Lean Roundup #15 – August, 2010

Selected highlights from the Lean Blog Community from the month of August, 2010.

My Personal Spin on PDCA – Steve Martin explains PDCA with the acronym SPIN for Sketch, Play, Inquire, and Nourish.

Establish a War Room (Obeya) – 2 Lean Principals explains the reason behind creating war rooms is for improving communication.

How to Design Poor Service - Expect 100% Utilization of People or Resources – Mark Graban shares some thoughts on why 100% utilization leads to waiting and poor service.

Fire at Will! – Brian Buck explains the dangers of the burning bridge approach for change instead of alignment.

How To Manage What You Can't Measure – John Hunter has a great piece on management and measures based on Deming's ideas.

Clear and Relevant Metrics – Matt Wrye looks at two characteristics that result in successful metrics that drive improvement.

Suggested Change to Job Instruction – Bryan Lund suggests introducing the Training Matrix before the Job Breakdowns to encourage challenging the training.

Build an Environment where Intrinsic Motivation Flourishes – John Hunter talks about building a culture with respect for people and build joy in work.

How to Motivate Front Line Workers – Jon Miller answers the common question of motivating employees but from the environmental factors of a grass roots movement.

What is Leadership Commitment? – Mark Rosenthal answers the popular question of commitment in terms of willingness to learn.

Saturday Afternoon with Captain Karl's Lean Nation – Karen Wilhelm in a post which is part summary of Lean Nation's recent shows and part editorial on learning from podcast is enlightening.

The Smarter Company – Gregg Stocker explains what sets some companies apart from others and how to be better at it.

Your Own Worst Enemy– Jamie Flinchbaugh illustrates what happens to change when change agents have to decide to hang on or let go of control.

In Defense of Kaizen Events – Mike Wroblewski compares Lean Kaizen events to that of the nourishment of babies with milk.

Be The Change – Maureen Sullivan explains the change cycle with a real example from a frontline leader in healthcare.

The Stranded Manager: A Lesson in Working With People – David Kasprzak shares two typical employee stereotypes and which one is helpful in improvement.

Developing Leader Standard Work- Five Important Steps – Mark Hamels says 5 steps will get you a long way on developing standard work: 1) walking, 2) questioning, 3) working, 4) testing, and 5) adjusting.

Teach Everyone the Business – Lee Fried shares a story on the importance of educating employees about the financial health of the business.

How I Sustain and Clean PC Desktop – Ron Pereira uses Lean Thinking to clean up an messy desktop.

Choosing Online Collaboration Tools for Teams– Karen Wilhelm summarizes a discussion on LinkedIn about online collaboration tools.

To Shingo or Not to Shingo – Kevin Meyer continues a discussion on the Shingo Prize and the worthiness of its prize criteria.

Getting to the Root Cause– Dan Markovitz shares a story on root cause analysis by the National Park Service and the relates that to the increasing waste in your inbox.

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Personal Kanban Kaizen

A couple of months ago I talked about a kanban for personal management. This concept had two desirable elements:

1) Visualizing your work
2) Limiting your work.

In my previous visual task board I found prioritization meaningless. Tasks are either important or not. If it is important then put it on the list. If not then don't waste time or space pretending that you'll get to it, because you won't.

Dan Markovitz from TimeBack Management and I had several discussions on the set-up of a personal kanban. We discussed how to determine the size of WIP. The WIP limit shouldn't be determined by the number of items, because one large task/project consumes as much time (which is your critical resource) as eight small tasks. Unlike a production line where the cycle time is both known and constant, knowledge work is inherently more variable. So it's tough to determine the appropriate WIP level.

We also talked about using the calendar as kanban. By designating dates and times for specific tasks and projects, you've essentially created a production schedule for your work, with the calendar (and the calendar alerts) acting as a kanban that pulls work forward.

I decided to try to create my own kanban system following these steps:

1) Establish Your Value Stream – The flow of work I chose was Backlog, This Week, Today, and Done.

2) Establish Your Backlog – I put every task onto a post-it-note, if the task had a due date I put that on the note as well.

3) Establish Your WIP Limit – I limited my Today column to 3 (good place to start) and therefore limited my This Week column to 15

4) Begin to Pull – I moved tasks into the next two columns and got to work.

