Monthly Archive : May 2006
by Ted Eytan, on 15 May 2006 05:05 am
The Journey
Flow: It takes time
I’ve discussed this before - one piece flow, or flow of any kind is antithetical in health care, or perhaps in all work environments. When I work with colleagues, it seems that everyone is buoyed by the idea that they can juggle many balls at once. I’m going to make an admission - I am not very good at juggling balls. Why? Because I feel that if I can’t finish something, really nail it down, then it is not worth starting. The result is that I take a mini-time out or ask people to slow down. Those who know me probably can’t imagine that I ask others to slow down, but I do. This probably explains why I drift to one piece flow as a concept so easily.
Last week I was confronted with another mini-project where I think lack of flow did us in. It started as a minor enhancement to our electronic medical record application. There was a piece of workflow that needed to get tested, the last mile if you will. It was not tested and the functionality was released to less than positive results. Our staff immediately went to use the functionality using the untested workflow, and there was uncertainty if it was working or not. We’ve spent some time doing cleanup on this one, in addition to all of our “regular” work. On the one hand, we all feel that we don’t have the time to squeeze in urgencies like this. On the other hand, I feel that an investment of time up front to explore the functionality a bit more would have left us better prepared.
by Lee Fried, on 12 May 2006 06:55 am
The Journey
Quote Day
Heres one of my favorite quotes about the kind of leaders I admire:
“It is better to lead from behind and to put others in front, especially when you celecbrate victory when nice things occur. You take the front line when there is danger. Then people will appreciate your leadership.”
–Nelson Mandela
by Ted Eytan, on 12 May 2006 05:21 am
The Journey
Which direction?
I just got back from a conference hosted by our national affiliate organization, where I gave a variant of a talk I have been giving about what we are doing with LEAN. This is probably the fourth time I have given this talk. Each time I talk about this subject, I become a little more uncomfortable, because it’s my nature as a “change agent” type to not rest, and question why the content of the talk isn’t changing even more than it is. That’s just the way we’re built. Which way is next?
by Lee Fried, on 11 May 2006 09:25 am
The Journey
It is the Work
As the organization moves forward in it’s LEAN journey and takes on more ambitious change it is important that we avoid the assertion that LEAN is about projects. Projects have a beginning and an end. LEAN never ends. To avoid this pitfall it will be important for the leaders of the organization to ensure that LEAN strategy will build alignment across departments and help them achieve their departmental goals. This means that senior leadership needs to ensure the each departmental strategy is in perfect alignment with the overall organizational strategy. LEAN cannot be successful if it is viewed as additional work that managers need to complete on top of their regular jobs. Instead, it needs to become the actual method by which managers go about doing their jobs better. LEAN is the work, not a project!
by Lee Fried, on 10 May 2006 09:36 am
The Journey
Faster…
Since the day I first picked up the book the Toyota Way and began to learn the principles of TPS I have become impatient. Every day as I move through my organization I see waste, and incredible opportunity for the patients. I have days where I am often overcome with an incredible feeling of urgency that we need to improve faster and do it now. Maybe it all of the media reports about the uninsured and the “broken healthcare system.”
There is no doubt that we are making progress on our LEAN journey. Often leaders with long tenure in the organization tell me that they have never scene change happen so quickly. For me the challenge will be to harness my eagerness for change and turn into passion that others will follow as opposed to allowing frustration to get the better of me
by Lee Fried, on 09 May 2006 07:23 am
The Journey
Staff Know Best
I am currently working with a group of managers to help them transition their current batch and queue process to one that is going to do work in real time. The current process is designed around accommodating silos and maximizes the efficiency of specialists. We plan to transition the process so that it is designed around product families and relies on the flexibility of generalists. It has taken the managers about a month of intensive analysis and training to begin to understand the advantages of the new model.
The other day we were out on a process walk and one of the managers was explaining the model to staff. The managers have been really nervous about how these changes will be received by staff. After the manager got done explaining one of the staff members smiled and printed out an email that they had sent to the CEO’s suggestion program over a year prior. In the email the staff member explained that the current silo based model was inefficient and provided poor service. The staff member further explained that the organization needs to become more flexible and to do this it needs to develop generalists and organize around product families.
The manager was very surprised yet delighted. All I could think about was how much easier it would have been to convince management if we had only done the process walk a month earlier!
by Ted Eytan, on 08 May 2006 09:15 am
The Journey
Planning and Implementation
Lately I have been struggling with the amount of time one should spend planning versus implementation. It is said that in the Toyota world, it should be 80 percent planning time. In most American companies, it is 20 percent planning.
We are doing rapid process improvement events with physicians and staff in medical centers. In theory we should spend 80 percent of our effort planning for the event before we get there. But here’s the problem. We can’t plan what to do without the physicians, staff, and patients. In the LEAN world, I suppose you would ideally invite a medical center staff to participate in the planning up front. We don’t have the ability to do that though.
What I think, instead, is that we should do 80 percent planning, but on site. This reduces the implementation time when we are there. However, why would we want to spend all of our time implementing if we don’t know what the customer will pay for?
I think I am done struggling with this now.
by Lee Fried, on 08 May 2006 07:28 am
The Journey
Harder not Smarter
This Saturday I retreated to my desk to do some work while I listened to NPR in the background. A timely and interesting interview came on with an economist for the University of Chicago. The subject of the interview was about how Americans are overworking themselves, which the economist believes is the main cause of productivity declines that have been reported in recent months. He has some data that showed that for every hour over fifty than a white collar employee works there is actually a negative impact on overall productivity.
This interview made me reflect on the projects I am currently working on and how much wasteful work is completed every day with good intention. How most organizations in today’s economy are constantly asking every employee to do more work with less, which will inevitably prove to be unsustainable. This interview reinforced to me the importance of LEAN thinking, where we focus on reducing waste as opposed to attacking direct labor. This interview also motivated me to put my work away and enjoy my Saturday!
by Lee Fried, on 05 May 2006 06:51 am
The Journey
Quote Day
A consultant that I work with refers to this as the urge to go our and kill something. There is a common belief that LEAN is just about action, while in fact LEAN is about planning thoroughly and acting quickly.
“It is more important that you know where you are going then to get there quickly. Do not mistake activity for achievement.”
Newcomber
by Ted Eytan, on 04 May 2006 05:00 pm
The Journey
Knowing how to do it yet
Today I spent time with a group of our doctors and nurses as part of a general rapid process event.
I always have to remember the mantra: “we don’t know how to do it yet.” I caught myself saying that there are things we couldn’t do.
I have a built in bias that I have to constantly check, which is that committing to explore something is more work to do. While that’s true, I also don’t know sometimes when putting in the work will have great payoff for our patients.
I was reminded yet again today that our staff has the best interests of our patients at heart. This is what makes the work infinitely energizing.