Daily Kaizen

As we continue to define and transition into a Lean management system one of the most challenging problems we are trying to solve is how to balance organizational and customer needs for consistency and performance with the engagement of frontline teams in defining improvement. When improvement is brought to a team defined and ready to implement it is difficult to engage that team in the process. Even if the improvement was designed by their peers (the old “it was not invented here” challenge). When improvement work is left completely up to teams based on a achieving a standard you may get the same outcome on paper, but in a service organization the customer experience may be so different that many complexities and problems are created.

This is particularly difficult when:

• Multiple locations provide the same services like we do with many of our clinics, pharmacies, labs, and specialty services.
• You are working through a sixty year hangover of improvement being 90-100% top down, management defined and specialist (project manager or consultant) implemented. 
• You are early on the journey of implementing a daily management system and managers are very uncomfortable in turning over improvement responsibility to their team members. This is because they don’t know how to engage their teams in PDCA and thus they don’t want to turn over control. This is often expressed by them comments such as, “there teams are really busy and I want to protect their time.” 
• You are using event driven approaches to improvement like rapid improvement workshops where only a small sub-set of those eventually impacted by the improvement are directly involved in defining the new process

Across our organization we are in the midst of trying to manage through these challenges. So where do we start and what should we do? I don’t claim to have all the answer on this, but we are working hard now to try and figure some of them out. Here are some suggestions:

• Simultaneously work on improving your management system from the top and from the bottom. While building the system from bottom up might be the best way in the long-term the realities of the short-term (political and business) often mean that we need to focus on both. Improvement work that is being driven “top down” will be disruptive no matter what. Yet, this disruption can be “softened” if teams have the opportunity at the local level to influence and PDCA parts of the process once it has been implemented. The trick is defining parameters for what can and cannot be changed. Consequently leaders who are driving work down in the organization need to be very clear about what these boundaries are and for items that are not “critical to quality” they need to get out of the teams way in allowing them to improve. 
• Related to above it is especially important that teams begin to implement a Daily Management system from the very early stages. Without this system teams will not be able to sustain improvement over the long-term. Not only will the reinforcement and checking systems not be in place, but teams will not be engaged if they cannot see the effects of their work. If improvement is always pushed on them they will eventually grow frustrated and either rebel or passively resist. I believe that the most powerful aspect of Lean is when teams fully engage around improving their daily work. This is the heart of the Daily Management system.
• Once a large scale change has been made “top down” it is wise to turn over the PDCA process to a local team. Again within parameters. This means pushing down the responsibility for improving the now stable process to those that are doing the work. Leadership should set the new standard and ask the frontline to come up with the next generation of improvement for the process. For a system with multiple locations it might be advantageous to rotate this responsibility among the different teams or reward it to the highest performing unit. Over time, teams that get a chance to improve processes that others must adopt will be more willing to adopt processes that other teams designed.
• Rotate as many people into Lean events as possible. As most of you know, people that participate in rapid improvement events often have a light go off and become big supporters of change. Many organizations have relied on this as their only method, which we don’t believe would be sufficient here, but it is a great tactic. 
• Finally, create every opportunity possible for teams to share learning’s and promote lateral improvement. If you can create systems that frontline teams are engaging with and pulling from each others improvements it becomes far less necessary for leadership to push improvements down in the organization.. Leadership sets the standards, creates the system for lateral learning and defines the parameters for improvement. Parameters might look like: “teams are free to pilot improvements, but in order to change the process permanently they must demonstrate an improve result with data” or “all teams much adopt a minimum of two processes a year from another work team.”

Anyway, this struggle will continue for us. I hope some of these suggestions help others. Please share your ideas!

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Please find below the lastest guest blog posting by Connor Shea.  Connor is a Lean consultant at Grou Health that is always got a set of great ideas and never seems to not have a smile on his face.  In the post Connor shares some of his learning’s from a recent project he worked on.  Enjoy!

