Daily Kaizen

I believe it’s important to separate oneself from reality at times to think about ideas that may not be possible, but have the potential to move our thinking forward. It’s only through thinking on this edge between what’s crazy and what’s possible, that we can continue to inspire continuous improvement. This is one of those ideas.

The result of getting married, and inviting 265 people to our wedding, has been an unbelievable sea of presents in our 624 square foot apartment. What continues to amaze me is that the fixed reality of our square footage forces us to go through iteration after iteration of getting rid of things and then better organizing and storing what we do have. The fixed space forces us to continuously improve our storage processes. Every time I see the FedEx truck pull up, I don’t think it’s possible to do it again, but every night I am amazed at the improvement we’ve made to make it work.

Living through this brings to mind a question, albeit a radical one, in our work places:

What would happen if an organization set strict guidelines on hours worked – making them effectively fixed? (For all employees – front line through senior management)

Thinking about lean improvement in general, this idea doesn’t seem that radical, as many of the things that occur in lean improvement fix previously variable processes. Setting standards, and standard work, all take variation and make them fixed, allowing a foundation for experimentation and improvement. But, applying this idea to the envelope of the work day sure seems radical.

Making this idea a reality would turn a common site on its head. Currently, people talk about “work/life balance” until they’re blue in the face, but then still stay late / come in on weekends to deal with the reality. Because time is elastic, there is no true requirement to work smarter, only personal incentive. Sadly, many I’ve observed become overwhelmed by the prospect of doing their work differently, and just give in to the reality of making hours elastic, forfeiting work/life balance.

However, if hours were fixed, meaning the amount of hours available to meet the needs of our customer would be fixed as well, then it’s only the processes by which we complete our work that becomes elastic.

By switching the often unobtainable goal into a given, it would fundamentally switch the conversation and tone in the workplace. This shift would ensure staff requirements are met, but gamble with the customer requirements, which no one ever wants to do intentionally. However, what we know from reality is that in some organizations that lose site of the needs of their staff, the customer’s requirements are eventually unmet, or met by another organization, as the staff burnout.

So, as radical as it seems, it seems that it may be an experiment worth running.

Has your organization run an experiment like this? Do you know of an organization that has?

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It’s been a while since I’ve updated you on the progress of our Front Line Improvement (FLI) process. Currently the FLI process is actively spreading across care delivery teams throughout our integrated group practice. We have implemented in most of our 26 Primary Care medical centers, as well as other departments such as Occupational Health, Eye Care, and Pharmacy. Other areas, such as Laboratory, Behavioral Health Services, Continuing Care and other Specialty Care Services are planning to implement very soon.  Non-clinical departments, such as Human Resources and the Primary Care Appointing Center are also planning to implement FLI in their own areas.

The success and interest in Front Line Improvement continues to gain momentum and it’s very exciting to watch and be a part of. But just getting FLI implemented is not the end of the journey. There are many improvements currently underway. I wanted to share two of them with you.

Team-facilitated FLI groups: We have a few clinics that have been doing FLI for long enough that the improvement work is now led and facilitated by experienced front line team members rather than managers. These “experts” understand the FLI purpose, principles and process and are gaining skill in helping to train others and facilitate their peers through the improvement process. The managers are able to stay fully focused on coaching and supporting the FLI team as well as developing the skill of the team leader. This has created even greater engagement and ownership and given the managers a chance to hone their coaching skills and help build leaders at every level.  I was in our Redmond clinic recently watching a front-line led FLI meeting and was astounded at the ability of the group to map a process, identify waste and scope their work.

Measurement: Part of our work is not just supporting teams to improve their own work but to make sure that the FLI process is continuously improving. We have the ongoing challenge to keep the process as simple and effective as possible while continuing to build engagement and ownership at the front lines. No small task! Right now we are running an experiment in three of our teams to test a revised FLI process that incorporates measurement into the standard process. We have been able to make slight adjustments to the process that do not increase the cycle time at all, but allow the team to quantifiably show whether or not the experiment they have run is an improvement. This adjustment allows the teams to answer the question “How do we know if this is an improvement?” while still supporting the spirit of experimentation and without making them feel like they have a management mandate to drive a certain result “or else”. While our early iteration of FLI had big wins simply from giving people a simple, standard way— including time, training and support—to solve their problems, this gives them what they really need to make the best decisions.

This played out recently at one of our pilot sites at our Northshore clinic. The team identified their problem as the “end of day labs”. They believed they had too many patients having lab specimens taken at the end of the day in the clinical teams and so it was causing a log jam in the lab leading to overtime and a stressful end-of-day work experience for their lab colleagues.  Everyone believed that the demand was higher at the end of the day and therefore, they had an “end-of-day” problem. They followed the standard process of going to see and map the process and identifying the waste. But they needed more information so they stopped and collected data during the week BEFORE they planned their improvement experiment. And what they learned was astounding. The demand for these labs was fairly evenly distributed throughout the day. What was happening was that they were batching the delivery of the specimens to lab until after 3 or 4 pm causing and end-of-day backlog.  They also identified that the lab had standard times for processing and shipping specimens to go off site and by batching the specimens to end of day they were missing most of those delivery times which resulted in much longer wait times for patients.

For their experiment (currently underway) they were able to design a very simple process that reduces their batch size and increases the frequency of their delivery to coincide with the lab schedule and processing needs. The anticipated result will be reduced lead time for these lab tests, reduced overtime for lab staff and reduced defects (i.e. missing a scheduled lab processing and having to wait for a later one). They are collecting data as they run the experiment.

I don’t yet know the result of this experiment, but what I do know is that the team will have the data to tell them if their experiment really was an improvement or just a change. It will help them to make good decisions, effectively evaluate and decide next steps. I am excited to see the results and hear the learning from this great team.

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