DailyKaizen

Thank you to Mark Graban, from the Lean Manufacturing Blog, who interviewed myself, James Hereford, and Lee Fried recently for his Leanblog podcast. We had a lot of fun doing it, and it was great for all of us to get in the room together and recount the beginning of our story. The rest is still unwritten…

LeanBlog Podcast #23

Lee informed me that I’m on blog duty for the next week or so while he conducts a few lean events. That means I get to own the quote syndicate, too.

The following are from Donald Trump, who, without espousing lean itself, appears to approximate LEAN-like business practices, with good results.

On establishing a business system:

I have looked at so many businesses that are top-heavy, staffed by highly educated and highly paid people who are working hard and accomplishing little. In most cases, these types of businesses focus primarily on people and not on developing great systems. A great team of highly paid people will fail without great systems. - Donald Trump

On achieving success by doing only what is necessary:

…when people visit my core office at the Trump Organization, they are always surprised by how small it actually is. We generate a lot of activity from here because we don’t have unnecessary energy sappers like overstaffing, overstuffing or unused space. Everyone knows what they’re doing, and they do it. I know my name is synonymous with luxury, but tht’s because we know how to work to achieve it to begin with. It’s hard to be creative when things are too big to control, and it’s hard to control that which gets out of hand. - Donald Trump

And this one, which is my personal favorite:

FOCUS =

Follow
One
Course
Until
Successful

All are from his latest book, and they are a reminder to me that the core philosophy of LEAN is a part of many successful business operations.

In the Model Line we are current in the process of training all 85 managers in a program called Customer Focused Management Training.  The focus on the training as I have mentioned before is to put in place a Daily Management system where all processes are standard, visual, measured, etc.  The learning has a classroom component, but is primarily applied learning where each manager brings a process, learns a module and then goes back to their team to teach and try.    Today I was talking with one of the trainers that told me a fun story about one of the groups that is currently going through the training that I thought I would share.

The manager of this group picked a fairly complex process that she thought was fairly standard since there was procedures in place.  After doing some observations and collecting date she realized that she was wrong.  (Many of the managers believe they have standard processes at first)  In fact, nobody on the team was following the same steps and  there was more then twelve different ways that the team was completing the process with a large variations in quality and productivity.  Realizing this she gathered the team together to share her finding and to decide on which practice should be made the standard work.  A large debate broke out with several of the staff feeling frustrated because they believed they “had the most efficient process.”   After some hard work she got the team to agree to all follow a single, standard process and they even agreed to the steps they would follow. 

A couple week later the team was finalizing the last steps of the training when a member of one of the downstream process teams inquired what they were up to.  After the process was explained this staff member asked why they were standardizing the process they had chosen since nobody was using the information anymore and fact they hadn’t in a while. 

At first the team was frustrated, but they shouldn’t be.  This is what Lean is all about, reducing waste.  There should be no blame for wasted work of the past as long as we keep making improvements moving forward. 

I passed one of the managers of our clinical information system team this morning. She let me know that she was on her way to their weekly standup meeting. As part of our LEAN transformation, our information technologists have been shadowing physicians practicing their craft. Shadowing is a skill that involves being present for the purposes of observing, and nothing else. When I shadow a physician taking care of a patient (after consent is obtained), I work to minimize my presence, by keeping still and not responding to the interaction, even if asked a question or addressed by the patient. I will of course smile but will use body language that demonstrate that I am here to respect the patient-physician relationship. It was in this spirit that I shadowed our own team doing their work.

As much as we have been striving to see the impact of what our team does for our patients, it was great for me to see the impact of what our team does for our team. The standup occurred in front of the Cookie Jar, which has been pictured here previously. The manager went over each team’s work in sequence, and accepted suggestions for ways to have the work go faster. I learned about several items that were “must do’s” that got added in the last several days. The visibility of items like this was not high previously - they were just done without appreciation for the nature of the task. The manager gently introduced another LEAN tool as part of a conversation on cross training - the visual skills inventory.

