DailyKaizen

It has been striking me lately as I have worked with managers to stabilize their processes that the role of managers is in a LEAN organization is very different then their role would be in a traditional organization.  In organizations that have no process reliability managers spend their time fighting fires, meeting with other managers to try and fix communication breakdowns as work is passed between departments and making decisions for their staff.  In a LEAN organization there are very few fires since we can anticipate the effect of change.  In a LEAN organization the work is organized and managed around processes so there is not nearly as much time spent meeting with other departments to fix problems with handoffs.  In a Lean organization the manager has time to coach and mentor staff members and they don’t make all the decisions for their staff.  In other words, in a LEAN organization there is really no need for the “traditional managers”, there is only a need for leaders.  In the traditional organization managers spend their time trying to make sure that the current state is maintained, because without process discipline there is no time for improvement.  In the LEAN organization, processes are stable and thus the role is not that of a traditional manager but instead a leader, because leadership by its very definition is focused on engaging others to challenge the status quo.    

Priorities shift. What happens in an organization that is partially Lean transformed where this happens? My hope, if it’s believed that Lean is a superior improvement methodology, is that priority shifting is an opportunity to apply the philosophy (if not the tools) more broadly.
That’s my hope for this week.
There are a few ideas that help during this time. First, I have shortened work planning cycles to every 4 months instead of every year. Less batching of performance management measures is good. That’s serving us well.
Second and more important is respect for the customer and those who serve them. We do not commit to follow a course beyond its useful utility. We commit to provide maximum value every day even if that means changing focus. Care experience, clinical excellence, affordability. That’s the commitment.

In a past life I was a salesman and because of my experience I learned many skills that are applicable in my current consulting role.  The one thing that I have learned the hard way is that you cannot sell LEAN to someone that has not experienced LEAN.  After having some success with my first couple of projects I got really excited and became some what of a LEAN preacher.  I could really see the “what” and “how” that could result in transformational improvement and I couldn’t resist the temptation to tell everyone about it.  Once I figured out that people were not really buying into my ideas I worked really hard to sell them.  What resulted was pure frustration on my part and probably annoyance on their side. 

So I have changed tactics and have stopped selling.  Getting caught up in the excitement caused me to ignore just how much I was asking of these leaders.  I was basically telling them that everything they have ever learned is wrong that there is a better way to do things and that I got the answers for them.  Now my approach is to build curiosity.  To work with people over time to plant ideas that will slowly open their minds and get them excited to try new things.  Once they pull for support the trick is to contract with them for time and make them come on the journey with you.  Only through direct experience can you really change the way people view the world. 

I read Lean Blog: A Year in Healthcare written by Mark Graban, one of our colleagues in improvement, and it reminded me that I, too, have been in this (LEAN) for a year.
It started when I asked my boss if we might use PDSA’s to improve our electronic medical record system, and he responded with a very short e-mail that said, “Yes, and investigate LEAN while you are at it.” A cup of coffee or two with Lee, and for me the rest is history.
Even though I come at this with a different background than Mark, my conclusions are the same. Lean is a powerful methodology. It is not about learning Japanese or specific tools. It’s applying a new way of thinking to how we treat people. Yesterday, I had a conversation with our Medical Director of Quality - we talked about an upcoming kaizen we are co-sponsoring as if it was something we do every day. Now, it sort of is something we do every day. Remarkable.

People are people, and people in healthcare are amazing. Lean supports medicine as a calling through respect for each person’s leadership (citizenship). I was interviewed yesterday about what a staff intranet should do for myself or an employee. My response was that it should help shape our culture, where providing health care is special, and being a staff member in this organizaition providing care is even more special. Those are intangible assets.

All of this is supported by Lean. It’s a great fit.