Notes from Presentation on Clinical and Office Kaizen
by Marypat Cooper
© September 2009
We begin the presentation by polling the audience about their "Burning Questions." This gives us all a chance to understand something about what the attendees want to know about.
Most frequently asked questions are:
How can you apply what is basically a manufacturing technique to the knowledge industries of information, finance and clinical care?
How do you close the gap between GAAP and performance metrics?
What training would you recommend?
What do you do about dogged resistance to change?
What are the worst mistakes management makes during lean transformation?
How do you sustain transformation?
How would kaizen apply to the national debate on healthcare?
The list of all the lean tools as illustrated by Bill Moffitt’s summation of a House Without Waste can be overwhelming because it lists over 40 concepts, each of which could take up a whole college course to explain. Further, some particular aspects in office and clinical settings can make it even more difficult to apply. Folks that work in office and clinical settings have specialized professions which lead them to outsource process improvement and to depend on unreal numbers.
Process output is the source of financial results, but in driving for financial results, especially in office or clinical activities, we overlook the processes that create satisfaction and wealth. In his list of “Deadly Diseases that Stand in the Way of the Transformation,” Dr. W. Edwards Deming identified that the push for profit distracts leaders from the kind of process improvement they need to make to survive. If we ask an organization to show us how they are doing, how often are we shown numeric reports that make perfect sense? How complicated is the path between the output of the value adding work areas towards financial statements. Performance output hardly exists beyond the mind of the immediate supervisor.
The way towards lean transformation comes from a direct
and holistic look at the system as it provides value in measureable terms.
Kaizen and Lean must be taken on as
a whole, not in part, and not through someone else’s work. Yet,
attention spans being what they are, I find it more
effective to ask leaders to commit to a specific set of social and technical
ground rules than to try and explain the whole of Lean Transformation.
If we can commit to this "short list"
for 6 weeks on a chosen topic for improvement, we can get a lot done instead of debating the best
approach. We work our way together through system analysis and process
improvement, learning as we go about the finer points of lean
transformation.
TECHNICAL REQUIREMENTS/p>
The technical short list is to:
Maintain Process Focus
Discern Between Work and Waste
Identify the Customer Requirements in Terms of Time
Promote Pull Systems to Trigger Work Flow
Install a Value Delivery System in the
To Install Improvements that can be Tracked from the Work Area to Financials
SOCIAL REQUIRMENTS
The social short list is to:
Recognize the Need to Change for the Better
Include all Key Stakeholders from the Start
Show Mutual Respect at All Times
Follow the Kaizen Format for 6 Weeks per Topic
2 to Prepare
1 to Kaizen
3 to Follow Up
The bulk of the presentation then demonstrates through hands on workshop and video examples how these concepts work. We show how to use lean tools to transform office and clinical work flows and how to include everyone in the transformation.
LEAN TOOLS in OFFICE or CLINICAL SETTINGS
Value Stream Maps break down barriers between departments in any setting, whether clinical, office or industrial. If the map is constructed using standard icons (which are briefly introduced during the presentation) through direct observation by a team of interested parties led by a neutral spokesperson, it will track the progress of value adding work towards customer/patient satisfaction:
…Which will lead to questions and ideas about improving the flow:
IIf time permits, we simulate a kaizen following this format:
We briefly show examples of how to organize follow up and future topic selections through Strategy Deployment. And perhaps most importantly, we demonstrate how Standard Work with Visual Controls ensures sustainability./p>
These techniques make up the short list of physical process requirements of transformation. Yet, without including the short list of SOCIAL requirements, we are doomed to fail.
Our short list of social requirements is needed in any kaizen, but perhaps even more so in a clinical or office kaizen. Socially, we must recognize the need to change for the better, include all key stakeholders from the start (especially the ones that don’t agree at the start), show mutual respect at all time and follow the kaizen format for at least 6 weeks.
The presentation concludes with examples of the importance of follow up, highlighting dashboard metrics in use. Then a review of the burning questions brings the presentation to a close.
QUESTIONS IN REVIEW:
Q: How can you apply what is basically a manufacturing technique to the knowledge industries of information, finance and clinical care?
A: It has been demonstrated that lean tools are more than a manufacturing technique, that wasted time and effort occurs in any process, and that lean tools are adept at rooting out and removing such waste.
Q: How do you close the gap between GAAP and performance metrics?
A: In the ROUTINE of studying them both, and making good decisions about discrepancies as they occur.
Q: What training would you recommend?
A: For kaizen, as a practice (wax on wax off) – very little formal training. Perhaps an hour of orientation before the kaizen, but ongoing through every day of kaizen and especially during the leader’s meetings that review the findings of the team.
Q: What do you do about dogged resistance to change?
A: I respect it. It usually comes from the passion people feel about doing what they think is a good job. It also rightfully comes from previous inept attempts to make things better. I find that when we work on the process together, we find ways to make the process better, and that healthy, respected individuals will collaborate and agree on a better way to follow. Kaizen is about improving processes, not people.
Q: What are the worst mistakes management makes during lean transformation?
A: Trying to improve people instead of processes, reacting inappropriately to special or common causes, and failing to keep constant towards the purpose of the organization.
Q: How do you sustain transformation?
A: By keeping constancy of purpose, practicing 21 days of “softball coaching” pruning non-critical issues from the to-do list, attending to output measures,
Q: How would kaizen apply to the national debate on healthcare?
A: Tremendously. Applying the principles of lean thinking to clinical processes would improve the delivery of just what is needed to just where it is needed. Kaizen would not be a critique of individuals within the system, but a way to overhaul the system from the inside out, using the intelligence and experience of the practitioners within the system.
REFERENCES IN ORDER OF USE
Out of the Crisis W. Edwards Deming,
Massachusetts Institute of Technology, 1982, ISBN 0-911379-01-0 (not so
much to read cover-to-cover, but as a touchstone of truths)
Decoding the DNA of the
http://hbswk.hbs.edu/item.ihtml?id=869&t=operations
(visit
to see an article summary and to order the full article)
Learning to Lead at
(visit to order the full
article)
Real Numbers: Management Accounting in a Lean Organization
Orest J. Fiume and Jean E. Cunningham, Managing Times
Press, March 2003, ISBN: 0972809902 (essential)
Toyota Production System: Beyond Large-Scale
Production Taiichi Ohno,
Productivity Press Inc, February 1988, ISBN: 0915299143 (essential)
Gemba Kaizen: A Commonsense, Low-Cost Approach to Management Masaaki Imai, McGraw-Hill, March 1997, ISBN: 0070314462
Lean Thinking: Banish Waste and Create Wealth in Your Corporation, Second Edition James P. Womack and Daniel T. Jones, Free Press, June 2003, ISBN: 0743249275
Learning to See: Value Stream Mapping to Create
Value and Eliminate Muda Mike
Rother and John Shook, Lean Enterprise
Institute, June 2003, ISBN: 0966784308
The Memory Jogger, A
Pocket Guide of Tools for Continuous Improvement, Goal/QPC, 1985,
Who’s Counting Jerry Solomon; WCM Associates,
2003 (a good introduction to lean from an accounting perspective, and a
fun read because it’s a novel!)
The Goal Eliyahu M.
Goldratt and Jeff Cox,
Manufacturing for Survival
The Fiefdom Syndrome Robert J. Herbold, Doubleday, 2004
The
Creating a Lean Culture: Tools To Sustain Lean Conversions David Mann, Productivity Press, May 2005
The Reckoning by David
Halberstam; William Morrow & Co. 1986 (a compelling history of two
automakers, side by side, day by day – after WWII)