Archive for December, 2010

Lean Management Systems and Actionable Empathy…or, “How Was Your Day?”

We have all experienced significant stress. You know, the feeling that you’re treading water after just being dunked by more than a few unforgiving waves… and more waves are coming…and it’s dark.

There’s nothing worse than giving maximum effort and knowing that it might not be good enough. Well, actually there is something worse – feeling like you’re all alone and no one cares.

Primary care physicians can experience that kind of stress. Often they are a pretty autonomous lot. This can enhance the feeling of isolation. Enter the benefits of tiered meetings as part of an effective lean management system.

Tier I meetings, typically a short (5 to 15 minute) daily  meeting, fosters communication and helps focus the natural work team on process performance, improvement opportunities that have been surfaced in the last 24 hours, and planning for  the next 24 hours, etc. But, I never really thought too hard about the role of empathy within the tier I…until I heard a doc, a recent lean convert, describe how it has helped change everything.

His team of nurse, medical assistant and secretary, within what they appropriately reference as a tier I “huddle,” regularly starts with the staff asking the doc the important question of, “How was (is) your day?” Now, this didn’t start as part of the tier I’s standard agenda, but instead was an intuitive question asked by a caring staff.

As the physician described the tier I, he focused on the discussions around schedule, patient wait times, rooming performance, and team implemented improvements, but he also talked about how he no longer felt like it was him against the world. The question of, “How was your day?” seemed to change so much. His team cared, wanted to help and regularly did.

Patient satisfaction has improved dramatically over the last several months and so has provider and staff satisfaction. It all makes sense.

Related post: How to Audit a Lean Management System

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Guest Post: Going to the Gemba with Grandma

Being tech support over the phone is a difficult job, being tech support for my 87 yr old grandmother (Mimi) and her TV remote should qualify me for sainthood.

A few years ago I got a tech support call from Mimi on my drive home from work. Trouble with the remote again, the batteries both fell out and she wasn’t sure in what direction they should go back in.

Having a point of reference to verbally describe orientation was impossible. Her eyesight was poor and the remote didn’t have the (+) and (-) displayed very well. Instead of springs on the (-) end in the remote there were just slightly raised clips, so no help there.

Next, I pulled over to the side of the road for a 35 minute chat about changing them 180 degrees and trying different battery configurations. Finally, she said that the batteries might be dead anyway. The remote had been burning through batteries.

A remote that is draining the batteries constantly? Hmm…something didn’t sound right, so I decided it was time to go to the gemba with grandma.

Normally, when I visited her we played cribbage, but this time we were going to do some TV watching and gather some info.

She said she had been replacing the batteries about every 2 weeks because they kept dying on her. After replacing them, the remote would work for a short while and then have more problems and she would just change them again.

I tried using the remote and didn’t have any issues. She gave me a dirty look and said, “That’s all well and good until I need to watch The Days of Our Lives and then it won’t work, mark my words”

Then suddenly it happened.  The remote didn’t work for her. “Oh fiddle sticks there it goes again.” NOTE: Fiddle sticks is a curse word in the Mimi dictionary.

I saw something that I would never have discovered if I hadn’t gone to the gemba.

Mimi had arthritis which made her joints very sore.  It also made the pointer finger on her right hand crooked to almost a 90 degree angle.

When she tried to change channels or hit the buttons sometimes that crooked finger would block the Infra Red beam that would send the signal to the TV.  It was a user issue.

The solutions were simple.

Mimi had to remind herself to keep her finger out of the way and I put 2 fresh batteries in the remote and taped it shut so they wouldn’t fall out.

She never had trouble with the remote again and we played cribbage 3-4 times a week for almost two years till she passed away.  The new batteries actually outlasted her…I think she would have enjoyed knowing that.

This post was authored by Jon Wetzel, creator of the Lean for Everyone Blog where he posts about the uses of lean concepts in everyday life.  Jon has 16 years worth of experience in startup biotech, invented the scented pen, and balloon sculptures for fun.  He is also certified in Lean, a Six Sigma Black Belt, a member of the Michigan Lean Consortium and runs his own consulting company – Lean for Everyone.  Jon can be contacted via e-mail at jon.wetzel@leanforeveryone.com.

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Want a Kaizen Culture? Take Your Vitamin C!

Among other things, vitamin C boosts one’s immune system. That’s pretty important, especially around the cold and flu season. But there is another type of vitamin C. One that is critical to the formation of an effective kaizen culture.

The Toyota Way, as defined here by Toyota, is founded upon two main pillars: 1) continuous improvement , and 2) respect for people. The following “three building blocks” shape their “commitment to continuous improvement:

  1. Challenge – we form a long term vision, meeting challenges with courage and creativity to realize our dreams;
  2. Kaizen – we improve our business operations continuously, always driving for innovation and evolution
  3. Genchi Genbutsu – we go to the source to find the facts to make correct decisions, build consensus and achieve goals.”

The first building block contains vitamin C in a threefold dose:

  • Challenge. Constantly be ready and willing to question the status quo and look for better ways. The challenge can be fomented by the envisioned ideal state and/or a specific target condition. It’s about closing the gaps. Challenge should provide the “pull” dynamic for improvements.
  • Courage. Be ever willing to test improvement ideas and learn from trial and error. This is foundational to PDCA (they don’t call it “PDC”).  Lean leaders must actively nurture an environment within which people fearlessly (not recklessly) apply scientific thinking and trystorming.
  • Creativity. Trystorming without creativity is a sterile exercise. We must think and act differently – “Keep on doing what you’re doing, keep on getting what you’re getting.” Unleash the inner MacGyver!