Below you can see the result on my new kanban:

I have been using my kanban system for a little while and I want to share some things I have learned thus far:

1) For really small tasks I still keep a todo list with paper and pen.
2) This Week column allows me to plan out my week.
3) A WIP of 3 has been working for me for tasks around 1-2 hours in length.
4) The size of the task is not too important. Smaller tasks make you pull faster. For larger tasks I try to break them up into workable chunks.
5) The current board is not portable which I need.
6) Adding color to this system would help distinguish different types of tasks.

While looking at various ways to improve my kanban system I came across this presentation on kanban designs the inspire flow.

In the next version of my kanban I will attempt to address some of the previous short comings. Just as in Kaizen in your organization, having tried a quick and easy manual version of this kanban I found what works and what doesn't.  Now making those improvements will be even easier.

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Lean Quote: The Practice of Leadership

On Fridays I will post a Lean related Quote. Throughout our lifetimes many people touch our lives and leave us with words of wisdom. These can both be a source of new learning and also a point to pause and reflect upon lessons we have learned. Within Lean active learning is an important aspect on this journey because without learning we can not improve.

Feel free to share some of your favorites here as well.

"In theory there is no difference between theory and practice. But, in practice, there is." — Jan L.A. van de Snepscheut

This is true for leadership. If you want to lead you have to practice leading as this quote points out.  What does it mean to practice leadership?  To define leadership let's use the acronym PRACTICE:

Planning – Figure out the steps you have to take.  If a goal is to be achieved the conditions and resources must be put in place.

Right tool/technique – Interestingly enough, effective leadership is like a toolbox. Always use the right tool for the right job. This means knowing both your tools and the problem that you are trying to fix.

Awareness – Having a common knowledge or understanding.  Knowledge gained from observation, data, and personal involvement.  This includes self-awareness which means you need to know yourself.

Communication – Without it you travel alone. To become an effective communicator, you must know how to clarify your messages, be a good listener, be truthful in your words, and get feedback from those who listen.

Teamwork – People working together cooperatively can accomplish more.  Leaders should not think of themselves as simply managers, supervisors, etc.; but rather as "team leaders.

 Innovation – Innovation is two-fold: Bring new thinking and different actions to how you lead as well as creating a climate where others apply innovative thinking to solve problems and develop new products and services.

Culture – Culture tells people how to relate and how to get rewards by set of shared attitudes, values, goals, and practices.  Culture is the mechanism whereby not only management, but employees shape each others' behavior.

Environment – Leaders create conditions for success.  A learning environment with respect for each other which allows for empowered engagement and team work.

The practice of leadership is setting the right example, providing vision and guidance, and doing so is necessary for people within the organization to succeed. The really hard part, the art of leadership, is known as what to do, and when, why, and how to do it.

"It's only in the practice of leadership that we influence our world" - unknown

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Why is Lean Office more difficult than Lean Production?

I am a proud participant of the Western Massachusetts Lean Network. This is a network of Lean thinkers at various stages of their journey whose goal is to share best practices within the network as a way for all of us to continue learning. The Greater Boston Manufacturing Partnership (GBMP) is the host of our network. We recently started a forum for sharing online where we can post a question of the week.

I suggested the following question a couple weeks ago:

Does it seem more difficult to do administrative kaizen then production/operations kaizen? If so, why?

Bruce Hamilton, President of GBMP and Vice Chair of Shingo Prize (aka Mr. Toast), gave an insightful response.

In responding to this question, the following comment from Shigeo Shingo comes to mind: "The real problem is thinking there is no problem." Having spent half of my career in administrative functions (marketing, IT, materials management), I'm well aware that there are loads of problems in the office environment. Information wells, disconnects, and mazes are normal as are correction loops. Office layouts create huge excess motion and encourage batching of everything from sales leads to factory and purchase orders to inspections to invoices – and finally collections. Every piece of information is batched with all the problems that attend that practice. (Of course there are occasional exceptions to this stereotype, so before continuing, I apologize to them.)

