Daily Kaizen

Within an organization there are two types of work: routine and improvement.  Routine work is the day-to-day work of the organization that allows products to be created and services to be provided.  At our organization we often refer to this work as LODO (lights on, doors open).  Improvement work is the work that is focused on improving the routine processes of the organization to allow for better performance.  Every organization needs to balance the resource and capacity that it allocates to each type of work.  Over-committing to improvement work can cause great strain on an organization and can lead to fatigue and a diminishing return.  By only focusing on routine work an organization is doomed to fail, since its competitors will not stand still. 

Over the last year through our Strategy Deployment process we have learned a lot about routine and improvement work and we have started to get better at understanding how to create an appropriate balance.   Not to say that we don’t have a long way to go.  The good news is that the Strategy Deployment process has created a heightened level of transparency across the organization and we now better understand what the overall work of the organization is and what resources are available to get it done.  The Strategy Deployment process has also put an enterprise wide emphasis on improvement related work.  As we have struggled to keep the improvement related work moving forward it has allowed us to better understand what many of our challenges are within our routine operations.  Below is a list of some of these challenges as well as some of our insights:

• We have many pockets within the organization where managers believe that their entire focus is on running the routine operation.  They do not view improvement work as being their responsibility.  Nor has the organization taught them how. 
• Routine work is less challenging and its safe.  It does not require managers to work outside their functions like improvement related work.  Thus, it is very important to have systems in place like Strategy Deployment to keep improvement related work front and center. 
• Many of our areas capacity is 100% taken to support routine related work.  Thus improvement related work is always looked at as additional work on top of a full time job.  We need to get better at ensuring that every team has time available to improve their processes and that improvement work is viewed as being as much a part of the job as routine work.
• Many of our routine processes are unstable and out of control.  So even if managers would like to focus on improvement they never have time, because they are required to constantly be fire-fighting.  This is why we are so focused on putting in place standard work.
• A lot of senior leaders time is currently spent supporting routine related work, which slows down our ability to improve at a faster pace.  Depending on where you work in the organization the amount of time you spend on routine related work should diminish the higher you are on the org chart.  For example a VP would ideally be spending 70-80% of their time on improvement related work while a frontline supervisor might only have 5-10%.  Moving forward we need to define a management system that better balances the time available for senior leaders to focus on improvement related work.

While we have a long way to go the good news is that at least now we know enough about our organization to start having conversations about how best to focus our resources on the appropriate type of work.  Two years ago we would not have been able to even start the conversation.

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Like most organizations early on in it’s Lean transformation there are a lot of mid-managers and senior leaders in my organization that are not used to spending time in the gemba.  The traditional management system of the organization, like most organizations did not incentivize leaders to spend time in the workplace.  If fact, most management processes required the gemba to come to leaders in the form of report outs and status reports.  If you wanted to climb the career ladder it was very important that you got a job at the corporate headquarters far from where our members are served.   In most years executives probably only went to the gemba a handful of times and when they did they probably as uncomfortable as the teams they visited. 

As we have progressed on our Lean journey this has begun to change.  More and more leaders are spending time in the workplace.  While some leaders would probably rather stay at corporate I believe for most this change is really positive.  Most people that went into healthcare did so in order to help members and patients.  Something that the further you are away the harder it is to do. 

Yet, the transition to spending more time in the gemba is a difficult one for most leaders and is often short lived.  They are not used to working directly with front line teams.  They often don’t know the work nor do they know what to do once they get to the gemba.  Additionally, teams are not use to having their leader come to the gemba and for the first couple of visits there is often an awkward and uncomfortableness.   Often I think the leaders show up, they begin to ask questions, someone on the teams is brave enough to share a problem and the leader not knowing what to do immediately jumps into problem solving mode.   After a couple of rounds the leader has had enough and the gemba visits no longer appear on their calendar.  Sound familiar? 

