by , on 19 Dec 2014 05:12 pm
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Immediate Detection & Correction: Easier Said Than Done

Our team recently had the opportunity to learn directly from Sensei Chihiro Nakao, founder of Shingijutsu USA.

http://www.shingijutsuusa.com/team.html

We will continue to study and deepen our understanding of what he shared, but one area he helped illuminate is the relationship between JIT and Jidoka.  Specifically, a process that has so clearly defined “normal” that “abnormal” can be immediately detected and corrected is only achieved if it delivers just what is needed, in just the required amount (the first two steps of JIT). Or simply put, if variation is the norm (normal = abnormal), then detection and correction are not possible.

Ouch! Sensei distilled the central riddle of my seven years consulting in health care into one sentence. At first, this was a discouraging thought. The silver lining that emerged is that the question “where do we start?” from front line teams becomes easier to answer.

As a result, for the next while we are exploring the following improvement focus with teams:

  • Define and experience “normal” and “abnormal” in more and more detail, and as that clarity grows, take immediate action to correct any abnormal situations.

A simple concept, but proving to require much focus and discipline. Sensei Nakao challenges us to see why we must have urgency with correction: if an abnormal situation isn’t immediately corrected then the process is actually reinforcing that as normal – missing an opportunity and taking a step backwards in our improvement trajectory of understanding the work in more and more specificity.

In an event a few weeks ago, I was face to face with an opportunity to stop the process and strongly encourage one of the team members to take the abnormal form back upstream to the provider and ask that it be fixed. Somehow my discomfort with the cognitive dissonance this real time confrontation would cause (or that I imagined it would) gave me an excuse to wiggle out of immediate detection and correction.

I am living proof that simple is not easy! A few easy steps to follow and I couldn’t bring myself to bring the last to life! Further humbled, I will carry on, and try again, hopefully returning to report a stronger constitution soon.

In the meantime, it would be helpful to hear how you have helped teams do immediate detection and correction. What have your experiences been? What have you learned?

Popularity: 3% [?]

by , on 03 Dec 2014 02:36 pm
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Walken the Walk by Jane McGillivray

Christopher Walken

Walken the Walk

 

How many of us have seen a movie with Christopher Walken playing some role?  Probably most of us.  I saw an interview a long time ago where he talked about how he perfects the art of acting.  He said, “I Act!”  He takes every role he possibly can as he believes that doing the work, is the way to improve the work.

How does this relate to continuously improving your work?

In a recent improvement event I was in, the team reached a point where they pushed back on continuing to work through cases and try different things.  One team member stated, “I don’t see the value in running through additional cases, I don’t think we will learn anything different.”  As the team debated the merits of trying more ideas, one team member simply started doing the work.

Shortly after someone asked, “Are you just doing it?” and the entire group rallied around our Christopher Walken as he worked through another real case, and we did learn more!  We improved more.  In continuing to do our work, the team learned more and further improved their process.

This type of leadership is needed to push through resistance to win an Oscar for our customers.

In a follow up presentation for this particular event, it was refreshing to hear that multiple improvements had continued to happen after the event.  These improvements included implementing the new process three weeks earlier than planned; adding talking points to a knowledge base used by front line engineers to help them better understand how to resolve customer issues; and the escalation engineers increased the solutions they wrote up when they resolved “unknown” issues thereby increasing the number of issues that could be resolved by the front line.

All of these improvements went toward giving their customers exactly what they stated they wanted: that the first person they talk with can resolve their problem.  The post-event improvements occurred as the team did their real work after the event.  They referred to these post-event improvements as “unintended consequences.”  Unintended or not, the act of doing their work, with knowledge of what is
important to their customers, gave them everything they needed to continue improving.

I can’t wait to see them starring in their next movie!

Popularity: 39% [?]

by , on 26 Sep 2014 05:35 pm
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Why We Are Here

The poem (below) jumped out at me from a therapist’s office wall.  A local team of our behavioral health providers were in Day 2 action, practicing and refining with real patients toward the ideal visit. I sat as still as possible, hoping to meld into the background, or maybe even disappear, as the patient and provider tackled the challenges in front of them.

In my attempt to disappear, I scanned the walls of her office, and found myself intrigued by the implications: clearly this providers found inspiration for her role in this poem, but didn’t it also have immense wisdom for my role as an improvement consultant?

A colleague once said it to me this way: “if you’re teaching someone to ride a bike, it’s not a very effective strategy to pull them off the bike and ride it for them.” The analogy helps highlight the absurdity, but as improvement consultants in the real world, is this not what we’re so often tempted to do – give an answer; Do it for them? For me, this temptation comes from many sources,
including:

  • The business needs bottom line results now
  • The leader(s) and team get frustrated and want
    answers
  • Maybe most challenging, our own patience and ego
    is constantly under attack as we try to stay focused on going at their pace, not
    our own; empowering them to unleash their capability, not flaunt our own.

