Does Technology Actually Provide “Solutions”?

Technology can sometimes seem like the right way to address issues but most people do not know about the extra problems it can create.  You may get a short-term win with technology but end up suffering in the long-term.

If your hospital or organization in on a Lean journey, technology can sometimes go against your philosophy and management system.

Here are some things to consider if you are looking at technology: 

  • Never automate a bad process. Eliminate waste and understand what the process really needs before you find a way to make it faster. Quicker waste is still waste.
  • IT systems should fit the process, not the other way around.  In The Birth Of Lean, there was an early Toyota document with the following: “It is not a conveyor that operates men…it is men that operate a conveyor…”  So often people change processes to meet the rigidity of the technology.  Ensure the technology does not force standardization that has waste, lowers quality, or makes no sense.
  • Be able to make changes after it is implemented. So often organizations are stuck with wasteful systems because nobody has knowledge to make iterative improvements or the cost to bring someone in is so high that nobody fixes it until it is totally broke.
  • Trial first instead of piloting. Pilots usually happen after you buy the system. I have rarely seen organizations stop implementation if a pilot does not work out like they expected.  Organizations usually just change their messaging and training to fit what the technology can do instead of ensuring it does what they wanted it to do.  Trialing is part of PDCA thinking and will help ensure the IT system meets the needs of the process without being financially committed to rolling it out.
  • Know the problem you are addressing. With today’s technology, there are all sorts of bells and whistles that seem great.  Although impressive, the added features may be more than needed (overprocessing waste) and can sometimes distract from why you were looking for technology.  These ‘extras’ can also add complexity to your processes.

I think technology can be embraced in Lean organizations but it is important to ensure it is thoroughly tested, reliable, and improvable before you commit to implementing. 

Any other tips?

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Shhh! People Are Learning

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.

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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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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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How Do You Deal With Service Problems?

If your customers are unhappy with your service or quality, how do you deal with it?

During my wife’s pregnancy, she craved burgers and onion rings from a large chain that sells gourmet burgers.  She was very specific on what she wanted – plain, very well done with no pink, blue cheese, and cut down the middle to ensure it is doneInstead of the normal fries, she always wanted the onion rings.  I would call ahead and fetch the food to bring home.

I can think of six times in the nine months where the order was wrong.  One of the elements she required usually did not make it into our to-go box. 

After the first few times of arriving home with a wrong order, I began opening up all of my boxes in the restaurant to inspect and still found errors.  I began prefacing my call-in to tell the person the common problems I have experienced and still did not get the right thing.

Why did I keep going back?  The management apologized profusely and always gave me my food for free.  As a customer, I know the company will always take care of me.  This is a plus for them.

On the flip side, what else could the burger joint do to handle problems?  If they were committed to continuous improvement, they could use the event of paying for someone’s meal as an opportunity to ensure the problem never happens again. 

  • The manager could have a chef hand out the free gift card for a non-well-done burger to help them see what the customer is experiencing.  This will help gain committment for change.
  • For the times when the person taking the order over the phone did not put in the substitute for onion rings, the leader can work with the person to identify what caused the problem (maybe entry screen is unclear or inoperable, maybe the process is to just verbalize the substitution to the chef). 

Do you think real-time problem solving can be done in a high-volume restaurant or is the immediate counter-measure of giving food for free the best they can do?

Keep on improving!

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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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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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Lean Fulfillment Interview

 

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

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

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

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

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

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

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

Would you answer any of questions differently?

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

Keep on improving!

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Check Out My @leanblog Guest Post

http://tinyurl.com/2bxcole #lean #in

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

Keep on improving!

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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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