DailyKaizen

Next week I will have the opportunity to facilitate the beginning of a Hoshin Strategic Deployment process.  One of the goals of the Model Line is to find new and more effective ways to plan and deploy improvement efforts and resources for the organization.  We are starting with a single business line, but hope to take our learning’s to the greater organization for adoption. 

In preparation for the event we have asked the Model Line leadership team to identify key outcomes they would like to achieve over the next year through Model Line implementation as well as to list all of the improvement projects that are currently in queue for 2007.  Our goal is to gain agreement on what work is required to reach the desired outcomes and then everything else comes off their plates.  This is the only way that we will be able to have enough support and operational resources to realign the organization to one that flows horizontally.  As the homework has trickled back in it has blown me away how much work is currently underway within each of the functional areas.  Some departments have dozens of projects underway or in queue, most focused on optimizing vertically, few focused cross-functionally.  Priorities are constantly changing and the time to just manage the inventory of partly completed projects must be huge.

Moving forward we will encourage departments to continue to improve on their own, but supporting resources will be focused on making improvements across the departments along the Value Stream.  We will down the number of projects to a handful, and focus, focus, focus.  Hoshin will be a powerful tool and I can’t wait to learn.

I have been reading Mary Poppendiek’s book and this posting from the Shmula blog. The challenge I have now is how to support a much larger information technology project in health care using a LEAN approach. Since this blog is about what I learn every day, I’ll just say I have a lot to learn. I think there’s a lot here that can be applied to a health care environment, even if we are not talking about profit and loss.

I just finished reading: O’Toole J, Lawler EE. The new American workplace. 1st ed. New York: Palgrave Macmillan; 2006.

There’s a nice discussion at the end about the rationale that American executives have used to justify various choices made in involving and empowering employees. It has typically boiled down to “I have no choice. Everyone else is doing it.”

The quote is

The statement “I have no alternative” is one of the surest indicators of leadership failure in government, business, or any institution. Great leaders use their strategic and moral imaginations to create viable options where others see none. When there appears to be no choice but to take an action that is negative for a key constituent, imaginative leaders look for alternatives that haven’t been tried or for ones that others assume “won’t work.” In business, such leaders take the extra step and search for actions that serve all their stakeholders.

I like this because it meshes well with one of the quotes I’ve been using since we started this work: “Not everything has been tried before.”

Last night I was preparing for a Strategic Planning session and found this quote and it was timely.  The group I am working with is having difficulty understanding what the future will look like once we have applied LEAN principles.  Basically, they won’t understand until we are in the work making the changes.   “One must learn by doing the thing; for though you think you know it, you have no certainty until you try.”

A few examples of innovation and respect came across my RSS reader recently. The first is from Mayo Clinic, who are involving their patients in the development of innovative approaches to providing care. This seems like a great way to move past a fear of failure and maintain relevance to those we are serving (yes, the customer, as Lee points out). I hope we will emulate this spirit as we involve our members in our workshop events, too.

The second example is a piece on self-management that appeared in the Harvard Business School Working Knowledge Series. This one also got me thinking - would managers be necessary in every instance if the process for doing work was clear? They would probably be necessary, but not in a command and control kind of way.

I then began to think of some situations we’ve encountered recently. As we interact with groups that know less about LEAN process, they have tended to use typical methods of “expediting,” which usually entails checking back on things periodically until they get done. If they are not visibly completed, then a person of higher ranking does the checking back. I believe this is a norm in most businesses, so it is not a surprise. It is an opportunity, though. With a good process, which we have set in the area we have most focused on in health information technology, we can trust the process and expediting is not necessary. The instinct to “tender” and move the process along, much as a ship’s tender does when it moves cruise ship passengers from ship to shore is real. I learned this week in one case that this wasn’t necessary. If I trusted the process that we set up, no checking was needed. And in fact it wasn’t. When I spoke to the process owner that we’ve designated, I learned that a piece of work that was asked for was being completed on time. When I spoke to the key stakeholder, I learned that she was aware of this, and comfortable with the process. I am in recovery, too.

In Healthcare the question is often asked, who is the customer? Is the customer the patient? Is the customer the member of the health plan? Is the customer the employer or agency paying the bill? Is the customer the physician?

I can’t tell you how many times I have been in the midst of this debate during LEAN events when we are specifying value and requirements from the customer perspective. The answer is always the same: it is the patient, and it is the member. No matter how far removed they may be. Some may claim that this makes the process confusing, especially in areas that don’t have contact with the end user. I believe if harnessed it is one of the most powerful tools that we have at our disposable. Working is healthcare is a higher calling. The work literally changes people’s lives. By connecting everything to the end customer, no mater whether it is nursing work or claims processing we have a rallying point for change and improvement. If people are able to see how their work has an impact on patient care or member service they are much more willing to give something up to help someone out. This is why LEAN is such a powerful way of thinking for an industry that desperately needs it.

One of the great challenges facing this organization and any organization on a LEAN journey is the need to slow down, even if it is just for a short period of time, in order to be able to speed up. It is my belief that to have a sustainable LEAN improvement strategy the focus upfront has to be all about developing PEOPLE, PEOPLE and PEOPLE. While LEAN is a process-focused strategy, it is the people that need to be engaged and empowered to figure out new ways to do work within the process To get them there you need to be able to teach them new ways to view the work, their role and customer requirements. This takes time and investment. It means staying the course and being disciplined to create a culture of continuous improvement.

Over the last year we have taken an event-focused approach toward improvement and building LEAN competency. While I think this strategy has been sound and should continue it is not sufficient on its own. Time and again we have executed on Kaizens and then have had to invest considerable resources post-event to ensure results stick due to struggling managers. As a next step for the organization we need to supplement our event driven approach with a training and development program focused on building competency within our managers. We need to change their role from one of making decisions for their staff to one of coaching, mentoring and championing standard work. If done correctly we can take a giant step toward building a high performing culture, but it will mean slowing down to bring these folks along with us. It all about respect!

I found this quote last week and it struck me as being very powerful. At work, I find that there is so much fear of making mistakes that often great ideas are stuck in paralysis. To build a great organization you need to foster a culture where failure is not only accepted it is also rewarded, as long as those that fail had good intention and learned from their mistakes.
“We pay a heavy price for our fear of failure. It is a powerful obstacle to growth. It assures the progressive narrowing of the personality and prevents exploration and experimentation. There is no learning without difficulty and some fumbling. If you want to keep on learning, you must keep on risking failure–all your life.”

–John William Gardner