Daily Kaizen

Sometimes what seems like really small and simple changes can make a huge impact.   The type of changes that team members ask “how did we ever work in the old way?”  A great example I have seen again and again in healthcare is the lack of teams being “co-located.”  The traditional ambulatory model has the “flow staff” located centrally surrounded by the exam rooms and the Providers located along the parameter in their offices.  Flow is designed so that while the Provider is seeing one patient the flow staff is “rooming” the next.  Thus, often based on the building design their paths rarely cross.  I think somehow we thought with the implementation of an EMR teams no longer had to
communicate.

As a result of this design all kinds of waste is built into the process.  The opportunities to prioritize together, problem solve, ask for help, and relay important information, etc. are lost.  Flow staff and Provider waste
incredible amounts of time looking for each other and patients are often left
repeating themselves multiple times, waiting, or not having their needs
met.

Back to small changes that make a huge difference.  I am working with a client that is working on synchronizing the process between the flow staff and the Providers and one of the elements of the change is “co-location.”  The MD’s have moved out of their offices and into the “flow area.”  The team has 5S’d and worked (through a lot of challenges) to reconfigure the space and to make room.
It is early in the change, but teams are feeling an immediate difference
and so will soon the patients.  It is easy to see the improved efficiency and to feel a growing sense of “team.”  Small changes = Big Difference!

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Last week I had a chance to catch up in the hallway with a Medical Leader I had not seen in over a year.  This conversation made me proud, because it showed me how powerful Lean Management can be if you stick with it over time.

I always liked working with this leader, because while he was always a little skeptical, but he also always showed up as a good student and would immediately take the learning and apply it in his practice.  We had some good debates.

One of the areas I often gave this leader feedback (usually during gemba walks) was his tendency to take problems away from frontline teams and managers too luickly.  He grew up in a management system that was based the premise that managements job was to solve problems so that frontline teams could do the work.  Thus, once he started to gemba he got a lot of feedback and ended up taking a lot of “to dos” many of which were missed opportunities to turn the request into a coaching opportunity.

During one of my training opportunities a Toyota Sensei once told me that the highest form of “respect for people” was allowing people to solve their own problems.  This statement stuck with me and I have often used this during training/coaching sessions.  Apparently, this statement also stuck with my friend.  In the hallway last week he said after a year of gemba he finally understood his role as a leader and what I meant when I talked about “respect for people.”   He said at first he loved the Lean approach, because he loved being in gemba, but after a while the follow-up became overwhelming to him and frustrating to the teams he worked with.  He said each time he went to gemba he felt guilty about the increasing number of problems he was not having the time to solve.

Finally, he said he had a really rough week and realized he needed to do something differently.  He asked for help from his boss.  He started to ask more
questions.  He started to trust that others can take the ownership for problems.
He told me it is fun again and he is amazed at how many people are
stepping up to the challenge.  He also told me it is really hard work to not step back into the problem solving mode and that he is only just getting a knack for it. I give this leader a lot of credit, because it would have been an easier path to go back to the traditional management approach.   I share this story, because I believe that most leaders follow a similar path.

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