Underlying my responses to these common temptations is my answer to the poem’s title, why am I here?

Maybe my job title helps me with my answer? Maybe a “lean consultant,” a “Kaizen consultant,” a “TPS consultant,” a “CI consultant,” a “PI consultant,” etcetera, each answer differently?  My experience says no, that these titles are quite often used interchangeably, and have at times been indistinguishable in behavior from “management consultant”, or “business consultant”.

Unfortunately, my job titles won’t bail me out, I must answer on my own.

 

 

Why We Are Here:

 

We are here to listen,

not to work miracles.

 

We are here to help people discover what they are feeling,

not make feelings go away

 

We are here to help people identify their options,

not to decide for them what they should do.

 

We are here to discuss steps with people,

not take steps for them.

 

We are here to help people discover that they can help
themselves,

not take responsibility for them.

 

We are here to help people learn to choose,

not to make it unnecessary to make difficult choices.

We are here to provide support for change.

 

Anonymous.

 

Popularity: 38% [?]

by , on 25 Jun 2014 01:14 pm
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Waiting for Health Care – no longer ‘just the way it is’?

http://www.nydailynews.com/news/politics/obama-mulls-cleveland-clinic-ceo-head-veterans-affairs-article-1.1816789

The Cleveland Clinic’s capability to provide same day access for any specialty came up during a lunch break at a recent kaizen event. The idea of this capability, to me a seminal achievement in the customer first healthcare movement, baffled many in the event, but the fact that Cleveland Clinic actually does it, and advertises this capability nationally, left some dumbfounded.

Following this, you can imagine that I was very excited to see Obama considering the Cleveland Clinic CEO, Dr. Cosgrove, for the vacant secretary of Veteran Affairs job. For me it signaled, on the national stage, that lead time now matters in health care, and that patients, the media, and consumers at large are demanding health care to be on par with other industries in the time it takes from request of good / service through delivery (as retail creatively looks to shave minutes / seconds off of their lead time (see article below), does it not make the weeks / months in health care seem even more outdated?).

http://www.nytimes.com/2013/11/24/technology/in-war-for-same-day-delivery-racing-madly-to-go-last-mile.html

As a practicing lean consultant, working with clinical teams on the front lines, I have the opportunity of seeing this thought revolution occur one team/team member at a time. A transition to:

  • Seeing their work as a process, and a process that needs to be customer first – challenging paradigms, a sense of helplessness, and other perceived barriers as they take action toward better.
  • Experiencing the paradoxical power of diving into the details to produce big results: challenging the steps and sequence of their work – striving toward an ideal, and reducing cycle time and lead time as a result.

I’ve found the most enjoyment in helping teams experience that small improvements in their cycle time can add up fast, as:

  1. 5 minutes taken out of each 30 minute visit means 70 minutes back into their day. And this time back reduces lead time dramatically for other patients, as they can be seen today instead of tomorrow or next week.
  2. They break through the belief that ‘it’s as good as it can be’ and experience that the process can in fact be better for the patient and themselves, they begin to discover opportunities everywhere – big and small.

We have just begun to experience the tremendous possibility of this humble approach at Group Health, and the spread has been rapid as clinical teams rediscover what is possible, and that they are the experts – capable of leading the way to dramatic improvement in lead time, quality, and cost. I am left with high hopes – for what Cosgrove’s consideration (he has since declined) tells us about our nation’s growing expectation for health care, and a local parallel – my teams work to support a transformation in Group Health’s small piece of US healthcare. And why not be optimistic, maybe same day access for any specialty will be the norm across the US very soon…shouldn’t it be?

Popularity: 32% [?]

by , on 06 May 2014 12:04 pm
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Why does it take so long to make things happen? by Sean Sessions

 This year I became a home owner.  With a new interest in the quality of life within my neighborhood, I’ve reached out to local community groups, hoping to combine my loves of civic involvement, and community service, with my passion for process improvement.  Apparently both community service and lean have been married for a while with a movement known as “lean urbanism.”

Lean urbanism is a movement which seeks to challenge the current paradigm of long-standing rules, as a way of reducing the burden on business and development to quickly innovate and implement new ideas.  The challenge comes by simply testing the rules by taking action, gathering people, and mocking up what is possible

The red tape of city ordinances restricting where and when to plant trees and at what cost,  where to install crosswalks, bike lanes, recycling bins, outdoor seating, dog parks, etc., all greatly lengthen the time to build and implement; if the hurdles to implement don’t completely stymie the implementation all together.