Here are a couple of tips that I have provided to leaders I am working with that are spending more time in the gemba:

• Experience is very important for both the leader and the teams.  The first couple of times will be awkward for both.  Over time the leaders will get more comfortable and so will the team. 
• Always go to the gemba with a purpose.  Are they going to check on the progress of a critical improvement?  Are they checking standard work? Are they checking on quality, cost or delivery metrics?  It is very important that leaders are going to gemba to check on an aspect of the teams work.  Otherwise the visit risks either being perceived as micro-management or PR.
• Visual systems really help, especially early on.  They provide information and easy content for coaching opportunities.
• Never own the problems of the team.  Leaders are used to getting handed problems for them to solve.  I have seen countless leaders take problems away from teams even when they were the teams problems to solve.  The purpose of the walks is to check the work and coach the adjustment.  Not to take the responsibility away from the team.
• At first, bring the hierarchy with you.  In other words, if a senior leaders is going to the front line the mid-managers should go as well.  Mid-managers struggle the most during a Lean transformation and its only further complicated when their boss is coaching their teams.  This challenge will go away over time. 
• Be organized.  The team should know you are coming and the purpose of the walk.   Be careful not to overwhelm the team.  Watch your tone and your energy.  Take good notes and listen.  Always leave the team with one or two questions and/or next steps that would would like them to work on.  When you return to your office summarize your notes and send them out with a thank you message as well as reinforcing the questions/next steps you would like them to pursue.
• Always start where you left off.  Develop a knowledge management system so that you track your notes and requests from each visit.  Teams will be blown away when a senior leader shows up and remembers everything from the last visit and asks them how they are progressing on answering the questions that they left during the prior visit. 
• Finally, ask for feedback.  Ask the teams.  Ask a peer or a Lean consultant to come along and provide coaching.  

Anyone else have some suggestions?

PS–For those of you interested in learning more about the work that we are doing with our Medical Home Model in Primary Care you can find an interesting article at the following link:  http://seattletimes.nwsource.com/html/pacificnw/2008628080_pacificprimary18.html

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Happy New Year to everyone.  Sorry for taking so long to get another post published.  Its been a really crazy couple of weeks and I was lucky enough to get some time off.  So much has been happening in the organization on the Lean front that it hard to pick what to write about next.  I guess since its a new year I will talk a little about what has happened over the last year and how we are adjusting for 2009.

Yesterday, I attended an all day session with the top 120 leaders in the organization.  The purpose of the session was to vet the Group Health Management system and to move from planning to doing in our Strategy Deployment process.  It was fascinating to sit in the back of the room and reflect on just how far we have come in a single year.  Here are some of the major To–> From highlights:

• One year ago this month the organization was beginning it’s first cycle of strategy deployment and our first draft of Mother A3′s were being developed.  Maybe 25 people out of the 120 knew what an A3 was and probably only 50% of the people in the room had participated in Kaizen.  Yesterday, there was not a single person in the room that did not know what an A3 was and probably around 75% are actively driving Kaizen in their areas. 
• Last year at this time the senior leadership team was still viewing Lean as a process improvement methodology and a tool set.  Yesterday, the CEO and his EVP’s spent most of the day describing our enterprise lean strategy (growing the organization without adding commensurate cost) and outlining the Lean Management system we are putting in place including components of all three management system
• Last year implementing Lean was voluntary and mostly held in the hands of the early adopters.  There was a lot of talk about it being a fad or program of the month.  This year the CEO has made it clear that “we are not going back and that supporting the Lean strategy and Lean behaviors was a condition of employment.” 
• Last year we were just finishing up another destructive traditional budget cycle and laying off hundreds of employees.  This year we have dismantled the budgeting process and we are focusing the organization on improvement as opposed to layoffs.
• Last year my dear friend and Vice President over the Model Line self-described himself as the “crazy man on the corner” for championing Management Standard work and linked checking, because nobody was following his lead.  This year the executive team is implementing management standard work and linked checking themselves and its mandated to all top leadership.
• Last year we had way to much work to complete in a single year.  This year we have way to much work to complete in a single year 

What a difference a year can make.  Looking forward to 2009 there are several changes we are in the process of making that will hopefully make my list even more impressive one year from today.  They include: 

• Redefining our product development process to help maximize the advantages we have as a vertically integrated organization
• Implementing a Medical Home model across the organization
• Redefining the metrics of the organization to better match our Lean strategy
• Redefining our financial management system.   Implementing KPI’s across all of our operating Divisions and continuing to unwind from our destructive budgeting process.
• As I mentioned above the implementation across the entire organization of management standard work, linked measurement and checking including visual systems
• Moving to a quarterly planning system based on a one year plan.  Driving quick iterations of check and adjust on a weekly basis in order to become more nimble and drive execution
• Etc.

It should be a fun year.  Cheers!

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