Daily Kaizen

Entering our 7th calendar year of lean at Group Health, many of our largest improvement opportunities aren’t new – our mental models just haven’t allowed them to be implemented. As these known opportunities accumulate, and our organizational knowledge and willingness grows, our leaders are beginning to realize that successful kaizen is often not about the creation of new ideas. Instead, it’s about aligning individuals to see the whole picture, share a disgust with the actual, and agree to a standard / standard process to close the gap. If we’ve learned that this is what a successful kaizen requires, we are still learning that achieving these tasks depends on nemawashi.

At Group Health, we’ve summarized nemawashi as a “Japanese term for “preparing the soil for planting a tree.” Making decisions slowly to ensure all options are considered, input is widely obtained and consensus is gained; then implementing rapidly. “

There is no clearer example of the importance of nemawashi in capitalizing on opportunities we’ve known about for years then the process to prioritize and load enterprise wide improvement work. Traditionally, improvement work has sprung up organically from all over the organization, resulting in an abundance of work in progress. Because of this work in progress, the leaders and managers of our organization are left without the satisfaction of completed improvements, and instead with the weight of improvement inventory on their teams and minds.

Despite living this frustration, we’ve continued to understand the problem in the context of “other’s” improvements, but rarely in reflection on improvement work we’ve initiated. This is because our leaders don’t see the full impact of their improvement as it joins others in fragmenting and outstripping the capacity of support functions, front line teams, and management. They don’t see that pushing more and more inventory into the system further hides the rate limiting bottleneck areas in a sea of waste. They don’t see that the best way to get their “favorite” improvement done is not by doing it covertly through politics and hired hands, but by improving our throughput and improvement processes as a whole.

Until recently, this inability of the organization to share a common understanding of the problem has prevented the subsequent steps of creating a unified disgust with the current state, and finally a standard process to begin pursuing the future state. However, in the past three months, the owner of our Hoshin process has used the power of nemawashi extensively to gain alignment and move the organization forward.

Prior to the kaizen event in mid December, our Hoshin process owner; through e-mail, phone calls, and 1 on 1 meetings, accumulated and shared a growing knowledge of the current state. In every interaction, the dialogue he engaged in with various individuals increased his own knowledge of the problem, but also allowed him to add to their understanding by sharing the accumulated learning from all previous conversations. Just as the owner of an A3 will continue to gain a deeper understanding of the problem through gemba walks, discussions, and reflection, our Hoshin process owner became the conduit to synthesize various inputs into one emerging understanding.

As knowledge grew, the nemawashi transitioned from seeing the whole problem, and sharing disgust in it, to an emerging vision of a future state. Again, through e-mail, phone calls, and 1 on 1 meetings, the vision of our future state was revised, refined, and eventually accepted and aligned around.

This allowed the event, which was only 2 days, to move quickly into designing the detailed standard processes, job breakdowns, and job aids required to bring the vision to life.

Once a process was in place, our Hoshin process owner continued to use nemawashi to align the organization on the improvement opportunities that would come forward for the first quarter, and the prioritized order they would fall in using the intake process and scoring criteria developed in the kaizen. In many ways, this was even more difficult a task then aligning the organization around the event, as the topic moved from an abstract process to real improvement work.

However, once again through a tireless cycle of drafting, sharing, learning and improving prior to the loading event, nemawashi paid off as confirming the order in the event was a non-event.  All the leaders and managers involved understood the order, and felt heard about any concerns they may have had prior to the event. This allowed the bulk of the event to be focused on the more important part – matching demand to capacity by loading each improvement opportunity to the roughly 300 front line work teams that could be impacted by the work.

Through this diligent, unglamorous, repetitive, and often trying process of nemawashi, in two short months our Hoshin process owner was able to align the organization around a common view of the problem vs. many adversarial views of the problems, a shared future state vision, one prioritized list of enterprise improvement opportunities, and one load of this list against the capacity of all required work teams – something we’d never achieved as an organization.

