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In Lean We Trust; Especially in a Crisis 

3/17/2020
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In Lean We Trust; Especially in a Crisis 

When phone calls and cancellations started coming inthe COVID-19 crisis became more than a news report about somewhere else. We knew we had our own situation to deal with.

Undoubtedly, you’re responding to this unprecedented situation tooI’d like to share with you how the LEI team is tackling our biggest challenge – the cancellation and subsequent transformation of the Lean SummitAt a time of social distancing, it’s the only gemba from which I can report. I hope it will be a useful reminder of why we practice lean thinking 

A Problem Interrupts the Work 

The Lean Enterprise Institute, 501(c)(3) nonprofit organization, is dedicated to research and the teaching of lean principles and practicesFor more than 20 years, LEI has advanced (a) our collective understanding and (b) its use in making Work – and our lives – better. The annual Lean Summit is our largest activity. More than 500 members of the Lean Community gather together in one place for plenaries, breakout sessions, workshops, and more.  

Everything LEI does ties into the Summit. Organizations undergoing lean transformations presentpractitioners with situational knowhow run breakout sessions, and thought leaders with deep insights conduct workshops and sell booksMost of all, lean practitioners interact by sharing stories, passing on learningsexploring questions, and relating to one another’s challenges. All of it adds up to a rejuvenating experience where people get inspiration and encouragement to keep tryingThe Lean March continues. 

So, when the Lean Summit was questioned, it was like twisting an ankle during a routine yet intense morning run. “Just walk it off!” you think to yourself. “Keep going!” But then the swelling starts. We had to respond.   

A3 Thinking 

We did what lean thinkers do. Following those calls and cancellations, the team hunkered down, spending the next few days working through an A3We gathered the facts. Did the research. And began planning.  

We identified three possible countermeasures: 

  1. Reschedule the Lean Summit 
  2. Hold it with fewer attendees and enable remote participation 
  3. Transform it into a virtual experience that takes place 100% online 

At first, all three seemed viable. However, as we analyzed the merits and demerits of eachwe learned more about the situation surrounding the coronavirus. The safety risk of gathering people together came to dominate all other considerations. Increasingly, we knew we had to cancel the in-person event. It turned out we had no choice. (One “countermeasure” we didn’t consider was to cancel outright. That wasn’t consistent with our mission or lean thinking in general.) 

What excited us the most was how we might transform the Summitstill bringing people together for learning, albeit virtually. To figure out what a virtual experience should be, we talked to attendees and speakers alike, past and present.  

Responding to the Voice of the Customer 

We learned that people who attend the Lean Summit value four things: 

  1. Getting away from the office and ideally, visiting somewhere nice 
  2. Hearing stories of lean transformation for inspiration and encouragement 
  3. Obtaining new knowledge that can improve their own organizations and Work 
  4. Networking with like-minded individuals who have similar challenges 

The effort humbled me. I have more clarity than ever on what attendees valueFor that I am grateful. 

We’ve discovered that the overall value propositiocan absolutely be met online! The more we learn about the capabilities of online platforms like Zoom and Slack, the more we believe that the Virtual Lean Summit Experience (VLX) can be as good if not better than the in-person SummitTo learn why we believe that, you can visit lean.orgYou can also watch a webinar with LEI Team Leader Matt Savas and describing the VLX at a high level. And soon, you’ll be able to listen to a WLEI podcast with LEI Instructional Designer Masia Goodman who, having studied online education for several yearswill talk in depth about the exciting possibilities for learning with the VLX. Of course, an online experience cannot transport you to sunny California. I’m sorry about that too. 

Reflections 

Thankfully, lean thinking gives us a powerful way to address problems of any size. It focuses us on what matters: purpose (the value to create), process (even when, or I should say especially whenit must change), and people (be thankful for your team!). It guides us through figuring things outand continuously improving, with structured cycles of Plan-Do-Check-Act. 

Just like the team at LEIyou’re facing this crisis too. Every one of you. Worldwide. The myriad problems caused by the coronavirus are testing our capabilityAll of us are doing our best to meet the challenge. At LEI, wintend to keep sharing our story with you. Not because it’ll be perfect. Not because our thinking will be complete, or all our judgments will be good. They won’t be, not always anyway. But because we’ll use lean thinking and learn a helluva lot along the way.  

Josh

Josh Howell 
President, Lean Enterprise Institute 
BostonMassachusetts 

P.S. Please be in touch (virtually, of course) and share your stories too. We’re listening and will do what we can to helpAnd please, please, pleasebe safe.  

1 Comments | Post a Comment
Erica Lorie March 17, 2020

I want to thank Josh Howell and LEI for this insightful post today.  I found it especially inspiring and wanted to thank him for his valuable perspective—and add to it.

As lean practitioners, we have always been taught to “trust the process,” and this current worldwide pandemic is definitely proving that to be true.

The Lean Health Care Practice (LHCP) of Moss Adams is a team of lean health care consultants that uses lean methodologies and thinking to help support our health care clients and apply to our own internal team. The key themes in Josh’s blog—rapidly changing what we normally do, using A3 thinking to address the problem, responding to the voice of our customers and applying PDCA thinking—resonates with all of us.

