Sunday, February 9, 2014

The Waffle House of Cards

Have you been to a Waffle House?  For any of my Southern brethren, I already know the answer is an emphatic "heck yeah!"  For those of you that haven't, go ahead and grab $10 and get there right away.  It doesn't matter if it's 2am Saturday night and you're leaving the bar, or noon on Sunday and leaving church; the Waffle House will treat you right.  And ignore those hateful monikers i.e. the "Awful House" or the "Poor Man's IHOP."  What does Vince Vaughn have to say about that?

Okay, I promise this isn't some ridiculous paean to the Waffle House.  No, it's not about how they produce tasty food, incredibly fast, at dirt cheap prices (they do).  No, I won't be celebrating how these dingy, cramped, greasy joints with skeleton staffs have somehow managed to satisfy the masses for decades (they have).  Don't believe me?  Well, any company that can claim to have served 1.8 BILLION hashbrown orders is doing something right.  For real.

But alas, that's not what this post is about.  In fact, I'm going to recount an imperfect experience I recently had at the Waffle House.  This overdone and excessive analysis is being done in an attempt to draw parallels with my own work experience and to learn from the analogy.  Let this trivial pursuit commence.

My Waffle House Experience...

So, I recently went there for a late Saturday morning breakfast with my wife.  It happened to be really busy when we arrived and there was a wait for a table, but we were in no big hurry so we decided to wait.  We actually got a table after only a few minutes, but we could tell the restaurant was super busy and our waitress, Tish, seemed to be the busiest waitress of all.  Several fairly large groups had been sat in her section at the same time, along with my wife and me, so she was slammed.  Again, we were in no big hurry so even though we waited several minutes without even being acknowledged by Tish, we never felt the need to do the whole "excuse me, miss, can I get a coffee" thing.

But then an interesting thing happened.  A different waitress, Sandy, saw that Tish was slammed and came over and asked if she could get us something while we waited.  My wife ordered a coffee.  While she was ordering it, my wife had been inadvertently pointing to the meal she wanted to order on the menu.  The waitress saw this and asked my wife if that's what she wanted to eat.  My wife said yes, even though she had not intended to place her food order yet.  I was observing, thinking that we should order only coffee from Sandy and wait for our waitress to take our full order.  But I went along with it and ordered my meal as well.  Then I sat back and waited to see if my hypothesis would prove to be valid.


Yes, I made a prediction.  You see, these types of scenarios pop up everyday at work.  In a hospital, just like any other workplace, we are always dealing with issues:  errors, delays, miscommunication, dissatisfied customers, etc.  If somebody spots the issue, they'll usually respond.  On a process improvement project, for example, a team member may get the impression that the project is is not making progress, and in response she might lobby the project's executive champion to intervene.  This act may be totally well-intentioned, yet still cause unintended consequences.

For example, the project facilitator might be intentionally reigning in/throttling progress during the early stages when we're analyzing the current-state, so as to prevent jumping to the wrong solutions (a tendency with clinicians).  If somebody like an executive champion intervenes without understanding this rationale it can cause us to proceed too quickly, select the wrong solutions, and end up having to go back to the drawing board.  This sort of thing happens all the time, but an experienced facilitator can see it coming from a mile away and preempt the situation through good communication, consensus-building, etc.

Back to the Waffle House Story...

Similarly, at the Waffle House, I could see an an unintended consequence coming from a mile away.  When we proceeded with ordering our whole meal with Sandy instead of waiting for our waitress, I predicted that we'd wait forever to get our coffees.  That was my hypothesis anyway.

My hypothesis was valid.  Sandy, who initially was just going to grab our coffees real quick, ended up handing our full order off to our waitress and completely forgot about our beverages.  Then, after the order hand-off, our waitress had to go back to Sandy twice to get missing information about our order.  Next, our waitress immediately placed our order with the cook, but she never thought to bring us our coffee.  So, yep, we did wait forever to get our coffees.


