I interviewed Reza Ziaee who discussed The Functional Tree-Structure Concept and Tools Within the Health Care Industry.







It’s great to speak with you today, Reza. I’m looking forward to hearing your views on the functional tree-structure concept and tools within the health care industry. Can you first provide a brief background of yourself?


Sure, sir. My name is Reza Ziaee. I’m a Ph.D. in applied statistics and quality engineering with more than 20 years of experience in health care, operations improvement, quality improvement, and also some clinical background. Having said that, I do have experiences in teaching. I taught classes for M.B.A. students, specifically speaking, health care-focused M.B.A. programs, and I had a lot of fun. I also taught operations management and health care economics.


One of the things I’m really aware of is basically lack of complete understanding of operations management, or operations in general, in health care settings. That is the reason, after 20-plus years of experience, I put all thoughts, approaches, and experiences into this book that is called Preparing for Continuous Quality Improvement for Health Care.


As far as my education goes, I do have, as I mentioned, a Ph.D. in applied statistics and quality engineering and also an M.A. in economics an A.B.D. in economics. Did I answer your question?


Yes. Can you talk more about the problem?


As I mentioned, in health care or any organization—I do not know if you have studied some of the publishing that came out in 2010 that about 70 percent of operations-improvement projects, between nine months and three years go to the wastebasket. Everybody came up with some solutions on how to make this operations-improvement approach sustainable but nothing has occurred. If you’ve studied Deming in detail, that’s where Deming advised us that we have to really create stable processes to really gain limitation of variation or limit the variation.


When I looked at everybody in the specific health care setting, everybody wants to do something different or do improvement without knowing the domain of the functionality and also understanding in detail the processes. Before they stabilize the structure, they start improvement. My analogy is this: Before knowing if they are living in the Eiffel Tower, they start building some other structure, but, unfortunately, in reality, they are living in the Pisa Tower. As soon as they build extra stuff on it, all of a sudden, the tower really leans more. Because of that, you might say it’s more inclination to get to the ground and just collapse, they go and pick it up and eliminate it.


There are a lot of other analogies we can really provide this. Case and point, to have a car and you get a flat tire on the passenger’s side every other day. Finally, you get an expert and say, “I want you to create a tire that never goes flat.” But without the dimensions and specifications for that tire, these experts create a tire that looks like a tractor’s tire. When you put it under your car, it tilts your car. For a few days you’re happy because you’re not going to get a flat tire, but after a week or two, you get tired of it because your car never functions in the appropriate manner. You take it out and bring it back the old way.


It happens in operations-improvement concept. People are doing improvement; they just really go and grind one piece of—in health care, for example, they’re just looking to create the triage better to get the patient in. When we create the triage in a very succinct and optimized manner, you really create constraints for every other function. After a while, while triage is functioning well, the other parts are clogged up due to that improvement and focus and then they want to say, “Let’s go back to the old way.” That’s the reason this study has shown—it was published in 2010 that demonstrated 70 percent of the total projects not only in health care, every other organization also, go to the wastebasket between nine months and three years.


For completing our book, myself and my counterpart, we did this similar research. We sent a survey through SurveyMonkey to around 2500 people, and we got around 200 responses. We compiled and really analyzed the data received. We came up with the basic result demonstrated as supported the previous studies, which was around 70 percent of the projects these experts have been working on after nine months or three years went to the wastebasket.


And can you talk about what the solutions are?


The solutions this book really addresses is to make what and how visible. What you want to say is this. At any organization, not of course, piecemeal; it should be a holistic approach to the organization. Case and point: If you are looking at a hospital, you have to look at every subsystem within the hospital to make sure that it works well. When I say “works well,” it means make what and how for any department or division visible based on the function and subfunctions and also processes. Then, when you really make it visible, understand you’re working on two aspects: optimization, standardization, and alignment, which means that process A that feeds process two need to be aligned with each other. Also, within that structure, they do need to be standardized and also optimized.


