You’ve heard me whining about my back and hip problems — well, maybe not that much as I don’t like to whine in public. Turns out I have a herniated disc and an inflamed piriformis muscle. Let’s just say together they make one big “OUCH!” The doctor recommended an epidural steroid injection (ESI).

Since all this happened on Friday and the doctor does injections only on Fridays, I managed to get an appointment for the injection late Friday. But I had no idea it was more involved than a standard cortisone injection, which happens in the doctor’s office. I went home and researched ESI on what little information I had.

I realized it was as much work as an endoscopy. No eating or drinking, involves anesthesia through sedation, and an xray to ensure the doctor inserts the needle in precisely the right place between L4 and L5 (bottom two lumbar vertebrae). He had to do it twice because of the thinning disc between the two vertebrae.

Had to show up 1 1/2 hour early (yuck) to register. Well, I limped and followed the signs to registration only to find I went to the wrong desk. I needed to go to outpatient registration. Never saw separate signs for that. A worker retrieved a wheelchair and took me to the right desk.

The woman at the registration desk was a delight and worked smoothly through the paperwork. As soon as we finished, she called the patient area and the nurse arrived within five minutes — wow! No long wait. The long waiting came in the preparation and going into the surgical room — but that was expected.

In the prep room armed with a bag full of magazines, I looked around the room reading the signs on the wall. The first one I noticed asked, “Tired of us asking the same questions over and over?” “Good! That means we’re doing our job!” The gist of the sign was that asking repeatedly questions wasn’t a sign of one hand not knowing what the other was doing — but to make sure they had the right patient, the right procedures, and the right notes such as what medicines was the patient allergic to.

That sign earned my respect and provided comfort. Instead of aggravation when asked the same question, I felt safe and secure. Several other signs posted on the wall had similar information. What a great way to to be proactive with patients already grumpy from not eating and drinking and having to wait.

The nurse updated me throughout my process in the prep room. She also announced whenever she was about to do something such as take my vitals and put in the I.V. Ack! I saw the I.V. was going into my hand. Arm — no problem. Hand and wrist area… problem due to bad experience when I was 14 (let’s just say both wrists turned into pincushions).

She talked through the I.V. insertion process including cleaning it and verifying I wasn’t allergic to latex or iodine (another safety check). She did a beautiful job with the needle that I barely felt it. Bless her.

The procedure was supposed to be at 4:30pm, but I didn’t go in until 5:00pm. I knew it wasn’t the doctors’ fault because they were in the staff area. They were probably waiting on the surgical room’s availability — something I wish someone had let me know about. The was the only complaint about the whole service — not bad!

My husband had to chauffeur our kids after dropping me off, so he couldn’t get there until near the end of my stay. The staff had no problem reaching him and bringing him to where I was after the procedure.

I have to go through this again in two weeks. I can only hope the staff I get will be as wonderful as this one especially the nurse who will insert the I.V. (the hardest part about the whole thing). I share this because it shows great customer service is possible even in an industry bogged down with paperwork, strict procedures, and insurance pains.

Bruce Mau lists a process-related item in his Incomplete Manifesto for Growth. Item #3 says, “Process is more important than outcome. When the outcome drives the process we will only ever go to where we’ve already been. If process drives outcome we may not know where we’re going, but we will know we want to be there.”

I advocate process as a journey not as a destination. Let’s look at an example — You want to watch a favorite TV show. Here is one process:

1. Locate remote.
2. Press the right button(s).
3. Change the channel to the right channel.
4. Watch TV show.

And another process:

1. Go to TV.
2. Press button to turn it on.
3. Press button to flip through channels (this could take a while if you have cable, digital or satellite TV).
4. Watch TV show.

Step 4 is the outcome of the process. The steps you take to reach the outcome is the process.

But what if you don’t know the outcome? You’re endlessly flipping channels. But if you don’t know what is the outcome, then how will you get there? Some say we’ll know what we want to be there. How? By twitching your nose and conjuring magic?

On the other hand, when you know the outcome, you design the process to get there in the most efficient way possible. Thus, you’ll find the shortest route with the fewest obstacles to get to the TV show. If the toddler manages to turn off the TV or take away the remote and changes the channel, then you adjust the process to get to the TV show.

