Category Archives: Business

Fire At Will!

I have been reading the excellent book ON THE MEND about ThedaCare’s Lean journey.  The authors talk about the importance of having a burning platform to drive change since the clearest way to get someone to jump into the water is to burn the platform.

I started to think about what happens when an organization takes this concept too far and begins to torch the entire field and surrounding buildings.   Everybody thinks their platform is the one that should be lit and nobody is controlling the distribution of matches, lighters, or moltov cocktails.  Here are some of the results:

  • SMOKE FILLS AREA: Direction becomes unclear.  People can not see where they are headed. 
  • PEOPLE BECOME TRAPPED: If all the surroundings are on fire, people can not reach the water to feel a sense of accomplishment.  People will become tired trying to fight all the flames and will either melt-down or burn-out.
  • THINGS DIE: Even if firefighters quickly dash in to extinguish the blaze, not everything can be saved since the fire covers a lot of ground.  People, equipment, and resources such as water become scarce as many people fight the fire across such a wide area.  A lot of effort is made but only ash remains.

Organizations need to work at aligning over lighting only a few platforms to get effective change for their performance.  Identify your organization’s pyromaniacs to help them not set everything else on fire!

Keep on improving!

Photo is from here.

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Filed under Business, Change Management, Communication, Improve With Lean, Improvements, Lean Hospitals, Learn Leadership, Respect For People, Strategy Deployment

Funny Escalations

I recently discovered this funny online webcomic 1.00 FTE.  This particular one reminds me of the waste of overburdening people.  An unreasonable request is made to a team and escalation is conducted to force it to action.

What is a better way to meet with senior management about this? 

  • Bring the senior leader to watch and talk with the team (gemba) to find out why they can not do the task.  There may be waste causing them to not be able to complete the task.  They may not have the resources or skills.  There may be other barriers for them.
  • Deeply understand the task that is being requested.  The task may not fit into the organization’s strategy or help your customer.  The task might not be worth doing right now (or ever).  It may just be someone’s pet project.  The team may have bigger priorities.

Keep on improving!

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Filed under Business, Change Management, customers, Encouragement, humor, Improve With Lean, Learn Leadership, Learning Organization, Personal Development, Project Management, Respect For People, Strategy Deployment

Lean Fulfillment Interview

 

I recently had the opportunity to ask Robert Martichenko and Kevin von Grabe some questions regarding their new book Building a Lean Fulfillment Stream.  I have not had a chance to read the book yet but I have flipped through it to come up with my questions.  I am excited to read it since I have not done any fulfillment stream projects or outside supplier work yet on my Lean journey.

1. At what point in the Lean journey do you recommend improving the fulfillment stream?  Is this more advanced thinking or can be done in parallel in the beginning?

There are a few different approaches that can be taken.
a)      You can improve the fulfillment stream in parallel with the other aspects of your Lean Journey.  If you take this approach it is important to note that you may be making improvements in the fulfillment stream ahead of being able to fully leverage the improvements.
b)      You can improve the fulfillment stream as it becomes a constraint on your Lean Journey.  In other words you have a manufacturing strategy and your fulfillment stream is preventing you from taking the next step, you then transfer focus to those constraints.

2. How is the book relevant for service industries such as hospitals? 

            The section in the workbook regarding SKU classification and rationalization is particularly relevant for service industries.  In hospitals SKU complexity is a problem as each practitioner has preferences regarding supplies, tools and equipment.  This poses traditional fulfillment stream challenges regarding inventory levels, stocking locations and replenishment methods.

3. The book has a calculation for keeping both buffer stock and safety stock.  How do you see these two as different and why have both?

It is important to calculate buffer stock and safety stock separately and to review your inventory levels frequently.  Buffer stock protects you from common cause variation in demand.  You should routinely have a need to use buffer stock as demand fluctuates.  Safety stock protects you from special cause variation in demand.  You should rarely have a need to use safety stock and when you do “dip” into safety stock it is critical that you understand the root cause of the variation.

Would you answer any of questions differently?

Full disclosure: The publisher sent me a review copy of the book.

Keep on improving!

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Filed under Business, Fulfillment, Outside suppliers, Pull Systems, Quality

Check Out My @leanblog Guest Post

http://tinyurl.com/2bxcole #lean #in

I am very honored to be asked to provide a guest post on Mark Graban’s leanblog.orgI write about the importance of empathizing with the waste patients and families experience. 

Keep on improving!

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Filed under Business, Change Management, Improve With Lean, Waste

Why WHY?

