Daily Kaizen

As you all know a Lean transformation is an incredibly difficult process for leadership at all levels to navigate.  It requires a new set of skills and behaviors and it challenges leaders to unlearn much of what has made them successful in the past.   Going into the journey alone is a daunting task and so many organizations invest in providing Lean coaches (consultants or sensei) to help leadership navigate these changes. 

Over the last year our Lean efforts have greatly expanded across the organization in terms of both breadth and depth.  More people are engaged in the process of transforming their operations then ever before and many of the leaders are in their forth and fifth years meaning that many of the problems they are trying to solve are no longer at the basic level.  The days of just running improvement events in a small number of areas are in the past.  With these changes comes a need for increased capabilities within our Lean team.  Over the last couple of months I have participated in many conversations within our Lean group discussing how to effectively coach leaders and I thought it might be useful to share some of our thinking. 

First and foremost the most important requirement of coaching is being able to gain the trust of the client.  Without having their trust it is unlikely you will make a lot of progress.  Yet, it is not easy to describe what it is you need to do in order to earn trust.  Here are a couple of thoughts:

• Trust begins with developing rapport.  Spend the time upfront getting to know the client.  Ask them what gets them out of bed in the morning.  Talk about their past.  Talk about what they are interested in getting done and how you can help. 
• Be yourself.  Use your personal style.  Often times I see consultants get nervous and they try to be someone that they are not.  Clients can often see through this façade and they will sense something is off.
• Walk in their shoes.  Go to the gemba and ask a lot of questions.  Lean coaching is not content free; the more you learn about their operation the more you will be able to help them move to the next level. 
• Don’t try to do too much too fast.  I often see coaches provided their clients with 2-3 pages of bulleted feedback.  This leads to overload and the client will begin to drown you out.  Start with one area of improvement and then move to the next. 

Another area I see coaches/consultants struggle is staying true to their role and we often venture off the path into the realm of over functioning.  Let’s be clear the purpose of coaching is to build capability into the leadership line.  Yet, as we all know it is often difficult to “hold the line” and as coaches/consultants we are often asked to do work that is really the work of leadership or we see gaps and we jump in when it may not be appropriate.   Within our group we often have a debate about whether we should ever over function.  Personally, I believe that there are some instances where stepping “over the line” and assuming the role of the leader may be required for the good of the company.  Although this should happen rarely and there will be a long-term cost, because the opportunity for learning has been compromised.  What is most important for me is that when this happens we did intentionally and we are aware of these costs.  I tell the coaches I work with that if they are not sure if they are over functioning that they call a time out and ask for help. 

There is a lot more writing I could do on this subject.  For now I am going to turn it over to comments to see if others have thoughts.

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I remember hearing someone say a while back that if your Strategy Deployment process is not driving you completely crazy you are not doing it right.  Based on this measure I feel like we are doing pretty well at Group Health.  In all seriousness, I think that anyone that has experience with Strategy Deployment understands how difficult, frustrating and effective this system can be.  Difficult, because it forces the entire organization to learn how to work and behave differently and adopt new mental model for management.  Frustrating, because the organization begins to learn a lot more about itself and the more it learns the more it realizes just how many problem it faces.  Effective, because as we break free of traditional models of management and begin to solve problems we have never understood in the past we begin to create more value. 

For the last three years we have been experimenting with Strategy Deployment at Group Health and it has been a difficult, frustrating and effective experience.  Overall, we have come a long way in a short period of time.  When we started the strategic planning process of the organization was primarily a list of functional based projects.  There was not a single set of organizational goals and strategies that everyone was working to achieve.  Much of the resourcing decisions were made based on influence and very few people participated in the process.  In terms of checking and adjusting, I think it only occurred when a big problem was made visible and there was no formal process. 

