Category Archives: Learn Leadership

Book Review: On The Mend

“On The Mend” by John Toussaint, Roger Gerard, and Emily Adams is highly recommended for any level of leader in a hospital.

The authors stress the importance of how leaders need to change themselves in a Lean transformation.  Insights to the thinking of leaders at ThedaCare will challenge a hospital’s current management approach and hopefully inspire experimentation of a new style.

Woven throughout the book is the continual discussion of the impacts of a shame and blame culture.  The authors discuss some of the root causes of shame and blame.  They explain some of the counter-measures they used to improve the culture.  There is a whole chapter on engaging doctors that is of value for any healthcare leader.

The book greatly shows how time reduction is not only a productivity metric, but how timeliness impacts the health and safety of the patient.  Other examples throughout the book demonstrate that Lean can make great improvements in a hospital.

I appreciate the credibility of the authors.  Many times, they state when things did not work well, how they were the problem in some cases, and how they would approach differently in the future.  I think it is important for these sort of books to be honest since a Lean journey is not easy.  “On The Mend” provides a realistic look at how this kind of thinking can make lasting transformation in hospitals.

More information about the book including videos, author interviews, and a free chapter available at L.E.I.

Disclosure: A review copy of this book was provided to me by the publisher.

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Filed under Book Review, Health Care, Improve With Lean, Lean Hospital, Lean Hospitals, Learn Leadership, Plan-Do-Check-Act, Problem Solving, Productivity, Quality, Respect For People

Book Review: Kaizen Event Fieldbook

Mark Hamel’s “Kaizen Event Fieldbook” is an excellent addition to the library of Lean literature.  Don’t let the title fool you though, there is more to this book than just the technical details behind a kaizen event.

The book definitely delivers on the myriad of details for progressing through the different phases of a kaizen event.  Instead of just explaining what to do, the author provides the reason why it is done.  The book’s emphasis on the thinking behind the actions is valuable for Lean leaders, facilitators, and consultants .  While there are a lot of similarities to how my organization conducts events, it is nice to see the differences recommended by the book.

There are many great tables and visuals throughout the book.  A few of my favorites are the decision tree for what should be a kaizen event, a table with nine symptoms of event malpractice, and a team behavioral audit for the facilitator.  There is also an exhaustive appendix with blank forms to use for kaizen events.

In addition to the technical details, the book has a lot of insight for transformational leadership.  I enjoyed the different short stories in the “gemba tales”.  I like to learn how others teach Lean concepts and the book has an excellent chapter where the author does just that.  I am glad the book also discusses the need for daily kaizen and what that looks like in relation to kaizen events.  Lastly, there is an outstanding section about the role of a kaizen promotion office and the core competencies of those who work in it.

The “Kaizen Event Fieldbook” is a book I open often and refer to.  I highly recommend it.

Mark Hamel writes a great blog at http://kaizenfieldbook.com/marksblog/ and can be found on twitter as @markrhamel.

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Communication Or Announcements?

Photo Source: On The Sauce http://onthesauce.net/?p=391

You have a new change coming, do you communicate or just announce it?

I define communication as two-way where input and feedback is requested and announcements as one-way “this is coming or it’s already here” kind of messages.

Announcements are not an effective way to bring your organization along on your Lean journey.  People feel done-to or it appears as though they have no voice.  Announcements give the impression of very top-down leadership even if you had some of the front-line staff involved in creating the change (intent versus impact).

For people to be engaged in the change, ensure you are seeking input and feedback from those affected.  Firstly, before you make a change or set a target condition you should have gone and seen the actual process.  Use this time in gemba to get feedback about the problem.  I have seen flipchart paper put in an area for staff to add input prior to developing counter-measures to trial.  Use staff meetings to ask for thoughts before you start improving.

When developing counter-measures, share ideas with stakeholders or involve them in the trial.  Ask them what works or what further adjustments should be made before it becomes the new standard work.  Their input will make a better counter-measure and help them be invested the change.

After the standard work gets implemented, have leadership and key coaches on the floor soliciting feedback and providing clarifications.  The counter-measure may have some missing pieces that are only discovered after “launch” or people may not understand it enough to follow it.  This communication helps your organization sustain the improvement.

Honestly look at your “communication” strategy.  Is it really just announcements or are you actively asking for feedback to be seriously considered?  Did you bump the communication discussion from every agenda and now stuck in the mode of announcing because a counter-measure is developed and ready to go?

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Don’t Call HR Yet!

“If someone isn’t following standard work then it becomes an individual performance issue.” 

Have you ever heard a leader say something like that? 

It is important to help leaders understand that there are many reasons why standardized work may not be followed and creating a human resource performance improvement plan should not be the first step.

A leader must go and see the actual condition that is causing the employee to not follow standardized work (SW).  Leaders need to ask why SW isn’t followed.  Here are some potential reasons:

  • They don’t know about the SW: How was the change communicated?  At a team-meeting where not everyone was present?  Via email buried under other announcements?
  • They aren’t trained or capable to do the SW: They may not have the tools or the environment does not allow then to follow it.  The training provided might not have been enough for them.
  • All situations not considered when creating the SW: In order to respond to customers, the SW may not be capable to meet their needs.  Do not jump to the conclusion that there isn’t a good reason why an employee did something different.  They are on your team because of their hearts and minds and not just a pair of hands right?
  • They already discovered a better way: Help them know how to spread improvements discovered by frontline workers.
  • No leadership involvement: If leadership does not show they care the process is being followed on a regular basis and helping solve problems uncovered after implementation, then how can you expect employees to care?
  • Outcome not achieved but SW still being requiredStandardization is not a Lean goal but a tool to help improve outcomes.  If your hypothesized outcome didn’t come true, why are you still requiring staff to follow the SW?
  • You aren’t improving the SW: Over time the SW will unconsciously change if the continuous improvement of it is not designed or part of your culture.  The SW may have had elements missing or wasn’t fully tested.
  • Leadership has placed the wrong person in the role: There are some people who willfully do not follow SW.  Leadership must take responsibility for this too since they either tolerated bad behavior because of their productivity or have been so uninvolved to know a person does not fit in their new culture.

As you can see, there are many reasons why people do not follow standard work before you need to punish with HR.

What are some other reasons you have seen why SW isn’t followed?

Photo Source: http://wonderfie.blogspot.com/

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Lean Advice From Sobek & Smalley

“From our experience, improvement efforts in companies become ineffective when the emphasis becomes adhering to a standard tool and enforcing a certain way of doing things.  Inherently, the adherence is all well intended as a means of promoting standardization and ultimately improvement.  Unfortunately, the implementation of a certain tool or technique can become more important than improvement of the process or current situation.  In other words, the means trump the ends……place the emphasis on performing, improving, and learning rather than on conforming to templates, tools, and procedures.” – From the highly recommended book “Understanding A3 Thinking (Sobek/Smalley)” page 133.

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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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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

Great Recent Lean Blog Posts

I have been pretty busy lately and haven’t had much time to write.  I hope you enjoy these blog posts because I think they are pretty great!

Keep on improving!

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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

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

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 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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