So, take copious amounts of vitamin C and, as an effective leader, ensure that your folks do the same. Boost that organizational immune system and foster a kaizen culture.

Related posts: Telling “How” Removes Responsibility, Kaizen Principle: Be like MacGyver, use creativity before capital!

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Guest Post: Creating Gravity for Transformation

A few weeks back, I had the privilege of attending the 2-day Shingo Prize workshop on the Principles of Operational Excellence.  The experience was nothing short of mind-blowing, as I developed a far deeper understanding of Lean and why it works, not just what works.  In other words, my understanding grew from something based on an understanding of Lean’s tools to something based more on Lean’s philosophy.

As I reflected on my own experience as a student of Lean (and what I will now refer to as Operational Excellence!), I began to think of how to relate my understanding of these concepts to others.  To my mind, the critical element in Lean transformation is the organic development of leadership based on experience and ability to mentor.  For this to happen, traditional hierarchies where managers use positional authority to push their influence onto others need to be replaced.  Simply put, leaders who encourage the use of knowledge and experience to coach others and approach their work with a commitment to “know-why” being of greater value than “know-how” will generate an influential, gravitational pull towards transformation.

Several months ago, I stumbled across John Husband’s site dedicated to the concept of wirearchy.  According to him,

A major shift in the ways activities are planned and managed is occurring in many spheres of human activity, from command-and-control to coordinate-and-channel. When customers have more power and employees want to communicate and be heard, the dynamics have to change.

A new organizing principle is emerging, called Wirearchy.  The working definition of wirearchy is:

A dynamic two-way flow of power and authority based on information, knowledge, trust and credibility, enabled by interconnected people and technology
.

Operational Excellence relies on many of these same concepts, particularly the need to move from “command and control” to “coordinate and channel.”  The “two-way flow of power and authority based on information, trust and credibility” sounds like the very definition of “respect for people” as well.  While Husband’s concept relies heavily on the development of technology to produce non-hierarchical, collaborative teams, I think any community where people become critical “nodes” in an interconnected network as a result of their knowledge, experience, embodiment of an ideal and willingness/ability to teach others (as opposed to authority based strictly on rank and title) fits within the wirearchy concept.  What wirearchy sees technology bringing is something I believe the Operational Excellence would consider an ideal state:  free-flowing and distributed authority based on the relentless pursuit of cultural transformation.

A representation of Wirearchy

I recently came across a presentation from Jeffrey Liker, where he offered ideas based on a PhD dissertation from Robert Kucner.  Kucner models what he calls the organic spreading of Lean culture and values as spirals circling outwards from certain processes, eventually touching upon others to penetrate deeper and deeper in an “inch wide, mile deep” fashion.

In both models, we can see areas where people or processes are forming critical centers of activity that influence those around them.  How do these critical “nodes” at the center of the activity form?  I think the answer has to do with a sort of gravity that develops when organizations, or individuals within organizations, insist on driving change.  This never-ending pursuit of excellence usually starts within smaller sub-units as depicted above, however, sustaining the effort may have more to do with forming a single dense space at the epicenter of the desired behaviors than it does with spreading outwards as quickly as possible.  In other words, leaders may find that sharing knowledge to develop a deeper understanding of operational excellence in a few areas builds more momentum, more easily, than trying to spread the concepts as far and wide as possible.

A depiction of the organic deployment of Lean

If we turn the model on its side, we can more easily see how the nodes collect and gather the loose, swirling mass of ideas and behaviors until they grow deeper and denser, forming a vortex that draws others in with it.  Using this perspective, it is easer to understand why deeper is better than broader.  As multiple objects in the same space grow larger, they eventually grow together, adding energy to the phenomenon.  What this means for transformation is that when smaller organizations within an enterprise appear to be outpacing others, don’t stifle them.  Allow those deeper areas to keep going and growing deeper, eventually creating the gravitational pull that will bring other elements into the vortex.

Across any enterprise, there are organizations and individuals that develop greater depths of Operational Excellence.  While some focus only on utilizing mandated tools, others begin to pursue cultural transformation.  The focus on tools to implement change, however, prevents the strong vortices that generate an ever-deeper understanding of excellence from being formed.  As organizations evolve from a tool-driven understanding of behavior to systemic, cultural and philosophical levels, they begin to develop their own gravity, pulling in other organizations within their reach and eventually determining the behavior of the enterprise as a whole.

How to create this gravity?  As with most things that require behavioral change, constant communication and education are vital.  People at all levels of the organization need to be educated on the principles of Operational Excellence and not just why it works in general, but why it will work here. Just as important as educating people on why it will work, is building the sense of urgency that answers the question, “Why is this necessary right now?”  The more you can provide education and communication on why things are changing, the greater the cooperation and buy-in, the deeper the resulting understanding will become, and the stronger your gravitational pull towards transformation.

This post was authored by David M. Kasprzak, creator of the My Flexible Pencil blog, where he shares his thoughts on improving workplace culture through the use of Lean concepts.  While working as an analyst to develop and analyze program-level cost & schedule metrics for the past 10 years, David has now turned his attention towards understanding the behaviors that create high-performing organizations.  He currently lives near Nashua, NH with his wife and 2 sons. David can be contacted via email at david@myflexiblepencil.com

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