The scene itself was impressive to me, embodying so many aspects of LEAN philosophy. The manager was standing in front of a white board that had a list of the team’s accomplishments from the last week on it. An e-mail was printed out containing a list of changes to our production system made in a short time with the words “WOW” written in a highlighter across it. The meeting took place in front of the visual system cataloguing the team’s work. There were so many cues beyond what was said that sent a clear message of “we respect your contribution.” None of this was planned to come together this way - the positioning, the visual messages, and the conversation - but it did in a great way.

Of course, I now want to bring a physician to shadow the shadowers with me…..the learning will be bidirectional always.

 A co-worker of mine last week said that they believed that the greatest value that Lean provides to an organization is the ability to make problems visible and then solve them in methodical way.   As we move forward with our Lean efforts a key to our success is our ability to not only teach people the ability to see problems, but also to get them excited about solving them.  It amazes me that every organization I have ever worked have had cultures where problems are considered bad, hidden most of the time and often are career limiting to those that happen to have the blame placed on them.  After years of operating in a culture like this it is hard work getting people to accept the idea of a no blame culture.   In this spirit I have chosen the following quote:

“Good management is the art of making problems so interesting and their solutions so constructive that everyone wants to get to work and deal with them.”

–Paul Hawken

Our team completed its second 90 day plan using the Hoshin method. I am looking forward to third, which will mean that we have a cadence.

I am already in the rhythm. Now when I want to add something to the workplan, I know when to have that happen, and with the next one coming out less than 90 days from now, it’s not that much of a wait. So what I will do is do some prep work for adding something, and not spend a lot of energy trying to get it prioritized right now. Just right.

In the meantime, I will help the current plan along. I have seen people remark that they know that the team is now fully deployed for the next 90 days as well, so will join in to that process, too.

I’ve pasted this in a few messages recently, as well:

“When people ask me when something will be finished, I respond, ‘It will be ready sooner if you help.’” - Richard Stallman, luminary from the open source software movement

A couple of months back you may recall we conduct our first RPIW in the Intake area within Model Line.  The focus of this event was implementing a work cell where we would cross-train several teams and combine into one, level work, create flow and build quality into our processes.  We just did a sixty day check and the results are powerful.   

Going into the event we anticipated that by eliminating handoffs, leveling work, implementing control points and cross-training staff we would see improvements in quality, cost and delivery.  After sixty days we have reduced backlogs by 80-90% and are now doing “today’s work today”, something that has never happened before.  We are cross-training staff so they can support other teams that will allow us to avoid having to hire new positions and temps.   Most exciting though is the improvements made in quality.  Not only has quality gone up significantly within the team, but quality has drastically improved downstream as well.  For the first time we are slowing down our individual productivity in order to increase the overall team productivity.  In other words, we are making problems visible, stopping problems from being passed between teams and solving more of them at the root then ever before.

Throughout the year we will continue to make similar changes in dozens of teams throughout the Model Line as well as advancing the changes we have already made in areas like Intake.  We are just scratching the surface of what is possible. 

I have been working with a leader in the Model Line area who is the Pacesetter for a workstream we call “Implementing a Lean Management System.”  We decided early on that we need a separate work stream to ensure that we properly resource and assign accountability so that the implementation of this system (thinking and behavior) continuesto progress in the organization.  In 2007 our goal is to begin to put in place the basic structure of the three management systems of Lean:  Daily Management, Cross-Functional Management and Management by Policy (Hoshin).   Today we presented to the leadership our goals for our Hoshin for 2008 and here is our plan:

For 2007 we picked five goals and deployed them only one level down in the organization.  When we deployed most of the means were pre-determined.  We conducted only a basic reflection on internal processes and did no reflection on the management system itself or the external environment.   We instituted a VP checking process with standard work, which in turn has created a department level checking process, but it does not go deep into the organization.  

For 2008 we are excited about the next evolution.  We plan on deploying goals down to the manager level, which is one level deeper then this year.  We will also have most of the means being determined by the teams that are responsible for the work.  We plan on initiating a thorough reflection process that includes both an internal view (which will have far more useful data this year due to our Cross-Functional and Daily Management System implementations) and an external view that will include competition, voice of customer and “on the horizon.”  We also plan on having a fully functioning dashboard to support the checking process and informing root cause analysis as well as having synchronized checking taking place at the team, manager, director and VP levels each week.

