DailyKaizen

One parting message that the team I am part of wanted to make sure I saw came to my in-box, and I was told it’s fine to share.

We are announcing a change to the upgrade schedule [for our Statewide Clinical Information System].  We are now targeting the weekend of October [] instead of Nov [].  Please share this information broadly.  We are making this change based on two factors:

We are ahead of schedule on upgrade work due to focused efforts of our team and our various partners.

In addition to wanting to make you aware of this new date, we want to call out the best possible reason to make this change – our patients.  Efficiencies in our upgrade process and the ability to focus our resources will allow us to ‘give back’ a week of capacity for several cross-functional teams.  This means we will be able to accomplish even more for our patients in 4th quarter 2007.

We have confirmed with clinical and technical partners that this new date is feasible and will work diligently, in partnership with all of your teams, to ensure a successful upgrade a week earlier than planned.

Sincerely,
Emily, Wendy, and Vadim
Managers, Clinical Information System Team

An upgrade of a system of this magnitude is essentially a replacement of the clinical central nervous system. It would be the equivalent of rewiring a small community for electricity and communication, with the requirement that every connection is 100% accurate. In the past, these have taken several months. The system must be upgraded with 100% integrity, and prior to LEAN, we used techniques that got us there, but with multiple handoffs, rechecks, and separation from our members’ experience with the tool. We didn’t know how to do it differently.

Since then, the team has adopted Hoshin Strategy Planning, the creation of multiple work cells, and daily management including the use of copious visual displays. Most importantly, the staff works much closer to our members, in our medical centers, alongside our nurses and physicians.

I asked Emily what the result of this shift of schedule meant in terms of person hours. The number: 1,200. These hours will now be used to continue enhancing our system and adding new features and functions to help serve our patients better, so the savings will multiply across 10,000 staff, who will have a more advanced system sooner.

A few observations of mine:

1. This ROI is different than the type of ROI calculated from a one week rapid process improvement. It’s the culimination of a complete redesign of planning, cross functional, and daily management, over the past 2 years. The team simply works differently now. These are addative.
2. The focus on the impact to patients comes from within. These terrific leaders have been experiencing LEAN for themselves, and with the right environment from their leaders, have done the transition work in a self-directed way.
3. They have the self-efficacy through the use of LEAN philosophy and methodology to do better every time, and they want their colleagues, our members, and the world to know about it. The want to set an example that continuous improvement matters, and it can be done, if people are empowered to do it.

How do I know that #3 is true? Because I asked if it was okay to post the message on this blog, and the answer was, “Or course! That’s why I cc’ed you even though you don’t need this information from an operational point of view :)”

In a field (health information technology) that is expected to see investments upward of $50 billion in the next 2 years, it’s nice to know that there is a way to make this work less complex, more doable, and more in service to patients.

Imagine that your health care organization had a team that tirelessly advocated for the best patient experience, and was never satisfied with the status quo in care delivery. In most organizations, I would say this is your Web Services team. Why? Because it’s their job to make your system function well for patients they never see, and they know that even the best technology can’t repair dysfunctional physical processes.

This is the team I started working with when I joined the organization and the one I continue to associate with, because of their initiative to transform our sysem. Given this background, it’s no wonder that they wouldn’t be satisfied with their own processes. At the same time, if they changed nothing about what they did, they would still be highly regarded - the number of national awards this team has garnered in creating the ideal patient-centered experience online filled a whole wall at our old headquarters.

About a year ago, this team transitioned to Agile software development, and as a marker of their transformed processes, they transformed their physical operations, when we moved to a brand new headquarters. Pictures are below.

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It has been a difficult week for me.  For the last year I have spent countless hours working in the organization’s Model Line.  Many of my experience I have shared with you in posts on this blog.  I was there when it was just on paper and I have watched it grow and take form.  It has provided me an incredible opportunity to learn, develop great friends and work with an amazing group of leaders, managers and staff.  As you can probably tell I take great pride in having been part of this work and feel a lot of ownership to its continued success. 

What has also become obvious to me over the last couple of weeks is that it is time for me to get out of the way and take on a new challenge.   The leaders and Lean specialists in the Model Line have progressed very quickly and I am at a point where I often find myself getting in their way, which is a good thing, because it means we have been successful.  I have been asked to take on a new role and will be working with our centralized Lean group in developing a Hoshin Kanri system for the organization.  It will be another great opportunity to learn, teach and write new blog posts.