Today, we have a single plan that is visible and that the entire organization is working toward achieving.  This plan was created with the input of hundreds of people through a standard planning process.  The organizational calendar has been standardized and we have check/adjust processes linking the different levels of the organization.  While we are far from perfect we are off to a good start.  Throughout this process we have learned a lot about what not to do and there are areas where we seem to continue to make the same mistakes.   I thought it might be useful to share some of our learnings:

• Not having enough focus.  As an organization we don’t understand enough about capacity.  As a result we constantly “load” far more work then we can accomplish.  This drives all kinds of waste.  Besides making hard decisions and getting more effective at understanding capacity I am not sure how to get better at improving our focus. 
• Changing the tools and construct.  Each year we have made changes to the tools and process.  These changes have led to a lot of confusion and instability.   Early on it is important to pick a process and stay with it a couple of years so that people learn the process.  We have been too quick to PDCA
• Build in time for reflection.  It is important to spend time each year stepping back away from the content of the work to reflect on how effective your management system is working.  Some of the most valuable time we have spent over the last couple of years has been in reflection. 
• Planning and Doing is important, but the most powerful learnings come from the Check/Adjust.  The areas where we have been most successful with Strategy Deployment are the areas that have been most disciplined with the Check/Adjust process. 

For anyone out there just getting started I hope this list is helpful.  I highly encourage you to push forward with the process, but be careful it might drive you crazy.

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One of the most basic and fundamental aspects of managing an operations is having a good understanding of demand.   Yet, I find in my work that often the teams I work with know very little about their demand.  Maybe it has something to do with the service industry where there is a long standing miss belief that it is impossible to predict when the end customer is going need a service, thus you need to just do your best.  I cannot tell you how often I have talked with managers that believe that forecasting demand is nearly impossible and shaping demand is completely impossible.   The problem is that without having systems and processes to understand and even shape demand operations are often in a constant state of firefighting trying to deal with whatever shows up at the door.  Thus these same managers are constantly trying to implement improvements on an unstable platform and are often not successful.   The new standard work system or other tool will work until there is a huge spike of demand and then the staff throws it out the door in order to manage the overburden. 

Often when I begin working with a team I ask them to simply post on a visual board that graphs day by day or hour by hour their incoming demand for each service(depending on the takt time) with a comments field for what they are learning.  After getting over the initial pushback most managers agree to give it a try.  After a couple of weeks I will come back and talk with the team and I have yet to find a case where the team was not surprised by how much they  had learned.   This becomes an excellent way to get a team engaged in understanding and improving their own processes, because often they have control over simple solutions that can help them better manage demand (i.e. changing the schedule or putting in place rings of defense).

I have a couple of simple stories to illustrate how small steps in understanding demand can lead to big improvement:

• Recently I worked with a clinical team that was convinced that they were understaffed to manage incoming demand.  Wait times for their service were way above standard and the team was feeling incredibly overburdened.  The management was in the process of requesting more staff even though adding staff in the recent past did not seem to help.  After collecting data for six weeks the team was surprised to see that the demand for appointments was more than double on Monday, Tuesday and Wednesday then it was on Thursday and Friday even though the team had the same amount of staffing each day of the week.  Thus the team was overwhelmed during the first part of the week and had open appointments later in the week.  As a result of this knowledge the team agreed on their own to change schedules to better match demand.  Additionally, the team is beginning some work to understand why the customer is demanding more service early in the week as opposed to later in the week.  The good news is the hiring is going to be left on hold. 
• Last year I worked with a team that handles clinical questions from patients.  The team collected daily demand and had fairly good forecasting capability on a day to day basis.  For a couple of months managers started to notice a problem with service levels on certain days of the week.  Yet, the daily demand was not far off from forecast.  I met with the team and suggested that they collect demand hour by hour.  After a couple of weeks of data collection I met with the team to review the data.  They had met prior to me coming and they were excited to show me what they had learned.  Their graphs had quickly shown them that on two days a week they got a sharp increase in the number of phone calls coming into the system at lunch time.  This created a backlog that took a long time to work down.  After asking “why” they were able to determine that another department in the organization had decided to shut down their phones a couple of days a week for staff meetings without understanding the downstream impact.  Changes were quickly made to alleviate the problem. 

I share these stories to simply illustrate how important understanding demand is to managing an operation.  By simply studying demand and putting in systems to understand demand on an ongoing basis teams can create a lot of knowledge that can lead to improvement.

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