Daily Kaizen

Our company is now a few years in to implementing a lean management system. Some parts of the organization are deep in, while others are just getting started. There is now an organization-wide commitment from all levels of leadership to ensure that we implement a daily management system, have an annual strategic planning process, use a systematic approach to improvement and problem solving and continually strive to reduce waste and create more value for our patients. It’s very exciting to see this all come together. It’s also a bit painful. Why?

As the parts and pieces come together to form a whole system there will inevitably be pinch points. Where do I see these occurring?

Side to Side (Domain versus Responsibility): Recently I was involved in an improvement event. It became clear during assessment that one department’s standards and processes were having a negative down-stream affect on patients and two other departments (and vice-versa). All three of these departments have active improvement plans in place, fairly robust daily management systems and experience with kaizen events. So, why were the problems so buried and why was there so much pain being caused up and down stream? Each department was dealing with the problems from their own view, with some sense of the patient experience, but had not come together to sort out the accountability for ensuring that the standards and processes align to create value for the customer. It was clearly broken, but whose responsibility was it to get it fixed?  

Top to Bottom (A Break in the Chain): We have a lot of work going on at all levels of the organization. There is daily front line improvement happening. Whole departments are implementing the improvements designed in kaizen events across multiple front-line teams in multiple sites. Higher-level leaders are coming together to create standard processes for prioritizing and loading cross-functional work for care delivery and administrative processes. Executive leaders are working to ensure that long and short-term business priorities result in sound strategic plans that can be executed to achieve desired results. Department managers are implementing leader’s standard work. With all of this great work going on it is inevitable that everything that needs to move from the top of the chain to the bottom, and from the bottom of the chain back up is not occurring. This can result in:

• Leaders loading new work on already overwhelmed teams.
• Front line teams feeling like everything is ‘top down’ and not feeling empowered to improve their own work
• Multiple teams or departments trying to fix the same problem without visibility of the other.
• Staff doing improvement work but not receiving meaningful recognition

Inside/Out (Us and Them): We are just beginning to get a view of how our improvements, our decisions, and our new approach affect our suppliers, purchasers and business partners outside of our company and how we can join with them to create more value for our patients. I am confident that there is much opportunity here that we have barely begun to understand.

So is the pain of doing all this worth it? Shall we endure?

If our goal is just trying to create a better approach to cross-functional issues or improve the flow of information from leadership to front line and back up or achieve better coordination with business partners (which are all admirable goals) then maybe not. It’s my hypothesis (and not only mine) that what will truly take us to a place of unmatchable performance where we can achieve unprecedented value for our customers will be our ability to bring those pieces together to form a whole.

 I think a good picture for the system we are trying to create is an interlocking web (not necessarily a house or scale which I often see used to describe lean companies). A web is strong, flexible, responsive and effective. Imagine a future in which no matter where the customer touches our system, no matter what level of the organization or in what department an employee works, no matter how a supplier is connected to us–that place on the web will be connected to every other (top to bottom, side to side, and inside to outside) to ensure that all the appropriate resources align to eliminate waste, create value, and ultimately give our patients the best health care imaginable.

To that end, I say yes. The pain is worth it. And I hope we endure.

Popularity: 2% [?]

Across the organization teams are working on putting in place Daily Management systems and I am often getting asked questions about how to get started.   Just this last week I visited two different teams in two very different parts of our Delivery System that were early on in the process and struggling with what to do next.  Both teams had started to attempt to improve their processes, but had not first defined their process outcomes and standards.  Thus the teams were struggling, because they could not measure if they were making a difference for the customer or not.  They could not test their hypothesis. 

I thought I would share with you the approach I recommended to these teams and have recommended to many others as they begin the process of standardizing and improving their core processes.   

• First, start by defining your customer or stakeholder requirements.  What products and services do you provide?  What requirements do you need to deliver on to successfully add-value? 
• Second, translate these process requirements into outcomes.  What level of performance in terms of cost, quality, delivery and satisfaction do you need to meet in order to meet the requirements?   If the customer requirement is they don’t like to wait long ask the customer enough questions to understand what they mean by “wait long,” is it 2 minutes or 20 minutes? 
• Third, define (and potentially map) each of the core processes that are required to reach these outcomes.  Study the processes and determine the baseline performance. 
• Finally, pick a process to standardize and improve.  Select a process that is not meeting customer requirements based on the defined outcomes.  Translate outcomes into in-process standards and run some improvement experiments.  Pick the next process once complete. 

What is most important about this outline is that we are always starting the process with defining what our customers require and then translating those requirements into clear standards we can use as indicators for improvement.  That way we are clear about why the change improvement is needed and we can measure along the way to know if we are making progress.

Popularity: 9% [?]

This last week I participated in an improvement event taking place in one of our medical centers and in one and half days we were able to accomplish a considerable amount of improvement.  Three or four years ago it would have taken us an entire week to cover the same amount of ground!  The team came ready to get things done, there was very little disagreement and the work was incredibly well supported. 

Driving away on Friday night it was fun to reflect on why this was the case.  What is it that is allowing us to move faster then we have been able to in the past?  As I pondered this question I began to realize that there was no single answer, but many.  This event was a demonstration of how our culture has begun to change and the supporting management systems are becoming more capable.  So what is different now then four years ago?  Here is a starter list:

• There is a common improvement language that all of the managers and staff now understand.  We did not have to spend time training people on the basic concepts, because they have been practicing them for a couple of years in their work areas. 
• Team members did not spend time pointing out how problems are the result of others actions.  Team members did not try to explain away the reasons for the current state.  They instead accepted that “it is what it is” and got busy making it better.
• Management was well prepared for the event.  They knew their role in advance, did not delegate responsibility, knew what expectations needed to be set and ensured that the right amount of resources were in the room.  Most importantly, they knew how to properly scope the work to ensure the team had stretch targets, but not going so broad that we could not possibly implement for a long time.
• Support services were active participants.  A couple of years ago at the end of a workshop we would always end up with a wish list of IT changes, measurement changes, etc. that we would have to then beg for resources to complete.  This Friday we had IT folks, Finance folks and others all in the room prototyping solutions along side the team. 
• Finally, everyone in the room focused on process and not people or technology.  A couple of years ago it was really hard to get people to think process and often the conversation would slip into either blaming others or asking for the new technology that would save the day.  On Friday I overheard a couple of times team members encouraging each other to “use their minds not their money.” 

It is hard to quantify just how important these changes are and will continue to be for the performance of the organization.  What is clear is that rate of improvement is increasing each and every day.  It is fun to think about how much more we will be able to get done three or four years from now.

Popularity: 3% [?]