DailyKaizen

This morning I ran into a former client of mine that I have not worked with in eight months. In fact, they were one of the first leaders that I worked with at Group Health. Early in 2006 I helped this leader facilitate a workshop on a bottlenecked process that was leading to a lot of frustration with other departments. We showed some good results at the event, but yesterday I learned that the real results have come afterwards.
It was fascinating to hear about the innovative process the leader has developed. Since the workshop the leader and a few designated supervisors have continued to apply Lean principles in their area and have begun to move upstream working with other departments. Due to staffing issues the leader determined early on that it would not be possible to conduct full five-day RPIWs and as a result developed a standard one-day “mini-event.” The leader has gone out and developed a future state map and then broken the implementation plan down into more then a dozen mini-events. During the mini-event the team focuses one specific problem like a lack of standard work or leveling workflow. Each team is made up of around five staff members and they are held accountable to achieve measurable results. An entire tool set have been developed based on the problem they are trying to solve. Over the last six months they have been able to free-up much needed staff and have greatly improved cycle times, quality, etc.
Lean is all about sharing knowledge. This is a great example of a Lean consultant learning a new Lean technique from an operations manager. I plan on using this process moving forward with some of the Model Line work. How fun!

This is an image of the visual system that is part of the Agile development process that is being pursued on one of the teams I serve with, and discussed recently here.

As a little orientation, the very left side is labeled “The Fridge,” the middle panel is labeled “Front Burner,” the right sided panel is labeled “Done, Done, Done.” The colors are the equivalent of meta-data, showing visually the scope of tasks required to support each “Story” (the green slips).

Imagine walking past this in a place where you work. Does it show that a project is nearing completion? Does it tell the story of a team’s current priorities?

Beyond the story about the work that this tells, there’s a story it tells about changing the questions being asked from “What are you doing?” to a much deeper one of “How are you doing what you do better?” :

When I asked the team’s development manager if I could post this image for the benefit of our colleagues and our community, she responded with “I have no objections to anything regarding Lean and its spread throughout the company.”

One of the greatest challenges of being an internal consultant is being able to distinguish noise from problems. Noise being defined as assumptions, opinions and beliefs that are not based on facts. As we move forward with the Model Line we are creating a tension with the rest of the organization that is resulting in all kinds of noise. The change is massive for not only the operational area, but also for supporting departments. Since we are using Lean to drive our overall business strategy we are not only changing the way that we “do work”, but also how we support and measure it. This is the true value of a Model Line, we are using as a laboratory to figure out how to do all work differently and not just tweaking operational processes. So back to the noise. As we move down the path we have begun to question why we do many of the things that we do. Many of these things are managed in areas outside of our control. Everyday we are questioning logic that has been in place for decades and is backed by professionals that are smart and have a lot of experience. Our questioning has led to a lot of excitement and fear. This generate a lot of noise. We are also using a different process for managing change then we typically use. Instead of doing a lot of upfront “change management” work we are first defining the process and then taking appropriate countermeasures when problems arise. This also creates a lot of noise, because we are running up against a culture of consensus. A year ago I would drop everything anytime a problem, real or perceived would come up. That is no longer possible. To be a good consultant I need to help my leadership team stay focused on the right problems. I need to identify facts and data to bring clarity to their work, because there is never enough resources to manage everything, and the noise can be a powerful distraction.

A big lesson I have learned while working with my Sensei over the last three months is the fact that there is no such thing as a simple solution. For months we have been pouring over the data and identifying cause and effects. Going into the work I thought I had it all figured out. The solution was easy: just build a couple of work cells and eliminate handoffs. If it was just that easy it would have already been done. What I thought was simple has turned out to be incredibly complex and my simple solution did nobody and good when it came to the right tactics to get there. We so often assume we have the right solutions when we really only have the right concepts. The solutions come from the details and they are hardly ever simple. Here is the quote:
“For every complex problem there is a simple solution that is wrong.” –Shaw

As this press release indicates, a new book by Pascal Dennis has just been published. Mr. Dennis is the individual who taught the course on Hoshin planning that I attended with several leaders here, and then subsequently attempted to implement, oh, within 24 hours or so. The impact was significant.

So far, so good. I am looking forward to having the whole thing in reference form.

Lee’s asked me to mind things over the holidays; fortunately, there’s a lot going on.

I would say the most important thing I experienced this week would be the “standup.” This is the daily 15 minute meeting that one of the teams I serve is now having as part of their transition to Agile development. It’s situated around the visual display that they created around a major development project. The team is facilitated in going through all of the development, testing, and approval tasks, split up in to manageable pieces, to complete this project. It honestly reminds me of hospital rounds, in its measured review of each part of the project and team members’ contribution to it. During the standup, developers make arrangement to be available to help others whose tasks were up, based on what needs work. Quality Assurance has become a visible focus. I’ve been trained from the beginning that the QA team is to be respected; this process makes that clear to everyone involved. QA is visible throughout the work.

The team has been doing this for a few weeks. What’s interesting about it to all of us is that their visual display is in a very well trafficked area of our building. This serves the desire of efficiency for the project, and also for creating curiosity around a “new” way to do things by other teams. Wheels are turning, moving us forward.

