DailyKaizen

I had an interesting debate last week with a manager that believed that by instituting a checking process for management we were embedding waste into our process just like an inspection step on a work team.  This manager was frustrated, because she felt that by “checking” she was disrespecting her employees and showing that she did not trust them.  I countered that if done correctly checking was about showing respect for employees.  It was about seeking to understand the challenges of the system from the customers perspective and removing them.  Its about making worker smarter, simpler and more enjoyable.  Its about having opportunities to make problems visible, to learn, to teach and often most importantly to listen. 

I understand why the manager is frustrated with the idea of checking.  She is a good manager and has invested a lot of time and energy in building up her team.  In the organization the work “check” has a negative cogitation, because in our traditional management system it has most often been associated with performance management, employee appraisals, etc.  So when a group of consultants start asking her to follow a new process she is bound to resist.  In order to win her support we need to teach her why this form of “checking” is not about finding people performing poorly its about finding system performance issues.

 While from an ideal state the manager might have an arguement that the checking itself is waste, but I believe there is a high value if it is done correctly.  In fact, from my perspective our focus on establishing standard work for management with a regular checking process is one of the most important things we are doing this year in the Model Line area.  Why?  For many reason, but most important is the short-term we need to change management behavior at all levels by getting them more involved in the actual work.  They need to understand what happens in their departments from a system perspective and why it his happening.  With checking comes understand and the best opportunities to learn and teach.

In order to force this behavior change we are asking managers to follow a standard checking process.  Once every eight weeks the VP over the Division visits every work team under him and seeks to understand by asking a standard set of questions.  In order to support the process each work team has a visual system up, which tracks measures and shares improvement activities.  The VP is seeking to teach managers through out the Division how to manage with data and facts, how to identify root causes and how to take responsibility for problems.  The first time he visits a team and asks a set of questions they really don’t know what to do, but when two month later he comes back and asks the same set of questions they begin to take him seriously.  Over time we have found a correlation between the teams that have visited and the highest levels of improvement.  The VP is also requiring that all of his direct reports institute their own checking processes and many of them are requiring their managers to do the same. 

As the entire Division begins to embrace the checking process I believe the rate of learning will greatly increase as will our ability to sustain improvements.  I guess time will tell…

This week’s quote comes from John Seddon and was taken from his new book Freedom from Command & Control.  I have enjoyed this book very much.  I am currently working with my companies Customer Service Center and the book is rich would great examples and Seddon is spot on when he describes the management systems of service organization. 

I chose this quote, because of it’s timeliness.  On Friday, I facilitated our mid-year checking meeting with the Model Line Leadership team and I would say that the single biggest change in the conversation since we met last three months ago was how much more the team now knows about the work.  Rather then each leader having to try and convince their peers about the challenges within their function most leaders could just state the challenge and their peers knew enough about the situational information to understand.  I can’t overstate the importance of leadership understanding the real nature of the work.

“I generally find managers know everything about volumes and activity, but little or nothing about the real nature of the work.”

“If you want to convert the culture of an organization, and that organization contains n people you first need to convert the square root of n.”

I have seen this attributed to Edward Deming, or Brent James, MD, from Intermountain Health Care. If anyone can verify attribution, please do so!

When we look at a group of 100 physicians and ask if culture change is possible, it may be easier to ask if we can find 10 physicians in whom culture change is possible.

In my view, if the culture change is about taking better care of people, then we’ll find 100 physicians in a group of 100 physicians as easily.

I spent a good part of the day today in our customer service center working with a couple of bright consultants that are working on their first improvement project.  I always enjoy the opportunity to coach new consultants, because I think it is the best opportunity for me to also develop my skills.  Coaching other consultants always keeps me on my toes because they ask great questions and having limited experience myself I am often not as confident as I would like in helping. 

In preparation for the coaching session I had the consultants pull together a current state map for the process, which we reviewed.  They had done a lot of process observations and had drawn out the process and had begun to fill in the situational data points in terms of volume, quality, delivery etc.  I had also asked the consultants to begin to identify opportunities in the process for waste reduction based on their process walks.   For the area of customer service that we are working with a lot of calls come into the center that need to be escalated (handed-off) to other groups (specialists) for resolution.   As a result the consultants had come to the logical conclusion that the best way to reduce waste was to eliminate the hand-off through the creation of standard work.

