DailyKaizen

Here is one quote from way back in the past from Thomas Jefferson.  I just got finished reading his Biography.  He was a facinating man.

“Give so much time to the improvement of yourself that you have not time to criticize others.”

–Thomas Jefferson.

I am again in medical practice this week, serving our patients in one of our downtown family medicine medical centers.  During my use of our electronic medical record, I noticed a new feature that was recenty activated that allows us to easily link groups of care experiences together for our patients.

As a user of the system, I think this is just great - it will help us coordinate care better.

As someone who has accountability to maintain and develop the system, this is remarkable, because I know that we wanted to activate this feature about a year ago, but didn’t know when we would be able to because of other pressing projects. The assumption was that other work would be completed and this would get its turn. The other assumption was that our team would move this forward as the “leaders,” and that it would take the amount of time it took for something like this to be thought through. However, that’s not how it happened.

Instead, the issue of being able to do this came up at a recent rapid process improvement event, where the need was articulated by a care team taking care of patients, the feature was explored, and it was activated.

I wouldn’t have believed a year ago that some of the innovations we wanted to produce wouldn’t come from “us.” I assumed we would have to do it. Now, what I am seeing is that innovations are coming from the just the right place, where the impact to our member can be demonstrated. The people are the same, the process is just different. The “leadership” to “citizenship” idea comes from the Fred Lee book, “If Disney Ran Your Hospital…” It is a great discovery to see what every citizen can do to move things ahead. 

Once or twice a week I meet with various leaders in the organization for an hour or so to provide some consultation on “what LEAN would do in their situation.”  The meetings are a great opportunity for me to stay in touch with what is happening at a strategic level and hopefully some of the nuggets of education I provide will stick.  Often the leaders bring with them the latest models for management, process or structure that they have developed (most based on benchmarking or academic research) and they ask me to provide them with feedback.  I always ask them the same question: “was their model developed in the content of the work.”  Most often I get the same answer back: “no, I made it on my own.”  So I always suggest that they go to the place where the work is being done; observe how the work is being done; ask lots of question on why the work is being done the way it is; and then see if their model is still valid.

While I believe that benchmarking and academic research is important it should never trump what we can learn by spending time learning from and testing in our own operations.  All organizations are different and what works in one organization might be informative to another, but this does not mean that it can be successfully replicated without first adapting it to fit the culture and current state of the organization. 

From what I have learned about LEAN, I understand that “expediting” is one of the things to be avoided. I use it as an example when I talk to people about batch and queue, by asking them what percent of their time they spend working to find out where a project is, and moving it to the front of the queue.

I used to do a lot of expediting, with variable success. Now I do a little. Before, I assumed that this was a function of my role and a way that I helped things happen for our members. Now, whenever I do it, I ask myself, “how did this come to be?” and “how do I help our members better by supporting an environment where expediting is unnecessary?”

I received a request to expedite recently and the above questions came to mind. It felt much more comfortable to ask these questions than to accept that expediting is a function of my role. This benefits those who ask for help (who do so out of frustration) and those who benefit from the help (who don’t expect a staff member to spend time on this activity as opposed to directly supporting the value they receive as customers). In this specific case, there was a difference of understanding of the impact of a certain piece of work closer to the patient, which provided an opportunity ask exactly what the patient needs and provide it.

I am glad LEAN has allowed me to ask these questions and look for answers.

Over the last year I have had the opportunity to work on many different LEAN projects in a wide range of areas.  I have worked in transactional environments, with administrative teams, ancillary departments, and clinical departments and recently with our IT/informatics groups.  What is most interesting to me is the fact that every project is very similar in terms of opportunities and challenges.  For example:

• All of the teams I have worked with started out with the notion that LEAN was not applicable to their work and “was for cars.” 
• All of the teams worked in batch and queue systems.
• None of the teams had process measures for their work.
• Most teams did not follow standard work.
• All the teams have surpassed my expectations.

What I have come to realize as a consultant is that it maters very little where I end up working in terms of the function as long as I get to work with engaged and committed teams and strong leadership.  I wonder if others have found similar conclusions?   

