Category Archives: Improvements

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

Doctor PDCA

I had an experience recently to renew my excitement to help transform hospitals with Lean.  Our son’s pediatrician is helping us deal with his colic.  The doctor said he wants to try one change at a time to determine what will help my boy.  This is Plan-Do-Check-Act!

Some organizations want to implement a ton of stuff at once.  If the problem is fixed, it is difficult to pinpoint which of the myriad of countermeasures did the trick.  If the problem is not fixed, they throw a bunch more changes to the wall to see what sticks. 

Our pediatrician patiently tries one thing at a time.  Once the issue is resolved, he will then begin removing some of the counter-measures (medication and other soothing techniques) and continue to check that the colic is still gone.  How often do organizations remove some of the counter-measures after they implement a bunch at once?

PDCA is scientific thinking and doctors use it.  My excitement is renewed because I see how using PDCA with providers will help make Lean relevant for them in hospitals.

Keep on improving!

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Filed under Change Management, Improvements, Lean Hospital, Plan-Do-Check-Act

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

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

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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Filed under Change Management, Consulting, customers, Improve With Lean, Improvements, Lean Hospital, Learn Leadership, Learning Organization, Problem Solving, Productivity, Reflection, Respect For People, Strategy Deployment

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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Filed under Change Management, Encouragement, Gemba, Improve With Lean, Improvements, Kaizen, Learn Leadership, Personal Development, Plan-Do-Check-Act, Problem Solving, Root Cause

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

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

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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Motivating Knowledge Workers

Dan Pink has an outstanding TED talk about how to motivate workers in the 21st century (some readers may need to open this post to be able to view the 19 minute video).  Dan’s message about the difference between what science knows versus what business does will hopefully give you a new perspective. 

Leadership can get into a trap when it tries to get compliance instead of commitment or engagement.  Dan discusses how incentives can do more harm for your business.  The speech discusses the need to move from a reward by carrot or punishment by stick practice. 

Dan also speaks about an interesting study by Dan Ariely whom I greatly admire.  I wrote about how his findings can help you connect actions to cost.

Please comment with your reactions to Dan’s speech.

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

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Windows Of Frustration (part 2)

To get new windows in our house it has taken a minimum of five installations due to lack of inspection. 

After the problems with the first installation (see part 1), I kept in constant contact with the sales person to ensure the windows that will be replaced are double-hung, has the same grid pattern, and the same energy efficiency.  The sales person advised me the windows will be the exact same as the first installation except double-hung.

I had a family member at my house while the crew came for the second installation since I have to work and they only come M-F 8:00-5:00.  After the windows were installed, my family member called to advise there were grids in both the top and bottom glass instead of just the top (which is how the single-hung windows looked like at the first installation).  We also advised the crew to inspect one of the other windows that were installed previously because the framing was chipped.

The sales person advised me that I now have to work with the manufacturer since his company finished the install.  The issue was now part of the warrantee with the window company and not the sales/installation company.  The sales person told me the window company has a week backlog before they are even able to call people back to discuss problems.  The sales person added that the window company will have to deal with the chipped framing as well.

I finally got a call from the window company and they advised they will come out to replace the windows with the incorrect lower grids.  I asked for an evening or weekend install and they refused.  I asked them if their refusal was serious especially since it is to fix a mistake they made.  They advised they were serious.

The correct windows were finally put in for the third installation.  They looked at the chipped framing window and advised they will come out again to replace it (M-F 8:00-5:00 only again).  Luckily I happened to have had a weekday off to be there when they came a fourth time to fix the chipped framing but the installer ordered the wrong parts and needed to come back a fifth time.  This Thursday will be the fifth time so my fingers are crossed but the cynic in me is expecting trouble.

I share this story to help highlight where Lean could help this situation.  Below is a partial list:

  • The sales/installation company should have done a quality inspection before spending the resources installing the wrong parts.
  • The window company should have a better quality check before they wasted time building incorrect custom windows.
  • I am sure there was a communication flow issue between the sales/installation company and the window company that can be standardized.
  • The fact that there is a weeklong backlog before problems can even begin to be addressed should be seen as a problem for the window company.  Getting to the root cause will help them fix the issue instead of always putting out fires.
  • An understanding of what is value added to the customer will help both companies.  I expect more value when a problem is identified but they treated the issue like it was normal.  From my experience, most customers judge a company by how they deal with problems if they unfortunately encounter one.

What other opportunities do you see for either company?

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

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Windows Of Frustration (part 1)

As someone who helps people improve their processes and quality for a living, being a consumer can sometimes drive me batty!  I think there will always be a need for the lean principles to be applied (although some companies do not recognize the need).  My wife and I recently purchased new windows for our whole house and have had cascading problems since. 

The sales person did a quote while we were at work and mailed it to us.  To understand what the windows he quoted were, we visited the showroom and the sales person showed us a double-hung window where both the top and bottom opened.  We advised we wanted the energy-efficient and gas-filled glass.  We pointed out the measurements on the quote weren’t correct so he was going to send someone out again and provide us with a more accurate quote. 

The updated quote came and the price was good so we agreed via telephone.

During the day of the first installation I stayed out of the way from the crew.  I popped out at one point to see one of the windows that was finished.  It was a single-hung window where the top did not open like I ordered! 

I called the salesperson who was very rude stating it was on the quote I agreed to.  I advised it was not the window my wife and I saw in the showroom.  He said that was just a demo of the window brand and we were not clear to him we wanted double-hung.  I asked where it said on the quote that it was single hung to alert me as a customer that I might not be getting what I expected.  He said next to each measurement is the code “SH” for single hung.  I advised him that as the window expert, I would have expected him to explain technical codes to me the consumer and asked why he would not have tried to up-sell me on the more expensive window anyways.  We eventually came to agreement to get the correct custom windows installed.  This was truly a test of my respect for people principle!

Besides the obvious upset customer (me!), there was a lot of waste for the sales/installation company and the manufacturer: 

  • The installers have to send their crew out twice (you will find out it will be three times in part 2!). 
  • The single-hung custom windows are now scrap cost to  the installer and/or manufacturer. 
  • The time the salesperson spent fixing our problem took time away from him to generate new business for the installation company.

Potential counter-measures: 1) Train salespeople to ask customer’s the right kind of questions to ensure their needs are met prior to ordering.  2) Make quotes visual with descriptions with explicit explanations with no code so the customer can understand what they are agreeing to.  3) Don’t blame the customer when problems happen but own the issue.

I will share part 2 next week.  Any other wastes or counter-measures you see in this story?

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, customers, Improve With Lean, Improvements, Information Flow, Problem Solving, Quality, Respect For People, Root Cause, Value Added, Visual Communication, Visual Language, Waste

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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