As our leaders transition from leader as knower/ teller to leader as teacher, the importance of who has the idea, is taking a back seat to who can help align stakeholders around the idea. Our Hoshin process owner has demonstrated a powerful model for our leaders to learn from. As this nemawashi model is shared, and the skills of aligning and teaching gain the spotlight, I am excited by what’s possible in our rate of improvement and for the experience of our members.

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We are now five years into our Lean journey at Group Health.  Being an organization that employs nearly 10,000 employees across a large geography you would not be surprised when I told you that there is a high degree of variation across teams in the depth of understanding and ownership of Lean principles and practices.  What is incredible to me as someone who has been in the thick of things from the beginning is that every manager and team has started on the journey.   Collectively we are learning how to act our way into a new way of thinking.  

Those of you that know me would not be surprised when I say that over the five years I have been often impatient with the pace of change.  The variation I mentioned above has led to a lot of sleepless nights reflecting on what I/we needed to be doing differently.

• Why did the leaders not see how much more effective we could be if we moved faster?
• Why does it feel like so many people are just trying to wait this out and hope that it goes away?   
• Why so often have teams made progress only to see it disappear with the change in leadership or a short-term problem that compromise all that we have gained with the staff? 

None of these questions have simple answers, but I think most of you would recognize the many challenges we face as Lean leaders in trying to bring about transformational change.  In our case we have had a sixty year old organization that has moved from one management program to the next.  We have talked about quality, innovation and staff engagement, but our actions have not always matched our words.  This has created a level of skepticism within our teams that will only shift through action and not words.  This means changes in behavior throughout management, discipline to not stray far from the principles for too long and most importantly each and every employee needs to have meaningful and direct involvement in improving their own work. 

I have often been coached (some might say talked off the ledge) by colleagues with more Lean experience that I need to remember that it takes five to seven years for Lean to really begin to become part of the culture of “how things are done here.”    This makes complete sense when you think about the requirements I shared above.  It takes a lot of time for a management system to become capable of hooking all 10,000 employees into the process of continuous improvement.

 I thought I would end with a story from an experience I had this last week that helped me relax a little bit (for a while anyway).  I attended an event where a group of frontline leaders and staff were coming together to PDCA a statewide care process that was first standardized and implemented two years ago.  At the end of the session I overheard some of the managers talking about their experience.  One mentioned that things had gotten much better once she had stopped fighting the process and started learning.  In the past she had viewed her role as one of “protecting the frontline” from the variation of higher level management and for the first time she was realizing that she could trust that this change “in doing things was good for everyone.”  Another manager then commented that for the first time in her career management had asked her to help improve the same process for a second time.  She was used to management moving from one project to the next and never staying with an improvement long enough to see it stick.  Her words not mine: “I realized that I needed to get on board, this was not going away this time.”

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Like all of you it has been painful to watch from afar and see the onslaught of negativity being aimed at Toyota.  For me it feels like the star quarterback of my favorite team that I have held up on a pedestal for most of my life finally brings his team to the Superbowl and ends up being benched in the first half after throwing three interceptions.  There is not a day that goes by that I am not asked by someone to explain my perspective on what is happening or worse asked to defend why I still believe what I believe. 

It is easy for me to speculate on what has happened at Toyota.  It is even easier to get emotional and end up on the defensive.  Are these problems the result of:

• Toyota’s obsession with growth that led them to sacrifice the principles and practices of the Toyota Production System leading to lower quality and less customer value?
• Are these problems real, but overblown by a media that is smells blood and wants to make an example out of the icon?  Why have other recalls under way (Honda over 1 million airbags, Ford faulty brakes) seem to be ignored while Toyota makes the front page every day?  Do people really believe that Toyota makes a product that is lower quality then is competitors? 
• Are they problems making so much noise, because Toyota is now confronting them directly and taking responsibility (many may argue that they are not)?  I think of how in the healthcare industry when patient safety concerns are voluntarily made visible the health system is often crucified by the media and the public for doing the right thing.

