Thursday, August 27, 2009

Healthcare - Do Passionate Practitioners Sometimes Slow the Spread of Lean?

Business meeting There is an excellent blog posting on the Lean Blog linking to video clips of an interview with Dr. John Toussaint, the CEO of Thedacare, a healthcare organization gaining notoriety for its successful application Lean. I will not summarize the content here - Mark Graban, who publishes the Lean Blog, has done an excellent job already – you can read his posting and access the video clips here - Thedacare News Coverage & More from Fox News.
However, I thought the first comment after Mark’s post, submitted by Michael Balle, asked an interesting question, “Why isn’t Lean spreading more quickly.” I’m not a Healthcare industry expert, but, for the sake of discussion, let’s assume Lean could be moving more quickly to improve Healthcare as well as other industries.
I recently made a presentation to a small group interested in learning about the application of Lean to Healthcare. The following discussion regarding the perception of Lean making a negative impact on Healthcare may shed some light on the subject.

I see two major concerns about Lean from the Healthcare community:
1. it will have a negative impact on the patient experience
2. it will have a negative impact on service providers by making things worse for the physicians, the nurses, the technicians, and so on … (they understand eventually this comes back around to impact the patient in a negative way)
I think people are seriously and legitimately concerned that Lean will have a negative impact on health care; that it will make it more difficult for the providers to do their job in the best way. They are saying, “Lean might reduce cost but at what expense?”
Audience member question:
You said the concerns are legitimate - I’m not so sure. Aren’t those concerns just “resistance to change”?
I don’t see it that way. I don’t believe healthcare providers have anything against reducing waste and lowering costs; they understand Lean is a way to accomplish those objectives and they know Lean has worked well in other industries. They just see the Healthcare industry as different. They are concerned applying Lean to Healthcare will make some things worse as it makes other things better. They are particularly worried it might make things worse for the patient.
To gain a better understanding, it is important to note how healthcare providers see their industry as different. They see Healthcare as more concerned about the “human experience” than other businesses. …I use the word human in this instance to make sure we don’t miss the fact that there is an important special perspective involved here.
Let me explain further- if you are making a car there is the perspective of the car. In the auto industry, efforts to improve production and quality often take on the perspective of the car and ask, “What is it that leads to the production of the best car?” But a car is not human. A car is a car.
In healthcare the product is a healthy human being, or better quality of life for humans, or affecting a cure for a human disease. The fact that we are talking about human beings makes it different – human beings and inanimate objects are different. If service providers know of Lean mostly as successful in industries dealing with inanimate products and services, and now it is being applied to an industry dealing with human beings – well I can certainly see a legitimate concern.
Audience Member
I understand what you are saying but I am not sure I agree. Making cars isn’t just about cars. People buy cars for a reason - so in the end it’s about what cars do for people – it’s about the impact on people. So there really is no difference.
Excellent point! What that reflects - and you are correct – is your deeper understanding of Lean. You realize producing cars is not just about cars – it’s about transportation; it’s about transportation for people.
Audience Member
…and status and other things.
Right again - and I’m glad you bring it up - cars are about all the other things they do for people as well. Again, I think your points reflect your deeper understanding of Lean. What I want to point out here is that when people from the healthcare industry are first introduced to Lean, it looks pretty obvious to them – working on humans is different than working on cars. And that makes the healthcare industry different. To a healthcare worker being introduced to Lean, the difference is justifiably very important. In fact, I think it is so obviously important, it will likely be pointed out again and again. If a Lean practitioner dismisses this important difference, or communicates a superior attitude by explaining the deeper understanding of Lean, before they recognize the valid concern and acknowledge its importance, they will not win many friends of Lean in the healthcare industry.
Audience Member
I can see what you are saying. It makes sense.