If I ever want to know how this project is progressing, I really don’t have to find someone. I can just walk in a certain part of the building. If I ever hear or feel that there’s something that needs higher priority, I can do the same, to understand what is already prioritized, and manage my energy. Knowing what is being done is the antidote for asking for something else to be done!

The best part of the whole thing for me is that this team created this system on their own after receiving training. There is now one more fountain of knowledge that I and others can draw from when we connect their innovations to others’ who we work with. I will say “Not invented here, but we’re going to do it anyway.”

Back to the hospital rounding analogy, I wondered by we don’t have standups in the outpatient setting, but only in the inpatient setting. Maybe it is because inpatient care is an experience of intensely focused, acute interventions, where team functioning on a daily basis has large impacts on a patient’s care. Why wouldn’t an outpatient team also benefit from this focus and organization and enjoy what they do because of it? More ideas for integrating LEAN into the content of all health care….

I received the treat of the sight of Lee yesterday, when I brought a professional colleague into what we are calling our “Hoshin planning room.” This is for a different planning process than the one I described previously (we’re just trying it everywhere). In this process, the affinity diagram is occurring on the walls of a colleague’s office. It’s “live.”

When I interrupted Lee, he was conducting a meeting amidst the scenery of the room as I brought my colleague in. I gave my colleague the tour and told her the “story” around the work of our team in 2007 as Lee and his colleague watched. It was great to see us intersect in this way, each moving ahead in a different part of the organization.

This planning process is challenging - the walls are literally covered with work items and there is no way we will complete them all in 90 days. At the same time, they are all there in plain sight. Nothing is hidden. It’s a little bit like mourning - realizing that the thing that we want to do can’t be the priority, and at the same time seeing very impressive aspirations for our organization in 2007 taped on the wall, on slips of paper. No database. Just paper on wall. Seeing what we will accomplish should pull me out of the valley of forced optimism!

I know this is Lee’s job, so it is just a suggestion
I encountered this while reading Carly Fiorina’s book, “Tough Choices.” She quoted it several times throughout.

The bad leader is he who the people despise. The good leader is he who the people praise. The great leader is he who the people say, “We did it ourselves.” - Lao-tzu

Today I visited with Lee and my colleagues in the Customer Service Center, along with our Chief Information Officer. Actually, we didn’t just visit. We plugged right in. Literally. To headsets and customer service professionals’ workstations. This group has been studying and implementing LEAN principles as we have, so they knew immediately what we needed - to watch and listen to care being provided to members.

It was a great experience in so many ways.

First, I saw a different side of health care - that of a member doing the work required to acquire and maintain their health benefits. For a member aging into Medicare, this is a very important transition, and I could hear it in their voices. What I observed was that our customer service staff were doing as much as a physician might to - obtain a history, do an exam, make a diagnosis, and collaboratively create a plan. All without being able to see or touch. The experience creates great awareness and respect that the non-clinical portion of health care is as important as the clinical one in terms of empowering patients and supporting the patient-physician relationship. I am grateful once again that I work in a system where we can create improvements in both the clinical and non-clinical parts of health care.

Second, in speaking with the management following the shop floor experience, it was very clear that they understood LEAN concepts. Again, I had the feeling of traveling to an international destination and meeting someone with the same cultural background. The team knew about takt time and value added and non-value added activities and were working to enhance value for our members. It was and is energizing to know that there are even more people for me to learn from.

My last impression, and the one that was most profound for me, is that the members calling about aging into Medicare were all baby boomers. It is sobering to see first hand that they’ve arrived to this point at their lives. This is the generation that had boundless energy and enthusiasm for improvement on so many levels. And now they are facing a potentially challenging transition, away from full independence. I could hear it on the headset. It is humbling. Our continued care and compassion for this group, one that sacrificed so much for those that came after them, will be vital.

I thought I would take the opportunity to make some personnel, professional reflections about where I am right now and how I am feeling. This entry is all about me. I am currently the lead consultant and project director for the most ambitious Lean effort we have ever undertaken in this organization. We are in the process of attempting to completely transform a department that is large enough to be considered a very large company in most states. This effort is being labeled the “model line” because our goal is to learn the key levers and methods of a Lean transformation so that the rest of the organization can follow our lead and benefit from our learning’s. There are many across the larger organization that are counting on our success while others probably just want us to go away.
Every day I come to work with an incredible amount of excitement and energy, but also a lot of anxiety. It is an honor to be given this assignment and the resources to back it up. Yet, I feel a great responsibility to our patients and members. I feel an even larger responsibility to the leaders and staff that have put a lot of trust and faith into me and my team. Line-managers that have been willing to suspend twenty years of business experience and follow us down a path of what is to them unknown. This is by far the most challenging endeavor of my life and I often find myself questioning whether I am going to be successful in my role. I have never been down a path like this before and am often not sure where we should be going next. Yet, I am determined to keep marching. Yes, I know I will make mistakes. Yes, the pressure is likely to grow. Yes, I will continue forward with an open mind backed by a great team and the right principles. Its all worth it when I get to watch others “get it” for the first time.
I have learned so much so quickly that it often makes my head hurt. I wake up in the middle of the night locked in problem solving. I have begun to reorganize the way I live my life based on the principles I teach at work. One thing is for sure, I would continue to do this work even if I didn’t need the money to survive.