The truth is that I am far from the gemba and really have no idea what the problems are that Toyota faces and how much of the hype is simply just noise.   What is important for now is that we study from afar and learn from Toyota’s mistakes and how they respond to them so they we can avoid similar pitfalls.  Anyone who understands Lean understands that trying to copy what Toyota does was never the point.  If fact, it most likely will lead to failure.  Lean is about creating systems that encourage employees to solve problems every day.  It is a set of principles and practices that each company to be successful needs to make their own.  Toyota was once (and may still be) the best problem solving company in the world and so of course we all should want to learn from them. 

So what I have learned so far from this experience?  What is interesting is that moving forward there is one thing everyone (media, bloggers, Toyota, etc.) seem to agree on: that Toyota needs to refocus on quality and problem solving.  Nobody is saying that the Toyota Production System does not work, but instead that there needs to be a greater focus on the capability of that very system.  That in itself is the greatest lesson for me.  As my organization over the last couple of years has grown it will be easy for us to let quality, cost or delivery slip and lose all that we have gained.  As the healthcare industry moves into the great uncertainties of policy change and inflating costs it will be easy to change course and move away from the Lean system to meet short-term requirements.  Like Toyota there is no doubt we will face many, many steep challenges in the near future and so there will be a wealth of learning from their experience.   While I have no way to predict how and if Toyota will recover from these challenging times, if I was a betting man I would not be betting against them.

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Years ago, when I was in kindergarten my teacher taught us students a catchy little rhyme about traffic lights and safety.

            “Red means stop.

            Green means go.

            Yellow* means wait, even if you’re late.”

Good adage. It is simple, memorable, practical, and keeps you out of trouble. It has a nice visual control to go with it. We all know what a red stoplight means and what action to take when we see one. Other cars are coming. It’s not our turn. We need to put our foot on the brakes and come to a complete stop. We know what a green light means. We get to keep our foot on the gas pedal and continue toward our destination. Yellow is our caution that very quickly things will not proceed as normal and we need to prepare to shift our foot from the gas pedal to the brake. We need to do something different to respond to the change in status. When drivers don’t comply with these standards we know what the results can be. But if we adhere to them they help us achieve our desired outcome while on the road, namely to get where we need to be safely. 

I think this is a powerful analogy in a lean organization. In the last year we have become very accustomed to seeing ‘reds’ and ‘green’ in visual systems all over our delivery system. But do we understand their meaning? I think we are still learning. Here are some common misconceptions I hear and see regularly.

• Red means ‘F’. Green means ‘A’.
• Red means hide. Green means I don’t have to pay attention since everything is fine.
• Red means do a lot of explaining. Green means I’m doing everything right so leave me alone.
• Red means you do not understand what you have asked me to do and how hard it is and how busy I am doing my real job. Green means I got lucky.
• Red means rounding is not going to be fun. Green means rounding will be easy.
• Red means I have a big problem to solve by heroics or brute force. Green means I must have done something heroic and brute force works.
• Red means I don’t agree to this change and am opting out. Green means I will do it because I have to.

What if instead of seeing these complementary colored indicators through the lens only of personal success or failure, we saw them through the lens of process performance in pursuit of customer requirements?  

Red means stop. Green means go.

• Red means your process is not in control—take different action. Green means your process is in control—keep doing what you’re doing.
• Red means it’s a good time to apply problem solving methodology and ask 5 whys to understand root cause. Green means you can focus on other problems for now.
• Red means check more often. Green means check less often.
• Red means go to the workplace to understand where the process is breaking. Green means that being in the workplace is paying off.
• Red means we are not meeting our customer’s needs. Green means we are doing a better job of meeting our customer’s needs.
• Red means opportunities for coaching and support. Green means opportunities for recognition and shared learning.
• Red means we have opportunity to improve. Green means we have opportunity to improve.

I know that many of our leaders and front line staff have already started to make this shift in thinking but we still have a ways to go. I anticipate there will be a lot of opportunity in this coming year for our leaders to model different thinking about reds and greens to the people they lead. If we truly want to create a culture where problems are gold and transparency leads to continuous improvement this will be a critical shift for us to make.  

