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.

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…

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.