It’s like saying a company will hire staff, buy equipment, and get to work on something without knowing its business goals. If you don’t know what you’re targeting, then you more apt to miss by taking a blind shot.

So, chicken or egg? Process or outcome?

How to Ruin Web Design — The Design Curve is a simple and accurate view of what happens to a design when more people get involved in providing feedback and the time spent in changing the design. [Link from Web 2.0 Blog]

If you don’t read the rest of this entry — this picture tells all [Link from comment].

This concept also applies to meetings and projects. When I worked on a process team for a company, we started holding weekly meetings (or was it every other week?) to discuss process changes. The attendees included a handful of managers. The process worked great for over a year.

Then things changed. We took in another company and its software development team merged with ours. Now we had team members in three states. The process meeting slash teleconference attendees doubled and we accomplished less. Too many different ideas and opinions. It was tough to arrive to an agreement and we tabled many discussions for off-line discussions.

Not only did we have too many people involved, but also people who shouldn’t be attending the meetings. What’s more is that each process undergoing review had a sub-team. This worked well until we grew and the wrong people got assigned to those sub-teams. In the earlier days, it was easier to get the right people involved.

Part of the challenge to fix these problems is getting heard by the right people. Or they hear, but don’t consider the advice. Have you been able to convince decision-makers to change something? How did you make it happen? That was an area I struggled in when working in corporate USA.

I meant to comment on Bruce Mau’s item numero tres last week when it was posted on Textism’s "Annotated Manifesto for Growth", but alas I got snowed under (OK, bad idiom when you’re from Texas, but you know what I mean). It says, "Process is more important than outcome. When the outcome drives the process we will only ever go to where we’ve already been. If process drives outcome we may not know where we’re going, but we will know we want to be there."

Textism’s response went way over my head. No doubt that whatever he said was a counterpoint since he argued against everything Mau said in his own unique way. I had to re-read Mau’s process statement a few times to get what he was saying through his PhD style writing (in other words, show off). Let me put it in English as I understand it:

Picture a cup on the table. You want to pick up the cup. The cup is the outcome of the process.

The steps you take to reach the cup is the process.

Mau says that the "walking" (process) drives the "picking up of the cup" (outcome). Now, pretend you don’t know what is the outcome. You’re walking and walking and walking and pick up a plate. Nope, that’s not the outcome. But if you don’t know what is the outcome, then how will you get there? Mau says we’ll know what we want to be there. How? By twitching your nose and conjuring magic?

On the other hand, when you know the outcome, you design the process to get there in the most efficient way possible. Thus, you’ll find the shortest route with the fewest obstacles to get to the cup. If the family dog manages to steal the cup and move it to a new location, then you can adjust the process to get to the cup in its new spot.

It’s like saying a company will hire staff, buy equipment, and get to work on something without knowing its business goals. If you don’t know what you’re targeting, then you more apt to miss by taking a blind shot.

Conclusion: The outcome drives the process.

The Economist has an inspiring article, "God meets Mammon: the profit of turning thugs into programmers" about a Jesuit who gives up his millions and instead of saying his vows, vows to work with gangs. Brother Holub recruits the gangsters from one of Milwaukee’s South Side and starts with a drug treatment program since 90% of the gangbangers are drug addicts. Next comes getting a job and studying to get a high school diploma. Roughly 80 make it through the program and 25 of those enter programming. The programmer wanna-bes attend Homeboyz Interactive (HBI) to receive technical training and after completing the training, they switch to the HBI Consulting side to gain experience.

Doubt its success? Of the 150 who entered the HBI program, ZERO have left! HBI Consulting is expected to earn US$1 million profit based on $2.3 million revenues. Let’s hear it for the boys! This is the kind of program we could use throughout the country.

Thank you, Steve, for giving me the motivation to update these notes. I still have to clean up the CSS file, which is a mess from all the tinkering. I got too tired once I was almost satisfied with the new look. What do I mean by “almost?” I am NEVER satisfied with anything I do. The mark of a perfectionist will never fade away.