Summarizing A3 Management on Last Minute Notice


A friend asked me to help him prepare for a last minute interview for a management position at a "Lean" company.  He was concerned that he did not know enough about A3 to answer questions about the topic.  I created a summary of A3 to assist him.  I thought others might find my response useful and so I've posted it here.  The summary follows: 
Bruce, (not his real name) 
A3 is being promoted heavily by the Lean Enterprise Institute to emphasize the need to apply more than just the technical tools and methods of Lean but the social/management side of Lean as well.  Thoroughly understanding A3 is a big undertaking – but you have an excellent advantage – you understand many of the components already.  A3 is structured scientific problem solving to:
· meet company goals
· develop/ coach all employees to be better problem solvers
· develop managers to be effective problem solving coaches and to become creators of more managers with the same capability 
Together these goals ensure the organization will continually improve its capability to deploy strategies, meet goals,  respond to changes in the marketplace, and solve performance problems.
The name comes from the paper size (roughly 11 x 17) used by Toyota as the standard for creating and displaying  their A3 reports.
The important thing to understand is, “it’s not about the tool”.  It is about the points above.
It can get complicated or it can be kept simple.  For instance, I have a reference book that lists nine different types of A3’s used by Toyota.  And I have worked with companies using only one type.  In its simpler application, a single A3 form can serve as one stop shopping for learning about a project and how it is going.  During the course of project work, the information on an A3 form may go through the following logical progression:
· At first the A3 describes the problem, goals, objectives  - agreement is established between the project manager and a business or functional leader (the project manager may be a person whose role in the organization is that of an engineer, or a supervisor, or a team lead, to name just a few)
· Next an action plan is developed – those closest to the work help put it together and again agreement is established  among the extended team– this time all of the people who are responsible for the action plan are included in the agreement (this is done to ensure the plan is realistic and doable – people closer to the work are better able to determine how realistic the plan is)
· Actions are taken to carry out the plan and at appropriate intervals the A3 is updated – for example, a department level A3 may be updated every month while a division level A3 may be updated every quarter. 
· In a more complex application of A3, lower levels A3’s are collected to support higher level A3’s.  This is done to verify that the project results are rolling up to successfully meet the goals of a larger program or initiative.  It is typically not a straight mathematical rollup; instead its a loosely coupled to provide for a measured implementation.  Rather than tracking every penny of savings or improvement, the aim is to get the plan done and delivered the goals of the organization.     
The Lean Enterprise Institute has made examples available here
Bruce, you can see A3 it is not very different from methods that I know you have used in the past.  The A3 approach simply places special emphasis on:
· provision of clear communication
· accomplishment of a common understanding and agreement
· top-down and bottom-up planning   - executives say what needs to be done, employees say how it will be done
· an approach that supplies clear evidence of a working plan with a data driven approach  for carrying-out the projects that complete the program or initiative
· visible assurance that managers are actively coaching their subordinates to apply the process at every level of the company, from the executive ranks to the front lines of the business   
Just about anything else I point you too will likely confuse you on such short notice.  Descriptions for A3 thinking are all over the map.  By considering A3 the way I've presented it above you should get  through the interview just fine.
I’ll be around in the morning if you have questions.  Good luck!

Friday, August 21, 2009

Hoshin Kanri Strategy Deployment, Product Development, and Lean Process Improvement Efforts

I came across the video below while doing some research. Mr. Kelley is “the founder and CEO of IDEO Product Development, America's largest independent product design and development firm. In addition to his work at IDEO Product Development, Kelley is a tenured professor at Stanford University in the school's innovative Product Design program.” (taken from his bio)

The approach he describes is by far the most successful way I have found to carry out the design and implementation of Lean process improvements. The video promotes an iterative development method which begins by putting a basic prototype in the hands of users as soon as possible. The iterative tactic represents what I find to be one of the most powerful aspects of the Hoshin Kanri strategy deployment framework. The approach emphasizes learning your way to the best solution by working in partnership with the end users (consumers). Note how he attaches the characteristic of both “speed” and “best” to the method.
If you found the video interesting you will most likely find the posting below helpful:
Does Hoshin Kanri Rely on a Form of Consumer Opinion?
For a more abstract analogy on an executive perspective of the iterative process as applied to a Lean implementation, please read:
Organic Lean, Natural High Performance – A Racing Analogy Explores Executive Perspective
You may also be interested in reviewing the presentation:
An Intro to Organic Lean – A Natural, Resistance-Free Implementation Approach

Wednesday, August 19, 2009

Does Hoshin Kanri Rely on a Form of Consumer Opinion?

thumbs_up_computer20090819 Utilizing the Hoshin Kanri strategy deployment framework to manage a breakthrough initiative often involves a process design/ redesign effort. The framework guides the project in many ways similar to a product development effort. In product development, it can be advantageous to put an early working prototype in the hands of the consumer to find out what works and what doesn’t. The valuable consumer feedback obtained from this kind of exercise is used to modify or change the design to achieve a better fit. The exercise is repeated until the consumers become satisfied and the design becomes stable.

Hoshin Kanri guides strategic initiatives in the same way. An early basic version of the design is put in the hands of the consumers to get their feedback. But who are the consumers? In this case the consumers are those who will be most impacted by the changes required to meet the objectives of the initiative. For example, for a Lean material management/ kanban initiative the consumers might include representatives from the front lines of the operation, operations management groups such as those responsible for scheduling, production and\or or service delivery, inventory management, and distribution. The sales group may also be impacted and in many cases customers or suppliers may need to be included as well.

The team working through the process design/ redesign must recognize the Lean concept of “seeing value through the eyes of the customer (consumer)” as important and work diligently to uncover and incorporate the feedback into the evolving design. When the team recognizes they are receiving the “thumbs up” from consumers of the planned changes all along the value stream, the team has done its job well. The Hoshin Kanri/ strategy deployment framework includes all of the technical elements necessary to make this happen.

Hoshin Kanri and the Quality Management of Systems on the Move

at the meetingHoshin Kanri has been described as the application of quality management principles to change management. And it is true, frequent checks are made to ensure the kinds of breakthrough improvement efforts typically managed by Hoshin Kanri are both proceeding as planned and delivering the expected results. Yet there are certain characteristics which make the quality management of breakthrough improvement different from other applications of quality management. Understanding and handling these differences requires experience, good judgment, objectivity and patience.

To read the full article, click here .