As they walked me through these conclusions I had a flash back to two years ago during one of my first improvement workshops where we had come to the same conclusion, but in a different call center.  In this event we had developed standard work and made some fairly impressive improvements in productivity by reducing hand-offs.  Months later as I was working with yet another area I had a realization that in-fact reducing hand-offs was not addressing the root cause.  To address the root cause you have understand why people are calling the service center in the first place and reduce the need.  If a customer calls the center it means there is a defect in a process and we need to learn where the defect took place and fix it.  It does not mean you don’t reduce handoffs in the process, but your first priority should be to solve the problem for the customer before it ever happens.

So back to my coaching session.  I was able to ask a couple of questions that led them to the same conclusion that I had come to.  I had helped them avoid the miss that I had made when I was in their shoes.  I felt like my experience had gotten me to a place where I actually had earned the right to coach.  Fun…

As Ted mentioned in his last posting we finally got to catch up in person after a long time of us both working independently in different parts of the organization with the same common goal of transformation.  Like always it was a great opportunity to share our frustrations, recognize all the accomplishments (like the pull from our medical group that Ted mentions in his posting) and to coach each other on strategies moving forward and professional development (mostly Ted coaching me).   

One thing Ted called out to me during the walk was that I did not realize was my lack of enthusiasm and positivity in my blog postings over the last couple of weeks.  This surprised me, because I am very excited about the progress we have been making in the organization with our Lean efforts and have not intended to be negative. I took this feedback and went back and read through my last ten postings and as usual Ted was correct.  

So why the negative undertones?  I think the root cause has to do with what this blog has become for me.  When I first started out it was an experiment.  To be honest, Ted persuaded me to give it a try and I reluctantly agreed with a fair amount of whining.  My early entries were often forced and I spent a lot of time thinking about what the audience would want to read.  As a result a lot of my postings would come out more like PR then interesting content.   I believe all of the time I invested in trying to write a good posting probably resulted in bad posts.

Over time I have begun to use the blog very differently.  Most of my entries are written late at night and are typically a reflection on the problem that is most on my mind from that day at work.  More of a journal then a vehicle to deliver content to others.  A sounding board where I can get direct feedback from those that will listen.  In the end, I guess I am saying the customer of this blog is me.  I am almost embarassed to write that statement down.  I have a hunch that the more personel the blog has become the better the content to others, but you, the audience will have to judge.

In taking the feedback from Ted I want to write a disclaimer to all.  If an entry seems negative please read a few more, because I think you will find that over time I am telling a very positive story.  Its just some days are harder then others.

“Be harsh with yourself at times”–Seneca

….I never get to see this guy anymore, except on this blog :). We did catch up though. His work is having impact far beyond the model line and is inspiring to many.

This week, I gave the first presentation I have ever given on LEAN to our own medical staff, which is very impressive to think about. I mean, I have been giving 30-45 second versions of our intent before the 30 or so rapid process improvement events and working to “show” rather than “talk” about LEAN. I think that’s been really successful. But I haven’t until this week been able to stand up in front of medical leader colleagues and talk about the philosophy behind LEAN, our journey, and how we could use it in the clinical environment. This is also not to say that they haven’t been given this information in other venues.

This is the first week that I have done it though, after 2 years of active work in the area. Does that make me happy? I think so. What I can speak to today is all of the things the organization has done to bring respect and thoughtfulness to a multitude of processes we use to take care of people. We have not become a factory or distanced ourselves from our commitment to our members. I would say in my work, it’s very much the opposite - our commitment has always been great, now it’s even better represented in what we DO. If we had not improved the way we take care of people, I would not have been able to be in front of this audience 2 years later.

All of this said, this also highlights that our work to date is mostly….in the administrative areas of our organization. This week, and weeks before, and weeks following are starting to change that. I attended the first organization wide report-out led by a clinical care team on Friday. Outstanding. As a member of the profession responsible for spending 84 cents of every health care dollar in the United States, I never forget our duty to lead and not follow in creating maximum value.