The barrier to engaging administrative departments is initially higher than in production for are several reasons:
• Top management is predisposed to round up the usual suspects when problems occur, and those suspects are in production. Management rationalizes that problems occur there because production employees are less well formally educated or because they are paid less and are therefore less likely to care about their work – or maybe they're tired from working a second job and therefore more prone to mistakes. None of this is true, of course, but production often faces this bias and then takes it on the chin when problems occur.
• Office employees take their lead from management and tend to have the same misconceptions about production. At the same time they have an unchallenged complacency for their own situations. While production has a long history of absorbing blame, office employees have remained mostly above the fray when problems occurred.
• Knowledge work" as it's called is not so visible and is mostly unscrutinized. Although waste in knowledge work is huge, office employees fly below the L,M&O radar.
• Office employees (including department managers) have more position power than factory employees and are therefore better equipped to fight change. Many a change agent has been derailed by choosing to battle a savvy office manager.
• Managers of administrative functions are often paid commensurate with the number of reports, so a system that may recommend few reports will not be motivating.

The challenge to overcoming these initial barriers is to:

1. First identify early victories that make the job "easier, better, faster and cheaper" (the theme of our October 19-20 Northeast Shingo Conference). Don't pick a project that involves work or them with benefit only to production (e.g. "Scheduling smaller batches" or "More timely and accurate forecasts.") Pick projects lessens their loads (e.g., "easier pricing system for order entry" or "better customer information for collections" or "printers in the right locations.")
2. Choose "small" projects that can be completed quickly and make sure resources (often IT) are available to complete the efforts.
3. Third, publicize victories to the stakeholders keeping in mind all of the objections and predispositions (and surrounding politics) implied in the points above. Share the success and give credit to managers and employees. Provide explicit descriptions of before and after conditions with hard numbers.

The bottom line is that administrative departments will buy-in once managers and employees understand the benefits and are persuaded that these far outweigh any potential threats. Your objective is to respect and answer their objections while they are learning.

My experience with Lean in the office mirrors that to which Bruce summarized.  Lean is a building, thinking process which requires both learning and thinking by building on experiments.  Bruce provides some logically first steps for any kind of improvement activity.

What are your thoughts on Lean in the office compared to Lean in a production setting?

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Is Lean Government the Next Frontier?

In a recent post Jon Miller mentioned Paul Anker, who is running for US Senate on a Lean platform, has started LeanAmerica.org.  Lean America is all about helping government organizations throughout America learn and implement lean thinking; by empowering their workers to continuously improve, eliminate waste, and to add value for all Americans.

Related to Jon's post I came across an interesting video regarding Lean government in Cape Coral, Florida. The video is sort of an infomercial for lean government based on the Mission Impossible theme but  there is a great message.  The City Manager, Terrance Stewart, explains the concept of respect for people well.

The city of Cape Coral Florida is creating a model of excellence in Lean city Government by implementing Lean-waste free (Toyota Production System) principles. Cape Coral began transforming in Aug 2007 by using kaizen methodologies to establish new breakthrough processes. The results are in the +millions, exceeding any Baldridge award winner by setting ROI of +20X.

Cape Coral has also been recognized as a leader in Lean Government by the ICMA (International City/County Management Association).

Envisioned in 2006 and launched in August 2007, the City of Cape Coral’s Lean Government system saved and/or prevented the City from spending $2 million. Based off James Womack and Daniel Jones’s book, Lean Thinking, the Lean Government system has a goal of increasing productivity and reducing cost, while maintaining quality and service. The system achieves this goal because it gives management the necessary tools for greater efficiency, allows them to identify and eliminate unnecessary employee workloads, and lets the City provide services in a challenging economic climate.

The city's lean government system has proven very effective to increase productivity, lower cost and provide hope in these challenging times.

Even though there have been obstacles, such as fear of change, reduction in force, declining revenues, the Lean methodology has held to its intent to eliminate non-value added steps in a process.

There appears to be a number of good Lean government examples. Is this industry the next frontier for Lean?

Karl Wadensten and I had the opportunity to talk about Lean and government this past Tax day on the Lean Nation Radio Show from the Rhode Island State Capital.

Link Lean and Government with Karl



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Quick Changeover

In manufacturing, changeover is the process of converting a line or machine from running one product to another. Changeover times can last from a few minutes to as much as several weeks in the case of automobile manufacturers retooling for new models.

