Again this week, I've been facilitating Lean Basics classes. The audience for each of these recent classes has been principally composed of nurses.  More than any other group for whom I've facilitated Lean Basic classes, I must say that nurses quickly pick up Lean Thinking and the methodical ways of solving problems we teach in Lean Basics.  Anyone have ideas on why this might be true?

During the class, we sought to differentiate between Lean Thinking and the tools that support Lean improvements.  We stress that a successful deployment of Lean requires changing your way of thinking - your frame of reference - your worldview - your mindset. To amplify upon that point, we spoke about a powerful Ted Talk by Simon Sinek in which he discusses the "Golden Circle" model of leadership.  A link to the video is below but the key point is that you have to believe before you act". In the context of Lean Thinking, you have to adopt the mindset "everything we do can be improved" before you begin using the tools

http://www.ted.com/talks/simon_sinek_how_great_leaders_inspire_action

One topic we covered at the end of class was where to find communities of people that are truly passionate about applying the art and science of process improvement, including Lean Thinking to healthcare delivery problems. I told the class about the Society for Health Systems, a global community of people, including nurses, engineers, physicians, scientists, and many others that all have a common passion in the improvement of healthcare delivery processes.  People interested in finding out more about this great organization can visit:

http://www.iise.org/shs/

I hope you are able to take advantage of the many networking and knowledge transfer activities the Society for Health Systems offers.

This week, I had the pleasure to facilitate a Lean Basics class to an audience of brilliant people that work with healthcare organizations every day to help those organizations improve clinical processes through the use of technology.  During the class, they raised some great questions about the basics of Lean that are worth repeating.

We spent time discussing the importance of standard work as an enabler for process improvement. A key teaching point is that the documentation of the steps to perform an activity is the foundation for improving the process.  A common concern is that "standardization" of the steps to perform an activity drives away innovation and is not suitable for the nature of work performed in clinical settings.   I found a great article on Standard Work by Mark Graban that seeks to address this concern.

http://www.leanblog.org/2010/02/my-thoughts-on-standardized-work/

Incidentally, Mark's blog is a worthwhile daily read.

Another topic we discussed was value stream mapping.  For people that want to learn more about value stream mapping, I recommend an excellent video on value stream mapping from Karen Martin

https://www.youtube.com/watch?v=5YJYMLaV9Uw

Yet another topic was the concept of daily management - in essence, establishing a cadence for paying attention to the critical few metrics that we can use to make "course corrections".  Here is a nice presentation on daily management:

http://asq.org/conferences/six-sigma/2009/pdf/proceedings/g5.pdf

We can use social media to build bridges and to establish connections with others in ways that we never imagined.  Many of us tend to gravitate towards "birds of a feather" - people that are doing similar work nearby.  Sometimes we expand our networks by getting to know others doing the same sort of work in other locations.. However, building an network of colleagues who do work that is different from yours can help you become far more effective.Dr. James Rawson shared with me the concept of "randomized coffee trials" - a play on the term "randomized clinical trials".  Randomized coffee trials, or "RCTs" for short, represent a cool way to facilitate connections between people in an organization or ecosystem that don't know one another especially when the people are separated by distance and time.

Here's how it works. People who want to expand their network express interest to a facilitator. The facilitator pairs up participants randomly and provides contact information to the pairs. It could be a colleague doing the same sort of work but in a different place. Or a colleague that does very different work.  Next, the pairs agree to "meet for coffee" using technology like Skype, FaceTime, Lync, etc. During their virtual meeting, the paired up individuals discuss topics of mutual interest.  You can read more about RCT's at:

http://www.gurteen.com/gurteen/gurteen.nsf/id/randomised-coffee-trials

Have you participated in RCT's? I would enjoy hearing about your experiences and the connections you've made.

   

I often hear people saying the explosion of social media in the 21st century is, in fact "anti-social" ,and causes us to become more "isolated" rather than more "social".  I wanted to share a TEDxTalk on this very topic presented by Dr. James Rawson.  He argues that social media can build a virtual community in which to transform the sharing of ideas into real life endeavors. Social media can be used to build connections and relationships to have impact on the world.

What do you think? Is social media isolating or bridge-building. Here is the link to Dr. Rawson's TEDxTalk

https://youtu.be/5txst5mOywM

To improve almost anything, one has to diagnose what needs improving and then make the improvement.  The other day, I became engaged in a discussion regarding the relative importance of the "diagnose" vs. "make the improvement" activities.  From one perspective, you could argue that diagnosing and implementing are like your right foot and left foot - which foot is more important in the walking process. Of course, both feet are equally important.

When it comes to diagnosis and implementing an improvement (or treatment of the problem), the answer is not so clear.  Some of my colleagues argued that implementing the improvement is more important. Others argued that if you don't diagnose the problem and get to root cause, all attempts to improve are futile because you will only improve by accident.  