Reacting.  Something I know a lot about.  In a world of processes that are not standard and under control most of us spend most of our time in a reactive mode.  Most managers I work with like to describe themselves as “fire fighters” running from one problem to the next.  In most organizations those that know how to best react are the ones that are first promoted or given the employee of the month award.  In the world of consultants there are armies of smart professionals for hire that can come in and help you react even faster and better as an organization.  It truly is fascinating.   

There are many reasons why organizations get caught in the frustrating cycle of jumping from one reactive situation to the next.  To name a few: 

• Short-term incentives that don’t allow for sustainable improvement. 
• Management that lacks visibility of the Gemba. 
• A lack of focus on stabilizing and standardizing processes.
• Underinvestment in people development. 
• Lack of effective measurement systems that all for the identification of root causes.
• Not enough focus on the customer’s needs.

As we move forward with the Model Line work we are doing our best to break this cycle, but it sure is hard.   For each of the reasons listed above we have work underway to make improvements.  Yet, in the interim we are challenged in balancing the short and long-term.  For example, without having standard processes across all of our working units fires pop up all the time, and because we lack an effective measurement system it is often hard to tell how big they are and what bolt of lightning got them started.   So our instincts and experience tell us we need to jump to reaction mode.  We need to roll up our sleeves and call out the fire brigades.  Each time this happens there is an opportunity cost for long-term growth and improvement.  We are forced to move resources away from proactive work and because we are in reaction mode we don’t lay the foundation that will lead to sustainability.   More then often we find that the “big fire” was not nearly as bad as we thought, but we jumped anyway, because we lacked visibility of what was really happening.

I don’t have an answer to this challenge except to continue to focus on our long-term foundational work and to use our best judgement on whether to fight fires in the short-term or to let them burn for a while.  

I spent the last four days on the beautiful Olympic National Park coastline watching rolling waves come to shore, whales chasing salmon, and long walks to reflect.  The last four or five months have been moving at a crazy, exciting, and often overwhelming pace and it felt really good to get away. 

One of the things I spent a lot of time during my walks on the beach was reflecting on my own development and how I can do a better job moving forward balancing my many different work objectives.  Over the last year I have been wearing a lot of hats and am often not sure if any of them fit quite right.  I am currently a manager of a consulting team, a project director (whatever that means) over the Model Line work as well as a Lean consultant working on the Model Line.  I love the fact that my work is so diverse, but there are a lot of things I need to get better at.  Mainly, I need to practice what I preach.  Here is my thoughts on what I need to do better from a Lean perspective:

First, I need to spend more time with my team in the Gemba.  I have often gotten caught up in my own consulting projects and have not spent sufficient time understanding the work that my employees are working on.  I am always telling my clients that they need to spend more time with their direct reports, well so do I!

Second, I need to learn how to say no better.  I have far to many pieces of work in progress, which leads me to cut corners and not do them at the level of quality that should be required. 

Third, we need to invest more time as a consulting team putting in place standard work and visual management systems.  We have made progress in this area over the last couple of months, but we have a long way to go.  We spend a lot of time telling others to follow work, its about time we do as well.

Finally, and most importantly I need to ask more questions and make less statements.  I am coaching a lot of leaders and consultants right now and as time become less and less available I have often cut corners by telling other what to do as opposed to helping them get to the answer through thoughtful questioning.  Thus for short-term relief I have compromised long-term learning.  I need to show those I work with respect and allow them to come to the answers through their own thinking and not mine.  This is the most important improvement I need to make.

Previously on this blog, I talked about how I jumped in to apply skills I learned in Hoshin Strategy Management literally the day after I was trained. My “new” ideas were relatively well received by the senior leaders I was working with. We even got so far as to prepare a live affinity diagram, which I posted here as well.

After those efforts on this project, things sort of reverted back to the traditional way of doing things. At one point, this change back was even acknowledged publicly (and respectfully, I would add) when at a meeting later on in the project, we were presented with the more traditional project plans and checklists. It was said, “We went back to doing what we know how to do” (I’m paraphrasing).