Here is what we are finding and learning around the clients who are doing the incredibly challenging and heroic work of trying to keep our communities safe and healthy.

  • “What we normally do in health care” is changing minute by minute. It is requiring our clients to be aware of and on top of the ever-changing recommendations coming from CDC and WHO. Applying the lean methodology of scanning the environment and using the information to guide what are our highest priorities helps organizations focus on what they need to do.
    • It is essential for hospitals to put in place a robust hospital incident command system (HICS) so that an informed group of decision makers can quickly take information and make decisions.
    • The components include team huddles throughout the day, available real-time data to know the situation in the hospital and a capability to rapidly make decisions.
    • What is essential is to also have an established and organized system to disseminate the ever-changing information throughout the organization.
    • Observation: We are seeing hospitals establish these systems; however, there is a big gap in the non-hospital-based health care systems that do not already have an incident command/decision making structure.
  • Robust daily management systems are key methods to link the incident command/decision making team and the front line workers.
    • Visibility boards and daily (or multiple times a day) huddles allow the teams to know where they stand on essential metrics (e.g., number of patients screened, number of available masks in store room)—the key need-to-know information coming down from the organization’s decision makers.
    • These methods also establish a forum for staff to identify problems, rapidly problem solve, and/or escalate information up to decision makers when they can’t solve problems.
    • Anecdotal example: A good friend who is a medical-surgical nurse told me that they were being asked by their manager to share safety googles because supplies were running low. When she escalated this infection control risk through the management system, it turned out that it was a miscommunication of information. Once aware of the miscommunication, the leaders were able to strategize, develop a specific PPE workflow, and disseminate to all nursing units within one hour. Without these structures in place, the nurses would have continued to feel the hospital did not care about their safety and would have likely developed work-arounds to keep themselves safe (such as hoarding supplies).
  • Use A3 thinking: As recommendations and information rapidly change, health care organizations must be able to do the following:
    • use first-hand evidence from their gembas (where the actual work is done) to experience and then understand the problem in front of them at that moment (e.g., running out of supplies, staff calling in sick)
    • assess root causes
    • propose possible counter measures and determine next steps.
    • Observation: We see most teams planning for each shift/day. However, they need to have a long view and propose counter measures that will get the root cause of the problem.
    • Recommendation: Apply the same thinking proactively to think about how you will need to respond a week from now when the number of cases may have likely double; then have the foresight to plan a month from now, three-to-six months from now, etc.
  • Respond to the voice of the customer: What are patients saying they want/need—and how do you balance that the with voice of your employees? I have spoken to many health care leaders, and when I ask what their biggest worry is, it’s very often: How can we help our team not feel so anxious? In this new climate, hospital employees don’t have the option to stay home and work remotely.
    • Using lean methodology, we can create processes that ensure quality care while, at the same time, securing safety for patients and employees. This includes processes such as triage, waiting room flow and clinical decision making workflows as well as supply chain and supply processes.
    • Anecdotal example: We have witnessed a number of innovative organizations increasing capability for virtual health care and drive by services. Yesterday I spoke to a director of Physical Therapy who was experimenting with offering virtual check-ins and progression of home exercise programs for patients following surgery.
  • Apply PDCA thinking: PDCA thinking challenges us to use rapid experimentation to test proposed counter measures and then check on the impact and act/adjust as needed. This agility of thinking is essential in this ever-changing environment.
    • Anecdotal example: A registration team member in a medical clinic identified that the plan to space waiting room chairs six feet apart did not address the issue with the line of patients waiting to complete check in at the kiosk. This resulted in an experiment to tape six-foot space markers on the floor and put sanitizer wipes at the kiosk for each patient to use prior to touching. The clinic director committed to revisiting the waiting room every hour to assess how the process was working.

At the earliest signs of the outbreak, our LHCP team began offering our clients our help and support in ways specific to a public health crisis. Most of us were part of and witnessed the incredible benefit of using lean methodology during the Ebola outbreak. We knew that if we trusted the process, we could help hospitals and health care delivery systems improve preparedness for the COVID-19 pandemic. We responded to the voice of our customers by helping them establish processes and systems to respond to the ever-changing health care environment.

Our customers were not the only ones to adapt quickly: We too have had to change what we normally do and apply lean thinking to assess other counter measures.

  • As of today we have stopped all air travel to our clients and are re-structuring our team to accommodate remote lean coaching.
  • We are currently experimenting with ways we can continue to support the needs of health care organizations across the country virtually.
  • We have established our own virtual COVID-19 obeya for:
    • tracking metrics and providing visibility and transparency for our entire team
    • daily team huddles 3x/day organized for cascaded information up and down through the organization
    • established project teams with identified team leads
    • created communication structures for dissemination of information and escalation of critical information to our leadership team

We have much to learn. What we do know without question is that we feel so much more prepared having this structure. We must be intentional to ensure ongoing reflection in order to check-act on what we are doing today. And we are certain that by working cohesively together as a team and helping health care apply lean principles, we can have an impact on helping save lives.

Stay healthy!

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