Where do you weigh in on this matter?

Some people describe "culture" as the "unwritten rules about how we do things in our organization."  The other day, driving home from the airport, I saw a large billboard promoting the corporate culture  of a company, Delta Air Lines. The gist of the billboard was that the Delta culture made a difference for its customers.  The billboard had a URL for further information.  When I got home (I promised I didn't do this while I was driving), I visited the URL and read about Delta's culture.  There were several things that intrigued me.  First - that Delta was marketing its culture to its customers. Second, the manner in which they had taken the "unwritten rules about how we do things around here" and turned them into a written articulation of their culture called "Rules of the Road."  

www.delta.com/c...of-the-road.pdf

This leads to several questions for you:

1. Could your organization write down its "Rules of the Road?"

2. Could your organization write its "Rules of the Road" in a way that you would be proud to share them with uour customers?

3. Can an organization's culture be promoted to its customers as a differentiator?

I recently read an article in Harvard Business Review titled Help Your Overwhelmed, Stressed-Out Team (source: https://hbr.org/2015/01/help-your-overwhelmed-stressed-out-team?)

Helping teams cope with and remove excessive stress most definitely can help improve organizations.  After reading the article, I found myself thinking about the work of Steven Covey. Many years ago (late 1980s and early 1990s), Covey, author of the "Seven Habits" series of books posited that all our time falls into one of four quadrants delimited by columns labeled not-urgent and urgent and rows labeled not-important and important.

Covey argued that we tend to spend too much of our time in the "urgent but "not important" quadrant and too little of our time in the "not-urgent but important" quadrant.  Yet, it is in the "not urgent but important" quadrant where great and meaningful things are accomplished professionally and in our personal lives.  

Covey also noted that time management practices focused on prioritizing and calendarizing (allocating time for) tasks principally based upon urgency.  Covey argued that people needed to shift their planning timeframe from "today" to a far longer perspective so that we changed our perspective of "priority" to include the "important but not urgent" matters. 

I recall a carton that depicts several "cave men" pulling a wagon with four square stone wheels. As you can imagine this required a lot of effort.  Following the wagon was another cave man carrying a "round" wheel. This cave man is saying "try this new wheel, it will make your job pulling the wagon much easier."  The cave men pulling the wagon responded "we don't have time try anything new because we are busy pulling this wagon.

Ironically, despite Covey having "discovered" these important points about making time for the important but not urgent matters (and having made a lot of money teaching others about this) decades ago, I wonder why these principles haven't gained traction? Is it a lack of time? A lack of interest? Or are the ideas simply flawed?

Any ideas on why these ideas didn’t gain traction and what we could do differently today in order to feel comfortable allocating time to the important-but-not-urgent?

Any organization or organism seeking to improve does so by changing some aspect of the current condition. An athlete seeking to improve her 10,000 meter times, trains by running longer distances at slow paces and shorter distances at faster paces.  These training regimes may can result in sore muscles and breathlessness (I know, I’ve been there).  However, the athlete knows the pain associated with training is what leads to improvements in performance. In essence, the improvement comes from the change in training regime.

In many work environments, however, we loose sight of the connection between improvement and change. We focus on change and ignore the reason for change — change is the vehicle for improvement.

Charles Kettering, a famous early 20th century engineer once noted "The world hates change yet it is the only thing that has brought progress” (source: http://www.happypublishing.com/blog/15-change-quotes/).

Perhaps the reason “the world hates change” is because we focus to much on the change and too little on the improvements? Or perhaps we are comfortable with our current state and don’t care to improve? Or perhaps we don’t believe the proposed change (whatever it is) will lead to an improvement.

What do you think?

Zombie Initiatives

Recently, a colleague shared with me a story about an initiative that continued well past its useful life.  Without getting into the details, the initiative, which had good intentions, resulted in formation of a committee to review requests to use an IT application in a specific use model..  The “good intent” was to ensure that, early in the life of this use model, there would be special oversight to ensure success.  That was the good intention.  After three years and several hundred applications, the committee was still meeting on a regular basis.  When asked under what conditions the committee would deem its work completed, no one knew the answer. In fact, no one recalled who chartered the committee or who was authorized to deem the work of the committee done. What was clear was that the committee charter did not include the conditions under which the committee work would be deemed complete – even if it was just the passage of time.

Committees that never finish their work and projects that never end are best described as Zombie initiatives because you cannot “kill them” even if you try. In LEAN terms, it seemed that the wastes of Over-Processing and/or Over-Production were present here.

