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I’ve lost about 18 pounds in the past three months, so I’ve been thinking about goals and performance improvement. (When I say there’s more to me than you might think, I’m not necessarily bragging.)

In February, people in my wife’s office started a Weight Watchers group. It seems if enough people sign up, the Weight Watchers organization arranges for a leader who coordinates weekly meetings. My wife saw this as an opportunity to lose weight that had begun to bother her. I’ve gotten to benefit from the program without having to be in the group.

This post and its planned successor aren’t meant to advocate for Weight Watchers per se. What I’m doing is examining this specific program as a multifaceted approach to a complex problem.

You’d think the goal part would be simple. “Lose 20 pounds” sounds reasonable. When you hear that, you assume someone’s done some analysis, and a 20-pound loss is the desired result. In a way, it’s like a client who wants people to “understand” some business process.

When I’m off duty, I think “understand” is a terrible word to see in a goal. It utterly fails the Heydad test: “Hey, Dad, watch me while I understand inventory management.” Not that I don’t believe in understanding. It’s more that people will load this over-broad term with their own meanings, and it’s inevitable that the various meanings will clash.

I’m reluctant to change a client’s own vocabulary at the outset, though, so I’ll try to find out what “understand” means in terms of observable results. And that’s an approach to take with “lose 20 pounds” as well, even if the client is your own fair self. Probe for the symptoms, probe for the possible causes, and look at the fit between cause and possible intervention.

What tells you you need to lose weight? What indicates that 20 pounds is a good amount to lose? What time frame do you have in mind (and why)? How do you know a diet is the way to go?

To make some of those answers explicit for myself, I’ve come up a goal of being in the best shape I can be. That’s tough to write, because I’m not in particularly good shape, and because I can be mighty self-critical. But it helps me reframe weight loss as an enabling objective: I want to lose weight as part of getting myself in shape.

This reframing also helps keep quibbling down. Take body-mass index, a widely used formula to relate weight to health risks. If you’re really tall, or really short, or really muscular, then your BMI may not be a good indication of health.

On the other hand, if you’re six feet tall, not muscular, and weigh 243 pounds, you could do worse than pay attention to your BMI number.

That number would be 33. It’s beyond overweight; it’s  more than 20 pounds into the “obese” range. Whatever a good weight for you is, it’s probably not one with a BMI of 33.

When you come to Weight Watchers, the program assumes you’ve done some of that analysis, and that weight loss is a reasonable goal for you. I can’t say for sure, but I’d guess the meeting leader tries to counsel people who don’t seem to need to lose weight.

The program’s “healthy weight ranges” make use of BMI, suggesting that you aim somewhere between 20 and 25 (for that six-footer, 147 to 184 pounds).  But dogmatism isn’t the characteristic tone:

For now, use the Healthy Weight Ranges chart as a guide… your ultimate weight goal is totally up to you, and any weight loss that results in a lower BMI than your current one and can be maintained for the long term means success.

In addition, if you adopt a goal outside the range for your height, the program will accept that with a note from your doctor.

While I assume many people have some ultimate goal in mind from the beginning, Weight Watchers suggests an interim target of 5% of your current weight. (That 243-pound person’s target would be 12 pounds.) So you’ve got a flexible goal tailored to the individual, one that relates to the short-term desire for progress while acknowledging that its achievement is a stage on the way to greater accomplishment.  The next target?  10% of starting weight.  (That’s cumulative, not an additional 10%.)

I see a great deal of value in this. For most people, it’s hard to lose weight. Without extreme effort, a pound or so a week is good progress. But who wants to “progress” through 20 or 30 or 40 or more weeks? Three months isn’t a bad time horizon. In fact, in the initial stages of a weight-loss plan, most people lose at a slightly more rapid rate.

Here’s the deal: if you want to lose weight, you have to use more calories than you consume. How you manage that equation can vary: eat less, move more, or combine the two. “Eat less” and “move more” are concise expressions of complexes of behavior.

In my next post, I’ll talk about a number of approaches to initiate and sustain behavior to help achieve the overall goal.

CC-licensed photo of baby and scale by Salim Fadhley.

In an online conversation, I found myself again quoting Joe Harless. In this case, the quote was from a March 1975 interview with Training magazine.  I haven’t found this online anywhere, so thought I’d summarize a bit here.

