Daily Kaizen

I love that my job gives me so much variety. Two weeks ago I am in the gemba in California mapping frontline Primary Care processes, and this last week I am working with the senior executives of Group Health to define the critical hoshin’s for the year. This week I am back to define the future state of Primary Care. I am working at different organizations, with different levels of structure, solving different problems; yet, what I love about Lean is that the thinking process is the same. The simplicity is what makes Lean so powerful.

By approaching all work through the Plan, Do, Check and Adjust (PDCA) cycle is incredibly powerful and transferable. It allows everyone to think and talk about their work in a consistent way and it creates a repeatable, data driven approach to improvement.

• The process always starts with the check where you focus on “grasping the current situation” and reflect on what is happening and learning’s from the prior cycle. At the frontline this may look like the huddle in the morning where the team reviews the results from the day before and identifies problems. At the value stream level this might look like the weekly stand up meeting to review demand vs. production levels and common defects across the system. At the strategic level this might look like a review of last year’s activities and a reflection on learnings.

• Next we move to the Adjust cycle. In this cycle we review the data to decide if we need to adjust to correct problems, adjust to improve processes or Act to maintain the current process. At the frontline this may look like the at the huddle in the morning where the team defined what worked well the day before and what experiments they want to run during that day. At the value stream level this might look like a gemba to check on standard work or an assignment to complete an A3 on a particular problem. At the strategic level this looks like the shaping of hypothesis for improvement for the year including defining critical goals the organization must meet.

• Next we move into the Plan cycle. At the frontline this might look like the number of patients we will see today by hour and the cycle time targets we must meet to keep up with demand. At the value stream level this might look like total cycle time the clinic must meet from door to door to keep up with demand. At the strategic level this might look like the small number of strategic improvements the organization will make over the next quarter.

• Next, we move into the Do cycle. At the frontline this is the team seeing patients. At the value stream level this is moving resources between teams to keep up with demand. At the strategic level this is implementing the future state vision through a series of kaizen events.

• Finally, the cycle continues. We are back to the Check. Where the frontline teams reviewing their visual system know that they are off from the plan and pull resources from another department. Where the value stream leaders review the plan for the week and bring temp employees in to work down the backlog. Where the senior leadership team completes their monthly check and develops a countermeasure to respond to a competitor’s new pricing. Each cycle supports the next.

Each level of the organization follows the same approach. Very powerful.

Popularity: 100% [?]

This last week we had a fantastic time kicking off the Model Line at Palo Alto Medical Foundation (PAMF).  It was a really great team that will do really great things.  As the Model Line they are challenged with piloting not only the care
model for the organization, but also the Lean Management system.  As you might imagine a lot of questions and concerns were raised about how the work would be “spread” from one site to the next.  Spread being defined as “how do you get more than one team to do the same thing across a system?”  Or overcoming the “not invented here” mentality.

I shared with the team my confidence that they will be successful in overcoming this challenge, because they are committed to Lean Management.  My experience on this subject is that organizations often approach spread as a technical problem (standards and standard work) as opposed to a leadership opportunity (Lean management system).  While spreading standard work over time is essential to increasing the rate of improvement of an organization it will never occur or sustain without simultaneously putting in place a Management system.  The problem of spread becomes much easier to solve if leadership takes the approach that management is a process, and like any process to get a consistent outcome the process must be standardized, stable and capable.  If as leaders we would like teams to standardize and improve then we should ask no less of ourselves.

As leaders begin to define and put in place a consistent process of management it removes all kinds of waste and overburden from the system.  Management and teams begin to speak a common language and exhibit common behaviors/practices as they work across teams, sites and services.  At each level the organization is forced to clarify and define who needs to come together to do what how often?  Performance within and across sites become visible and if the system is put in place with the right incentives teams will start to become curious about what is happening beyond their own walls.   You know you are on the right track when “spread” becomes pull as opposed to push.

Popularity: 74% [?]

Tomorrow I get to help lead the kickoff a Model Line effort in a large medical group on the West Coast.  Over the next five days we will begin mapping the current state of four large service lines and will train the team Lean principle and practices as we go.  By the end of the month we will be deeply involved in kazien.  It is very exciting

Over the last seven years I was lucky enough to participate from the beginning in a Lean transformation.  We started with point improvements, began a proof of concept transformation (Model Line) and then had the chance to coach leadership as they focused on putting in place a Lean Management system.  I was part of the
first group of internal resources that were trained in Lean.  We hired great Sensei and right from the start they put us to work leading kaizen.
It is amazing how fast time seems to have gone by and how quickly the
transformation moved.   Throughout the process it has felt like I have been holding onto the side of my chair (just the way I like it!) since I was constantly working in unfamiliar territory and learning as I went.

Flying south on an airplane I am reading through the PowerPoint slides I will be teaching over the next couple of days.  The focus of the materials is mainly Lean 101 modules including Value Stream Mapping, Steady Flow, Standard Work and Visual Management.  It has been a while since I have trained teams on the basics so I hope I am not too rusty.  Seven years ago I stepped up in front of a room and trained on similar materials. The difference now is that I have a lot of stories of my own to go along with the didactics.  Instead of talking about cars, airplanes and concepts I can talk about patients, docs and nurses and real experiences of how Lean has improved people’s lives.

Popularity: 70% [?]