This also gives me a chance to take a couple of weeks off and spend some time in Europe with my wife who has often seems like a stranger lately since work has been so involved.  So you will not be hearing from me until Mid-October, but I am sure Ted will hold down the fort while I am gone.  With both of us taking different pathways it will be interesting to see if the blog looses something or gains something.   Guess time will tell 

Take care all and thanks for reading!

Last week I spent a morning with a couple bright members of our human resources team dicussing career development and career paths in a Lean organization and how they are different then in a traditional organization.  It was exciting to see how receptive and open these team members were to new ideas and their willingness to be creative as we try and work through some challenges.   These challenges include career development paths that are constructed around organizational functions, rewarding of specialized skills, and a culture that place prestige on those that have larger and not smaller functional budgets.   

In the areas in the organization like the Model Line that are now deeply engaged in Lean transformation it has been necessary to begin to reshape the career development pathways in order to promote different types of behaviors.   This has created a tension with our human resource systems,  which is right now most visible with our compensation methods.  These methods rely on benchmarking in the traditional market place, which means that jobs are priced against organizations that are most batch and queue.  Thus the more specialized the skill set the higher the value.   In a Lean organization as standard work for management is put in place it becomes possible for leaders to rotate across functions and leaders are promoted for their ability to transcend functions. 

I chose the following quote from Lean Thinking to illustrate this difference:

The conventional idea of a career progressing up a ladder toward general management, with more and more direct reports, now needs replacement because the value stream doesn’t benefit.  However, a new concept of a career in which more and more skills are gained and applied to more and more difficult problems is both good fore the employee and good for value flow.  What’s more, gaining the agreement of employees that this is the path to the future is the key to self-perpetuating lean enterprises.

We have all heard a variant of this story: “The Kaizen went really smooth except for Department X that wasn’t able to move quickly enough to change things around.” “Department X” from what I have heard has tended to be “I.T.” or “Facilities.” We could talk about how respectful it is to have a Department react with no notification separately, of course. Putting that aside though, what would happen if your I.T. partner heard about your LEAN transformation and said, “I want to transform with you?”

At the urging of our Chief Information Officer, then, I went to visit the Director of Information Technology for our Model Line work. I’ve included pictures with descriptions below.

This business unit has adopted Agile Methodology for its work, and the Director had a well read copy of Lean Software Development on his bookshelf. He also had all of the other LEAN books that I have read, which made me feel very at home.

Read on for more…

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This is a little bit of a commercial break as I get a little caught up on things, but there’s definitely a LEAN connection to be made. This article made the front page of the Seattle Post-Intelligencer on Friday about our organization’s work changing the relationship between patients and physicians:

The doctor will e-mail you now

What is great about the article is not what is said about us, but what is reported about all of the other major healthcare organizations in our community. They are all working to find ways to be closer to their patients. This is not the norm in many communities around our country, where the emphasis is on limiting patient access in the name of efficiency.

I put this together with several conversations I have had recently with physicians from some of the most innovative health care organizations in the United States. The ones I admire, or should I say, the organizations I would most want to be a patient in, are not all doing exactly what we are doing with technology. They may give cell phone numbers to patients for easy access, for example. The theme of what they are doing is the same though - they are working to be closer to their patients, not farther away. These are the organizations that you can bring LEAN philosophy to and they say, “When can we do that?” And they probably will, if they have someone like Lee walking around with a copy of “Lean Thinking.”

I came into work this morning feeling like my head is completely full.  For the last two days we have had two visiting Sensei (as discussed in the last post) visiting the organization and helping us conduct a detailed check against the current capabilities of our management system as well as helping us think through how we will spread our Model Line success to other parts of the organization.  Much of the conversation was focused on developing a strategy for Hoshin Kanri, because we have CEO support to apply the methods and thinking of this management system to the broader organization this fall.   I thought I would share two of my personnel reflections on what I learned from the last two days:

My first reflection comes from the Model Line area and our review of the current management system.  During our check we spent more then half the first day in the Gemba talking to work teams that are busy implementing standard work.  It was exciting to see how far the front-line teams have come, but was obvious was that we have not sufficiently connected their efforts up through the hierarchy so that we have a clear line of site between the voice of our customers and the work that each employee does each day.  After asking why five times we think we found the reason that this gap exists.  We have focused a lot of energy on teaching the front-line teams as well as our senior leadership PDCA thinking and standard work, but we have not invested the same energy at the mid-level management level.   As the work and roles have changed at the frontline and at the top, mid-managers have struggled with how to manage in this different world.  In other words, we have not treated management like it is a process and as a result we have not required standard work for all levels of management. 

