DailyKaizen

I have had some interesting discussions lately with some leaders from supporting departments about how they can think and work differently in assistance of our clinical and administrative production processes. Many of these departments have had success over the last year applying LEAN within their functions to improve quality, cycle time and efficiency. As these leaders have become more experienced in apply LEAN principles they have begun to realize that to bring about transformation they need to change their approach. Working up their functions may produce some low hanging fruit in the short-term, but it is a limited approach in the long-term. The real benefit will occur when these supporting departments begin to reorganize and align their structures and their work to support clinical and production departments where the true value added work takes place. This is both exciting and freighting to these early adopters. This change in approach will challenge long-standing batch and queue practices. It will challenge all of the current finance, measurement, planning, and human resource systems. It will put them at risk with their peers and leadership that is inexperienced with this new way of thinking.

I wonder how they will proceed? The cultural tension between the “old” and the “new” way of thinking and doing has begun and will only grow. What a great time to be in this organization.

We have begun to run into one of our first significant challenges as we work to transform our organization.  The challenge is time.  More specifically, it is how managers and leaders spend their time.  As we begin to rollout Daily Management Training (TWI) and begin conducting Kaizen events it is essential to our success that our managers and leaders are present in the work environment supporting production and their staff.  The change will be hard on the organization, and we need solid leadership to coach, mentor and communicate to staff that will be looking for direction.  Thus not only will the role of frontline staff change, but also the role of leadership.
 
The challenge is that most of the organization is still operating in a functional mode.  This requires that managers and leaders spend their time in meetings trying to coordinate the complexity of our systems and the handoffs that are common in a vertically aligned organization.   There is a great fear among leaders that if they are not present there will be decisions made without their input and problems will arise.  At the same time, they are sick of the meetings and would much rather spend their time working with staff in the production areas.  My fear is they will try and do both, and LEAN will become an add-on to their jobs as opposed to being their jobs. 

This is the tension we live in and a problem that we need to work out.  Overall, there is probably a middle ground, where managers attend only the most important meeting, fill in for each other and then spend more time in production where they can add value. 

I am a big fan of Peter Block and chose this quote from his book The answer to how is yes, because it describes one of the greatest challenges I face as a consultant when I am trying to explain to leaders that my job is not to provide them with answers, but to instead challenge them to think in new ways. People are always asking how questions with the expectation that there will be a simple answer in return. But as well all know, if problems were simple to solve they would have already been solved in the first place. In effect, how questions gloss over the “real problems” and make it easy to stay within the confines of our current thinking. The right questions should always start with why!

“To commit to the course of acting on what maters, we postpone the how questions and precede them with others that lead us to more questions that perhaps lead us to more questions. So much for answers. In fact the most useful questions are ones that entail paradox, questions that recognize that every answer creates its own set of problems.” –Block

This week’s quote of the week was “sometimes you have to start where people are and not where you would like them to be.”  That is exactly what we did yesterday in our first Hoshin planning retreat with the Model Line Leadership team.  What surprised me was how far along they have come over the last couple of months.  As I drove into the conference center yesterday morning I kept reminding myself that I would need to be patient with the team and not push them to far.  What I experienced was the opposite.  They were very ready to give up the past and at first were frustrated with me for continually bringing them back to the current state that is our reality.  The day progressed with ups and down, frustration and excitement.  All of the leaders let go of something…
 
We had prepared for weeks for yesterday and I think the prep really paid off.  Basically, the team drew a line in the sand and said from this time forward we manage as a business first and a function second.  All of them agreed to give up on “pet projects” that they had in queue for their functions and instead offered up the resources to support our transformation to a Value Stream structure.  It is hard to express how hard this was for some of them.  The average tenure on the team is probably fifteen years.  Most of the leaders have grown up in these processes and with their heroic acts they have forged the current state.  To simply state, “it is what it is” and we are going to now completely change course must have been incredibly hard for them, but they did it.
 
We now enter the messy stage of transformation where we need to transition for the batch and queue world of improvement by project to a world of improvement by process.  In the short-term we will focus on the basics so in the long-term we can accomplish the breakthroughs.

I just returned from a nationally significant meeting of health care organizations just like us, in the area of health care information technology. The thing about health care IT, in my opinion, is that at the current time, the organizations investing in it are the ones investing in health care transformation across the board. It’s very energizing to be among such company.

During the conference my colleagues and I gave presentations that either alluded to LEAN, and in one, was about our LEAN transformation. I was amazed when one of my colleagues asked a packed room of 300+ people if anyone had heard of or was working on LEAN. About 70% of the hands went up. That was a “wow” for me.

