Category Archives: Standard Work

Walk The Talk

I learned a lot at the recent Lean Healthcare Transformation Summit and will blog my reflections from it.  The first thing that stands out to me was the consistent effort leaders were making to walk the talk.  I think the list below is a great start of what will help leaders help transform and sustain their organizations.

  • Go see, ask why, show respect, and learn
  • Practice respect for people as individuals, engage their heads & hearts, and don’t shame or blame.
  • Be humble
  • Lead as though you have no authority
  • Teach and ask questions
  • Persevere
  • Experiment
  • Be inclusive of everyone
  • Be free from the “smartest society” trap and don’t fear appearing to be outed as incompetent

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Filed under Business, Change Management, Communication, Consulting, Encouragement, Gemba, Improve With Lean, Lean Hospital, Lean Hospitals, Learn Leadership, Respect For People, Standard Work

Are You “Under New Management” Yet?

I often see restaurants and other businesses with signs outside advertising “Under New Management” and wonder why they need to advertise this to potential customers. It got me to thinking how Lean success requires new management as well to be successful.

I think local businesses hang announcements about a leadership change because they want to tell customers they will receive better service than before. Maybe they now offer better quality, improved customer service, superior product selection, friendlier employees because they are happier, safer conditions, or a combination of all. Lean transformations provide similar benefits but they require new management to achieve them.

The leadership team might be the same people as before, but their management practices will need to change. Remember, improved results were not being created and sustained under an old management model.

Below is not a comprehensive list, but here are some of the changes to traditional leadership:

  • Decisions are made based on data and observation, not just charisma and intuition
  • Leaders act as coaches and teachers to develop people to solve problems deeper in the organization instead of being the one to solve them
  • The voice of the customer is primary focus
  • Standardized work is followed by leaders and not just those in production
  • Credibility is earned by practicing Lean and not just sponsoring it or speaking positively about it
  • Ability to fire-fight is not a sign of great Lean leaders; removing root causes to prevent fires shows lean competency
  • Use long-term thinking for selecting activities and strategies
  • Practice Respect For People for all staff, customers, suppliers, and other stakeholders
  • Manage both the means and results by understanding how processes produce outcomes

Becoming “under new management” is not an easy task but it will help your organization remain competitive in the years to come.

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Filed under Business, Data & Charts, Five Whys, Gemba, Improve With Lean, Lean Hospital, Lean Hospitals, Learn Leadership, Plan-Do-Check-Act, Problem Solving, Root Cause, Standard Work

A C.O.W. Tale

Does your hospital have a system to ensure nurses have working equipment or they know how to get them fixed?

I recently visited a hospital where the answer would be “NO”. 

Last week, a family member needed a day surgery procedure done at a local hospital.  There were signs in the prep/recovery room touting their move to electronic medical records and no longer needing paper charts.  The problem for the nurse was, the Computer On Wheels (C.O.W.) did not work.  The nurse was unable to access or update the electronic chart!

A second nurse came in during the morning before the procedure to try to troubleshoot the malfunctioning C.O.W.  It was decided to grab a C.O.W. from another room and use it instead.  I am not sure if other nurses had to search for the missing C.O.W. now that it has been moved into our room where it sat there for four hours.  A third nurse eventually pulled it away to put back where it belonged.

The first nurse came back in and tried to access the original C.O.W. in our room and commented “This still doesn’t work yet?”

I looked at the C.O.W. and there was no signage about how to troubleshoot or who to call.  I do not know if a nurse tried calling their helpdesk out of my view but it looked like nobody knew what to do with the broken computer.  It seemed like nobody knew who was to take charge in fixing it.  One can almost infer they expected it to magically fix itself!

Three nurses spent time reacting to faulty equipment that could have been better used providing care to patients.  Instead of spending their creativity solving patient issues, they use it creating workarounds.

Lean thinking can help hospitals put systems into place to ensure equipment always works.  Procedures can be created for what to do when something is broken and how to handle.  Make things visual so staff doesn’t have to rely on memory or look up procedures because instructions are attached to the item being used.

Helping remove waste and frustration from those giving care with make a better experience for those receiving care.

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Filed under 5S, Business, Change Management, Gemba, Health Care, Improve With Lean, Improvements, Lean Hospital, Lean Hospitals, Problem Solving, Productivity, Respect For People, Standard Work, Value Added, Visual Language, Visual Systems, 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

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

How Does Autonomy Fit Into Lean Management?

Dan Pink’s new book “DRIVE” made me wonder how Lean managementwill 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 punishmentdoesnot 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) butcause 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 experiencesto 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. Weare 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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Filed under Change Management, Communication, Consulting, Improve With Lean, Improvements, Learn Leadership, Learning Organization, Problem Solving, Productivity, Reflection, Respect For People, Standard Work

Martyrs and Hidden Problems

There are people in your organization who live with drastic waste everyday but they do not communicate it to anybody as a problem.  I call them martyrs.

They take on work that is not value added for your customer.  They perform duties that are a waste of their skills and pay level.  Most of these activities have no thoughtful processes and are highly subject to variability.  Martyrs usually do this work without productive complaint because “someone has to get it done and nobody else will do it.” (I say productive complaint because they most likely share their frustration with coworkers and families).

Leadership must actively identify and help martyrs. 

  • Only by observing people doing the work will leaders see the problems martyrs face – because they will not tell you.  Some do not even recognize it as a problem. 
  • Help these martyrs recognize problems and do everything you can to help them solve it. 
  • Assist them with understanding processes so they can remove waste from their work.

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

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Filed under Business, Change Management, Gemba, Improve With Lean, Improvements, Kaizen, Learn Leadership, Problem Solving, Productivity, Respect For People, Standard Work

Making Robots Out Of People

“All of this standard work is just turning us into robots”.

Have you heard this before when you improved a process and made standard work?  A recent workshop team was concerned this would be the response from some of their peers.  In true sensei fashion, we asked the rest of the team how they would respond to their nursing peers.  Here are some of their responses:

  • We watched the current process across the hospital and it was different everywhere.  The standard will help our float nurses be sucessful since they work across many units.
  • The data we have shows not every nurse has been completing the process in the allotted 30 minutes which is causing overtime.  The standard was designed to ensure we don’t go past 30 minutes but still get everything done.
  • The nurses we spoke to said they can get too much or too little information at handoff depending on who they are partnering with.  The standard work will be less frustrating for those in this position because we will all get consistent information from now on.

 I really like these responses because they discuss the problem with data and observations.  They do not just explain the benefits of the change but clearly explain the current situation which led to the standardization.

What would your response be to a comment like this?

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

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Filed under Change Management, Communication, Encouragement, Improve With Lean, Improvements, Respect For People, Standard Work

Ideal State Challenge

I have been reflecting to gain a deeper understanding of standard work and came across this outstanding article from 2007 by Jon Miller called Standards, Abnormality and the Ideal.  Please check it out because the concept of negative inventory blew my mind.  I think ideal states are easy shortchanged and this article really challenges you to think a bit farther and deeper for where you want to go on your Lean journey.

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

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