It is exciting to see this system starting to come together and it is even more exciting to see what is possible in the not so distant future. 

This last week I spent a lot of time on the floor working with leaders at different levels in the Model Line organization.  What was encouraging was how motivated everyone seems and how much energy people seem to be putting into their work.  On Friday I had a great conversation with two front line staff where they talked with me about the next set of improvements that they would like to take on.  Both of them were in a recent RPIW where they seem to have caught the “improvement fever.”  Since the event they have been advocates for change within their teams even though they have no authority over their peers.   Later that day I talked with a manager that has been skeptical of the work, but seems to have turned the corner.  See told me that she “finally got it” and was excited for the future.  In this spirit I have chosen the following quote since motivated leaders and invaluable to improvement: 

“In order to make a fire burn, you fan the live coals.  In order to keep your organization fired up, it’s imperative that you find and motivate the leaders or potential leaders in your organization regardless of how far down the line they might be.”  –Dexter Yager

Today was the big day - my first tour of the Model Line. Lee met me at the entrance of one of our administrative centers, and I requested a trip to the espresso bar to recaffeinate. The espresso machine wasn’t operational today, but Lee told me there would be better coffee to be had in the model line area. Sure enough, they had the same fancy new automated machine that we had in our building, which produced reasonably good coffee and only cost $0.50. This machine had been set to dispense coffee for free, though. Lee said that this was on the VP for the team. It was in this spirit that the day started.

Lee led me past the dashboard visible on the wall, demonstrating cost savings and productivity, to “Klub Kaizen,” which is the VP’s former office. His present office is a cubicle outside. Lee tells me that he knows almost all off the 700 employees here by name, and has established a standard work schedule for himself that involves presence where the work is happening.

The workplan is visible on the wall as a series of post-its, which describe agreed upon activities to be executed throughout the year. Since much of this area’s work revolves around information technology, there is integration of IT work into the plan - no surprises when work is requested; IT is not set up to be seen as unresponsive.

There are mother A3’s and baby A3’s on one wall. Lee shows me the current state and the future state. One wall is about successes. Another is about the competition, the voice of the customer, and “on the horizon.”

I am then walked over to claims processing, where there is a heijunka box on display. Lee asks me, “Ted, can you tell me if anyone is behind.” I can. I can tell that most of the team is not behind, and that some are at lunch, at a glance.

The unit’s manager comes to speak with us. The backlog is now decreased and the flow of work is visible. “We can be faster, and more accurate.” The two seemed to be at odds before.

There are facilities professionals moving furniture around - Lee shows me the old office set up and the new work-cell office set up. The team is doing a slow conversion to this new setup.

I see a wall that describes “Customer Focused Management Training,” which describes the rework of specific processes through 10 modules of activity.

So, that’s what I saw. How did it make me feel?

Initially, overwhelmed. For as much as I’ve done in LEAN, I was asking myself if I could be competent to put a system like together if I were in Lee’s shoes (I’m really still not sure - but I would hope to do something as impressive as what I see). They are working on strategy deployment, cross-functional management, and daily management. After the overwhelm, I see all of the parallels to clinical medicine - “faster and more accurate.” The claims being processed are coming from my medical colleagues all over the State, after all. Lee has visible pride in all of the accomplishments of the teams here. The overwhelm is replaced with the realization that this work is going to continue. I can always come here to learn about LEAN, right within our own organization. I have time.

This is a pretty remarkable achievement. I hope that this work will be swarmed by physicians in the next few weeks-months-years, looking to apply the principles in all of the things we do for our members.

I’ve already recommended a visit to several of our executives, many who have already been here. I love the idea that one of the biggest innovations in health care here is not a new MRI scanner, but a better way of doing our members’ business so that we can care for them whenever and wherever they need us.

Model line images: Click on any image to see it in a gallery