Daily Kaizen

Yesterday I spoke with a new Lean mentor of mine about how to support leaders that are feeling overwhelmed by the magnitude of change.  The team I am working with has made great strides, but is now struggling with how to maintain production levels while completely transforming the production line.  In other words, we are trying to change the tire on the bus as it rolling down the highway.   He has a vast amount of experience in leading large transformations in a manufacturing setting and has graciously agreed to coach me twice per month on my consulting challenges.   His advice was both helpful and practical.  Here are the main points he made:

• Help the managers see value from the Value Stream prospective.  If you are able to get them to transition from a functional view of the world they will start to identify all kinds of work that no longer needs to be done.  Thus freeing up capacity to fund improvement efforts.
• Start small, but keep going.  Pick a couple of easy projects that will free up resources and execute on them and then reinvest the freed up resources into other, larger improvement projects.
• Finally, coach each of them individually, in the background.  Spend the time helping them get comfortable with the tools and the principles so that they feel confident in front of their peers and their staff.

I thought it was good advice and I wonder if others have additions?

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This quote reminds me of an old boss I used to have that taught me a lot. He always challanged me to take risks and learn more. He would never answer my questions, only ask me his own. What made him such a good boss is that he always assumed that I was capable of doing the job reguardless of my experience or ability. His belief that I could do the work always gave the confidence to try no mater how many times I messed things up in the past. This is a good lesson for me as a consultant. I often catch myself assuming that people are not capable when often they probably are.

“Treat people as though they were what they ought to be and you help them become what they are capable of being.” — Goethe

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There was a lot of interest in my last posting so I figured I would provide some more details on our Daily Management program and what we are trying to accomplish. The program consists of ten modules that we have developed internally, all customized for our healthcare and administrative settings, but primarily based on the TWI (Training Within Industries) program. For each module, all frontline managers will come to a two hour class and then return to their work setting to work through approximately 10 hours worth of homework. Each module builds on the last and they basically walk managers through the processes of identifying customer requirements, developing process measures, standardizing, training, creating visual systems and then improving core processes.

The first group of managers to undertake this training comes from our health plan administration group, but the goal is to roll it out to the entire organization, including clinical areas within the next two years. As we organize around Value Streams we will role the training out along those Value Streams. Each training will include the managers of the “production environment” as well as the managers that oversee the supporting departments like IT and HR. Our Lean team will take responsibility for improving the program as it roles out.

While at the surface this program may seem like just a process improvement training our goal is far more ambitious. Each module has specific goals identified of incrementally changing behavior of all levels of leadership. Managers will be required to become more involved in the work and to become trainers and coaches and not just decision makers. We are aligning this program with our strategic plan and every manager in our model line area will be required to standardize three processes over the next year. Finally, in the past it has been the norm that managers seek advice, coaching and support from our training departments. This will no longer be the case. Instead, we have established a cascading coaching and training model where our Directors are required to support front line managers and our VPs are required to support the Directors. For each leadership level we have creating supporting tools to make their jobs easier, but these tools will not be sufficient. To train and coach you need to master the details and know the work. Thus, we anticipate the leaders to be far more involved in the work areas in the future.

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Yesterday, in the Model Line we launched our Daily Management Training program that is based on the TWI (Training Within Industry) program.  Our goal is to have all 80 managers trained over the next five months and most core processes standardized within the year.   If successful we will completely change the culture of the organization.  There will be many challenges that we will have to overcome as we roll this training out.  Here is a list of a few of them that we are anticipating:

• Drastically changing the role of managers and supervisors from fighting fires and making decisions to maintaining standard work and coaching staff.
• Requiring that senior leadership be present in the work environment more often and have a greater knowledge of the work.
• Establishing process measures and visual systems for all processes meaning that expectations and performance of staff will be visible to all.
• Overcoming the cultural bias of “not invented here” where teams are resistant to adopting others best practices. 

I am excited for these changes, but I would be lying if I did not admit that I am a little anxious about the magnitude.   I am wondering if there are any others out there that have led a TWI like implementation in a service or healthcare environment?  If so, got any tips?

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Last week a senior leader in the organization commented that I am one of the most persistent people they have ever met. I guess I will take it as a compliment. In an organization that is just starting out on its Lean journey it is critical to have persistent people around, holding people to their commitments and reminding them to ask why. I like this quote for these very reasons. There are many, many educated, talented people in healthcare, but maybe what is needed is more people that can help them channel their energies.

“Nothing in this world can take the place of persistence. Talent will not; nothing is more common than unsuccessful men with talent. Genius will not; unrewarded genius is almost a proverb. Education will not; the world is full of educated derelicts. Persistence and determination alone are omnipotent.”

