Daily Kaizen

We are an organization that produces an incredible amount of data and information.  The problem is that most of the information we produce is focused on lagging indicators, often months old and almost entirely outcome focused.  As a result, when I first start working with a team almost all of the data that we use is collected manually.  Often the high demand for manual data collection is met by push back from the management team.  Managers are used to getting automated reports delivered to them and at first they don’t see the value in having to collect information manually. 

I usually push through this resistance, because having the teams and local managers collect the data manually is one of the best things they can do to learn their processes and understand the problems of their area.  Let me explain.  When I first start working with managers in a area that has little or no experience with Lean it is almost always the case that the leaders do not spend much time in the gemba and thus they do not understand the work.  Team members often understand their own work really well, but know very little about the the work of the people upstream and downstream from them.  When we engaged the team we usually start by defining standards for the process and then identifiying in-process measures at critical points along the process.  The goal is to teach the teams to think and see process and much of the data that we collect will be posted on visual systems. 

Once the standards and in-process check points are defined we ask the managers and the team members to collect data on a frequent basis and to post it visually.  Often, for the first time the team have a full view of the process and the problems quickly become visible.  The heightened level of transparency puts a lot of pressure on the managers to solve problems and in order to be effective they realize quickly that they need to understand the process.  This means more time in the gemba, often collecting more data manually as teams begin to ask why!  That’s why collecting manually is a good thing, because it gets everyone focused on the process and understanding root cause.

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Sorry to readers for not writing for quite some time.  Early this month I got a much needed vacation off the grid.  It was a great opportunity to get away and clear my head.  I am now back to work and somewhat caught up and will be recommitting to sharing some stories on the blog. 

Since I have been with the organization we have had a constant struggle measuring outcomes and being able to assess causality.  It is very important for organizations to understand results in order to support decision making and to effectively  manage the PDCA process.  Yet, in healthcare most outcomes are elusive at best.  Unlike a tangible product you are often trying to measure the outcomes associated with a complex, living thing where causality is dependent on multiple factors (I am sure those of you in manufacturing are probably rolling your eyes, because there is probably no difference and I am playing the “we are different card”).  You may be providing preventative care that would not end up preventing a negative outcome for thirty years!  If someone is re-admitted to a hospital or an infection develops post operation it is often hard to pin down why.  Was is the actions of the care team, the patient, or simple nature running its course?  Often you will not ever know.   On top of that so much of healthcare is still not understood and evidence is not available about what should be done.  

Apply this challenge to an organization like mine that has a sixty year history of managing by objective and results and often you end up with leadership frustration and sometimes paralysis.  Over the last couple of years we have spent a lot of time trying to score strategies on effectiveness with incomplete information.  We have spent a ton of time trying to determine why outcomes are moving in one direction or another.  We have spent a lot of time arguing whose work is or is not impacting the result.  All classic shortcomings of management by objective. 

What is very encouraging is that things are beginning to change and we are starting to work through some of our paralysis with incomplete information.  Many of our leaders and team members are beginning to learn to see and think process.   We are studying the medical evidence through a process lens and asking what processes can we change that would lead to a different result?  Often, we are moving forward without good evidence and trusting the experience of our teams, simply, because this is the best we have.  What is important is that more and more energy of the organization is being focused on improving process as opposed to studying/debating outcomes.  As more and more processes change we will learn more and more about what works and does not work through trial and error and the experience of our teams and patients.  As we accumulate this knowledge we will understand more and more about what we need to do to impact the outcomes.  This is far better path forward then getting stuck dwelling in the outcomes alone.  Wish us luck!

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In consulting our organization on the Hoshin Kanri process, Pascal Dennis told a story that has stuck with me. It was essentially:

 Student: How long does it take to learn PDCA?

Sensei: 10 years P, 10 years D, 10 years C, and 10 years A.

 This story exemplifies the fact that lean is not, as we know, a set of tools that is easily understood and applied. Rather, it is a philosophical paradigm shift that impacts everything we think and do.

 Given this, and the fact that very few of us will ever master all aspects of this philosophy, it seems a logical conclusion that there are many places we can start this journey for our clients. Further, there seem to be many cases that, regardless of the lean method we need to ultimately arrive at to achieve the improvement/business results required, taking the most direct route might not be the best in reaching that goal.

 One such case has recently taken place. In this engagement a process was created to match the strengths and interests of a client as well as the business needs, as opposed to just the latter. In many ways this alignment was a great success for the client and their team. It also set a fire under the client to champion more transformational methods. I hope my reflection on that case can be of value to you and your clients as well.

 Case

Client Personality: Methodical, has strong emotional connection to work and staff, cares deeply about others as people.

Client Leadership Style: Is diligent to take in all perspectives and data, thinks long and hard before making decisions and taking action.

As with any, this personality and leadership style will have strengths and weaknesses as we pair them with various improvement methods. A few examples would be:

Kaizen? –  the rapid decision making and required comfort in allowing a front line team to experiment with improvement ideas may highlight the respect for people aspect. However, it will also cause friction with the need to methodically think things through before jumping to action.

Kaikaku (3P)? – The alignment issues called out with Kaizen would be magnified as this revolution, or radical improvement, would only increase the pace and severity of change, creating increased friction with the leader’s current style.

A3 Thinking? – This problem solving method requires the discipline of getting to the root cause of a problem before we take action. Further, it requires sharing your story over and over, and listening deeply to improve your understanding of the problem. In finalizing the countermeasures, it requires gaining consensus and creating an alignment through the nemawashi process.

What were potentially weaknesses with other methods are now strengths within the context of A3 Thinking!

Although as consultants, there was a fairly clear picture of where the A3 would lead, creating a situation where the leader involved is able to get there on their own and be fully invested in the countermeasures was critical. This occurred, and the countermeasures include several Kaizen events, that the client is now driving forward. This reality gives weight to the idea that we sometimes have to go slow to go fast.

Given the learning of this case, as you enter an engagement and begin to assess both the problem and the people, I encourage you to ask yourself:

 “What lean concept/tool/method would align with this leader’s style and help them gain confidence and interest in becoming a lean leader long after I leave?”

 In some cases they me be itching to jump right into a transformational change. In others, they won’t. If so, your consulting plan will certainly feel like a slower route, but your client and the improvement may go further as a result.

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