One of the more important lean concepts is “standard work”. Time and time again, I see problem solvers apply interventions based on a solid root cause analysis only to find a lack of improvement at the end of a P/D/S/A cycle. When this happens, one can ask “why?” 5 times if they wish, and hopefully recognize that there is a central root cause that must be addressed first in most every scenario: standard work.
As a wise lean practitioner once noted to me during a visit to the University of Michigan Chelsea Health Center (where I was Medical Director): “Don’t expect any improvement if there is no standard work.” When I heard that, I wrote it on a whiteboard on my office door. It sat there for years as I struggled to truly understand what it meant.
In any setting, if you’re going to use lean principles, the true experts in any given process are those who are closest to the source. If separate groups, with unique personalities, work styles, and work environments are given the same problem to solve, they will come up with different solutions. What may work for one set of people in one setting may be a complete failure in another location. Hence, effective problem solving relies on unique (and variable) solutions. So, here is my conundrum: standard work in one area is important, yet non-standard work in different areas also seems to be a viable and logical outcome of good lean problem solving.
How can organizations develop standard work and still rely and value the creativity and effectiveness of local problem solving which inevitably is tailored to the individual level? It took me a while to come up with a an answer to this question, let alone a simple one. It came from an unexpected source: a lecture at a national meeting on utilizing an electronic health record. I don’t recall the name of the lecturer, and the topic of the lecture is not important. But at the end of the talk, an audience member asked the speaker this question: “What you said is well and good, but how do I get the staff, doctors, and nurses at my hospital to make the types of changes required to have success?”
The speaker gave a brilliant answer. He said, “I assume you are a leader in your organization? Then LEAD. Just LEAD.” The speaker shook his head, as if astonished this wasn’t obvious to everybody already, and moved on to the next question.
In this moment, I found the answer to my conundrum, but I didn’t recognize this until I was at an amusement park with my four daughters. My youngest, age 4, was excited to drive a gasoline powered car around a racetrack. At 4, she could be just like her daddy and drive like he does in rush hour traffic! I let her take the wheel without hesitation (and with a camera on hand to capture the moment of course). I knew that it wouldn’t matter how she maneuvered the vehicle because the road was engineered with a strip of metal that insured that the car would go exactly where it was supposed to without risk of going astray. I realized, my 4 year old was a frontline worker. She could problem solve how to turn the car wherever she wanted and was oblivious to the reality of the systemic limits. The chief engineer laid the path that ultimately had to be followed, albeit in the unique, zig zaggy manner of a 4 year old driver.
If you’re a leader of an organization, you need to lead. You set the track, you engineer the framework and direction, the vision, or (if we want to use lean terms) the high level value stream. Team members are free to vary within that framework. If as a leader, you engineer the systems appropriately, vehicles stay on track with local variation superimposed on a larger framework of standard work.
Now I know: standard work is essential, as is “non-standard” variation. But both only function well if senior leaders have developed a shared vision and framework that can truly support the variation which is the key to any successful, truly living organization.
David Verble & Judy Worth
David Verble & Judy Worth