– Calvin Coolidge

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It is amazing to me how powerful a simple change can be if it puts employees in a position of empowerment. A couple of weeks ago a Manager that I have been working with participated in a site visit to Genie Manufacturing were she watched a team of staff pulling work from a leveling system. This image stuck with her and she decided that she wanted to implement a similar system for her administrative healthcare process. Without any training she went back to her administrative work area and formed a small team and they discussed her ideas. They decided to pilot a very simple Heijunka Box with a group of four staff members. The results were amazing. With just four of the twelve team members participating they were able to work a backlog that typically runs five days down to all work coming into today getting done today. Now the entire team is on the system and they are taking on additional work that was backlogged in other departments.
Some of the staff members were concerned at first, because if they were slower it became visible to the rest of the team. This concern quickly disappeared as faster team members now support slower team members once they have finished their work. Staff members have stated that it was the first time they have ever felt like they were a team and not just a collection of workers. Additionally, the team has continued to improve on a daily basis and morale is high. Kudos to this manager, this is what make my job fun!

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Wow, my job really has changed. This was really evident this morning as I began to re-write our Lean consultant job description that we will soon be posting. A year ago the job requirement of this position was the ability to lead RPIWs and to work with line managers to develop improvement plans. The work was focused primarily on point improvements and ancillary value streams that for the most part were contained in functions like laboratory or pharmacy. Recruitment for this position was far easier then it is today since there were many internal candidates that we could quickly train to fill the role.

This is no longer the case. Lean has become the chosen methodology to achieve many of the strategic objectives of the organization. As the organization moves toward organizing around product families the skills and knowledge necessary to plan and execute this type of work is far more demanding on both leadership and consultants. Consultant need to be able to convert complex theory into successful application. They need to be able to teach, mentor and advise VP level leaders in seeing their work differently. They need to possess specialized knowledge and technical expertise that is far broader then what is required to lead point improvements.

To develop, find and retain this type of talent we need to be smart. We need to make this position a key component of our leadership development and succession planning track. It has to become the place where up and coming leaders go to gain the skill necessary to moving into line positions. We also need to find new ways to attract talent from the outside, including from outside of healthcare.

Overall, this is a good problem to have. It shows how far we have come, but if we are not careful it could limit how far we go…

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One of the first departments that our centralized Lean team worked with was Pharmacy and this was the first place that I participated in a Lean Workshop. Over the last year and a half we have conducted several RPIWs in this area, coordinated 5S events and have even trained two pharmacists to become Lean facilitators. Our Lean office’s involvement in this work has gradually been phased out as the managers and leaders have taken on a larger role in leading improvement work. Yesterday I ran into one of the leaders from this area that was ecstatic about the results. The leader told me they have greatly reduced cycle times, improved quality and achieved significant cost avoidance. She describe the new program they are about to implement a form of the” Daily Improvement” system where small teams will begin to conduct mini-Kaizen every day of the week.
This conversation really put me in a good mood. When we started with Pharmacy we were really green. Each of us had read Lean Thinking and participated in an abbreviated training program, but we jumped right in. We made a lot of mistakes with this group, but our successes far outweigh them. Most importantly, we have stayed the course and helped the Pharmacy leadership get to a level of maturity that they can now stand on their own. There has been a true culture change in Pharmacy. As Lean grows more popular in the organization it will be more and more tempting for leaders to spread our centralized Lean resources thin. I hope the organization takes the lesson from Pharmacy to heart and is willing to continue to support work long enough so that leaders can truly fish.

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At the end of my day on Friday I had a conversation with one of my peers about a new service the organization is about to offer our patients. The service will be incredibly difficult to administer and the verdict is still out if it will be considered value added by the patient. I left the conversation wondering if the organization had gotten so caught up in finding a way to operationalize this new service that maybe we forgotten to continue to ask why it would be of value in the first place. Thus when I saw this quote today I could not resist.
“Quality in a product or service is not what the supplier puts in. It is what the customer gets out and is willing to pay for. A product is not quality because it is hard to make and costs a lot of money, as manufacturers typically believe. This is incompetence. Customers pay only for what is of use to them and gives them value. Nothing else constitutes quality.”
Peter F. Drucker

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It’s not always rainbows and butterflies during a LEAN transformation. I would characterize the state of our team with regards to the LEAN transformation (not with regard to working) as semi-dormant. There are several open positions and we are gearing up for a major software upgrade. I think this is a great time for reflection regarding our next steps. That’s the “semi” part, and I think this is about right. We have a pretty impressive record for the year behind us and nice thoughts and kudos continue to trickle in. All in preparation….

In the meantime, Lee briefed me on the model line work he’s doing. It advances what we have done to the next level. He even mentioned that his group got some ideas from our experience. This is excellent. Every innovation is a springboard to something more significant for our members. I’m excited to see his progress. Soon, we’ll be stealing ideas back. Not invented here is the best kind of innovation!

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