WHY is one of the most important questions for your Lean journey. Here are the reasons:

  • IMPROVE ROOT CAUSES – Instead of fixing symptoms, determine what is causing the problem by asking WHY five times (Wikipedia example)
  • GOOD CHANGE MANAGEMENT – Ensure your staff knows WHY an improvement is made or the reasons for standardization.  This is only helpful if the answer to WHY isn’t “because I told you so”.
  • SUSTAIN GAINS – Just because a brilliant process has been designed for standardization does not mean all staff will follow it. Leaders need to ask WHY an individual does not perform to standard. It could be because of lack of training, a misunderstanding of WHY change was made, a physical or space limitation preventing the ability to follow it, a flat out refusal to adhere to it, or many other reasons. You can not sustain unless you find out WHY people are not following it.
  • BETTER TEACHING – In my experience, teaching the reasons WHY behind the Lean tools helps people think critically.  Just explaining how the tools are used can lead to a misuse of them.
  • IMPACT PERFORMANCE – Your organization probably has a lot of demand for projects.  Find out WHY the projects are needed and use that information to select those that impact your performance.  Projects can keep a lot of people flurrying in activity but are not always conceptualized to achieve improvement for the organization’s performance, creating value for customers, or achieving strategic aims.

What other use of WHY have helped you on your Lean journey?

Keep on improving!

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Filed under Business, Change Management, Five Whys, Improve With Lean, Improvements, Learn Leadership, Learning Organization, Problem Solving, Productivity, Project Management, Root Cause, Standard Work, Strategy Deployment, Value Added

When Visual Controls Go Bad

While this picture is a piece of artwork it made me think what your organization can look like if you view Lean only as a set of tools.  Losing the perspective of your system can easily lead to creation of complex and unusable solutions like this traffic light. 

 When I look at this traffic light tree, I picture one team adding one of the lights, then another team comes along and adds a light for their use, then a management team adds a third light to summarize what the other two teams lights represent, then more teams continue to add their light for their own use, and so forth.  While a new light may be a solution for each group individually, the net result is a confusing and unusable tool for the system.

When you set out to improve things, think about the needs and impacts to the system.  Take the time consider all options before acting.  It is not true improvement if you optimize one area but the result is sub-optimizing another.

Keep on improving!

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Filed under Business, Change Management, Consulting, humor, Improve With Lean, Improvements, Productivity, Visual Systems, Waste

More Committed Than Ever

I am now back from my wonderful 4.5 weeks of paternity leave and am more committed than ever to help hospitals become lean.  Through the birth and follow-up pediatrician visits, I have been a customer of health care and see many opportunities for staff and patient satisfaction.  Here are some of the things I experienced:

  • New IV Ports – One nurse had trouble connecting an IV port on my wife during labor.  She exclaimed “they changed our ports a few months ago but we kept on using the old ones.  Now the old ports have been thrown away and we are forced to use the new ones.  I don’t see why they switched them.”  Another RN mentioned the ports later and said “I was on vacation when the ports changed so I never got the training for how to use them”.
  • Lack Of Patient Centered Care – Our OB seemed to have an agenda on the day of labor and increased medications without telling us first despite our birth plan and previous conversations requesting informed consent for things like this.  The OB was using scare tactics to push for a c-section without explaining pros and cons for alternatives.
  • Pediatrician Office Visit Late – For our one month check-up the pediatrician was 20 minutes late.  The doctor looked visibly flustered and distracted.  He apologized for running late and expressed how bad he feels to be running behind and hates to make people wait.
  • What Is Up With Our Hospital Bill? – The day before we discharged, a person provided an estimated amount and asked for a credit card.  A month later we get a bill in the mail for half the amount we already paid without any indication our initial payment was credited towards anything.  I called their billing customer support only to be told the initial credit card amount was applied later in the day that my bill was mailed.  The rep told me the lower bill we got in the mail was incorrect and we really owed the larger amount we originally paid for with a credit card (plus an additional $68).

Lean transformations can help each of these situations.  Using better training, job instruction sheets, and explaining why would help the nurses with their ports (although I question what prompted the change if they were allowed to use the old ports for a few months if someone claimed safety was the reason).  Helping providers understand what their patient’s wants and needs are will allow them to better serve their community and will most likely help with growth.  Doctors can have reduced stress and better engagement if the root causes for being late for appointments are improved.  Lastly, recognition that the patient experience usually ends once everything is paid can help improve billing accuracy/clarity and save money from rework due to patients calling in to ask about their bill.

With renewed energy and passion I return to work to help those in hospitals see the opportunities all around them while providing guidance for how to capitalize on them.