A little background: Harless coined the term front-end analysis.  As he wrote in a workshop guide, to help our client achieve its business or organizational goals:

We begin at the end and work backwards in the basic progression:

1. We first find out what goals are not being achieved satisfactorily, or what the new goals are when they are set by the client.
2. We then find out what accomplishment is not being produced satisfactorily that is causing the goal not to be met.
3. We then find out what behaviors are not being obtained that cause the deficient accomplishment.
4. Then, and only then, can we determine which of the influences need to be manipulated.

The process just described is called Front-End Analysis.

The Training interview asked if FEA were “just the Joe Harless shtick.”  Harless replied that it was real “if you define real as having a definite set of procedures…and data and case histories” along with people who are applying these things.

Front-end analysis began with the realization that we could produce excellent training packages, ones that pleased not only the developer but the client.  And yet follow-up evaluation ( “which…we jokingly called rear-end analysis” ) revealed that, as often as not, skills didn’t transfer to the job.

So Harless wondered why.  “Being devotees of the scientific method, we advanced certain hypotheses… [And] we began testing these hypotheses.”

To Harless and his collaborators, rear-end analysis asks, “Why didn’t the training produce the intended result?”  Front-end analysis asks three other questions:

• What are the symptoms that a problem exists?
• What is the performance problem producing those symptoms?
• What is the value of solving that problem?

And that’s where the quote comes from:

Training: Value in terms of what?

Harless: In terms of money. Front-end analysis is about money first and foremost.  So is training.  If not, you’re baby-sitting or doing psychotherapy.

Harless said this as an aside to the main theme of his interview.  Even so, this is a lodestone for anyone working in organizational learning.  I agree that the individual needs to have some personal investment in order to learn effectively on the job.  She wants to raise her skills, or master a new task, or prepare for a new position, or gain satisfaction from resolving new challenges.

Those are her variables.  The organization has variables as well; the relationship between the two sets is an effort to balance the work-equation.  How can those skills, those tasks, those challenges make sense for her in the organization’s context?  “Is it worth  spending X to achieve Y?” Solve for the organization.  Solve for your personal goals.

I’m not trying to reduce this purely to dollars, and I don’t think Harless was, either.  (The same people who get nit-picky about “ROI for training” are strangely silent when a merger like Daimler-Chrysler–financially analyzed, you’d think, to a fare-thee-well–ends up vaporizing billions of dollars.)

When Harless says, “Value in terms of money,” I see it as shorthand.  Money is the most common and most convertible indicator of value in group activity.  You can choose other indicators; you just have to work harder.

1975 was fairly early in the history of performance improvement, though I don’t think we’ve yet reached the Golden Age.  Here’s the Reverend Harless preaching on a related theme:

You know, trainers are forever going around looking for respectability.  They’re always asking, “How can we sell management on the idea of training?”

Well, the answer is, you don’t.  You sell management on the benefits of solving human performance problems. You make it clear to management that you are there to avoid training when it’s not cost-effective.

That’s how you get to be a hero.  That’s how you get to be respectable…That’s how you avoid being stuck off in some personnel department somewhere.

By the way, Guy Wallace’s Pursuing Performance blog has a 2008 video interview with Joe Harless:

“Almost always, the client came to us requesting the development of some kind of training intervention… [in a typical situation, the workers] already knew how to detect and correct…defects….They were not doing so because…they were being paid for the quantity of production rather than the quality of the production.”

A recent interview with Dr. Peter J. Pronovost dealt with safer ways to care for patients in hospitals.  Pronovost is the medical director for the Quality and Safety Research Group at Johns Hopkins Hospital in Baltimore.

The interview’s worth reading on its own merits.  I saw in it good examples of performance analysis and efforts to improve performance–with relative few attempts to train people out of non-training problems.

For example, for cardiac catheterization, Hopkins had an infection rate of 11 per 1,000 procedures.  According to Pronovost, at the time that “put us in the worst 10% of the country.”

Here’s a diagram I created to illustrate some influences on performance:

And here are points that Pronovost makes:

• Hopkins developed a checklist to standardize what to do before catheterization (wash hands, clean skin with chlorhexidine, drape the patient, etc.).  To me, this is support for item 3 above.
• Supplies, which had been stored in as many as eight places, were prepped in a cath cart–with someone assigned to make sure it was stocked and handy.  Item 2, equipment and materials.
• The hospital asked nurses to remind doctors to wash their hands–and empowered nurses to stop procedures if this didn’t happen.  Item 8 (standards) and item 9 (feedback) — and, you could argue, item 7 (consequences).