What was exciting about the gemba walks was how quickly the senior leaders were able to realize this gap.  After the Sensei asked the teams a couple of questions you could see the light going off in the Director’s minds.  As a countermeasure we need to act quickly to begin working with mid managers to define their standard work and how it connects with those above and below them.  By putting standard work in for management I am confident we will unlock a whole new set of opportunities that will come from additional flexibility, shared learning, deeper understanding and greater accountability.

My second reflection comes from where we are as a larger organization and what we need to do next.  For two years now we have applied Lean tools and methods with success.  With the Model Line we have taken our first step in applying Lean thinking as a transformational strategy to a part of our organization with even more success.  We are now at a decision point for the larger organization on where to go next, how far to go and what it means for our leaders and teams.  We have organization support for Hoshin Kanri, but there are choices to be made about what that means.  Will it be looked at as a set of tools and methods to cascade our plans or as a management system to build organizational capability?  There is a big difference in how we answer this question.  The Sensei used the analogy of explorers in Europe in the 1600s as they looked out over the ocean toward the new world.  The needed to make the decision if they should go or stay where it is comfortable.  If they went, there would be great challenges and great rewards.  If they stayed, they would stay.  Most importantly, if they made the decision to go they had to go all the way, because nothing was worse then getting stuck doing circles in the mid-Atlantic. 

I am confident that we will go, but it will be interesting to see!

Tomorrow is a big day and I am really excited.   For many years the organization has been wrestling with defining a strategic planning and deployment process that would bring focus, alignment and engagement.  Our current process is hierarchical, budget driven, removed from the gemba, heavy on planning, light on deployment and lacking the reinforced learning of PDCA discipline.  In other words, it is very similar to the planning system that you would find at 99% of other organizations.  

So why am I excited?  I am excited because our leadership team realizes that our current system is not working and they are vested in finding a new way.  Enter Pascal Dennis, author of Getting the Right Things Done,Lean Sensei and former leader at Toyota Ontario who is flying into Seattle tomorrow to help to develop a plan to change the plan.  Pascal is an expert at Hoshin kanri, the Toyota system for planning and deployment also known as strategy deployment.  

Over the next few years the organization faces many great challenges as it looks to reshape its management systems.  My hope is that Hoshin will be a big driver in helping break down silos, gaining organizational alignment and focus and most importantly shifting the role of leadership/management from boss to teacher.  From a personnel perspective I will have another great opportunity to continue my learning process with great teachers. 

For this week’s quote of the week I have taken a paragraph out of Pascal’s book Getting the Right Things Done:

“Action without theory is aimless; theory without action is lifeless.  Effective leaders move fluidly up and down a ladder of abstraction, between lower-level facts and higher level concepts.  If you speak at high levels of abstraction without having reasoned your way to them from lower levels, what you say is unlikely to be founded in fact.  Similarly, if you’re mired in lower-level data unable to extract the meaning, what you say is unlikely to motivate team members.”

Continuing on….I was asked by one of our newest LEAN consultants to visit with a specialty services leadership team yesterday. Our organization is finishing a brand new multispecialty medical center, and the group is using this as an opportunity to remake their practice, and they are looking at LEAN. Good for them! The operations leaders of this group are both compassionate and have a great depth of experience with the teams they serve. I really can’t even approach the experience and knowledge they have around managing sophisticated medical practice, so it was an honor to be asked what I know about how they might apply LEAN in their environment. Of course I think that they’ll observe their own areas and come up with the best ideas themselves.

What I appreciated most about the discussion though (and luckily, this is one they asked to have in person, not over video, not over the phone), was the look in their eyes. It was the same look that I saw about a year ago when I accidentally invited myself to a leadership team of our Web Services Division. The, “we know the current state well and we’re ready to make a change.” What both teams have in common is the high performance and general aptitude for innovation. I think they’re going to do great.

The Web Services Team did phenomenal after that time, with tools and support from their management. They are now practicing Agile and setting an example for the rest of our company. This reminds me that I should probably post some of their pictures on here…..

This has come up a bunch of times this week, all with reaffirming outcomes.

The most pressing for me was in diagramming the work of myself and the team I serve with as I plan to go on sabbatical. This is the post I was going to write a few days ago and didn’t do until now…

So, I am going on sabbatical. As part of this, I am relocating to the City of Washington, DC, where I will do more work on patient empowerment and (hopefully) LEAN, with different health systems. How about this blog? I’ll talk about that at the bottom.

As I prepared for this, I needed to respond appropriately to the concern that the work I am supporting continue for the benefit of our members. So I diagrammed it out and presented it to my boss first, and then to the team.

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