology. He saw his role as creating new uses for adhesives, not marketing more masking tape.

He progressed onto Scotch cellophane tape that has become a ubiquitous product in our households. Scotch tape was invented in 1929 for an industrial customer who used it to seal insulation in an airtight shipping package.

Then, there are 3M reflective traffic signages. As you travel down major highways at night, you will come across huge, bright green signs with the road names in either white or yellow, and reflective, to catch your attention. These are 3M products. In 1939, 3M combined the masking tap technology with the glass beads project technology and developed a weatherable film with reflective properties for traffic road signage. Today, improvement to the original version of traffic road signage can be found in products like Scotchlite, High Intensity, and Diamond Grade, all 3M patented products. Most road signs around the world are serviced by one of these products.

You board a double-decker bus in London. You are impressed by the huge ads hugging the sides of the bus. You wonder how long it took for advertisers to paint the bus. Now, here is the value. The advertisers do not pain the buses. Using a process called silkscreen, they transfer the ad messages onto non-reflective films that are then carefully positioned onto the buses. You guessed right. It is yet another 3M product called Scotchcal that was invented in 1953 to meet the needs of aircraft signage. Scotchcal combines the adhesive technology with another newly discovered 3M technology in polyester (PET) film.

You are walking towards a glass wall. The glass wall is so well polished that you would hardly know that it is there. You could almost have crashed into it if it were not for a thin, blue strip in the middle. Another 3M product? Yes, and it is called Controltac. Water is used to adjust the film’s position onto the medium. eM’s Controltac graphic markings are used as effective travelling ad. They are used for fleet markings, car decoration and awning designs. The word, ‘Fedex’, on the sides of the Fedex vans is probably made from 3M’s Controltac. So are colourful awnings on top of Z and BP petrol kiosks.

You drive along a particularly hazardous stretch of highway. You recognise that not only are the signage reflective, even the road pavement markings do the same. You have probably encountered yet another 3M product called Stamark. Stamark’s strength is its ability to retain retro-reflectivity.

You are going overseas. With your passport, you visit the immigration booth. The officer scans its data into the computer system. She verifies your passport to ensure that it has not been tampered with. With her blessings, you are cleared to proceed. Your passport may yet be protected by a unique 3M security film.

You injured your finger while cutting a pineapple. Blood is oozing out in small drops onto the cutting board. It is not serious but it requires attention. You open your pantry to look for your first aid box. Inside, you find 3M’s Active strips, flexible foam bandages as well as Micropore. You choose Active because it adheres better to moist skin. Active is yet another 3M product that represents a combination of the masking tape and medical technologies. Then, there are 3M Tegasorb ulcer dressings, 3M Tegaderm transparent dressings, and 3M Minitran transdermal delivery system that are able to dissolve the drug in the adhesive.

You enter your office. On your desk is a file with a piece of Post-It note paper informing you who will be coming by later in the afternoon. You look at the Post-It board on your wall. It shows you the key tasks that you have to complete by the end of the day. You are reading the documents in your file. Your colleague has flagged down a document for you to sign using, yes, yet another 3M product – the Post-It tape flag.

I could go on and on. The point is clear. 3M people have this uncanny ability to ask the right questions and come up with different uses for the same product or, if I may add, the same technology. They have also been able to combine existing technology with new ones to create new products.

Now, that is creativity.