Note also that the Hopkins project defined a specific problem (a high rate of infection), analyzed likely causes, chose action based on those causes, and measured the results.

Pronovost forcefully describes another barrier to performance: workplace culture:

As at many hospitals, we had dysfunctional teamwork because of an exceedingly hierarchal culture…

…in every hospital in America, patients die because of hierarchy. The way doctors are trained, the experiential domain is seen as threatening and unimportant. Yet, a nurse or a family member may be with a patient for 12 hours in a day, while a doctor might only pop in for five minutes.

I mention this not to single out doctors but to emphasize that performance problems usually have multiple causes.  Some you can address in a straightforward fashion (rethinking where to keep the supplies).  Others, you have to keep working at.  In commercial aviation, use of preflight checklists is maintained not only by regulations but by the active support of those who use them: it’s not smarter or more efficient to try memorizing the checklist.  In fact, it’s seen as counterproductive.

(Note what the Skout Group says about workplace culture–and checklists–in terms of USAir 1549, the plane that Sullenberger and Skiles managed to set down in the Hudson River last year, with no loss of life.)

Back to the hospital: isn’t there some need for training?

I couldn’t say; Pronovost’s interview doesn’t have enough detail.  It could be that some hospital staff need training in preparing for catheterization.  If that’s the case, I suspect that inside the generalization of “preparing for catheterization,” there are distinct subtasks: identify and obtain the supplies, prep yourself, prep the patient, assist (or be assisted by) a specialist, and so on.

And perhaps there’s a meta-skill: make sure the individual assigned to this task can first demonstrate an acceptable level of skill.  In other words, something like “we expect you learned this in nursing school (or wherever); here are our standards; we’ll observe you and tell you how you did.”

I don’t know that I’d put the necessary culture change under “training.” I’m pretty sure the label is less important than the goal: having doctors (most not hospital employees) and hospital staff work together to reduce the rate of preventable infection.

Word of the day: nosocomial, meaning “occurring in a hospital.” I came across it in this 2001 CDC report, The Impact of Hospital-Acquired Bloodstream Infections.  Its low estimate for life-threatening bloodstream infections acquired in the hospital is 87,500 per year.  The low estimate of deaths from these bloodstream infections: 8,750.

(And bloodstream infections are estimated at 10% of all nosocomial infection.)

Last week, I found myself in a couple of discussions about the difference between training and learning.  I only took one philosophy course in college, and later on I hollowed out the textbook to hide a gag gift, so it’s clear I’m not that contemplative on this issue.

To oversimplify, many people in more traditional training jobs felt strongly that there is such a thing as “training” and that it has the potential for great value.  Other people, by and large on the you-manage-your-own-learning side, seemed to place little value on structured training as such.

Although I doubt most participants intended it, you could interpret the divergent views as “this is important work I’m doing that helps people become more productive” versus “get out of your rut.”

Maybe not a rut, but at least a well-worn path.  I’ve spent a lot of time in that corporate-training path: 7 years at Amtrak, 18 at GE, and much of my consultant career since.  Usually I’m far from the executive suite, so I have some sympathy for challenges that first-line and middle managers face together with their work groups.

Which is why, over and over, I recommend Robert F. Mager‘s What Every Manager Should Know about Training.  Not just to clients (though I’ve even sent the book as a gift when I thought it would be well received) but to the corporate trainers supporting them.

It’s not a scholarly book, nor a thick one; you could probably read the 140 pages in two hours. But in that space, Bob Mager works hard to get managers out of the training-as-dosage mythology.

• Rule 1: Training is appropriate only when two conditions are present:
  • There is something people don’t know how to do, and
  • They need to be able to do it.
• Rule 2: If they already know how, more training won’t help.
• Rule 3: Skill alone is not enough to guarantee performance.
• Rule 4: You can’t store training.
  • Use it or lose it.
• Rule 5: Trainers can guarantee skill, but they can’t guarantee on-the-job performance.
• Rule 6: Only managers, not trainers, can be held accountable for on-the-job performance.

Mager: “If training is only a means to an end, what is the end toward which it strives?  It’s performance.”  Someone familiar with concepts like ISPI’s human performance technology model (links to a PDF document) recognizes exactly what Mager’s doing: smuggling performance improvement into the organization.  He’s just hidden it in a plain brown wrapper that’s labeled TRAINING.