In my glass 3/4 full (or really, 95% full) way, this wasn’t disappointing to me. We’ll plant seeds wherever we go, and flowers will bloom, I thought, and being a change agent over the long term means having good internal governance. I also realize that at a senior leader level with a critical project, innovation is more risky. In reality, I was delighted that they indulged me as far as they did. And I think this was a big indulgence for a group that had learned very little about this process on the outside. I proudly wear the change agent jersey (as does Lee) and we work every day to accept all that comes with it :).

Flash forward to last week to an oversight group discussion about this project. This time, plans are coming close to being firm, and things are more worked out. I asked about the priorities of the problems that were going to be addresed. They seemed clear to me. This team is going into a rapid process event in 2 weeks to manage a lot of issues quickly. They did a week long event earlier this year and it was a smashing success. They even invited one of our senior executives to come to the one coming up. On another issue one of the leaders said, “I recall that this was an important theme from the affinity diagram that we did as part of the Hoshin process.” (they remembered!)

It took me aback to see this group self-directed in the application of LEAN concepts. There has been a change. The enthusiasm for doing things differently has spread, in this group, and in the groups that we have all been working with.

Now that I write this, I realize that I shouldn’t be surprised that this would happen. It’s as clear to me today as it was on the day that I started medical school that health care is a special industry with incredible people. We may be conflicted at times about the best way to help someone, but we are never conflicted about actually helping someone. I really enjoy working with people who give new ideas a chance because they only want to be the best for their patients, and it’s great to see that this is a reality in the system we all work in.

Culture change appears to be happening all around now, to the point that I can’t keep track of all that is happening. It’s spreading!

Get something up on the wall and we’ll adjust as we go.

This was the instruction of one of our Information Services Directors to his staff, who he asked to begin using visual systems. I was invited on a tour of their visual systems along with the opportunity to ask staff what this meant for them. If you can imagine that in most companies, I.T. is supposed to be a support service that is never seen or heard from and where expectations for reliability are high. There’s also pressure to always say “yes” - as this Director put it, “You get a hold of us and you have a budget code and we can’t say no.” In an environment like this in most companies, you can imagine that creativity and staff empowerment are not the norm.

I saw just the opposite, in a series of visual systems, that did everything from introduce a team to the rest of their colleagues in terms of what they do and how they serve, to rich descriptions of kaizen and post-kaizen work and their impact on the members we serve.

This director tells his staff that “Problems are Gold” and sets up a goal of 50 problems for each manager. In this department, the reward for problems is a small troll doll. There are trolls visible throughout the department as a result.

On another visual system, a workgroup had laid out their priorities using sticky-notes, a visible representation of what they were going to do, but more importantly what they were not going to do. This would be hard in the I.T. space. I asked how it felt for the team to begin workplanning in this semi-public way. The answer was, “They felt honored by the process. It shows respect.”

In another example, we were introduced to a heijunka system for managing service requests, on line since April, 2007. Using this system, each responder gets no more than 2 hours of work at a time, at spaced intervals. This is a change from previous assigning schemes which simply loaded up boxes until all the requests were taken in.

Here is what the Heijunka looks like, in electronic form:

You can see the intervals, and the effort made to keep everyone at a understandable level of productivity. I asked about this, too, to their manager. What was it like to go from assigning tickets as they came in, to a person focused on leveling the work? Here was the response.

I didn’t want to be micromanaging. I’m not doing that. I’m giving them Clarity.

Finally, I asked what it was like for the manager herself. Any unanticipated problems?

I needed to change my schedule. I could not go to meetings without regard for the need for the box to be managed every 2 hours. Either I cut meetings out of my schedule or I arranged backup.

So the manager added structure and sacrificed flexibility to support her staff. And what did that feel like, I asked?

It feels fair.

All in all, I probably saw 20 different ideas that teams came up with to make their service visible, and make it a little better every day. When we started the tour, the Director said, “Let me show you what we’ve done and then you can give me suggestions or pick it apart.” I didn’t have any suggestions, just appreciation for the ideas that were flowing down the hallways and into every part of this business unit. It’s fun to think that in every part of every company there’s a monstrous capacity for creativity waiting to be unleashed.