In working with city commissioners, building inspectors, and others, lean urbanism seeks to create “pink tape” sandboxes, if you will, to test out mock-ups for business development while challenging timelines, permitting processes and rules preventing rapid implementation of business start-ups.

A community in Texas gathered some people together to build a dog park.  The group brainstormed and thought, we need to find a space that meets the 30-acre city rule for a dog park.  Then we should raise awareness, and get the word out.  Raise some capital to pay for it and design the build.  So, it should take about 5-7 months… Jason Roberts of BetterBlock.org said, “let’s do it tomorrow!”  So they did.  Within a weekend they had a mocked up dog park.  They challenged the rule of the size of the dog park, and were able to work with city government to move the mocked up dog park to a nearby location, at a size smaller than required by law.

In health care I see similar red tape conditions.  Rules determining when and where to appoint patients for care based on tricky clinical schedule templates, complicated staffing schedules, and varying business hours elongate the time between when a patient wants to receive care, and when they do.  Rather than focus on following the rule, why not ask what is ideal for the patient? When does the patient want to be seen?

I encourage those in healthcare to build your own sandbox to try new ways of thinking.  Challenge those rules.  Maybe break a few.  See how quickly you can incite improvement.  Do it quickly…Just try it!

Popularity: 19% [?]

by , on 06 Dec 2013 02:38 pm
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Moonshine in the Home?

As I watched a recent 3P team in action – I could no longer ignore it. a little voice saying: ‘for any home improvement, you must use the 3P moonshine principles!’

Make it physical with zero cost, and then simulate the process within that physical environment many times to experience and improve the process.

Seems simple, but I’ve never thought of doing it at home. To be clear, little voice you’re saying:

  • Before my wife and I knock down the wall that bugs us between our kitchen and living room, and put in the island that looks so cool in the magazines, we should find a way to mock up the physical environment and run through the scenarios of how we’d want to use the space?

 

  • Before we change the furniture arrangement, or buy a new piece of art, or lamp,  we should do the same?

 

Seeing the quality outcomes the team produced quickly and with no cost, the little voice’s answer was definite - ‘YES, absolutely!’  So, why don’t I?

  • It takes time, effort, and creativity to create the mock ups – how could we do it for no money but still real enough that we can have a realistic experience?

 

  • It takes patience. It’s a lot more fun to just tape up a picture on the fridge of the “Kitchen Nirvana” straight from a magazine, and start sledgehammering!

 

However, as I list these barriers, I realize none are in line with the wisdom I hope to live out, especially with the money, time, and energy that a home remodel requires.

So, for me, there are no excuses – I guess you’re right little voice.

Fortunately, a distinct lack of money is preventing me from taking any foolish home improvement actions at this time. However, if that ever changes, I will mock-up, simulate, improve, repeat, and then only after many cycles and the emergence of a thoughtful process, spend money.  

Have you ever done this for your home or another area of your personal life? If yes, how’d it go? If not, what barriers emerged for you?

Popularity: 28% [?]

by , on 22 Nov 2013 02:00 pm
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What Do Customers Want?

 

 

 

 

Can kaizen activities be truly meaningful to the success of the business if we lose sight of what customers actually want versus interpreting the customer’s requirements through the lens of the business’s current capabilities?

I am beginning to believe the answer is no, and that customer responsiveness is at the heart of kaizen.

I’ve used the pictures above in conversation with teams to illustrate the difference between customer requirements and current capabilities. Each new company gained market share by challenging the existing assumption for what customers really want – Netflix asked: Does a physical location have anything to do with the customer’s requirements? Redbox asked: Is mail delivery from an online selection meeting all of the requirements?

  • Was Blockbuster blind to the heavyweight competition Netflix truly was, mistaking past sales / growth as an indicator they’d met the customer needs instead of humbly recognizing ‘we’re just the closest to those requirement right now’?
  • Similarly, was Netflix blind to their weakness in achieving the “exactly when they want” component of the customer requirement that Redbox has exposed?

Of course, the story isn’t over, as each has attempted to respond to the exposed weaknesses. In fact, this will most likely continue forever, as customer requirements will never be perfectly met and sustained. Given this, will the most successful company be the one who is most relentless in their pursuit – the one who never stops believing the requirements could still be better met?

Which brings me to Health Care. At a recent lean health care conference, a CEO of a ‘high performing’ hospital system described their performance as “The Cream of the Crap,” which garnered wide spread applause. I can’t help but wonder if that was because it was not only humorous, but an accurate summary of our current state as an industry – are even the best performers nowhere close to what true customer requirements are?

Are health care organizations so consumed with comparing themselves to other health care organizations that we’ve lost sight of what customers / patients actually want, and how far off we all are?