SMED, or Single Minute Exchange of Dies, is the technique of reducing the amount of time to change a process from running one specific type of product to another.  The purpose for reducing changeover time is not for increasing production capacity, but to allow for more frequent changeovers in order to increase production flexibility.  Quicker changeovers allow for smaller batch sizes.

The benefits of quick changeover include:

     • Reduce defect rates - Quick Changeover reduces
       adjustmentsas part of setup and promotes quality on the
       first piece.
     • Reduce inventory costs - Elimination of, or reduction in
       numbers of batches, and their sizes, allows for recovery of
       operating cash and manufacturing space.
     • Increase production flexibility - Increase output and
       improve timeliness of response to customer orders.
     • Improve on-time delivery - Quick Changeover supports 
       the ability to meet customer demands.

The terms set-up and changeover are sometimes used interchangeably however this usage is incorrect.  Set-up is only one component of changeover.  Changeover can be divided into the 3 Ups:

     Clean-up - the removal of previous product, materials and
                       components from the line.
     Set-up    -  the process of actually converting the equipment.
     Start-up  -  the time spent fine tuning the equipment after it
                       has been restarted.

The keys to quick changeover are found in changing your thinking about changeover as in the following:

      1. Rethink the idea that machines can be idle, but workers
          cannot be idle.
      2. The ideal setup change is no setup at all or within
          seconds.
      3. Ensure that all tools are always ready and in perfect
          condition.
      4. Blow a whistle and have a team of workers respond to
          each changeover.
      5. Establish goals to reduce changeover times, record all
          changeover times and display them near the machine.
      6. Distinguish between internal and external setup activities
          and try to convert internal to external setup.

To start identify and separate the changeover process into key operations – External Setup involves operations that can be done while the machine is running and before the changeover process begins, Internal Setup are those that must take place when the equipment is stopped.  Aside from that, there may also be non-essential operations. Use the following steps to attack the quick changeover:

Eliminate non-essential operations – Adjust only one side of guard rails instead of both, replace only necessary parts and make all others as universal as possible.

Perform External Set-up – Gather parts and tools, pre-heat dies, have the correct new product material at the line… there's nothing worse than completing a changeover only to find that a key product component is missing.

Simplify Internal Set-up – Use pins, cams, and jigs to reduce adjustments, replace nuts and bolts with hand knobs, levers and toggle clamps… remember that no matter how long the screw or bolt only the last turn tightens it.

Measure, measure, measure – The only way to know if changeover time and startup waste is reduced is to measure it!


Ron Pereira from the Gemba Academy authored a video on Quick Changeover.  A great summary of quick changeover is shown below:



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Lean Quote: Top Disney Quotes

On Fridays I will post a Lean related Quote. Throughout our lifetimes many people touch our lives and leave us with words of wisdom. These can both be a source of new learning and also a point to pause and reflect upon lessons we have learned. Within Lean active learning is an important aspect on this journey because without learning we can not improve.

I am still on vacation with my family at one of the greatest places on earth for children.  I will be back next week.  Until then, I thought I would take this opportunity to highlight my top 10 quotes by Walt Disney.

Top 10 Walt Disney Quotes

1. "All our dreams can come true, if we have the courage to pursue them."

2. "The way to get started is to quit talking and begin doing."

3. "When you believe in a thing, believe in it all the way, implicitly and unquestionably."

4. "It's kind of fun to do the impossible."

5. "I can never stand still. I must explore and experiment. I am never satisfied with my work. I resent the limitations of my own imagination."

6. "Of all the things I've done, the most vital is coordinating the talents of those who work for us and pointing them toward a certain goal."

7. "Our greatest natural resource is the minds of our children."

8. "Get a good idea, and stay with it. Dog it, and work at it until it's done, and done right."

9. "People often ask me if I know the secret of success and if I could tell others how to make their dreams come true. My answer is, you do it by working."

10. "If you can dream it, you can do it."

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Guest Post: Lean & Social Media – Is There A Process for That?

I am pleased to be able to share a guest post by friend Jason Semovoski.  We met working together on AME's (Association of Manufacturing Excellence) social media council.