I met with a manager today to talk about changes that are going to happen over the next two years in the department she works in.  I was warned that she may be resistant before going into the meeting.  Her only knowledge about LEAN came from a copy of LEAN Thinking I gave her a couple of months back.  I could tell she was nervous, yet excited.  The first question she asked was “what do I anticipate will change?”  I took a deep breath and then told her “everything.”  I then asked her “if she was prepared for this major a change.”  She smiled and told me that she wanted to hear more about what “everything” means, but that wherever we are going she is ready to help us get there.  We spoke for another hour about some of the details and we agreed to meet again in a week so I could answer more questions. 

I remember hearing an interview with Art Byrne a couple of years back where he made a comment that people don’t fear change, they fear the unknown.  That comment has always stuck with me and as result I have always tried to provide people with as much information as possible upfront in the process.  On the way out of the meeting I thanked her for open mindedness and she thanked me for being transparent.   I told her that I was a little apprehensive about the meeting, because I had been warned that she did not typically support change.  She smiled and said that she doesn’t have a problem with change as long as she doesn’t have to find out about it after it has already happened. 

I guess Art was right.

For the last couple of weeks I have been spending most of my time working with leadership on strategy work.  I enjoy this type of work, but have been missing the gemba.  While I know this work is important to our long-term success, I have had to fight a subconscious pull to get back to where the value added work is happening. Yesterday, I had the opportunity to conduct a process walk and after the walk I felt energized.  Last night I realized just how much LEAN has changed me.  Two years ago I would have been perfectly content to spend all of my time working on “important strategic projects” in the comfort of the Executive Office.  Now I realize that if I am going to ever make a “real contribution” it will have to be made from where the work is happening.  I wonder if others have felt this change?

I have been thinking a lot about what I saw last week during my visit to Genie Industries.  One of the key learning’s for me is just how powerful the cumulative effect of small improvements can be as they collect over time.  Genie has created a culture where each employee spends time everyday to make small improvements or solve small problems. The improvements continuously improve the smoothness and reliability of the operations leading to less chaos and fire fighting.  The employee finds great satisfaction in doing this work, because they can see the impact over time the changes they make have on the customer and the work environment. 

Leaders and consultants often spend their time focused on finding or executing the “next big improvement.”   We plan for months, schedule five day RPIWs and bring about rapid change with a lot of hoopla.  I would be the first to admit that I thrive and am energized by the chaos of change.  Small improvements are not nearly as exciting for us, mainly because we are not needed.   

Luckily, there is plenty of improvement to go around.  The real trick is build the culture that will support the “big” and “small” stuff.

Today I met with a group of leaders to kick off a multi-year project where we will quite literally change almost everything within the current state. I have been working with the group for quite some time collecting data and conducting process walks and they have come a long way. Many started out as skeptics and are now fully behind the plan. As I sat with the team walking through the “high-level” project plan I could feel their excitement. I believe many of them had grown frustrated with their inability to create change and now they were being given the opportunity to bring about transformation.

Several times during the meeting we discussed just how hard this change was going to be on them as leaders. While each of them acknowledge and accepted the challenge I left the meeting not sure if they really understood what the future will hold. Since we have never undertaken a project with this big of an impact it is hard to tell. What I do know is that strong leadership will make or break this project, just like any other change. As we move toward achieving the future state their roles will change, systems will change, processes will change and we will create tension with many other parts of the organization. They will have many challenges as a leadership group. No matter how perfectly we execute their will be bumps in the road that they will have to overcome. There will be really good days, and really bad ones. The best advice we could give was to stay in alignment, stay the course, and stay strong as a team.

I wonder if there is anything more I can say to prepare them?

It was a good week.  I learned a lot from a lot of really smart people.  I am thankful to my organization for allowing me to get away from the Gemba and take advantage of learning what others already know.  I’ve been to Denver to learn from the best in Healthcare and I have been to Redmond to learn from the best in Manufacturing.  This morning Ted challanged me to learn ways to share what I learn and transfer my knowledge to others so everyone can benefit from the opportunities that have been given to me.  He is right.  In that spirit here is the quote of the week:

A man should first direct himself in the way he should go. Only then should he
instruct others. –Buddha