 *I’m saving yellow for another post.

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The times I’ve been at my best in lean consulting have always been when a mixture of personal passion aligns with acquired knowledge and a client’s genuine interest in learning. At the heart of these moments, is an ability to convey technical knowledge in a unique voice that resonates with the client. For me, acquiring this unique voice requires personal experimentation with lean concepts and methods. Outside of work, my favorite place to conduct these experiments has always been my 624 square foot apartment. It is here that learning often takes root, allowing me to speak to principles and concepts creatively at work.  Although wiser sensei have warned me that there are some parts of the job you just shouldn’t take home, especially if you hope to maintain any form of long term relationship, I have always found application to my personal life a great training ground (although, truth be told – the 5S’d bathroom was difficult to explain to my girlfriend in the early stages!).

New Years brings new opportunity for experimentation

As the New Year approached, and I set out to reflect on 2009, the fact quickly surfaced that by March I’ve often forgotten my goals for the New Year, yet alone reached them. This fact highlighted an opportunity for improvement in my methods of goal tracking and adherence in 2010. Given this, and some insight from a colleague, I decided the principles of Hoshin Kanri needed to be incorporated with my goals for the New Year.

Last year, a colleague of mine, Dan Weber, began applying the core principles of Hoshin Kanri to his personal life by setting a true north, deciding on 4 – 6 focus areas, and setting a select few measureable goals within each of those categories. He then had a monthly check on how he was performing to target, and for any gaps, used A3 thinking to identify root cause and develop countermeasures.

The simplicity of his application was intriguing. However, it wasn’t until he began to think about how his focus areas and goals may change for the New Year, demonstrating his adherence and goal attainment, that I was catalyzed to action.

As I began to ask “why” on my own difficulties in meeting goals in years past, the following understanding began to emerge:

General problem:  I consistently over commit to personal endeavors, leaving me scrambling from one to the next, never feeling like I truly completed any one goal. Whether it’s saving money, spending time with friends/family, or pursuing a hobby, I always take on too much to fully be “in the moment” and achieve true fulfillment.

Why? I lacked the discipline to pick a few goals and stay committed to those goals.

Why? I hadn’t found a method to stay focused on my goals and track my progress.

Hypothesis: If I can pick a general direction for 2010 (true north),  identify the various areas of my life that add up to that direction (focus areas), set goals within those areas, and consistently make my current status in relation to those goals visible, I can reduce distractions, achieve my goals, and a new found level of fulfillment.

True North: Disciplined Happiness

Focus Areas (5): Health, Career, Financial, Hobbies/Fun, Family/Friends (shamelessly stolen from my colleague)

Example Goals (5 – 6 per focus area, 28 total):

• Health – Play basketball or bike twice per week
• Career – Read 3 articles related to lean / health care per month
• Financial – Reduce credit card spending by 5% per month
• Hobbies/Fun – At least 8 Guitar / Piano lessons
• Family/ Friends – Make dinner with friends at least once per month

After creating my goals, I needed a way to make them, and my status, visible. To do so, I divided an old white board into 28 rows and 12 columns. Having this monthly view for each item then allowed me to make the weekly measures visible by dividing further the space in the month.  Similarly, the monthly goals that call for “x number per month” were broken down within that month.

This visual, along with a simple plumb line, allows me to do a binary red/green check at the appropriate time interval for each measure.

This application is clearly very simple, and will never replace the complex technical, political, and consulting skills obtained from application in a real business environment. However, for those of you who are early in your lean journey, using a problem that is straight forward, yet still relevant to you personally is a great way to truly internalize lean principles and tools from both the consultant and user vantage.

Being the user/client of my experiments has not only helped me better relate, as I can talk from experience, but also to be more sympathetic to the struggles of a new discipline, which can be critical to keeping the patience and humility long term success requires.

In the months to come, I will provide an update on my personal Hoshin Kanri. In the meantime, I challenge you to consider what opportunities for improvement you may have in your personal life? Further, what lean principles, methods, or tools would be helpful in that improvement?

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