Lean Consulting Challenges

Being an internal lean consultant at a hospital has some challenges.   In my consulting practice, I find countermeasures vary greatly depending on relationship with client and what stage they are on in their Lean journey.

Below are a couple of challenges to which I am still trying to discover my best approach.  I love what I do and things like this make everyday exciting.

• Pair of hands consultant versus collaborative consultant – A good portion of my clients initially expect the internal consultants to go and do for them.  They want their people involved in an improvement event but claim too busy or too understaffed when resources are needed for assessment, planning, and sustaining.  As a collaborative consultant I try to do as much WITH the client instead of FOR the client so they can be engaged and learn how to do this work themselves in the future.  I really see a lot of people struggling with this collaborative model. 
• Physician culture can be a tough nut to crack – While we have some excellent physician Lean champions, there are still a fair number of doctors that are not fully committed to the journey yet.  Providers are incredibly smart and independent.  They have a lot of goals such as providing excellent patient care, doing research, writing/publishing  papers, and educating Residents/Fellows.  Sometimes the systems-thinking focus and overall patient flow is not a top priority for them.  Some incentive plans make them compete against each other for surgical time so they are less likely to share best practices with each other.  The “what is in it for me” part isn’t always an easy answer if a focus on the patient doesn’t seem to be enough.

Have you experienced either of these?  Do you have a best practice?  Is everything really a case-by-case issue (get to root cause for each individual)?

My 2009 Hansei: Scarcity inspires creativity and innovation.  How can I help harness that inspiration?

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Keeping Lean Japanese

There is a trend towards removing the Japanese language or jargon from Lean transformations in the U.S.  I understand why organizations would want to make lean thinking and the  corresponding tools easier to digest, but I think we should seriously consider keeping it Japanese.

• People get used to new words and phrases better than you might think – Until a few years ago nobody knew what an iPod was.  A cougar used to be a big cat and not a woman who likes younger men.  Jewelry is now commonly called bling.
• There is no standard for Americanized Lean – Some call Gemba “three actuals (actual place, actual process, actual people)”, others brand it as “direct observation”, some refer to it as just “process walk”, and I am sure Gemba goes by other names.  The problem with this is members of your organization can not easily learn Lean from external sources.  Article and book authors tend to use the Japanese terms at least in reference but your staff may miss it if the original word is not shared with them. 
• Lean transformation is a significant change and language should reflect that – A lot of Lean will seem counter-intuitive at first and there is a major shift in thinking that will take place on your journey.  A significant change in the language will help communicate to the culture that things will be different from here on out.  To paraphrase Deming, you are no longer using the language of the old world.

Choosing the language of Lean is a strategic choice for your organization.  It is easy to dismiss the notion of keeping the Japanese out and making easier translations.  Please consider the pro side of keeping the original language.

I am very interested in your comments.

My 2009 Hansei: Scarcity inspires creativity and innovation.  How can I help harness that inspiration?

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