I do not suggest that at this stage of the game, for example, when you complete this you will get the optimum and the best solution. You will get minimally between 15 to 25 percent improvement, which is drastic. I have shown in different projects or not holistic approach but in the division or subsystem that when we employed this, we gained a lot. We redesigned at one location, the ED, and we did go through detail documentation on what and how within that department and we gained around 30–40 percent patient satisfaction, about 30–40 percent quality improvement, and we decreased the turnaround time or patient throughput from three to four hours to two hours and two and a half hours.


Thanks, Reza, for sharing this great information about the functional tree-structure concept and tools.


You’re quite welcome, sir, thank you. At the same time, another thing I would like to bring to your attention. Case and point:  it took 12 years to get to the best level of watching, I’d say, operations and success. My suggestion is that this process, if you’re going through the same thing, with the full support of the leadership. As Gary Kaplan became the flag holder or the first person to march to our next stage of operations, if that happens, I believe and can show the way to those willing organizations within three to five years to reach the best in class. Best in class means best quality of services and lowest cost of delivery. Of course, timeliness is also observed.


Great, thank you.


You’re welcome. I would suggest maybe people need to go and read the book and understand what it is. If they do need any clarification, they can contact me to get really to the level of operations or expertise to be able to deplore what I suggest.


Okay, where can they get the book?


They can go to Amazon, under my name or under the book name, which is Preparing for Continuous Quality Improvement for Health Care Sustainability Through Functional Tree Structures.


Great, and I’ll also put your contact information in this blog so the supply chain community can reach out to you.


That’s great. I’m looking forward to hearing more. I believe that nobody yet—I’ve never seen anything similar to what I do present. Currently, I’m working with a software engineer group that automates this process, which means that within, hopefully, six months, it will be available as a software. Any organization or department can sit down and really understand what the department does and how they’ve done it.


When you create that type of, what you might say, black-and-white or colorful pictorial presentation of what and how, communication becomes very easy, the creation of, for example, alignment of every staff working together, everybody will understand what’s expected of them, why they’re doing their job, and, also, the system can really deploy an [incentive] program that really creates what you may call a quantum leap. At that level, people do not need, even though it’s very important, that really provides you with a structure that people see the results of the activities and contribution. They can delay themselves and connect themselves to the strategic objective of the organization, and sales actualization became obvious and reachable to everybody.


At the same notion, everybody within that structure can communicate with each other very, what you might say, socially and succinctly. Every process that ends, a new process starts, which means that the process before the next process designs and works regarding with production or, for that matter, services that can be rendered or documents that can be delivered to the next process based on the customers’ specifications and requirements.


In totality, the whole structure will be looking at such that in sustainable operations improvement reached through, first, stabilize the structure; second, improve the processes through the SOAP construct, which is standardize, optimize, align the process. We are really simplifying this process by asking specific questions for each step of the way that has been detailed in the book.


The next part: establishment of a very sound and solid measurement system based on the setup smart metrics. This part, this T structure or pillar creates a supporting environment for the work organization because culture is an outcome; culture cannot be defined as an “infrastructure.” It is a superstructure even though later on, it will function as infrastructure. In here, culture as a connective tissue within each organization really becomes the by-product of what and how. These four pillars create a stable structure and also sustains any improvement that organizations embark on.


Great. This sounds like a good benefit for the health care community, and I’m looking forward to publishing our interview.


Thank you very much. At the same time, I should say it’s not only for the health care. It has been focused on health care, but the concept can be deployed in any operational setting.


Thank you for that clarification.


You’re quite welcome, sir, and thank you very much for the opportunity. Please keep communicating. If I can be of any help, I will be more than happy to assist and help you.


Thank you.





About Reza Ziaee


Here is the quick introduction to our book "Preparing for Continuous Quality Improvement" which is published by CRC Press. The book explains how to quickly reach best in class status by making visible the “What and How” of your operations as a precursor to improvement projects and includes case studies and tools on how to set a stable platform from which a successful Quality Improvement program can be built. Learn more about the book by going to




Reza Ziaee

Regional Director of Operations Performance at Banner Health System


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