DailyKaizen

Lasting change does happen, and several examples arrived in my InBox this week:

First, from a message I received from a colleague about changes they made to our information systems, based on standard work we created for them, to support our doctors use of evidence-based guidelines:

The long and short of it was that all the work got done (there had been quite a bit of pre-work) so that we could put together all the materials necessary for implementation … and sync everything up according to our [health care] system needs so that will be able to present all changes, all materials…within a very reasonable timeframe, something that historically would have taken months.

Lots and lots of very positive feedback from the whole team about how much was accomplished in a relatively short time.

Second, I participated in a rapid process improvement last week with colleagues (and led by one of this blog’s readers…) where we specified new configurations and several pieces of code, tested them, slotted them for production use, and found them loaded into our system using a standard process just two days later.

Prior to our transformation, I clocked similar changes taking 30 days each.

It isn’t so much that I notice the difference, though. It’s that the people serving our members who do the innovation notice the difference. And the difference is not just the speed at which they can create change, but that they get to lead change and see the impact.

I am of to the Lean Summit in Atlanta.  If there is anyone that is interested in trading war stories while there please let me know.  I can be reached by sending a comment to this posting with your email or phone number.   Also, if there is someone that has experience working with call centers on setting up data systems to accurately capture route cause I would love to buy you a drink. 

I have been thinking a lot lately about how great companies innovate.  In a former life I worked in the high tech industry and all we ever talked about was innovation.  In fact, the word innovation was thrown around so often it really no longer had much meaning.   Until recently, like most people I considered innovation to be the next big break through.  A brand new product or service that was so disruptive it would change the market place forever.   Why wouldn’t I think this way?  All of the companies that I worked with had specialized departments focused on finding the next big thing.  Innovation was the job of product developers, R & D, sceintists, or engineers. 

As you can guess my view of innovation has changed greatly through my Lean experience.  I now view innovation mainly an outcome of common, well planned out, process improvement.   Great companies like Toyota don’t rely on small teams of creative people to incubate innovative ideas, they instead look to all employees to make small improvements every day.   Here is a quote by Matthew May on this very subject:

 ”At the heart of all remarkable innovations in any realm lies a rigorous routine, a disciplined methodology.  And the learning cycle is at the core of the process.  By codifying it, applying it, teaching it and adopting it as your offical modus operandi, you gain enormous benefit.”

This morning I came in early and spent an hour talking with the team that was impacted by the RPIW two weeks ago.   My intention was to just do a quick walk by to see if the visual system was up to date, which it was, but ended up being pulled aside by a group of the staff that were working on their newly streamlined administrative tasks.   I sat down and informally began to ask them questions about their work.  I was a little nervous, because only one of them had participated in the RPIW and often those that don’t participate take some time to accept the changes.   

To my delight this was not the case.  Each one talked about how anxious they were going into the event.  How they all assumed that “management” was looking for ways to lay them off, but now that time has passed and they are all employed their fear seems to have turned to energy.  As I sat I was able to hear a series of stories about how much easier the work had become.  There had been bumps, but all of them agreed that they like the new way of doing things much better.  They wanted to know when the next RPIW was taking place, because they all wanted to keep driving forward with the improvements.   Several of them shared with me their ideas for improvement and asked who they should bring them to.  What was most impressive to me was how in just a two week time period this group of individuals was working and acting as a high performing team.  Before the RPIW the culture of the work group was very much focused on individual performance where most staff worked with very little contact with those that worked to either side of them.

As I walked away from the team I had a renewed sense of opptimism. Great things start small.  Months ago I wrote a post that discussed how our goal in the Model Line is to turn all 700 staff into improvement agents.  I would say we just took our first small step, but it sure is a big one!

Two days ago, I gave an update on our information systems work to a group of our physician leaders. Since LEAN is a big part of the work we doing to improve our systems, it was part of the conversation, but was not the topic of conversation. I demonstrated the gains we’ve made in reducing handoffs, being closer to our patients, and having a safer system.

After I gave my update, a physician working in Lee’s area talked about the work he’s doing, and referred to the Model Line work. This piqued my interest - I wanted to see how it would be presented in this forum, what the knowledge was about the project to date, and how well the concept was being received. The discussion was objective in my opinion, and I did not see much reaction (including acknowledgment of what this was) from the group.

I thought this was great. First, two physicians were talking about their work and how LEAN supports it, rather than them talking about LEAN. Second, hearing it from two colleagues gives the gentle sense that this is important to the organization, and it’s being used to support them better.

Before I left for vacation I had a coaching session with a senior leader in the organization. The topic of the session was how to manage time with so many competing priorities. Being one of the leaders in the Model Line area this leader has had a very hard time balancing the demands of the “new” and “old” worlds. This leader understands the importance of being highly involved in the development of her staff, spending time in the Gemba, conducting route cause analysis, etc. Yet, she is feeling overwhelmed, because she still needs to work within the context of the broader organization that has not been exposed to Lean principles. An organization that requires leaders to spend much of their time in countless meetings coordinating work across departments. During the meeting she commented to me that when we first started with the Model Line she was highly skeptical that Lean would change the way that she does her work and considered it merely a process improvement technique to improve operations. Six months later she is excited and fully committed to abandoning twenty years of “traditional” business education in order to behave and perform as a “Lean” leader if only others would tolerate the changes she needs to make. At the conclusion of the session we decided to treat this problem like  any other and to start gathering data. Her first step was to look backwards a month and forwards a month on her colander and to begin categorizing where she is spending her time and for what purpose. That way she could make a better case to key stakeholders on why she should or should not participate in an event, meeting or other engagement. Today, I ran into her and asked her how it was going and she told me that she felt much better. She said the exercise of gathering the data forced her to reflect on what activities were really value-added. She said that she was surprised by how much time she wastes on a weekly basis and was able to come up with some simple strategies that she thought would make a big difference. For example, she was able to move required meeting’s to the same day and location so that scheduling would be easier and travel time would be less.  Additionally, she was able to identify several standing meetings that at one point made sense for her to attend, but there was no longer any reason. She said it was embarrassing to her that she was not able to identify this earlier, but was so caught up in the motions that she never questioned why. I am sure that anyone that works in a large organization can relate.  Based on this leaders experience I have decided to do the same thing with my calendar. I wonder how much stuff I can simple stop doing with no negative impact. My guess is a lot.

