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!