Seek Multiple Views

This quote has been sitting with me a while and I hope it is relevant for you too.  So often, even a gemba experience may be different for people.  Even though facts are found at gemba, people may only see certain things and not the whole picture (like the four men & elephant story).  I think the Respect For People principle is at play here too because it suggests to mutually respect multiple perspectives and put together into one common view.

“Most disagreements about the right solution, decision, or course of action are really disagreements about the interpretation of current reality…Most statements about current reality are not wrong; they are incomplete. The person who adopts this principle seeks to put multiple views of current reality together to build one common and more complete view of it.”  – The Hitchhiker’s Guide to Lean: Lessons from the Road by Jamie Flinchbaugh and Andy Carlino

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World Class Blog Post

 

Source: http://www.icangiveyouhouse.com/2010/09/04/world-in-our-hands/

Have you dreamed of eating the Grove Café’s world famous pancakes or been lucky enough to try them yourself?  What?  You never heard of them before now?  It almost sounds like a classic Onion article.

Many hospitals aspire to be “World Class” but there is no measure to know if they succeed at it.  Just like the pancakes, only that hospital seems to define themselves as achieving that level of success.  For that matter, I am not sure what would make them stand out with that definition since a Google search of “world class” and hospital returned 47,300,000 results.

Do patients choose a hospital based on a world class definition?  Similarly, do local “top doctor” magazines drive patients to hospitals or is the US NEWS” Top Hospitals” issue a key deciding factor (despite its questionable criteria)?

I would worry about achieving the level of “World Class” (whatever that actually means) since being at the top of  a benchmark usually does not inspire people to improve once attained. 

I think a better mission for hospitals is to strive for “perfect care”.  Patients deserve predictable clinical outcomes and they shouldn’t get harmed or sicker by being in a hospital.  Patients want better customer service and should not have to experience any unnecessary waits.  Lastly, healthcare should have a fair and reasonable price for their co-pay and insurance.

Hospitals need to ask their patients if they want to be treated at someplace famous or where they will receive perfect care.  If forced to choose one over the other, which would they pick?  Focusing on the means (providing perfect care) will help hospitals achieve outcome of being deemed world class.

If you liked this post, then try:

• Guest Post: How Does Your Hospital Give Excellent Service?
• Crème de la Crème – What makes a world-class hospital? by Matthew N. Skoufalos
• Make Healthcare Awesome

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Relieving Workplace Mayhem

Does your workday frequently feel like mayhem?  I have talked with many people who feel like their job is filled with unnecessary chaos.  I believe a lot of organizations self-inflict themselves with craziness.  There is a way to stop the mayhem!

Overburdening people (and equipment) is a form of waste.  Your organization must first identify where people experience this waste.  Usually it is very easy to find just by asking who feels they are overwhelmed. 

Here are some examples of what you may find (also note that most below do not have a paying customer waiting for the outcome):

• Leaders asking for non-standard reports with quick deadlines (usually to sit on their desks for weeks before they look at them)
• Constant edits or change of direction to documents because planning is often done after the content was created
• Support departments get projects dumped on them without ever problem solving around their ability to have capacity to do the work
• Somebody’s procrastination or lack of planning becomes another person’s urgent priority

The next step is to acknowledge this kind of mayhem is a problem.  This step is difficult because firefighting heroics and the rush of adrenaline from last-minute deadlines becomes “how things are done around here”. 

As an outside observer, I usually see little need for subjecting employees to this kind of work condition and believe it lowers engagement.  Until teams align that overburdening staff is a problem, it will continue unabated.

The final step is to identify the root causes of the mayhem and eliminate them. 

What sort of unnecessary mayhem do you experience in the workplace?

(NOTE: The attached video is only related to this post because of the title and I thought it was a cool rockabilly song!)

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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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Book Review: Toyota Under Fire

 

“Toyota Under Fire” by Jeffrey Liker and Timothy Ogden is a highly recommended book for leaders, Lean-thinkers, and people interested in media criticism.

I initially thought it would solely be about the recall crisis which NASA has already vindicated the company.  The book also details the challenges faced by Toyota during the recession.  The authors provide candid information about how the company could have done better and show how they turned the crisis into an opportunity to become stronger.

The final chapter transforms Toyota’s story during the crisis into lessons other organizations can use to help them be prepared for a crisis.

The book helped understand the power of the Toyota Way and reaffirms why they are a company to be admired.  There are many great insights into the thinking of the people in the organization.  Some of my favorites were about how deeply respect for people is practiced, the examples of how important it is to be close to the problem to be able to improve it, the importance of culture, and how the five why’s were used to accept responsibility of the problem.

For those interested in media criticism, this book provides a lot of data that was distorted or omitted in the news during the recalls.  The examples of sensationalized reports with no follow-through once disproven will serve as a reminder to take what we consume from the news with a grain of salt.