Situation:

A recent consulting engagement with many area leaders, each owning a component of a larger process, resulted in a situation that can be simplified into the following example:

Leader decision making factors:

A)    Facts and data

B)     Personal emotions / feelings

C)    Collective emotions / feelings of staff

D)    Political implications

E)     Personal like / dislike of stability vs. change

Decision making prioritization (key component of mental model):

Leader 1:  B, D, C, A, E

Leader 2:  D, C, E, B, A

Leader 3:  C, A, B, E, D

Etc

Goal: improvement based primarily on A

Outcome: Improvement based equally on A – E

Target:

Long-Term:

Every person is made unique by their upbringing, education, peers, and experiences. This uniqueness brings depth to an organization and should be valued. However, just as we ask front line staff to take their same uniqueness and decide on a best practice, should we not have the same expectations of our leaders? It seems that until an organization has a shared mental model that is explicitly understood and rigorously adhered to, we will have tremendous variation in the lean improvements that are taken on, the quality of their execution, and their sustainability.

Short-Term:

Create a micro-culture that had consistent goals, methods, and decision making priorities, even if the larger environment does not.

Proposal:

As the organization takes on the long-term target, a colleague and I focused on the short-term. Not all were tools I had in my toolbox prior to this work, as many were learned through trial and error, but they are all tools I will carry forward. I hope you one or two are helpful to you as well:

• We made sure that we remained consultants to the improvement, and not drivers of the improvement:
• 1 on 1 we attempted to understand and treat individuals as individuals. To do this we:
  • Observed and talk to them directly – why do they come to work everyday? What do they do on the weekends? etc.
  • Sought out input on personality, hobbies, history, etc from colleagues, senior consultants and others we had a working relationship with
• With the large group we set clear expectations with all members & held all members to the expectation equally:
  • We contracted with the senior leaders up front around a clear / explicit decision making process as well as working guidelines that team members would be held to.
• We learned to not solve a consulting problem with a technical solution
  • Early on, I believed that if I just explained the technical concept in a slightly different way, etc., that the light bulb would go off, and we’d move forward. Often however, understanding wasn’t the root cause holding the individual from moving forward. 
• To the best of our ability we made problems visible
  • Once visible, we were careful to ensure the issue was still about the process and not the people.
  • We used our consulting hierarchy to raise issues and barriers. Senior consultants were helpful in providing ideas and to help judge the situation to see if higher level actions were necessary.
• Finally, if working directly with an individual wasn’t working, we learned the informal power structure of the group and use it to our advantage:
  • To someone they listened to and/or reported to we focused on making visible how that’s individual’s behavior / actions impacted the overall success.
  • When we engaged someone’s manager, we tried to do so as fairly and explicitly as possible. The person always found out, and when they did, we wanted to be able to explain why we needed to engage their manager to ensure the success of the work.
  • Over time, all involved, began to understand and respect that we weren’t being unfair or playing favorites, but simply doing our best to ensure a successful improvement. Amazingly, we actually joked and laughed about these situations later in our engagement.

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This last week I spent some time with a couple of colleagues of mine that are internal Lean consultants.  They are working in a large operations area within the organization that is just now getting started on applying Lean tools and concepts.  The leadership in the area has limited Lean experience and the management processes of this operation are very traditional.  All of us were somewhat frustrated, because it was very clear that Lean was being viewed through a project lens with a discrete oversight group, a set of experts coming in to facilitate the improvement work on behalf of operations, etc.  The work was being planned and organized around the existing structures and management constructs.  There was no view among leadership that this work was an opportunity to not only improve the frontline processes, but also to challenge and improve the management processes.   It was a classic case of Lean tools being applied within a system with no Lean management.

