by Ted Eytan, on 07 Feb 2008 06:14 am
The Journey | Tags: Gemba
A Guide to Bringing Your Boss to the Gemba
I’d like to ask for a little help with this one. Some of the work I am doing involves bringing leaders to the gemba for the first time, in the background of a non-LEAN environment. In what I do, this means shadowing a patient visit. I remember when I brought my boss to the gemba (see : Take your boss to the Gemba with you ) that I provided some guidelines to make things as appealing as possible. I felt I needed to do this because pre-LEAN, going to the place where work happens meant a lot of things to different people.
So here’s some of the guidance. I appreciate additions or changes:
Ideas about what this is for:
- To observe. Listen and Watch. Notice 10 areas of potential improvement every 10 minutes, or use a template like “Stand in the Circle“
- To be as close to the customer as possible.
- To get the facts as to what is happening in the organization.
- To learn a little bit frequently (one patient visit every week is better than 22 in one day every year).
- To be visible to staff (who enjoy seeing you and showing you how they serve the patient)
Ideas about what you do not have to do:
- Come with prepared comments
- Solve problems on the spot
- Stay the entire day
- Act on every single potential improvement you observe
In the above, I don’t want to imply that a leader should erase the experience from their mind. It is assumed that the facts will have an impact on understanding problems and solving them - as they are laid out in a strategic planning process. This is to get away from a behavior where every visit should result in requests for action on what was seen. When this happens, people begin to dread the Gemba visit, because they will see it as expansion of their workload, and those who report to them will feel the same. A good strategic planning process should bring problems (which are gold) to the forefront and the Gemba visit supports that.
If it helps, I suggest that someone who is a CEO or Division Head pretend that they are not the CEO while they are shadowing. Better yet, pretend that the CEO is the patient (and…just pretend that they are all the time anyway). If there is concern about their comfort or privacy, it will be respected, because the patient is the boss. Every visit will involve explicit consent from the patient, and there will typically be a break if a physical exam is involved, or at any time at the discretion of the physician or patient. (If this is truly the CEO/Division Head’s first time, I will accompany them throughout the experience until they are comfortable. One executive told me with some humor, “Don’t worry, I know how to talk to people.”)
The goal is for visits to become routine and not have tremendous amounts of what I call psychological overhead attached to them. Leaders lead best when they have access to the facts. And the facts exist as close to the patient as possible.
How does this sit with the audience? if you were a CEO would this make you feel comfortable about engaging in this activity? What else would you need to know or what questions would you have?
on 07 Feb 2008 at 1:14 pm 1.Pete Abilla said …
Hey Ted –
Here are a few items and behaviors that I’d encourage
* Curiosity - Facts are different than Data. Facts are at the Gemba, whereas Data is a step-removed from the Gemba.
* Be Visible - Building bridges and having an open-door policy is a good thing; trust is engendered, fear is driven out of the workplace, and participative management is encouraged.
* Conversation - “Management by Walking Around” is NOT the same things as Gemba Walks. A Gemba Walk is about being part of the work and that happens through participation, conversation with the workers that are doing the “value-add”, and in charitable observation and reflection.
* Empathy - A leader’s job is to coach and teach and model. A leader is to help others obtain self-reliance in problem-finding and in problem-solving. It is presumptuous for any leader to assume that they are needed to solve problems. Lean Management is about powerful coaching and in developing people to become effective problem-finders and problem-solvers. The leader can demonstrate empathy, encouragement, and also teach the skills necessary so that their people can succeed.
Great stuff, Ted. If I’m ever in Seattle, I’d love to visit your Model Line and have lunch with you and Lee.
on 07 Feb 2008 at 3:37 pm 2.Ted Eytan said …
These are very helpful, Pete. Keep the ideas coming!
Lee will tell you that we’ve had a bit of a moratorium on model line visits lately - it’s interesting that when I went to visit the lab at Kaiser Permanente, there was another tour happening at the same time. I think a system for promoting external sharing should be devised…
on 07 Feb 2008 at 5:32 pm 3.Joshua Seidman said …
Ted,
This is great!
One other thing that comes to mind: I think some people (particularly non-clinicians) may feel awkward about the idea of shadowing in the exam room (given a strong respect for privacy). Maybe adding something like:
*The goal in the exam room is to be “a fly on the wall” during the visit and just observe.
*In most cases, it turns out that in our experience patients are actually comfortable with this because they believe it ultimately will lead to better care (and we make sure that the clinic office staff make it absolutely clear that it’s fine for the patients to say “no” before or at any time).
*In some cases, the patients try to very hard to engage with the observer; while it’s ideal to “stay out of it,” at a certain point, you can use your judgment about engaging a limited way (when not doing so would cause the patient greater discomfort).
This last one is the biggest challenge: Where to draw the line? It may even be worth providing some tips of “things you can say” to balance being polite with wanting to remain an observer.
on 23 Feb 2008 at 1:39 pm 4.We did it! Thanks Affinity Health Plan and Urban Health Plan! | Patient Centered Health Information Technology (PCHIT) said …
[...] of either institution, it was about understanding facts. As I posted on another blog that I run on LEAN in health care, a visit to the Gemba should result in the kind of inspiration that makes people want to come back [...]
on 10 Apr 2008 at 9:54 am 5.We did it! Thanks Affinity Health Plan and Urban Health Plan! | Ted Eytan, MD said …
[...] of either institution, it was about understanding facts. As I posted on another blog that I run on LEAN in health care, a visit to the Gemba should result in the kind of inspiration that makes people want to come back [...]