Daily Kaizen

We do a lot of planning and talking in the organization (too much in my opinion), but we are also getting more effective at implementation.  Teams are now much more action oriented, trying things to see if they work and being structured about the experiments they are running.  In almost every venue I find myself in there is evidence of teams piloting work and there is no doubt that there is an increasing rate of learning and improvement.  Where in the past we would have spent months if not years talking about how we would do something we now tend to break the work down into smaller parts and implement changes quickly.  We then check these changes and see what works and what does not work and adjust accordingly. 

When I step back and think about what we have done to begin to shift the culture it is hard for me to pinpoint the specific causes.  There are probably many and a lot of them were not necessarily intentional.  I guess this is why we call this a journey.   Causes include:

• A management system that has required management to be much more disciplined and in the gemba asking teams to improve one week at a time
• Managers that are much more focused on the process then they used to be.  This leads to staff being encouraged to try things and learn from the doing. 
• New skills that teach all staff and managers about the value of standard work, problem solving, process thinking and reducing waste. 
• Greater transparency and visibility of what the improvement and daily work is and when it needs to be done.  This leads us to better understand and manage capacity (while it often does not seem like it).
• Etc.

Regardless of the causes, we have a lot more experimenters in the organization then we ever have.  In the long-run this level of engagement and ownership will lead to a true competitive advantage.

Popularity: 3% [?]

I just got back from a great two weeks of vacation time back east.  During that time I got to spend a lot of hours asking questions and learning from my father.  My dad spent thirty years working in Quality and HR before retiring and has a lot of great insight.  Funny story is that I did not even know my dad was a “Lean guy” until a couple of years ago when I was home for another visit and walked by his bookshelf. 

One of our conversations really stuck with me and I thought I would share some of my reflections.  My dad worked for a small (400 person) manufacturer that competes with South America and China.  In the late 1980s the company had serious financial trouble and a group of Quality focused leaders were brought into the organization to help transform them back into competiveness.  I asked my father what was the single most important change that leadership made during that time.  He replied that the leadership team (which he was on) insisted that every single person in the organization was taught the finances of the business and then given the skills to help improve the business (reduce waste). 

He commented that before the new leadership took over staff was for the most part kept in the dark about the health of the business.  Besides from a memo every once in a while announcing the newest cost cutting effort staff was expected to just do their job and go home.  With the new leadership team they got busy teaching everyone about how the financial side of the business works and why the business was in trouble.  At the same time they provided employees a new set of skills to help reduce waste in the business.  This team was smart enough to realize that their greatest asset for improvement was the people that work in the organization and that given the same situational information as management they would feel as much responsibility and urgency to improve as management does.  Clearly they demonstrated the principle of respect for people.

When I reflect on Health Care and my own organization I do not think we do a very good job at helping team members understand the financial side of the business.  I often hear managers say naively that clinical medicine is not about business so we should shield clinicians from the finances.  This results in a small number of people (mid and senior managers) taking responsibility for solving the financial problems of the organization on their own without engagement from those that make most of the decisions that drive most of the cost and quality outcomes.  Let me be clear, I am not advocating that a lot of energy be spent on teaching clinicians balance sheets and dollars/cents.  Instead, we should be helping them connect and learn about how their every day activities and decisions impact the financial health of the business and the patients.  Every time we have made these connections for teams they have stepped up and made great improvements.  Just this week I was talking with a team that was struggling with changing their process, because the change would only apply to 4% of their volume.   Once we described that on top of the 4% of patients getting better service this change could also result in $3000 savings per patient (15 million dollars) the team leaders got busy with the change. 

Just think of all the potential!

Popularity: 4% [?]

We are several months into our grand experiment to build a front line improvement process in all of our medical centers, allowing all staff to fix their own problems, every day. It is very exciting work, and we’ve learned a lot.

However, the journey has not been without speed bumps. Right now the process goes like this; a small cross-functional team comes together to select a process, identify waste, propose improvements and design a short-term experiment that can start the next day and run for up to a week. The experiment has to be communicated to the larger group that will help enable the experiment. Then the front line improvement (FLI) team collects feedback from their colleagues, does a check on the experiment, makes any necessary adjustments, and plans next steps. They might implement as designed, adjust and re-run the experiment or scrap it and start over. Then the process starts again.

Simple, right? Yes and no.

 The process itself is pretty straightforward. Identifying waste in their work is like fishing in a bucket. Bringing forward their ideas and planning experiments is not only getting easier but more fun. The bump comes when they take their plan and try to engage their colleagues in going along with the experiment.

Why is this? Much of the work in our medical centers relates to flow (patients, information). Flow requires a significant amount of teaming across various roles to deliver care and create value for our patients. This means most of the problems the FLI team sees and wants to fix directly impact how teams work together (handoffs, communication, reducing variation, etc). The result is that the FLI team needs the engagement of their colleagues to ensure the experiments can be run as designed. Otherwise, they will have no idea if they’ve created improvement or made things worse. And this takes the idea of ‘teaming’ to a whole new level.

At first, some team members openly resist or refuse to participate at all. This is discouraging to the FLI team. They are not used to dealing with resistance. That is management’s job. And it still is—to a point. But the FLI team has a role too and here are some things they can do to help:

• Tell the story in a way that connects with their colleagues. What would they want to know if they were on the receiving end of the experiment?
• Be willing to communicate multiple times if necessary and help reinforce the notion that this is ‘just an experiment’
• Don’t be surprised if you get a less than positive response. Check in with colleagues and really listen to their input or concerns
• Ask for their feedback during the experiment and thank them when they give it.
• Don’t get discouraged. Give people time to get used to this new method of improvement.
• Don’t forget that you will eventually be on the ‘receiving end’ of someone else’s idea

What is needed from management?

• Communicate clearly and often making sure the teams have what information and tools they need to be successful
• Set clear expectations for participation and reinforce regularly by checking and spending time in gemba observing the experiment
• Celebrate the process of experimentation, not just the results
• Recognize people for their participation and input and acknowledge what they are giving up
• Make sure all employees get ‘their turn’ to participate in this process

Soon the larger team (a clinic or cluster) will trust the smaller FLI team to identify problems on their behalf and will be willing to actively engage in the experiments and give feedback and data that is helpful. I believe this trust is a key marker on our journey toward continuous improvement where all employees are engaged in improving their work everyday. We won’t get there without it.

Popularity: 6% [?]