Jason is known for his strong background with technology management and is currently in the role of Business Analyst Consultant. His previous assignments include Plant Operations Manager and IT management positions. Jason is a Southwestern Region board member for AME.

He is currently working on several technology and Lean projects as well as leveraging Web 2.0+ technologies to improve business communications. You can follow Jason on Twitter- @jwsems or visit his blog Lean Stuff.
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Like it or not, Social Media (SM) is entrenching deeper into our lives. Everywhere we look Facebook, Twitter, or YouTube logos are emblazoned on almost anything we come in contact with during the day. One can argue it has definitely become a push process from a marketing perspective, but what about value?

In a great blog post "Social Media – Can we make it add value to lean?"  Karen Wilhelm presents a pull methodology regarding her experience with leveraging SM tools.  By all means, it's not a stretch to use Karen's example as "pull" in social media and I agree fully that her approach works well when properly utilized (Hint: read her blog post.).  Although even as a pull process can it create waste?

In "good" blog posts there are multiple links to external sites which is great to lend credibility and allow the reader to conduct further research, however you all know what happens next, right? One link takes you to a site which can drive you deeper into a topic. You click the next interesting link which may drive you away from the topic or you click on yet another link and drive deeper into the abyss of data. You can easily emerge from the web device two hours later having accomplished a large amount of reading as the only result. We all know this is easy to do even with our time deprived schedules.

So is there value along with a process?  Absolutely! Social Media and tech guru Clayton Morris addresses this topic in his podcast "Today In Social Media."  Specifically, Clayton outlines a simple process for integrating SM into your daily routine. Those of you familiar with the Getting Things Done or GTD system will find his advice quite similar to the GTD approach. Individuals with lean experience will find that Clayton has developed a standard work process for SM. He has integrated an approach similar to Karen's example of creating value while leveraging daily standard work. If this is too much for you, possibly add it as a weekly standard work item.

I realize the example is simple and why shouldn't it be. Building relationships and continuous learning are great "non marketing" examples of where social media can provide value to the lean practitioner. Making social media a part of your personal standard work process will keep you focused and assures you keep creating value for our lean community of practice.

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Guest Post: 5 Reasons for 5S

Today's guest blogger is Christian Paulsen, who authors Life's Lessons in the 21st Century Blog.  Christian is a food manufacturing manager with 20 years of manufacturing leadership and Lean Manufacturing expertise. He adds value to an organization by driving continuous process improvements and bottom line cost savings. Christian attended Purdue University on a Navy ROTC scholarship and received a Bachelor of Science degree in Applied Mathematics. After serving in the US Navy, he pursued a career in manufacturing with Frito-Lay, Unilever (Lipton), and Nestle USA as well as smaller private manufacturers. You can also follow Christain on Twitter @Chris_Paulsen.

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John, a young production manager, makes his way onto the production floor to see how an important changeover is progressing. He wanted to make sure everything is moving along as planned because orders are heavy this week and his team needed to be running the next product ASAP. In fact the scheduler wanted it yesterday and the trucks are already at the docks. John is disappointed to learn that the change over is running much longer than scheduled because the team cannot find some of the change parts for the filler... maybe now is the time to implement this 5S John has been hearing about.

5S is named for its 5 steps: Sort, Set, Shine, Standardize, and Sustain and is more than window dressing. 5S will bring several benefits to John's plant and your workplace. Let's look at the benefits to John's team as they implement 5S.

1. Housekeeping and Organization – When John's team has Sorted out the unneeded parts and supplies (1st S), they de-clutter their workplace. This enables them to Set Locations and Limits (2nd S). At this point, the team has a place for everything and everything in its place. John's team will not be wasting valuable line time looking for change parts during the next changeover since they have a defined location for the change parts.

2. Losses & Waste are Visible – The team will find abnormalities as they clean with a purpose. They find defects while cleaning to inspect as they Shine and Sweep (3rd S).

3. Continuous Improvement – Standardizing (4th S) enables everyone to follow these best practices. You should not expect consistent results when the practices are not standardized and you cannot consistently improve without standardization.