The other general “wow” is that we came back this year with a story about our growth and development using LEAN and on reflection, it’s enriched a lot of our thinking across the board, not just in the areas in which we concentrated. It’s enriched other physicians, CIO’s and Executive Directors, too. Specifically, physicians can and will participate in this work, and I think that’s great.

The other item to note for me is that I also co-led a talk on using Web 2.0 technologies, like blogs, to communicate and engage constituencies, and mentioned this blog to the audience when I was asked about blogging in the public space about what organizations are doing. What if every health care organization set up a blog about all of the effort it put into making health care safer, of higher quality, and with a better care experience? Maybe some of them will join us. In the meantime, the experiment here continues….

Once again Genie Industries has exceed my expectations.  During yesterday’s tour we had the opportunity to view their “Model Line” as well as another production line and their service parts area.  After the tour the leadership group gathered to discuss what they had seen as well as the implications for how they manage.   The team highlighted several key takeaways including:

1. Managers at Genie only meet for 10 minutes per day.
2. At Genie they shut the plant down and then do 45 minutes of Kaizen every single day.
3. Flexibility in people and process are key to a LEAN system.
4. Human resources, IT and other support departments are decentralized and allocated to support the Value Stream and not the function.
5. You cannot have breakthrough improvement unless processes are in control and standardized.  Thus the right to innovate comes after you have done the basics.
6. Make everything visible.
7. Managers are empowered to solve problems and make improvements on behalf of the customer without having to go through a long permission processes.
8. Manual and simple often trump automated and complex.

 Tomorrow the group will take these learning’s into our first Hoshin Planning process.  Our goal for this session is to transition our leader’s thinking from functional to Value Stream.  Leaders will be asked to let go of long standing principles and practices.  I am glad we went to Genie first.

Today I have the honor of bringing the Model Line leadership team to Genie Industries for a benchmarking tour. For the last two weeks we have been making preparations for the trip and the group is incredibly excited for the opportunity. As part of the preparation we had each of the leaders prepare a set of questions that they would like to answer during the trip. Reviewing these questions this morning it is evident that the team has come a long way. They are no longer skeptical that what is being done in manufacturing can be translated over to healthcare. They are no longer looking for justification on why they should embark on this journey, but are instead focused on gaining wisdom on how they can do it successfully. The questions are focused on how they must change their behavior and how people systems need to change. For example here are some of the questions that will be asked:

1. Can you describe the principal role of the front line manager? What different competencies did they need for the lean approach and how did you support their development?

2. What is your selection and orientation process for new associates? Specifically, how do you select and orient people who will be on board in a lean culture?

3. When and how were you able to transition from LEAN being a program that was supported by a critical group of leaders to one that is now considered simply the way that you do work?

I hope today will be a break through day and will further fuel the energy of the group moving forward.

This past week, I had several experiences where I spoke with colleagues whose jobs had changed in part due to the changes in process we made using LEAN philosophy. I heard comments like, “my job has changed, I am doing different things, and I like it.”

This was an amazing thing for me to hear. I have written here about the fact that my job has changed since we started this journey. I am more locally focused, I get to work as part of cross functional teams where I get into the detail of a situation and see how it impacts patients (a post on that tomorrow). I consciously sought this out as a change agent. While I hoped others’ jobs would change as well, I had no particular expectations. What I found last week is that others’ had this experience too - they looked at their processes and consciously adopted changes, from within and maybe a level above in the hierarchy. The changes didn’t come centrally from human resources, which is the way one would think this would happen in the absence of a LEAN-directed approach. There’s nothing wrong with human resources involvement in a LEAN transformation, by the way. I was just impressed at the impact our transformation has made for our entire team. It was humbling.

I took this quote to heart last week after a couple of days of frustration.  I had just left a meeting with a group of leaders who had pushed back on an approach that we were recommendating for some changes to organizational policy.  An external consultant that I work with made the following comment:

“Sometimes you have to start where people are and not where you would like them to be.”  –Box

This was a good lesson, because if  you push to hard you will cause people to shut down to your ideas. 

I belong to a large organization and as we move forward we are exploring different strategies for growing and spreading LEAN competencies. One of our strategies is to grow both in size and talent our centralized internal consulting group. While I think this is important, I believe it is not sufficient. In an organization with 10,000 employees we would need hundreds of consultants if we relied on them as our primary mechanism to bring about significant improvement and change. We have to be focused and intentional about how we build the skills and competencies of our managers and supervisors. We need to teach them how to develop standard work, establish measurement and control systems and to use scientific methods for improvement. In order to be successful in this effort it will require a significant amount of resources and a willingness of leadership to focus on the long-term. It will mean that results will incrementally improve, as opposed to a series of big bangs.