Growth Versus Development Warning

“We pursued growth over the speed at which we were able to develop our people and our organization, and we should sincerely be mindful of that.” – Akio Toyoda (2/23/10)     Quote obtained from Jon Miller.

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The Jury Is Out

Last month I served on a jury and really enjoyed the opportunity.   The pamphlet that was handed out to all jurors had some advice that I think is good for those in a Lean organization:

“It is enough that you keep an open mind, use common sense, concentrate on the evidence presented, and be fair and honest in your deliberations.  Remember: Don’t be influenced by sympathy or prejudice.”

Keeping an open mind is important for innovation.  So often our minds want to keep things the same or we may stretch to optimize how things are.  An open mind will help you create something  new.

Common sense is woven throughout Lean thinking.  While the concepts are simple, the applications of them are elegant.

Going to gemba will be the key piece of evidence for you to concentrate on.  The facts you witness and hear will help you make a good verdict for what improvements to make.

Lean is about focusing on your customers and what your business needs to prosper.  This focus helps you to be fair and honest while avoiding sympathy or prejudice.  Pet projects or individual agendas may not always fit into Lean thinking.

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Advice For First Time A3 Authors

Writing an A3 is a wonderful tool to solve problems and share the thinking that goes into resolving issues.  I have some tips to help first time A3 authors that I hope will be valuable for you.  (If you do not know what A3 is, I recommend visiting the A3 Thinking FAQ webpage by Sobek/Smalley).

• Get a coach – Coaches will help by asking you to describe the thinking behind what you write.  They will challenge you sometimes to dig deeper or in another direction.  They will be an outside pair of eyes to provide feedback on how understandable your A3 is.  There are many benefits to having a coach.
• Choose a small scope project in your area first – A3 can be used for large scope or cross-department issues but I find it is easier to learn A3 by focusing your first issue within your area and a smaller scope.  Look for recent fires your team has put out and use A3 thinking to understand the root cause so the fire will not happen again.  You may also look for workarounds that exist for your co-workers or other known issues* as inspiration for your first A3.
• Do not write your A3 alone – You will be the only author that puts pencil to the 11×17 paper but ensure you incorporate the feedback you get from the stakeholders you talk to.  The people you talk to in the workplace will provide more depth around the true issue you are facing, they will give background information that is highly relevant, they will help uncover root causes you haven’t considered, they will help tweak your countermeasures and target condition, and much more.  Writing in their feedback will help you understand the problem better while engaging the people doing the work.  In turn they will be more likely to change because you involved them in creating the countermeasures.
• Recognize that A3 takes time – Sometimes new authors think an A3 will be quick.  Observing the problem and talking with stakeholders can take time.  Be patient and recognize the time you are taking helps the quality.  Your first instinct might be to jump to a solution but A3 will require you to gain a deep understanding of the problem before you consider a solution.

* Sometimes people try to work on suspected issues for their A3 (issues with no data or feedback from others that something is a problem).  You may feel it needs to be investigated but there is nothing indicating you have a problem.  For first time authors, it will be easier to focus on known issues.

Does anybody else have advice for first time A3 authors?

If you liked this post, then try:

• My Past A3 Articles 
• Don’t Be A Firefighter
• Accidents Do Not Equal Success

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Lean Hospitals & Having A Baby

My wife and I are excitedly expecting our first son around the beginning of April.  I am getting a first hand experience of what it is like to be a “customer” of a hospital experience and it makes me realize how Lean can really help.

• Effects of on-call: My wife’s OB advised that she can not guarantee she will be the one to deliver our child due to the fact that the little boy can arrive at any time of the day (understandable).  There are 4 other doctors that would be covering for her if she is not available and we would have to schedule appointments if we wanted to meet them prior.  As a customer, this adds a complexity and I would prefer a reduced number of on-calls.  It would waste the other doctor’s times to meet with us if they did not end up being on-call on birth night.  Design the pathway to be simple for the patient.
• Potential rushing: One thing that concerns me is the notion of doctors pushing the birth faster to fit their schedules.  I am not sure how true it is, but from interviewing doulas and recent moms, some C-sections are given because the provider has other things to do or wants to go home (two cases as described to me).  Our OB said the other day she might do a procedure “to speed things up”.  If the patient chooses options to make things faster or it is needed for the health of the mom & baby – go for it.  If the hospital system is not flexible enough to allow births to take a natural course (if patient chooses) and requires speeding up artificially, improvement is needed for staffing and room utilization to ensure you are providing value to patients.
• Unpredictability and non-standardized: From conversations it appears as though every experience changes greatly on which nurse you get that day and your provider.  Babies and the human body are unpredictable and cause variation but some things CAN be standardized.  As a customer, I would feel more confident if it was explained to me that the hospital has a generally predictable practice and have plans in place if the mom shows specific signs.  Unpredictability is problamatic too from an insurance perspective since the hospital can not tell us who the expected roles will be to ensure each are covered so we can make an informed choice.  As a customer, I would chose a hospital with standardized work over an organization who just tells me “it depends”.

As a hospital customer, are my demands unreasonable?  If you work at a hospital, what are your customers wanting?  Do you agree or disagree with me that Lean thinking can help the hospital meet my needs?

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How Does Autonomy Fit Into Lean Management?

Dan Pink’s new book “DRIVE” made me wonder how Lean management will work with the book’s premise that knowledge workers seek autonomy.  Do standardized work and job instruction sheets take away from the need to have autonomy over what tasks people do, when they do it, who they do it with, and how they do it?

The book’s premise is that old motivating ways of using the carrot as a reward or the stick as punishment does not work for knowledge workers.  Knowledge workers are motivated by autonomy over task, technique, time, and team.  They are also motivated by the pursuit of mastery and fulfilling a purpose.  I posted a video from the author explaining the concept a couple of months ago. 

Pink breaks down processes into two categories:

• Algorithmic:  Tasks where you follow a set of established instructions down a single pathway to one conclusion
• Heuristic:  Tasks which require experimenting with possibilities to devise a novel solution and no single pathway exists

Carrots and sticks work well for motivating people with algorithmic tasks (to some extent) but cause damage when applied to heuristic tasks.

One of the challenges at my hospital is that most providers think providing all elements of care is heuristic.  They each have their own special skills and experiences to create care for the patient.  From a Lean perspective, we have variation and unpredictable results which cause waste.  Provider teams in the hospital are working at transforming some of these tasks to be algorithmic.  We are able to meet our patients’ demands better, less people are idle, and supplies are getting closer to point-of-use.

Despite these wins, is Lean thinking taking away autonomy by transforming heuristic tasks?  I do not think so but we have look at things a little differently.

Just because a task is algorithmic does not mean creativity is lost and robots are created.  For patient care, maybe all of the steps leading up to diagnosis are algorithmic but the value added part is heuristic.  This frees up the provider’s mental capacity to focus on the true customer problem and not on the problems getting up to the customer.

Another way of looking at this is that the problem solving part of everybody’s work is heurestic.  If every task is somehow transformed into a single pathway, your staff should still have the autonomy to recognize problems and experiment to fix them.  Helping people understand that their creativity will be focused on trying to improve experiences instead of trying to figure out what to do next or where something is.

Lean management should strive to motivate people as autonomous knowledge workers.  Even if standardized work makes tasks look ripe for the carrot and stick treatment, recognize you are asking staff to be creative and solve problems.

What do you think?

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