DailyKaizen

Like Ted, I was humbled by our visit to Genie yesterday.  It was truly astonishing to see LEAN principles in action and LEAN tools in application.  Everywhere I looked there were great examples of LEAN tools: hejunka boards, work cells, visual systems, and one-piece flow all integrated to make a truly safe and efficient operation.  The attention to detail was impressive.

Yet, what was most impressive to me was not the production line itself, but the people working on the line.  The energy and focus of the work environment was truly palpable.  At every station along the line workers were engaged in real time problem solving, working seamlessly as a team, and smiling all along.  The work is both physically and mentally demanding, but I did not see anyone that looked frustrated or disheartened.  LEAN is truly about creating an organization where every employee is responsible for the success of the whole and empowered to make a difference.  No organization can be successful over the long run with just a handful of change agents.  The key is to turn everyone into a change agent.     

I left the factory and was in a daze all the way back to my cubicle.  I had just witnessed firsthand the “what” that would “cure” healthcare, but the “how” was still distant to me and overwhelming.  I guess my big take away is that you have to start somewhere, and that success will be measured one step at a time.  That the “how.” 

Thanks Genie!

Lee and I toured the manufacturing plant at Genie Industries today, in neighboring Redmond, WA. He’s going to report on what he saw separately, but I was beyond overwhelmed by what I saw.

As I am one to do, I kept looking at some of the principles and asking myself, “Could our patients benefit from that approach? Could a health care system benefit?” Each time, the answer was “yes.” Things like, judging quality in real time, visual controls for training, and a team approach to delivering for the customer.

When we walked the floor, different roles were pointed out to us - one, the engineer designing the scissor lifts, another, the team lead, another, a skilled worker. The key was that they had to be pointed out to us - their role was not quickly identifiable by what they wore or how they interacted with their colleagues.

The focus on continuous improvement and each person’s role in supporting this was unmistakable. It permeated every part of the plant. With single piece flow, each person could tell where the product was and could have an emotional stake in its successful build. It seemed to me that people were not left to fend for themselves - there was a real interest in supporting their work for the customer by allowing them the creativity - every single day - to try new things.

Could LEAN prinicples used to manufacture scissor lifts be used in health care? Why would a physician make a house call to a scissor lift plant to improve their practice of medicine?

I think that’s not the best question. A better one is “does the calling to be a physician include continuous learning and doing everything you can to create the best health system for your patients?”

As I watch this team work, I am also humbled by our responsibility as a profession, to support each person’s ability to achieve their personal and professional goals through good health. We can be students as well as teachers, and use the gift that we are given by society to guide the delivery of the best health care, with the help of smart people everywhere. I’m up for it.

I spent the last couple of days in Colorado at the Kaiser Conference on Quality.  It was a great opportunity to interact and learn from some of the top thinkers in healthcare.  On the second day of the conference a Medical Director from Group Health and I led a breakout session on learning’s from our LEAN journey.   The audience was engaged and the questions were great, and I left the sessions feeling like we may have lit some small fires that will fester in the minds of our audience and eventually lead to improvement. 

As I sat in the airport last night waiting for my delayed plane I jotted down some of my thoughts and reflections on the conference.  There were several key takeaways that I thought would be useful to share:

• Healthcare is more broken now then ever and working harder will only make things worse, we need to find ways to work smarter.
• Group Health is far ahead of most healthcare organizations in the way we think about paitent centered care and quality.
• If the Quality Department owns and is responsible for quality there will never be quality.
• Outside of a few small pockets in different parts of the country most healthcare professionals have never heard of LEAN.  I think our talk was a breath of fresh air to many, who had listed to many of the others speakers talk from the negative.
• Many of the “experts” I heard speak talked about how hard things are, thus the need to start small and go slowly.  I reject this notion as did most of the other participants that I talked with.  We need to find ways to focus larger, and move faster (LEAN)!  The urgency is there and our patients demand it.
• Finally, I felt more convinced then ever that we are on the right track and LEAN is the model/principles by which we should run our business and serve our patients.  I saw no other alternative worth pursuing. 

It’s Tuesday again. I am walking to the first day of a rapid process improvement event, via Interlacken Park. It’s a fairly steep climb, especially in a shirt and tie. I happened to pass one of our doctors on her morning jog through the park.

Like other Tuesdays, I really have no idea what I’ll be doing in an hour. That’s the goal. Blank slate. Be ready to help improve our system.

I ran across this quote in the recent cover story in BusinessWeek on failure breeding success.

“Getting good” at failure, however, doesn’t mean creating anarchy out of organization. It means leaders — not just on a podium at the annual meeting, but in the trenches, every day — who create an environment safe for taking risks and who share stories of their own mistakes. It means bringing in outsiders unattached to a project’s past. It means carving out time to reflect on failure, not just success.

I like this. As they sometimes say at the beginning of a Kaizen, “your job may change.” My job has changed since we started this work. I now lead from a place that’s much closer to the patient, with the physicians and nurses that care for them.

