Steering an Ocean Liner: What Toronto’s Safe Injection Site Story Says About Agility (or the Lack of It)

Not exactly nimble.

In July 2016, Toronto Board of Health and city council approved the building of three permanent supervised injection sites for Toronto as part of an effort to deal with a growing opioid overdose crisis in the city. These sites, however, are not going to be ready until “the fall.” Frustrated by this time frame, a small group put up a temporary “pop up” site within hours.

There are two separate but related sets of questions and observations this story triggers: First, what would have to happen for the permanent sites to be designed and built not in months but in days? Second, well before permanent sites are established, why wouldn’t the government use the “pop-up” approach that the group of volunteers used to install the supervised injection site in Moss Park within hours?

I don’t think the issue in this case is as simple as saying that governments move slowly because they are naturally bureaucratic (although that it usually true). Rather, the issue is that too many organizations whether public or private move too slowly in general.

There are many root causes for the slow pace in organizations, but here are a few:

  • Waterfall approaches instead of agile. In the waterfall paradigm there is a focus on developing the ideal or final design upfront and then marching resources from A to Z in stages. ┬áIt’s not until the very end that we have something that can be used. In an “agile” approach a minimally viable solution is developed rapidly, given a test run to get feedback, and then adjusted during a second iteration of work, given a test run and so on. The solution emerges through short-cycle learning loops. The pop-up is a version of the short-cycle approach. In fact if the City is smart they’ll learn from the pop-up experiences to guide the build and operation of the permanent sites. This thinking is also the logic underlying the approach of a lean kaizen workshop where solutions are developed and implemented in days rather than try to make improvement happen through months or years-long “transformational projects.”
  • Sequential hand-offs versus cross-functional, concurrent work approaches. In the sequential handoff method the work is divided into chunks of work, assigned to different groups, who then perform the work through a series of handoffs from one specialist to another. For example, a sales function might “throw over the wall” a customer request to the product development department who may or may not correctly interpret the customer requirement. They build something and throw it over the wall to operations who tries to execute the product or service. Sales then looks at the resulting product and says that “they” got it wrong (cue finger-pointing) and everything has to go back to the drawing board. Meanwhile the client is still waiting. The concurrent approach has everyone — in this case sales, product development, operations, and also the customer(s) — in the same room at the same time to work the problem together. What does the customer really need? What can we consistently deliver with our capabilities? How much will this costs? Etc.
  • Centralized (read “senior”) decision-making versus empowered front line. The mindset that says that those at the frontline (which are usually lower pay grades) cannot be entrusted with decision-making authority is another root cause of the glacial pace in organizations. Teams must go back and forth from the high command to get approval on each item and issue. The idea of a grassroots pop-up is the very opposite of the command and control model. In addition to devolving more decision-making rights to an agile, cross-functional team, in those situations where a more senior person truly does need to make certain decisions, those senior leaders need to go down to the “gemba” (the Japanese phrase used in lean that means “the actual place” where things happen) of the effort and make those decisions on site in real time. If a number of senior people need to weigh in on the decisions, then they should all go to the gemba and make the call. Forcing teams to create a pretty PowerPoint deck and then present it to a steering committee is another great way to slow progress.
  • Traditional project management techniques and the student effect. Many project management approaches make the waterfall method even worse by building in buffer time into each major activity. This happens because subteams want to have some leeway and so they conservatively estimate the time required. Work fills the available space and so like students doing an essay for class, get things done just in the nick off time, using up all the schedule. Project management that uses the Theory of Constraints method does not put contingency into each major activity but holds the buffer at the highest level and only uses this if needed.

Let’s see how things go with this effort. Let’s hope they speed things up. In this case, time can literally cost lives.