Lean in Healthcare

By Al Norval

There’s an interesting groundswell occurring in the Healthcare industry that’s long overdue. Lean applied to processes that deliver care to patients and not just too administrative processes. The result – improved quality of patient care and less cost in delivering healthcare. Talk about a win-win situation. We can argue about what triggered this. Whether it was government legislation or a public outcry over rising costs, it doesn’t matter. Bottom line is there is an incentive now to change.

In the past, attempts to change the value streams of patient care were met with resistance in the form of arguments against “robotic medicine” and “standardized medicine”. Understandable considering the years of training medical practitioners receive.

The difference now is that we understand all work is a process and all processes have waste. By taking the waste out of the process and standardizing the value adding steps that are left, we create more value for the patient (customer). The standards form a platform for continuous improvement.

In the words of Taiichi Ohno “without standards, there can be no improvement”.

The healthcare provider teams are then more like a great jazz band, all following basic standards that allow them to riff and end up playing great music.

Healthcare teams riff according to the needs of the patient but the team must all be playing from the same sheet of music. The end result a significant decrease in medical induced errors and infections which are leading indicators of improved patient care and lower healthcare costs.

Lean Laughs

"A day without laughter is a day wasted"

- Charlie Chaplin



What is a Bozo?
bo·zo [boh-zoh] –noun, plural -zos. Slang.

1. a fellow, esp. a big, strong, stupid fellow.
2. a rude, obnoxious, or annoying person: Two or three bozos tried to cut in ahead of the rest of us in the supermarket line.
3. a hobo or tramp.

Origin: 1915–20, Americanism ; of uncert. orig.

• Anselm of Canterbury, in his dialogues, introduced a character named Bozo, who never got it right
• A character: Bozo the clown, was created in 1946 by Alan W. Livingston for a children's storytelling record-album and illustrative read-along book set
• Bozo has been named in several US presidential elections as a write-in candidate when people felt they were choosing between the lesser of two evils
• The term was used in the 1931 Marx Brothers film,
  Monkey Business: Alky Briggs, "Hey Bozo!" Groucho Marx: "Mr. Bozo to you!"

                                  

Best regards,

Pascal Dennis & Al Norval



Lean Implementation - Common Failure Modes

By Al Norval

When companies look at the success rate of organizations adopting Lean, they are always surprised at how low it is. Naturally, they always ask about common failure modes and how can we avoid these and learn from the lessons of the past.

As I’ve reflected on this, two common themes appear:

- Not recognizing Lean as a cultural change within the organization

- Senior Leaders not changing themselves and delegating Lean to middle managers

These two go hand in hand. Lean culture is about discovering problems, solving problems and sharing the learning across the organization. Easy to say but hard to do in most company where – “shoot the messenger” and “not invented here” rule.

When we understand Lean as a culture change, we understand the need for Senior Leadership to lead the way by modelling the new behaviours and making it OK for the rest of the organization to change. The culture change then cascades outwards from examples set by the Leadership team.

The Lean culture change required is based on Lean mental models (see Lean Learning Solutions Mental Model Cards); Leader as a Teacher is the first one. One of the key roles of Leaders is to develop the capability of the organization. Not through lecture style teaching but through Socratic style questioning. Leaders who make it OK to raise problems but then coach their teams on how to solve the problem themselves exemplify the role of a Lean Leader – one that can’t be delegated.

Lean Design – Customers Come First

By Al Norval

Lean Design is the ability to do more than just invent products. Many people can invent products. Bringing them to market and commercializing them is another thing entirely. In fact even that is not enough. Commercializing them so they become profitable value steams is the true goal of Lean Design.

To do this requires an intimate knowledge of the Customer. This is more than listening to Customers telling us what they need. It goes far beyond that. It involves determining needs of Customers they can’t tell you about or even articulate – their unspoken needs. To do this we need to study our customers, live in their space, and take time with them in their environment. Only then can we hope to discover the problems they have and gain insight into ways we can help them overcome these problems.

This is innovation.

Developing Products & Services that enable Customers to solve their problems, even problems they don’t know they have. This will drive a value proposition that enables profitable value streams.

I recall a company I was working with who made a common consumer product. The design team was a cross functional team composed of Product Designers, Marketers, Engineers and Manufacturing that was charged with designing a new and improved version of the product. As I worked with the team, I asked them “How many of you have used the product in the past 5 years?”

Incredibly, only one of twenty people replied they had used the product. They had studies and research depicting market trends and consumer preferences, yet most had never actually used the product. Without the knowledge that comes from intimate customer and product usage experiences, how can we design products that drive a value proposition that enable the goal of Lean Design – profitable value streams.

Keeping the value stream profitable over the life cycle of the product is another challenge but we’ll deal with that in another column.

More on Walt Disney

Further to my earlier blog posting, here are more musings on Walt Disney & lean principles.

Walt's natural instinct for Strategy Deployment helped him define Disneyland's famous Four Disciplines, which first appeared in 1950's training manuals.

They are (in order of importance):

• Safety

• Courtesy

• Showmanship

• Efficiency

I'm struck by the parallel with Toyota's famous four:

• Safety

• Quality

• Delivery

• Cost

At Toyota manager training these became our mantra. We came to understand that each focus area built on the last.
Safety improvements came first, then quality and delivery. Cost improvement was the last to come, but it stuck when it did, because we'd built a solid foundation for it.

Strange how so many companies focus on Cost alone -- and come to grief thereby.
Walt also understood the importance of touching the head and the heart -- another cornerstone of Strategy Deployment.

"The thing that makes us different is our way of thinking....We seem to know when to 'tap the heart'. Those who hit the intellect only appeal to a very limited group."

I recently took my family to Disneyworld in Orlando. I casually asked several "cast members" about the Four Disciplines.

Each was able to rhyme them off and explain their significance.

Focus and alignment -- half a century later.

Best,

Pascal

Walt Disney -- Lean Thinker

Just finished a fine biography of Walt Disney by Bob Thomas.

Walt's remarkable imagination, shone through, as did his energy, optimism and decency.
But there was something else too...

Walt Disney was a consummate Lean thinker.

He practiced the fundamentals every day, including visual management, go see, leader standard work and strategy deployment.  is contributions to visual management are legendary.  He invented story-boarding, for example, the visual approach to movie-making -- and so much else.

He practiced Go See every day. I see myself as a little bee," he said. "I go from one area of the studio gathering pollen and sort of stimulate everybody."

As a result he had a deep grasp of the situation and was able to articulate strategy in compelling ways.

The creation of Disneyland in the early 1950's was a brilliant example of Strategy Deployment.   Walt began with a clear and compelling vision which he articulated through images (story-boards).  His vision was informed by extensive travel and research into amusement parks around the world. He knew what worked and what didn't work. As every, he grounded his vision in concrete experience.

Then he put together an exemplary team, deployed elements of the plan to each team leader and checked progress with visual tools and leader standard work.  A remarkable leader indeed.

It strikes me, again, that what we call "Lean" is just good business.

Best regards,

Pascal

Make processes visible so you can see the waste

By Al Norval,

Many organizations mistakenly try to increase the capacity of their processes by speeding up the process. They make the value creation part go faster and ignore all the waste that forms the majority of the lead time through the process.

Lean organizations realize that sometimes we have to “Go slow to go fast”.

This entails clearing the fog by making the process visible so we can see the waste. Teams of people from the process can then implement counter measures to eliminate the waste. This frees up capacity allowing more throughput giving organizations the improvement they need.

In many cases we can actually slow the process down, eliminate the waste and get more out the end.

Contradiction? Only to traditional thinkers not to Lean thinkers.