4. Structure and Discipline – John's team gains structure and develops self-discipline as they build systems to Sustain (5th S) their 5S initiative. Sustaining 5S can be the most difficult step and it will not be successful without structure and discipline.

5. Pride & Ownership – John's team finds that they have increased ownership since they have more invested in their work environment and they find gratification because they can make a difference.

John and his team discover for themselves that 5S is not just a housekeeping project and is more than window dressing. They find and eliminate defects, they reduce waste, and they are always looking for ways to improve. More importantly, they develop the structure, discipline, and ownership needed as a foundation for a Lean Manufacturing journey.

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Lean Quote: Disney on Leadership

On Fridays I will post a Lean related Quote. Throughout our lifetimes many people touch our lives and leave us with words of wisdom. These can both be a source of new learning and also a point to pause and reflect upon lessons we have learned. Within Lean active learning is an important aspect on this journey because without learning we can not improve.

I am headed on vacation with my family to one of the greatest places for kids of all ages.  I will have several guest bloggers for the next week.  In the mean time I thought it would appropriate to look at a quote from the creator of Disney World.

“Of all the things I've done, the most vital is coordinating the talents of those who work for us and pointing them toward a certain goal.” - Walt Disney

Lee Cockerell, a former Executive Vice President of Resort Operations for the Walt Disney Company, shared his insights from his incredible 16 years of front-line experience living the Disney principle.  He defined 12 strategies that encompass great leaders:

#1 Foster An Inclusive Environment!
#2 Design Your Organization Structure For Success… “Break the Mold!”
#3 Make Sure You Have The Right People In The Right Roles!
#4 Ensure That Cast Members Are Knowledgeable About Their Roles!
#5 Make Dramatic Leaps In Guest Service!
#6 Implement Effective, Structured Processes For Getting Work Done!
#7 Explore, Probe, And Know What Is Going On In Your Organization… And Act Upon The Information!
#8 Actively Observe And React To The Performance Of Your Direct Reports - Take Time For Recognition, Coaching, And Counseling!
#9 Expand And Act Upon Knowledge And Experience Of The Best Service Available Anywhere!
#10 Partner Effectively And Successfully With Staff And Other Cross-functional Partners!
#11 Demonstrate A Passionate, Professional Commitment To Your Role!!!
#12 Understand And Demonstrate Mastery Of Business Fundamentals!

These strategies were further elaborated on in two previous posts (part 1 and part 2).

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Guest Post: Missing Element of Change = Bad Formula

Mark Hamel, author of Kaizen Event Fieldbook and blogger at Gemba Tales, recently extended an offer for me to guest post on his site.  I took the opportunity to talk about what is needed for change in a Lean environment.

For many people change means hard work, risk, and the need to learn new ways for unproven benefits. Change is one of the most difficult things for humans to readily accept. Charles Darwin said "It is not the strongest species that survive, nor the most intelligent, but the ones who are most responsive to change" which holds true for culture change.

Fortunately, there is a formula to make the change successful....

To continue reading this post and to find out what happens when you don't follow this formula head to Mark's blog Gemba Tales.

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Strategic Listening

According to Tom, "the single most significant strategic strength that an organization can have is not a good strategic plan, but a commitment to strategic listening on the part of every member of the organization: strategic listening to frontline employees, strategic listening to vendors, to customers."

Tom has created a great interlude about why strategic listening is necessary but what does this mean and how do we listen in this way.

The following information is adapted from: ©Chris Witt, all rights reserved. www.wittcom.com

Communication occurs on one to as many as four different levels at any given time:

    1. Facts
    2. Meaning
    3. Feelings
    4. Intention

For example, "The house is burning" is a simple, straight-forward statement.  But those four words — depending on how they are said — may mean:

   · "A residential structure is being consumed by flames." (Facts)
   · "The house we're in is on fire." (Meaning)
   · "Ahhhh!!!!" (Feelings)
   · "Run for your life." (Intention)

Maybe we are not listening but perhaps we don't understand how to listen so we hear the complete communication at all levels.  Strategic listening allows you to hear the various messages people are communicating. 

Level 1 The Facts

People want to:           Convey information.
Our task is to:             Listen for details and clarify.
We need to ask:          "Who? What? Where? When? Why?
                                    How?"
Our goal is to:             Picture the situation as the person is
                                    describing it.

