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Lean Transformation: Have You Hit the “Lean Plateau?”

by Craig Stritar
July 7, 2016

Lean Transformation: Have You Hit the “Lean Plateau?”

by Craig Stritar
July 7, 2016 | Comments (4)

"In the early days we joked that we did a lot of “drive by Kaizen,” which was actually detrimental to our transformation." – John Toussaint

About a year ago at Meritus Health, everyone knew it: our lean journey was stalled. We had been “doing lean” for nearly five years in the form of five-day kaizen events and A3 projects and had hit the lean plateau. However, over the past year, we have learned an approach to this common problem that many serious lean teams encounter, a way that has enabled us to make progress on our lean journey.

ThedaCare, an exemplary lean organization we benchmarked in pursuit of our quality goals, began its improvement journey long before we did, and helped us think through a productive approach after we recognized our improvement efforts had stalled. Like ThedaCare, we started to focus on what we wanted our daily management system to “look like” and thought it best to start out with a model line unit: an area of the organization where experiments and failures can occur in a contained environment without global impact. For the development of our model line at Meritus Health, we can thank Tammy Mariotti and her team on “5 South,” one of our medical-surgical floors. 

A few of us had been exposed to Rother’s Toyota Kata and agreed with the premise of changing behavior through a focused repetition of the desired pattern. Furthermore, the script ending with “when can we go and see what we have learned” resonated with Tammy’s willing, if still skeptical, team. They were already having daily huddles, so we asked: “What if we incorporate our daily improvement routine into the huddle?”

First key point: Senior leaders are not responsible for solving every problem but need to know “what problem solving looks like” at each tier of the organization.

After a few (admittedly painful) months of experimenting on our model line unit, the nurses began to make progress on stalled initiatives. Even the body language during the huddles changed, from crossed arms to a universally engaged and smiling team. What’s more, the improvement method was now more tangible to senior leadership. Our CEO, Joe Ross, then led an advance group to a two-day Toyota Kata seminar at the University of Michigan. Upon their return, we immediately incorporated kata into our two-day A3 course, giving the learners a method to transform their units using this daily improvement methodology, and … nothing happened!

Second key point: Changing daily behaviors requires daily follow up!

After a few months, we discovered Mark Rosenthal, my first kata coach, was available to to guide us through our “kata kickoff,” consisting of 25 different units in a 20 hour course.  At the end of the week, each manager (learner) signed up for a 30-minute daily block of time with our Operations Improvement department managers and their respective directors. Since the learners signed up for whatever time was available on the sign-up sheet, we learned the kata coaches and directors were “ping-ponging” all over the hospital. Currently, our next step is to schedule a two-hour block of time in the afternoons for directors and coaches from the improvement office to conduct their daily “kata walks.”

Final key point: Previous exposure to lean tools had little to no correlation as to the velocity of departmental transformation to the daily management system.

Aside from this final exciting revelation that a daily focus on developing the problem-solving skills of front-line leaders can allow an organization to skip the lean plateau, we had a fantastic validation from an outside source. Fewer than six months after the “kata kickoff,” we were greeted with our Joint Commission surveyors (a week-long accreditation survey generally occurring once every three years). The survey went so smoothly for senior leaders that a few actually described themselves as “relaxed” (unheard of during previous surveys). Furthermore, the surveyors were surprised to discover managers could not only be found, but were seeking them out to show off their latest improvement story boards!

In closing, I will follow the kata pattern in making a prediction: those of you who began the journey with little to no exposure to lean tools will see similar results and skip the lean plateau. When can we go see what we have learned? As soon as you share your experiences with the community in the comments below!

The views expressed in this post do not necessarily represent the views or policies of The Lean Enterprise Institute.
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Amber Ansari July 07, 2016
3 People AGREE with this comment

Craig,

Great insights to lean journey within an organization.

Your first key point resonates with my experience.

For the senior management to understand what problem solving "looks like", they have to become actively involved. In my expereince, most executive teams think since they have hired a consultant, or sent their managers to a lean training, everything should be fixed now. Training workshops and consultants do not eliminate the need for active participation from the executive desk. I advise clients to at least join in for 15 minutes during each session to be at least familair with "problem solving terminology". Recently, two executives joined us over lunch in a hospital's cafeteria. The team was using terms like WIP, lead time, process cycle efficiency, TAKT time etc. Not knowing what any of these mean created a very unconfortable scenario for these senior managers. Like Woody Allen said "showing up is half the battle".  

 



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Craig Stritar July 08, 2016

Thank you, Amber.

The obstacle of lean jargon getting in the way reminds me of Sami Bahri’s exclamation during “The Lean Dentist” learning session at last month's Lean Healthcare Transformation Summit: “don’t call it lean!”

Most organizations willing to spend money on a lean office support the idea of process improvement enough to allow the development of a model line. Our most recent experience is by no means “the answer” for every situation, but we found it was certainly easier to generate curiosity amongst executives when they witnessed a daily problem solving routine spreading throughout the organization until there was no avoiding it, than it was to insist they sit through presentations of lean tools and terminology.

Successfully engaging senior leaders after they have delegated the task of cultural transformation to the KPO or middle management could be the topic of a conference in and of itself. Great feedback!



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Mike Rother July 07, 2016
1 Person AGREES with this comment

Hi Craig,

It's a pleasure to read about your daily management approach changing body language to engaged. That's the IK/CK spirit for sure, with the Starter Kata routines helping to nudge an organization - through actual practice on real things - onto a path of discovery and adaptation, leading to its own style.

I've often noticed that the subtle changes in our mindset -- toward more scientific thinking and a greater ease with uncertainty -- happen at different times for different persons, sort of like a penny dropping. We discover ourselves talking about things in a different way, becoming less willing to jump to conclusions, and being excited about testing ideas. When I hear Kata practitioners referring to "the threshold of knowledge," and saying things like, "There may be an even better idea behind this one," I know we are doing a better job of managing and utilizing our astonishing human capabilities.

 



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Craig Stritar July 09, 2016

Thank you, Mike, for taking the time to lend your observations on our journey and for providing a “starter” format that laid the foundation to unleash the creative capacity of our team!

One of our biggest surprises was how quickly the language changed from “becoming less willing to jump to conclusions” to “testing ideas.” Less than a year since our first model line, meetings have largely gravitated away from deciding and implementing toward steering and aligning. The first “but this won’t work because ____,” is usually followed by “let’s do a kata.” The challenge is assigned to one of the affected departments. Once met, the new current best practice taught to the rest of the organization. Recently, best practices requiring a change in behavior are spread using an “implementation kata,” addressing obstacles unique to the respective departments along the way.



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