After getting some time away from this meeting I realized I should not have allowed myself to get so frustrated.  This case was simply a reflection of where the organization is on its Lean journey.  Across the organization we have a wide level of variation in how far and how fast different operations have embraced Lean.  Many parts of the organization are still holding out that this work will go away (although there are less each week).  Other parts of the organization are early on the path and they are focused on the Lean tools.  They us the traditional management system of using projects as the means for improvement and facilitate Lean events to improve processes.  Finally, in a couple of large operations like the Model Line and Primary Care we have leaders deeply embracing a Lean management system.   In these areas leaders have learned to view improvement through the process as opposed to the project lens.  Improvement is happening mostly through small changes being implemented daily across hundreds of teams, often being facilitated during daily stand up meetings called huddles.  In these areas Lean is used to not only improve the operational processes, but also the processes of management system.  Overall, in these areas Lean is not something separate that allows us to get the work done, it is the way that work gets done. 

So is it bad that we still have areas within the organization that are treating Lean as a set of tools or projects?  I don’t think so.  This is because through the application of the tools and the implementation of the projects an opportunity is created for learning.  Leaders involved in these projects with see first hand how the current management processes do not allow for sustainability of results.  How their own behaviors and actions often lead to negative impacts on the frontline and engagement, etc.  In other words, through the involvement in Lean projects leadership will see all the management problems become visible.  If they are good students and have good teachers they will then naturally begin to see how Lean applies not only to projects, but also their own processes (management system). 

The Model Line, Primary Care and all the other areas in the organization that have made this transition started with a focus on projects and then extend into a management system.  This did not happen overnight and it was often frustrating for those of us that were involved.  It was simply part of the maturation of our Lean system.   As consultants we need to make sure that we don’t get ahead of our leaders and expect them to master concepts without experiencing them first.

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Below please find the latest guest posting from Greg Burnworth.  Greg is a Lean consultant at Group Health and he has spent the last couple of years working within our Health Plan to support our Lean transformation.  Recently, Greg has had the chance to pioneer some really impressive work within our sales and underwriting functions that we are all getting the benefit of learning from.  Enjoy!

One of the most challenging aspects for leaders in our aspiring lean organization is how to effectively role model lean leadership. I find this also particularly difficult as someone not only trying to coach and support these leaders, but also difficult in my own daily behavior as a role model for them and others. So when I was approached by Lee about contributing to the blog, I was impressed with the quick, direct nature of his request, and how effectively he modeled “taking initiative” with just a one sentence question. I guess it worked, because it has driven me to action!

I like to remind myself that the lean leader’s job on a daily basis is to create change. Creating change means engaging people to take initiative to solve problems that improve the work they and others do. While this sounds simple enough, it does not come natural. It isn’t natural because often managers (and most everyone else) don’t want to be seen stirring the pot, and increasing the accountability of others. Second, many managers have been promoted by nurturing relationships and being well liked, and in their minds, challenging others could impact them unfavorably down the road. This couldn’t be further from the truth; taking initiative with a critical mind builds respect, it doesn’t diminish it. In fact, in working with one leader recently on preparing questions to ask in a gemba walk, this leader’s question to staff in this particular role play was,” are you feeling OK with this change?” While empathy is important, a better question to a team member would be, “how is your daily work different now than from before?”

Another compelling job of the lean leader is to shift the workplace focus to where value is created. Ideally, all staff should be in a position to provide more customer-focused value to our members than what is typically written in their job description. This is a more difficult proposition because it involves asking people to change roles. Incidentally, there are plenty of staff who are ready to learn new skills, gain experience, and support value added processes outside their own routine work.

It is often said it is easier to act your way into a new way of thinking than the other way around, but often we have no basis on which to know how to act! So how does an aspiring, if novice manager begin the lean journey and model the right behaviors? Perhaps the first thing to do is to honestly assess the style of their current management behavior, and then introspectively evaluate its effectiveness and all its shortcomings using a scientific approach. It requires the manager to personally see and recognize the limits of how he or she manages, and acknowledge and commit to a different approach. It requires humility and seeking help from a trusted mentor, and a willingness to make oneself vulnerable to acting differently every day. It is really rewarding to see managers, who initially met lean head on with distrust and discomfort, shift to a mental model of introspection, curiosity, and initiative.

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