One thing I found surprising in the book is that many cited sources were from bloggers and websites.  Since the traditional media seemed slanted against Toyota, these other sources appear more neutral.

Liker and Ogden’s book show how Toyota practices the Toyota Way.  It is not just about theory and philosophy but a demonstration of how it was recently done.  This was an excellent book.

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

If you liked this post, then try:

• My Past Book Reviews 

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Do You Have A Play Lab?

While cleaning up various packaging after my son’s first birthday, I noticed an interesting pamphlet from toy manufacturer Fisher-Price.  They have a “Play Lab” where they observe kids and families using their products to determine how to make them better!

Watching how your customers interact with your products and services will help your organization be more successful.  You will be able to better understand their needs to create new things to satisfy them.  You will spend time improving what matters because you are able to improve based on what problems you see them experiencing.

Here are a few quotes from the flyer:

…start in our Play Lab, where thousands of children test our toys in a fun, nurturing environment.  And our product designers get right down on the floor with them.

Have more than the customer-facing staff observe your customers.  Help others see how their work supports your customers.  Have leaders gain first-hand knowledge of how your products and services are being experienced.

…Fisher-Price does thousands of in-home tests – so we can really grasp how kids interact with our toys, how toys fit into their lives and how they play.

While simulated environments can tell you a lot, there is even deeper learning when observing in a natural setting.

 …we created Mom Panels, informal groups where moms can see our toy development and let us know what works for them and their children, and what doesn’t.

Engaged and loyal customers will tell you what is broken about your system if you just ask.  They will also tell you what is valuable to them.

Does your organization have a “Play Lab”?  If not, create the opportunity for many different people to be able to watch your customers use your products and services. 

If you liked this post, then try:

• Drawing: Treasure Map To Find Truth
• Debunking Myths Of Gemba
• Galileo On Gemba

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Make Healthcare Awesome

I was pretty excited to come across this “Make Healthcare Better” SlideShare presentation from Drew Weilage (RSS readers may need to click link to view).  His message of focusing on the patient and moving away from mediocrity in hospitals is exactly the mission I have.  I think Lean helps hospitals work to make things convenient for the patient and not just the provider.  I hope you find this interesting as well.  He also has a blog that is worth checking out.

This presentation really fires me up about what I do and the potential for hospitals.  I love the ending line: “Good is not good enough”.

Please share your comments about the presentation.

If you liked this post, then try:

• A C.O.W. Tale
• Doctor PDCA
• More Committed Than Ever

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Shhh! People Are Learning

Photo Source: http://mrshocket.info/default.aspx

I had a great experience recently when I was able to sit in on a meeting that was being led by a client.  They were debriefing an event and dealing with some uncovered problems afterwards.  I was thinking of some potential counter-measures or approaches to understand the problems deeper but the team came up with everything I was thinking on their own!

As leaders and consultants, it is so important to give people the space and time to figure things out on their own.  Be there to help if struggling, but allow them the ability to experiment and try things.  Coach to the method of thinking but not the solutions.

For me, Lean is about developing thinking and getting results. Unless there is an emergency requiring quick action, no result is worth sacrificing the time spent developing thinking.  Investing in people will help organizations thrive in the long term.  A company or hospital with more Lean thinkers will be more competitive than another that is just implementing the tools.

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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.

If you liked this post, then try:

• My Past Book Reviews 
• Fire At Will!
• Book Review: Lean Hospitals

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A C.O.W. Tale

Photo Source: http://www.flickr.com/photos/amosville/3165780788/

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.

If you liked this post, then try:

• More Committed Than Ever
• Martyrs and Hidden Problems

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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 required: Standardization 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/

If you liked this post, then try:

• Making Robots Out Of People
• Why WHY?

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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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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!

• Failure vs. Mediocrity – Dan Pink has a great thought about the creeping disease of mediocrity.
• How To Scold Like A Kaizen Sensei – Jon Miller explains the heart of scolding, something that surprised me in the Birth Of Lean book.
• Lost In The Land Of Firefighting –  This short video shows how we can easily lose sight when putting out fires.  I think it also shows why gemba walks need to be done instead of those doing the work saying “I already know it because I do it everyday”.
• An Idea Is Not Always Enough – Jamie Flinchbaugh uses an Aesop fable to demonstrate the importance of taking action on an idea instead of just talking about it.
• Of 777s and Heart Rate Monitors – Mark Graban tells a story about a hospital death due to a heart monitor being turned off and illustrating the need for error-proofing.
• Who’s Most Responsible for KPO Development? The KPO! – Mark Hamel encourages KPO offices to have intellectual curiosity to the point of obsession to be able to develop itself.
• Mocking Boards – Mike Wroblewski’s post demonstrates the effects of making problem’s visible.
• What does it take to be a Lean Manager? – Tim McMahon gives some practical advice for what makes a Lean manager.
• Magical Street Graffiti – 35 Breathtaking Illusions!! – Not Lean but the artwork is amazing!

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