He was clever in choosing the title, because I’d argue the majority of people who supervise or manage in organizations use “training,” at least in casual conversation, to mean a whole complex of things related to getting people to produce valuable results on the job.  Instead of trying to convert them to performance-improvement or informal-learning jargon, Mager starts where these managers are likely to start.  Then he builds on their likely experience in other dimensions of work to help them see how training (as a structured approach toward helping people acquite skills they don’t have) is one part of overall performance.

In the chapter, Where the Magic Goes In, Mager addresses another concern managers have:

Instead of asking, “How long will it take to develop my course?” you might consider asking:

What can you do for me with the lead time I’ve got?…

For example, if [the training department has] only two days for training development, the most useful thing they can do is to verify whether training is a valid solution, and to verify which solutions will have the greatest impact on the problem.

If the trainers have time to do one more thing, a task analysis would be the most useful action.  These analyses can be turned into checklists in a matter of minutes, and the checklists can be given immediately to the instructors…and to the trainees, to show…what competent performers can do….

If there is time to do one more thing, trainers can derive the objectives of the instruction and then draft skill checks by which instructional success can be measured…

…Which, by the way, isn’t a bad way to think about any sort of guidance you’d like to provide other people.

My driver’s ed instructor told my class:

You never have the right of way.
You can only yield the right of way.

Recalling this precept got me thinking about driver education / driver training, and that got me thinking about how people have very different readings for “training,” “education,” and “learning.”

Learning to drive is a good example of a complex skill (the kind van Merrienboër and Kirschner grappled with in Ten Steps to Complex Learning).  We tend to think we know what the outcome of the education or training will be: a good driver.

But what’s that?

On the formal side, it’s really about passing requirements.  If you’re an adult who moves to Maryland, for instance,  you have to:

• Pass a vision test
• Have had an out-of-state license within the past year (no suspensions)

And if your out-of-state license expired a year ago, you have to take “the knowledge and skills tests,” which I take to mean a road test and what was once known as a written test.

I’ve been driving for more than 40 years and have had licenses in four states, but I don’t recall taking more than one road test.  Not that I’m eager to do so, but you do get the impression that if you pass it once, still drive, and haven’t lost your license, you’re doing okay.

Some of what vM&K would call constituent skills for driving are recurrent ones–how to start the car, how to stop, how to steer, how to recognize signals and respond to them.  But there are many non-recurrent skills (things we do differently in each situation).  The other day I was exiting a strip-mall parking lot, wanting to turn right onto the highway.  An oncoming car on that highway had its right turn signal on.

Did that mean he’d be turning into the lot I was exiting?  How could I tell?  How could I help a novice driver figure that out?

My old instructor’s advice about right of way was a kind schema or mental model, like the two-second rule–one way to help new learners acquire cognitive strategies.

In writing about this, I’m seeing more clearly that there’s also an overlap of stakeholders: the general public (represented by the state) wants the roads to be safe; new drivers want to be able to drive; parents want their children to drive safely.

They might not even agree on the outcome.  Is it “status as skilled driver” or simply “holder of a driver’s license?” Is “skilled” the same as “safe?”

(I can answer that one: no.  Just take a drive through heavy traffic with someone who prides himself on what a skillful driver he is.)

Maryland’s Motor Vehicle Adminstration publishes a skills log and practice guide “to help the new drives gain valuable experience in operating a motor vehicle in a variety of conditions and highway environments.”  Maryland now requires 60 hours of supervised driving prior to taking the tests, with 10 of those hours at night.  The parent, guardian, or mentor of the new driver must sign a statement attesting to this, in addition to the 6 hours of behind-the-wheel instruction in the mandatory driver education course.

I like the guide (other than the mid-60s bureaucratic tone of the writing).  A “planning guide” (on the right; click for a larger version) summarizes skills; individual sections amplify them with descriptions, examples, and checklists.

Because of the state’s interest in having competent drivers, it makes sense for the state to have created this.  Is 60 hours the right amount?  Are these skills the right skills?  Will parents or guardians follow the guide, or simply certify that they had?

I can’t say–and, frankly, neither can you.  This is a complex skill; there’s no one right answer.  I think you can make a case that most of the skills in the guide are basic ones for a competent driver.  At the same time, no test is going to guarantee that a new driver, or even an experienced one, will never have an accident.  (I’d settle at times for “will not talk on the phone while driving.”)