Often, these Zombie initiatives become such a fabric of daily work that no one even questions, “why are we doing this.” Yet, by not questioning, “why are we doing this”, we are creating the wastes of over-processing and over-production over and over again.  Imagine the resources we could free up to work on customer-value-added or business-value-added activities if we could kill Zombie initiatives, whether the initiative was a project, a committee, or a regularly scheduled meeting.

Perhaps one technique to prevent future Zombie initiatives is a strong charter for the initiative that states the conditions that will terminate the initiative.  And one of the conditions should always be the lapse of time.  The sponsor can always renew the initiative if he or she desires. But, barring that explicit renewal, initiatives should terminate or sunset.

Pursuit of Perfection

Many definitions of LEAN thinking include the concept of relentless pursuit of perfection.  In a recent LEAN class that I taught, one of the students shared an excellent quote attributed to Vince Lombardi:

"...we will chase perfection, and we will chase it relentlessly, knowing all the while we can never attain it.  But along the way, we catch excellence..."

I think this sums up the intent behind continuous improvement - it helps us move towards excellence while acknowledging that excellence is a transitory state.  If one doesn't keep improving, today's excellence becomes tomorrow's mediocrity.   

As an example of the changing state of "excellence", I share the story of Mark Spitz and Michael Phelps, two of the greatest competitive swimmers of all times.  Until Michael Phelps won eight gold medals in the 2008 Olympics, Mark Spitz held the record for most gold medals won in a single Olympic Games - seven gold medals in 1972.  However, none of the times achieved by Spitz in 1972, many of which were world records, would have earned him qualification to compete for the United States team in 2008.  As an example, Spitz would have finished 55th of 58 swimmers in the 200-meter freestyle and 33rd of 44 swimmers in the 200-meter butterfly.  

We can  argue about what was the root cause of the dramatic improvement in athletic performance - was it the athletes, their equipment, their training routines, etc. However, what is clear is the "bar" was raised over the 30+ years between Spitz and Phelps.  Just as in athletics, continuous improvement is necessary to maintain a standard of excellence.

Good reads on LEAN thinking

Several of my LEAN Basics students have asked about some good reading on LEAN thinking. I am sure there are many great sources.  Two good sources are:

Lean Thinking

Womack, J. P., & Jones, D. T. (2003). Lean thinking. New York, NY: Simon & Schuster.

The Toyota Way

Liker, J. K. (2004). The Toyota Way. New York, NY: McGraw-Hill.

Do you have any favorites that you would suggest?

Internal and administrative process as value streams

This week, I have been teaching a class on Lean Basics.  One of the premises of LEAN thinking is that LEAN focuses on the stream leading to value as perceived by the customer.  During our discussion several students asked if that meant that internal or administrative processes cannot have a value stream.  After a passionate debate, we proposed the answer to that question is "maybe".  I shared a discussion posted on lean.org on this topic:

http://www.lean.org/FuseTalk/forum/messageview.cfm?catid=54&threadid=1943

I am not sure what the "final answer" is but there is an argument that certain internal processes could indeed be "supporting value streams."

Incidentally, if you are interested in LEAN thinking, I highly recommend bookmarking lean.org and/or subscribing to their content.

What do you think?

Does LEAN work in service organizations

Given the origins of LEAN in the Toyota Production System, it is easy to see how LEAN thinking can be stereotyped as being "something for manufacturing."  However, the degree to which LEAN thinking has been adopted across a broad variety of industries outside of manufacturing is remarkable although not surprising to a LEAN thinking practitioner.

To those wishing to explore LEAN thinking in non-manufacturing organizations, I would encourage you to view this presentation by Karen Martin:

http://www.slideshare.net/AMEConnect/value-stream-mapping-for-non-manufacturingmartinreplacement

And, read/ subscribe to  this blog by Mark Graban on LEAN in Healthcare:

http://www.leanblog.org

After reading this material, do you still believe that LEAN = Manufacturing?

Value stream mapping

One of the most powerful LEAN tools is the value stream map.  We tell our students that value-stream maps are similar to traditional flow charts but are unique in that value stream maps always depict the customer as well as time.

The power of value stream maps is they enable us to "see" the process. By "seeing" the process, we can see the process in all its glory and all its ugliness.  Waste (remember Tim Woods) becomes obvious.  If you've ever heard the saying "getting there is half the fun", that can apply to the process of creating a value stream map.  The process of value stream mapping creates a safe way of understanding the value stream in a non-defensive manner.  I've found that cross-functional teams that come together to create a current state value stream map often say things like "I never realized you had that problem".  Or "I thought you were doing ....".  The level of cross-functional understanding that comes from collaborating on a current state value stream map creates a degree of trust that is remarkable.

For those wanting to learn more about value stream mapping, I highly recommend "Learning to see" by Rother and Shook. 

Rother, M., & Shook, J. (2003). Learning to see: Lean Enterprise Institute.