Last night I stumbled upon Tom Peter’s blog, where he spends quite a bit of his time and effort bashing the Healthcare Establishment.    Dispatches from the New World of Work: Healthcare Archives  I agree with much of what Tom has to say, although he could be a little less harsh in how he says it.  Maybe Tom’s efforts will help build more urgency for change in an industry that needs it.  

To give you a flavor of what Tom has to say, here is the quote of the week: “The “system”—training, docs, insurance incentives, “culture,” “patients” themselves—is hopelessly-mindlessly-insanely (as I see it) skewed toward fixing things (e.g. Me) that are broken—not preventing the problem in the first place and providing the Maintenance Tools necessary for a healthy lifestyle.” 

I am practicing medicine at one of our medical centers this week (and I still approach this as the highest honor in my job - that a member allows me to take care of their personal health needs).

I noticed that a “QIST (Quality Improvement Support Team) Guide” was hanging from one of the workstations. It was a compendium of all of the tools that this medical center developed for our electronic medical record system during their rapid process improvement week. Prior to our “new” (LEAN) way of doing things, there wouldn’t be a guide like this. Maybe there would be an official training manual with all of the things that had been developed centrally, on official paper stock.

The guide says things like, “Here’s what we developed for use now in anticipation of this vision for the way we want to take care of our patients.”

I thought that was incredibly cool. You look at that as a member and you say, “my doctor’s health care team knows what they want for my health, and they have the ability to make it happen.” It’s like smaller standalone medical centers I’ve been at where you feel it’s a place that’s personalized and created by the doctors and nurses that staff it. I think that’s a good feeling to have as a patient.

I have been monitoring the web with interest lately to follow the story of healthcare organizations across the country that have discovered Kaizen and are running RPIWs at a feverous pace.  I would recommend for organizations that are just getting started: “be careful not to mistake activity for progress” and be sure that the event itself does not become mistaken for the outcome you are trying to achieve.  Kaizen is a powerful tool, especially in a professional service organization where time is so valuable. I have often witnessed consultants as well as myself get caught up in this excitement of the event leading to loss of the vision we are trying to achieve.    The number of RPIWs an organization is running should not be primary metric that an organization is focused on achieving.   In fact, I believe that to many RPIWs can have a negative effect leading to collective burnout and potentially loss of traction in a LEAN journey.  RPIWs consume a tremendous amount of time and resources thus LEAN consultants need to be good stewards of their use.   If a proper support infrastructure and planning process is not in place to bring purpose and organization around these events the results will fall well short of expectations. 

So my advice is to continue to teach and demonstrate LEAN principles in everything you do, but use the tools wisely.  Have others had similar experiences?

A recent article about Gamal Aziz, the President and COO of the MGM Grand in Las Vegas, in Business 2.0 caught my eye this month (it’s not published on the Web yet).

In it, his approach of looking at the maximum revenue of a space as a starting point and gutting it to get there, even if it is already profitable, was discussed. The article talks about this approach as turning improvement on its ear - instead of closing in on reducing defects, the article implies that he would start with zero defects and move backward. In this case “good enough” is not enough. There’s even a quote where he dishes Six Sigma as a measurement activity.

This made me think a little of health care. What are we shooting for? Does a doctor tell a patient with a sore throat, “I expect you to be symptom free at little or no cost in time and money to you.” Usually not. We say, “This medicine or treatment plan will help you get better, a little bit over time. If you aren’t making progress, let me know.” Maybe the first statement is unrealistic from a biological perspective. But maybe this one is not: “I expect you to have full confidence in managing your condition with me, safely and efficiently. In doing so, you’ll be better prepared for lifelong health. Even if you are feeling well, our target should be full confidence.”

I’m biased because I’m putting the expectations on myself. At the same time, I think we should know what we are aiming for, so our system will be built to support it. We’ve done some work with the Center for Information Therapy in Washington, DC, whose vision is compelling - information as part of care, to help patients make the best health care decisions. This idea has changed what I work toward in the LEAN world. It becomes less about “making the system easier to use” and more about “making the system benefit the goal - patients’ confidence in managing their health.”

On Monday I went on a walk with the physician co-author of this blog and he asked me an interesting question: ‘how would you describe what you do to someone you don’t know?’  It surprised me how difficult it was to answer this question.  My business card lists my title as a “Process Improvement Consultant” and based on this title I could easily give a canned answer about ‘streamlining processes and leveling work.’  While this answer may satisfy my job description it is only partly complete.  In truth, the technical piece of my work focused on process improvement is probably less then half of what I do.  Most of my time is dedicated to mentoring, and guiding leaders so that they see their work in new, more effective ways.  This is at the heart of what is called “LEAN Thinking”; it is more then just a set of tools, but a way of approaching everything we do for our patients.  To come in and just fix the process would not only be unsustainable, but I would also be ignoring the greatest opportunity in transferring my knowledge to them so that they can continue to make improvements long after I am gone.   So in retrospect the answer to the question is simple, I provide leadership development services. 

I wonder if other LEAN consultants see their role in a similar way?