DailyKaizen

Over the last couple of weeks I have been involved in several discussions in regards to the implementation and spread strategy for our Lean transformation.  Over the last year we have been selective in picking areas to extend resources.  We are trying to avoid mistakes of the past where improvement initiatives generated a lot of excitement, but because of a lack of strategic focus ended up following well short on results.  In assessing a potential area for transformation we take into account many factors, but none are more important then the ability of the line managers. 

Leadership is by far the most important success factor, but you need to be careful to be looking for the right type of leadership.  We have found that those that were successful in being leaders in the past in the organization may not be the type of leaders we are looking for in a Lean world.  In assessing leadership there are certain behaviors that we look for that are good indicators that the leader might be ready.  Most importantly the leader must be trusted by those that are under them and be able to inspire associates.   In that spirit I chose the followoing quote:

“Good leaders make people feel that they’re at the very heart of things, not at the periphery.  Everyone feels that he or she makes a difference to the success of the organization.  When that happens people feel centered and that gives their work meaning.”  –Warren Bennis

Like most heathcare organizations we have large information systems that process incredible amounts of information.  Over time these systems have become more and more resource intensive and rigid as we add services and the complexity of our products has grown.  Often the systems become so removed from the processes it is difficult to gain a line of site to the value that they are suppose to be providing in the first place.  Additionally, over time we have not been disciplined about taking the waste out of our processes before we automate.  This has resulted in us often locking in complexity and taking away the flexibility to make quick improvements to our processes since all changes become reliant on IT resources.

This week we began planning for our first “Moonshine group” in the Model Line area.  For those of you that don’t know a Moonshine group is a cross-functional team that is focused on making transformational change through prototyping.  The group, if approved by leadership is going to be focused on “right sizing” the technology of our health plan.  Our goal is to go back to the basics and see how simple we can make the programming so that what takes mainframes now might only take a laptop in the future.   If we are successful the opportunities for improvement are huge and we can begin to move closer to our goal of creating a real time enterprise. 

I am not sure if there are other examples or stories out there about Moonshine teams that were IT focused.  If so, please share!

As we drive forward with the Model Line work we are creating a natural tension between the larger organization that still operates in “traditional” ways and the Lean organization that is in the midst of transformation.  Creating this tension was one of our objectives, because it creates an urgency for the rest of the organization to quickly follow the path that is being blazed by the Model Line Division.   Over the last couple of weeks this tension has become more intense as we re-engineer processes that are cross-functional in nature and touch areas that are not within the structure of the Model Line. 

Even more noticable is the challenges faced by the leadership group that is overseeing the Model Line areas as they try to manage in both worlds.  In the old world this group spent most of their time in committees and meetings with their peers from other parts of the organization.  In the new world their time needs to be spent in the Gemba managing implementation and following their standard work.  As a result, many of them have taken a lot of grief from others in the organization that feel that they are no longer being good “team players.”  It is a little like have a foot in two boats that are slowly being pulled apart.

Over the next year our challenges are great, yet exciting.  We need to continue to push the innovation within the Model Line area while bringing the rest of the organization down the path right behind them.  If we allow the two boats to grow to far apart we risk creating a tension that we will no longer be able to manage and it will all fall apart. 

I am wondering if any one that has worked in an organization that has used a Model Line approach can provide some words of advice to us that are just beginning our journey?

“Every day you may make progress.  Every step may be fruitful.  Yet there will stretch out before you an ever-lengthening, ever-ascending, every-improving path.  You know you will never get to the end of the journey.  But this, so far from discouraging, only adds to the joy and glory of the climb.”–Churchill.

I chose this quote, because this in it Churchill describes the culture we are trying to create through our Lean efforts.  A culture where the improvement never stops.  One where every day you make gains for your patients, members and community, yet there is still opportunities around every corner.     A culture where hitting singles is okay and in fact may be better then hitting home runs. 

In healthcare times are hard.  There is a lot of pressure to get better and many organizations are searching for the silver bullet that will solve all of their problems.  In most healthcare organizations the result is a series of resource intense improvement projects which jump from one fad to the next.  In my experience these projects have discrete beginning and end dates and take incredible amounts of energy to make change that typically results in small improvement and collective burnout.  This has a led to a lot of very bright people no longer wanting to work in the industry.

We had an interesting experience here the other day, when a sister organization’s leaders and care providers came here for a site visit. They are new to LEAN and wanted to learn more. What we did was prepare a “museum” tour of the visual systems around our headquarters building. And instead of myself and my business partner being the docents, we asked the teams that do the work to explain each visual system and ask questions.

We toured them around 5 visual systems that represented daily management, cross functional management, and strategy planning. It was great to see that we have all of these types of systems now operational, across different Divisions in our organization. In fact, we are running out of wall space (and 11 x 17 paper…). It was also great to see the teams doing the work doing the teaching. People sometimes say that LEAN takes away creativity, but I saw a lot of creativity in how the information was displayed and taught. There isn’t creativity in producing for the patient or working to keep people informed, that needs to be done, but may be done in different ways. When you teach it, you have to learn it, and they’ve learned it.