If true, do we have any choice but to continue resolving the issue by asking:

  • What are the true customer requirements of health care?
  • What’s stopping me /my company from being the Netflix / Redbox of our macro health care system, exposing the perceived barriers that our current capabilities and paradigms create as fallacy?

Popularity: 23% [?]

by , on 11 Nov 2013 09:20 am
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The Importance of Minding the Gap by Lori Heniff

“Mind the gap!”

Travelers and commuters in London Underground tube stations regularly hear that warning to be cautious when crossing the gap between the station platform and the train itself. There might be significant distances or height differences between the two, and someone who didn’t see the disparity could easily step into empty space and find themselves in serious trouble.

 

 I thought about that warning during a recent event to improve the flow of patients between the Urgent Care (UC) and Radiology departments located on different floors at one of our facilities. To prepare, I did onsite observations and saw UC patients having very mixed experiences:

  • Once a patient had left the custody of one department, there was no way to track where they were and when they might be expected to arrive or return.
  • Patients might be given directions to the elevators and sent on their own, or they might be accompanied and dropped off to sit in a waiting room until the next department called them back.  
  • Some patients barely waited while others sat for an hour or more (sometimes wearing a hospital gown in a public seating area).

It was clear to me that staff in each department worked hard to provide exceptional care to “their” patients, but neither group felt ownership over the ones in transit between the two areas.  People were disappearing into the gap, but staff didn’t know because they couldn’t see the whole patient experience.

Years into my own Lean journey I still make a conscious effort to reframe everything in the customer perspective. I learn over and over that the gaps between steps that are invisible to us often provide the most dissatisfaction to patients, and if we don’t look deliberately and continuously we’ll never be able to see them.

The event had happy outcomes for our patients. Team members looked at the flow from the patient perspective and immediately saw the gap. Once they knew it existed and could quantify it, they began rapid cycles of improvement to prevent it. They’re instituting a pull system through which Radiology will regularly tell UC when they have immediate capacity, and staff will escort patients between areas to provide warm handoffs.

It’s amazing how something as seemingly easy as minding the gap can make such a critical difference.

Popularity: 23% [?]

by , on 31 Oct 2013 09:33 am
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The Art of Improvement

Process flows.  Standard work combo sheets.  Spaghetti diagrams.  Material and information flows.  Value stream maps. 

At the end of an improvement effort, we step back, crumple them up and toss them in the recycle bin.  We recycle this beautiful thing that is often the only physical evidence of weeks’ worth of work for the Lean practitioner.

I’ve spent a lot of time admiring these creations and started to daydream about seeing them outside the workplace, outside the recycle bin, and completely out of context.  Not to worry about what they mean or the stories they were designed to tell.  Instead, to step back and admire them as the things of beauty they are.  With a glass of wine in hand!

My best friends at work and my amazing team helped to make this daydream a reality.  We curated a gallery show reusing (upcycling?) these artifacts of improvement without using any additional resources from our employer.  But if anyone can throw a quality party on a shoestring budget it’s a Lean team!

Hope you enjoy seeing our photos from the event.  I hope it inspires you to appreciate the creativity and beauty that you bring into the world.

Click to enlarge

 

Popularity: 27% [?]

by , on 17 Oct 2013 02:20 pm
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Taking Stairs Two at a Time by Jennifer Haury

SMACK!  The other day, I was running late for a meeting and needed to climb 3 flights of stairs because I had no time for the elevator.  Of course, I thought taking the stairs 2 at a time would be a good idea.  I was running short on time and so I charged forward—with my batch of two stairs per step.  Until I tripped…and my papers went everywhere…and I entered my meeting late, unorganized, and out of breath.

It occurred to me this is often how improvement starts—we feel pressure to do better—in my case, it was a time crunch.  Often, it’s some gap between our target state and our current performance.  Instinct would often have us react by doing the work FASTER or leaving steps out!  “Of course, if we just work harder and go faster, that will help us reach our goal sooner!” we tell ourselves or our teams. 

The danger inherent in this level of thinking is that it often leads to quality issues in our process when we speed up the work or “skip steps”.  I remember working on a team responsible for taking incoming calls a few years back.  We made a decision to leave key steps out of our process during a phone call when our incoming demand reached a certain point, intentionally causing defects downstream just to do the work faster in the moment.  While that might seem foolish—don’t we often face the temptation to make shortcuts that undermine our overall goal?

The other day, if I had taken the time to take one stair at a time, I probably would have stepped in just as the meeting began and wouldn’t have scattered my papers.  If I’d taken the time to consider WHY I was running late and avoid those conditions next time, perhaps I’d have found out more about the root cause of my problem. Do you ever find yourself wanting to “take the stairs 2 at a time” to do a little more in your current role?  What helps you avoid this temptation?  Please share your thoughts with us.

Popularity: 27% [?]

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