Keep on improving!

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Filed under Business, Change Management, Consulting, customers, Improve With Lean, Improvements, Lean Hospital, Lean Hospitals, Productivity

Lean Related Posts Roundup

Since my work banned access to twitter, it is not as easy to share great Lean related articles.  I will do this on my blog now!

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Filed under Business, Change Management, customers, Gemba, Health Care, Improve With Lean, Improvements, Lean Hospital, Lean Hospitals, Learn Leadership, Personal Development, Problem Solving, Productivity, Project Management, Respect For People, Visual Communication, Visual Language

Be Different

Youngme Moon is coming out with a book called DIFFERENT.  The attached 3 minute video (RSS readers may need to open post to view) gives a great visual overview of how businesses can be different.  The video was created by XPLANE, a company that I enjoy their visual communication.  The book looks like something the Lean community would enjoy.

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Book Review: Lean Hospitals

Mark Graban’s “Lean Hospitals” is a must-read for any hospital going through a Lean transformation.  I recommend it for all staff and not just leadership.

I am an internal consultant in a Lean hospital.  One of the biggest challenges is helping clinical staff understand how stuff from the automotive industry and manufacturing is relevant to their work.  Mark’s book provides descriptions and case examples that tie the Lean philosophy and tools directly to hospital work.

A strength of the book is the realistic way to approach Lean in a hospital.  There are many nuances for standardized work that are valuable.  Wastes are identified as things people in hospitals experience.  Mark points out common issues faced by hospitals if you are looking for a place to start.  I can not emphasize enough how many valuable tidbits are throughout this book.

Leaders will get a lot from this book.  Lean requires management to change in order to support front-line improvements.  Mark provides many concrete things leaders can do to make their journey successful. 

The continued focus of  patient needs and employee engagement drives all aspects of the book.  This brings purpose behind everything else that is explained.  This book will help drive valuable change for hospitals.

  • Get the first chapter for free here
  • See a video with the author here.
  • Follow Mark Graban on his blog andor twitter.

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Filed under Book Review, Business, Change Management, Consulting, customers, Improve With Lean, Improvements, Lean Hospitals, Learn Leadership, Productivity, Quality, Respect For People, Standard Work

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:

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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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Filed under Business, Improvements, Lean Hospital, Learn Leadership, Productivity, Respect For People

Presentation Secrets Of Steve Jobs

Vodpod videos no longer available.

more about “The Presentation Secrets Of Steve Jobs“, posted with vodpod

 

Steve Jobs has a reputation for being an outstanding presenter.  This slideshow from Carmine Gallo is inspired from the book of the same name which I have seen a lot of references to lately (RSS readers may need to open post to view)

What tips do you have about presenting?

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Filed under Business, Communication, Consulting, Encouragement, Learn Leadership, Learning Organization, Personal Development, Problem Solving, Productivity, Project Management, Quality, Storytelling, Visual Communication, Visual Language

Development Versus Deadline

For Lean improvement workshops, non-customer driven deadlines should be negotiable to ensure time is given for quality development of staff.

Matthew E. May discusses how organizations are so addicted to action sometimes that the deadline drives people to get things out versus get things right.  To me, “Getting things right” does not mean taking no action until something is perfect.  I think it means staff has a solid understanding of how to assess the current state, how to use data to determine where to begin improvements, how to see in gemba, how to communicate to gain consensus about the problem and the countermeasures, how Lean tools can help them, and how the workshop can be a model for their daily work. 

To move forward without that deep understanding poses a big risk for your organization for its long-term Lean growth.

With workshops at a hospital, sometimes dates are set aside before the work has truly begun.  Nurse and provider schedules are a very real constraint to work with.  I think dates should not be set until after the assessment.  This may draw out your lead time to an event, but it will have a better long-term effect on your organization.  The trick is to not have the event so far away from the assessment that momentum is lost (easier said than done).

When deadlines are put above development of staff, a consultant or Lean expert in the area ends up doing the work or telling people what to do.  While you may get the desired results with this method, the problem solving process was not followed.

The best scenario would be to ensure all of the development and understanding happens before the deadline.  Sometimes Lean can be so counterintuitive that people need more time.  One last caveat, I do not define development as “after one single event the staff become experts” since the Lean journey is iterative.

Do you let deadlines rule over staff development?  Do you think one is more important than the other?  What do you do to get both done on time?

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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Filed under Business, Change Management, Communication, Consulting, Improve With Lean, Improvements, Learn Leadership, Learning Organization, Respect For People