After a much needed vacation snowboarding the deep powder of British Columbia I am back and energized to get started where I left off. Thanks Ted for holding down the fort while I was gone!
The week prior to me leaving for vacation was exciting and fruitful. During this week we had a very large Kaizen rapid process improvement workshop (RPIW) take place in the Model Line. You might recall my entry on February fourth where I introduced this event. Well, as expected the kaizen team did not let me down and the event was a huge success. Over the last couple of years I have participated in many RPIW’s but none as anticipated as this one. During the week we were able to achieve or exceed all of the expected deliverables. It its amazing how smart and creative people are when given the opportunity. Most importantly, we were able to relax much of the stress that has risen among staff and managers about the impact Lean will have on them.
For this reason I thought I would quote one of the managers that participated in this RPIW. This manager is highly talented and a real pleasure to work with, but has had a hard time over the last couple of months understanding how the changes we were planning would make a difference. She was very nervous going into the event. On the last day of the RPIW I checked in with the manager to see how they were doing. She had a huge smile on her face and remarked:
“This was the most fun I have ever had at work. I really get it now! I have been trying to make these changes for years and we got them all done in a single week. I want this to be my new full time job.” I smiled and told her it already was.

My stories tend to be about little victories that come from a change in philosophy. Each victory is a victory nonetheless…

Earlier this week my team was wrestling with a problem that was discovered in one of our systems by users at one of our medical centers. We received messages reporting the problem and worked to reproduce it to understand it better. We were having difficulty doing this based on written descriptions.

So, I called up a partner and I said, “Got time for a drive?” He did, and off we went, to the nearest medical center experiencing the issue. We were welcomed by staff who were in the middle of a busy day taking care of patients. After obtaining appropriate consent, we were allowed to observe a patient visit and talk directly with one of our providers. We observed not only the problem we came to see, but another one that was also emerging.

30 minutes later, we were back at headquarters, having replicated the problem, not only with accuracy this time, but also with understanding of what this meant for our members and care teams.

One of my mentors who had leadership responsibility that covered a statewide region once told the story of how he reacted to a problem by being at the desk of the person involved within 2 hours of notification. I like that story - it shows that when we think we can do something, we’re right.

That’s not a quote from me, but this is: Our customers don’t expect us to be perfect, they expect us to recognize our imperfections quickly.

This article, about the Washington, DC metro (login may be required), reminds me of some of the work we have done here. It discusses specific interventions being planned to improve safety, notably having supervisors ride the system they support, and allowing individual employees to halt the system for safety reasons. This sounds a lot like going to the Gemba and implementing an Andon cord system.

At first I read the statement, “Metro’s safety officers will have increased authority to stop actions they consider unsafe…Eventually, that authority (to stop service) will extend to all employees” with some suspicion. Why eventually? Why not starting now?

I then thought about our experience and also about the death of a worker on Seattle’s under construction light rail line last week. This article said that the contractor digging the Beacon Hill tunnel “failed to establish a culture of safety on the job site last year,” according to an audit.

We put in an andon-type system for safety after we established the intent and responsibility to maintain a safe clinical information system. “Pulling the cord” is a shared decision between a concerned staff member and a physician leader. Every staff member is empowered to receive advice from a member of our physician team, who are on call 24 hours a day, without worrying about the accountability of halting the system. The goal is “door to doc” time of 45 minutes or less.

The combination of establishing intent and responsibility first, creating a formal protocol that applies the tool, and running through it several times to build confidence has made this successful for us. Implementing the tool without the culture to support it would not have worked. When I am called upon to provide consultation, I provide it and then we follow the protocol. No judgement about validity is made. When the ball starts rolling, we pull out the binder and follow the steps. It’s a huge improvement in terms of keeping the focus on the problem and the patient need when these situations arise.

I assume that the “eventuality” of Metro’s employees being able to halt service is based on their creation of a standard process that is tied to acheivement of the outcome they are looking for. Our system took a little bit of time to put in place because of this, but it was implemented quickly when we recognized the need. I would say, then, that having this as an “evenuality” makes sense in the context of creation of culture.

Incidentally, our organization has made our information system safety protocol publicly available, and I have distributed it to to health care systems in our community to use as they see fit. If there is interest, I am happy to post it here. Any knowledge that we create to support our patients’ safety should be used to support every patient in every care system.

I like this quote a lot today. I have been working with colleagues who want to always do the right thing and be supported in doing so, which means being focused and saying “no” sometimes, so that the things we said “yes” to will get done.

For proper attribution, this comes from You are Being Lied To and Other Truths, by Larry Winget

Larry’s all-time best advice for business success:

Do what you said you were going to do, when you said you were going to do it, in exactly the way you said you were going to do it. You won’t ever get any better business advice than that.

Be there when you said you would be there. Deliver when you said you would deliver. Call when you said you would call. Be a person who can be counted on by keeping his word every time.

“If I do all of this, Larry, will I be successful?”

Beats me. Success is a funny thing. Sometimes you can do everything right and it still all goes wrong. If you don’t understand that, then you are naïve. So I can’t guarantee your success. However, don’t do any of these things and I can guarantee your failure.