DailyKaizen

As a consultant I have noticed in every area that I work there seems to be a tendency for teams to be paralyzed by what they cannot easily control. It is far easier to identify other’s wastes, variation, defects and poor practice then it is to see our own. Recently I spent some time with a manager that made a comment that improvement was out of her control and the only “real opportunity” was to fix others upstream. This was also the case six months ago when I first began working in the Model Line area. At that time there was a belief that the only way to make breakthrough improvement was to work upstream to fix the inputs. The leadership saw an opportunity to make small improvements internally, but were easily distracted by systemic problems that we hard to describe and even more difficult to develop countermeasures for. What is remarkable is how much good work can get done when this attitude changes. The leadership team has begun to look critically at their own processes and they have been taught how to see value flow. While the opportunity to work upstream is still powerful it is no longer the priority. Instead, the team is intensely focused on putting there own house in order. Before asking others to fix their processes the team believes they must fix “their house first.” In other words, flush the waste out of your system and then work up stream with your suppliers to do the same. The more visible and reliable your processes become the more evident it becomes that others need to make improvement.

Last week in Hoshin training we learned methods and tools to help facilitate the telling of compelling stories that promote change. The theme of the day was learning how to tell the truth. Until we are able to be honest about where we are and why we are there it is impossible to motivate people to do something differently. Great leaders are willing to share the truth and then do something about it.
“Great leadership does not mean running away from reality. Sometime the hard truths might just demoralize the company, but at other times sharing difficulties can inspire people to take action that will make the situation better.” –John Kotter

Like Ted, I spent Monday and Tuesday in Policy Deployment Training and got a lot out of the class. We brought in a world renowned expert and spent the first day training and the second day working on our strategy for the Model Line. What was most exciting about the training for me is that it confirmed that we are moving down the right path and that it does not take an expert to do good work. Several months ago we began working on developing a Hoshin strategy for the Model Line and for knowledge we turned to the literature. We bought a couple of good books from Productivity press and developed a process to engage our leadership team in strategic planning. We stuck to the basics:

For the previous two days, I supported our members by getting training in Hoshin Management. It was great - the right content at the right time and place in my own professional transformation.

During our training, we were exposed to some of the concepts I have read about, but not yet experienced, such as catchball and the pacesetter role, and some I have tried, but not yet had broad exposure, like A3 development. There was also a nice sprinkling of content and stories from the world’s most proficient companies in LEAN. There’s something inspiring about seeing a real-live A3 from Toyota Motor, developed at all levels of the organization.

I am particularly intrigued by the pacesetter role. In our organization, divisions are co-led by physicians and operational leaders, as dyads. The operations leaders manage the budget and administrative FTE, meaning that physician leadership occurs through influence rather than authority. I’ve been “practicing” with this setup for some time and am quite comfortable with it - it offers a lot of advantages to the organization in terms of providing clinical relevance in all we do. I am thinking that a physician leader in this environment could serve quite well as a pacesetter specifically because they do not have operational responsibilities. It could be a great mix of clinical knowledge, passion, and organizational structure, set up just right.

The other great thing was the connection to the others in the training. I had not seen Lee in some time, and was delighted to catch up with not just him, but all of his colleagues from the model line that also attended the training. It was like encountering the small society of other LEAN enthusiasts in the organization - a group that is getting larger every day. I also got to learn a lot more about the model line and gently challenged some of my assumptions about there being a “clinical” versus a “health plan” value stream for our members. We all provide care.

I walked to the training in downtown Seattle on the wettest day I have ever experienced in the city. My shoes, socks, and dress pants were completely drenched. Several of us were drying our shoes on the heating vents in the training. What a way to start thinking about the future.

The picture here is what we were left with on our way out of the training. It’s the view from the top of the Smith Tower, onto Elliott Bay.

The sun’s shining. Now I’m ready to do more.

I love this quote because it is so true. I have worked in a couple of larger organizations and have watched countless leaders paralyze themselves and the moral of their teams by waiting for permission. It is safe for managers to let others make decisions for them, but it leads to missed opportunities and frustration. If you assume authority, most often other will not question it, but when you go to ask for permission you make them think twice.
“If it is a good idea, go ahead and do it. It is much easier to apologize then it is to get permission.” –Admiral Hopper

Like the rest of the readers of this blog, I am following Lee’s adventures with interest and excitement. He is working on the health plan side of our organization, and I am still interested and focused on clinical care delivery. One thing that’s wonderful about our joint journey is that we are able to cover all aspects of health care, from financing all the way through to health services.

I’ve been away on vacation, and in addition, our team is in the midst of a reconfiguration, to support a very large software upgrade. This makes my role seem more like being along for the ride. Ordinarily (or should I say, Pre-LEAN), that might be an uncomfortable place to be. It’s not now, since those who are guiding this work are using LEAN principles and are impressing me with their imagination. We’re dabbling a bit in Agile development on one major project. On another, one-piece flow cross-functional configuration is being employed. I have not yet completed a large software project using LEAN.

I expect to be getting new content next week, when I’ll be attending a training in Hoshin planning with others, on behalf of the organization. I’m looking forward to that, and really pleased that as part of our transformation, our leadership supports learning along the way. This comes at some cost to our members in the short term; this is a reminder of our long-term commitment to the health and happiness of those we serve.

Only other update I’d provide is the usefulness of our philosophical principles in so many situations in just the past few weeks. In a request for new functionality that was brought to me, I asked to hear about it, but from the patient perspective only. The response was, “We haven’t thought about it in that way.” We proceeded to have a great conversation where we were able to capture the need from the patient perspective, and at that point what we needed to do was also made more clear. I left the conversation with yet another reminder that I have never met a care team that didn’t want to take great care of patients.

For the last couple of weeks I have been collecting data on an administrative process in our health plan that is supported by around 650 employees. Currently, the process supports eight products, many of which are very different, but all of which we are attempting to support on the same IT platform and with the same processes. Basically, it is the equivalent of Toyota trying to make forklifts on the same production line as a Camry. The result is that over time the process has grown increasingly more complex, and we have had to build in more and more checking steps.

This process is not un-typical, and I believe that most health plans are struggling with similar challenges. This is because over the past decade the market place has demanded a solution to the rising cost of healthcare. Health plans have tried to answer this demand by developing an array of new products. Once one health plan comes to the market with a new plan others quickly rush to follow the leader. The problem, most health plans have not organized around value streams, thus operations is always one step behind product development.

Walking the process it is incredible how good a job we are doing given the speed of change. Our quality and cycle times are better then almost anyone. Yet, as a Lean consultant I see an incredible opportunity. My task is to begin to reorganize the processes into production lines that handle like work. We will then expand upstream into our product development areas creating value streams. It is exciting and transformational.