Level 2 Meaning
People want to:           Make themselves understood.
Our task is to:             Listen for the big picture; summarize and
                                    paraphrase.
We need to ask:          "Am I understanding you correctly?"
                                    "Is this what you're getting at?"
Our goal is to:             Understand what the person means —
                                    and make the other  person feel
                                    understood.

Level 3 Feelings
People want to:           Connect on an emotional level.
Our task is to:             Listen with empathy; pay attention to
                                    body language and tone of voice.
We need to ask:          "How does this make you feel?"
                                    "It sounds to me like you're feeling..."
Our goal is to:             Recognize how the person is feeling —
                                    and make the other person feel
                                    connected.

Level 4 Intention
People want to:           Get their needs met.
Our task is to:             Listen for wants and needs; focus on
                                    solutions, action steps, and outcomes.
We need to ask:          "What do you want to have happen?"
                                    "What would help you in this situation?"
                                    "What can you/we do about it?"
Our goal is to:             Know what the person wants to achieve.

By understanding what people want to say, what we are to do, and what follow-up questions to ask we can accomplish the goal of hearing the complete message.  Whether you are a team leader or a team member listening is a significant part of your role.  Don't be an eighteen-second manager.  Take the time to listen strategically to employees, vendors, and customers.

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Book Review: On the Mend

While I am not a Lean Healthcare professional per say I am a Lean professional that has worked in various aspects of healthcare.  My experience varies from the patient floor, to the ER and OR, to long term care, to psychiatric ward and a few things in between.  Most of my family are healthcare professionals of some kind and I have been on both sides of care.  So when I had the opportunity to review On the Mend I jumped on it.

On the Mend, authored John Toussaint, MD and Roger A Gerard, PhD, is about the seven year Lean healthcare journey of the author's medical system Thedacare.  After some false starts with trying to improve clinical performance they went outside healthcare for an improvement strategy.  They studied the manufacturing industry and found Lean.  The Lean principles they learned had to be adapted to healthcare.

The first part of the book is about defining the principles that make up the lean healthcare process.  In summary they are:

The principles are presented with real life medical examples from the authors' Lean journey.  This creates a compelling reason to adapt these principles.   For instance, they relate the loss of time in healthcare to the loss of muscle, loss of brain, or even loss of life.

Focus on patients and design care around them.

Identify value for patient and get rid of everything else (waste).

Minimize time to treatment and through its course.

Continuous improvement of work practices every day in every area.

The second half of the book focuses on people aspect of Lean healthcare.  John and Roger introduce the leadership skills needed in a lean environment, how to engage Doctors in the process, how to create the problem solver culture, and how to develop future lean healthcare leaders.  The examples in this section are more personal in nature as you might expect. I particularly liked Roger's "communities of practice" where he describes the five stages of change: initiation, reality, resistance, compromise, and integration.

The book ends with a nine step action plan for starting lean initiatives in healthcare.  Based on the authors experience they recommend:

1. Identify the crisis.  What is the platform for change?
2. Create a Lean promotion office.  Critical for planning and managing change.
3. Find change agents.  They will help lean take root in your organization.
4. Map your value streams.  Understand the true patient experience.
5. Engage senior leaders early in strategy deployment.  Improvements must be focused on what is important.
6. Acquire and disperse knowledge broadly.  Learning and applying knowledge is necessary for everyone.
7. Teach a man to fish (or, become a mentor).   You need to create the leaders you want.
8. Involve suppliers in Lean.  Invite them to join in improvements and develop partnerships.
9. Restructure your organization into product families.  Design value from patients' perspective.

They conclude with this advice: Don't let anything stop you.  Trust the improvement process.

The real-life examples of patients' experiences with the Lean system make the book particularly compelling.  The book has plan that can be used to guide other healthcare organizations to sustainable improvement. They further prove this can be done without compromising the patient care; on the contrary it is improved.

The book is short, non-technical, and can easily be read in one day.  However, due to the subtle attention to detail you will find yourself re-reading it to truly get the most out of it. 

I definitely recommend this book to healthcare professionals and those practitioners associated with either the quality or upper management functions.

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