So, let's analyze some of the behaviors we saw.  First, the positive behaviors:
  1. Sandy wanted to help us (good customer focus)
  2. Sandy wanted to help our waitress (good team-oriented culture)
  3. There was a quick hand-off of the order from Sandy to our waitress (good sense of urgency)
  4. Our waitress quickly placed our order (good sense of urgency)
All those are great behaviors that we'd want in any organization.  But there were several other behaviors that had unintended consequences:
  1. Sandy, thinking she was just taking our beverage order, was just scribbling it on a napkin instead of using the standardized order template they normally use.  This resulted in errors/missing information that Tish had to go get from Sandy later.
  2. Sandy, after handing-off our order to Tish, forgot to get our coffees which was the whole reason she approached us in the first place.  This put our coffee order in limbo, with no clear owner.
  3. Tish didn't get our coffees either as she was focused on placing our food order, probably thinking we were starving because of the fact that we had hurriedly placed our order with the nearest waitress, Sandy.
As you can see, the intentions were all good but the outcomes were not.  This was predictable to me, just because of how many times I've made these mistakes on projects at work.  It all boils down to the fact that the Waffle House system of food delivery, while incredibly effective and efficient normally, is actually a house of cards (pun intended).  The whole model is predicated upon these waitresses performing the same routines over and over again.  When we "intervened" and allowed Sandy to take our full food order, these routines were circumvented and predictable unintended consequences resulted.

Back to the Waffle House Story once again...

So, our coffee order was in limbo and we waited and waited.  Eventually, we asked a third employee if he could bring us coffee, which he did promptly.  But right around the time he was delivering our coffee, Tish also brought us coffee.  So, we went from no coffee for 15 minutes to a total of 4 full cups of coffee at our table in a matter of a minute or so.

You see, Tish had been taken out of her normal routine.  She normally would have been aware of our coffee situation and responded accordingly, but because she had not even spoken to us yet she was acting on second-hand, outdated information.  This resulted in duplication of effort...and cold coffee.

This sort of thing also happens quite often at work.  We see a problem pop up on our project and want to resolve it as soon as possible, often unaware that somebody else is also working on a resolution.  Predictably, this results in duplication of effort...and probably cold coffee somehow.


So what can we do to prevent all this waste?  At the Waffle House and at work, we want people's positive behaviors (customer focus, teamwork, urgency, etc.) to result in positive outcomes.  When they don't, we need to address the system.  Here are some potential approaches to addressing the system:
  1. We can blame each other and tell the employees to do better.  This is obviuosly a really bad option, but unfortunately this continues to be the one most commonly selected.  STOP DOING THIS!
  2. We can work on the root causes of the issues.  In the case of the Waffle House, we would probably want to tackle the workload imbalance and inefficient processes causing our waitress to be so busy that Sandy needed to intervene.  Addressing root causes is always a great option, but this approach can take time and process improvement skill, which are not always abundant in organizations (more on this later).
  3. We can facilitate the process.  By this, I mean having somebody in-place whose role is to coordinate between the involved parties to prevent the unintended consequences.  In healthcare, for example, we have patient navigators, patient advocates, care coordinators, project managers, etc. whose primary function is to prevent issues from arising due to poor coordination.  In the case of the Waffle House, I could have prevented the predictable sequence of events from occurring by not allowing Sandy to take our full order, but that would have put me in the position of facilitator when I should be in the position of paying customer.  Paying customers shouldn't have to facilitate.  But with the way the Waffle House is staffed, having somebody assigned to this role is not feasible.  That makes option #3 impractical for their business model.
So, what to do?  For a system like the Waffle House that is essentially a house of cards relying heavily on repeatable, consistent routines to maintain order, it's absolutely critical that anything that takes waitresses out of their normal routines be eliminated.  This requires getting to the root causes of the issues, so option #2 is the right approach.  This is also the right approach for healthcare, even though we may sometimes have the resources to pursue option #3 as well.  But option #3 is a band-aid, not a cure.  Option #2 is the sustainable strategy.

Executing the Right Countermeasure...

So, how do we go about pursuing option #2?  Well, there's no one-size-fits-all approach to driving continuous improvement, and it can take a lot of patience and skill to execute.  Most organizations have severe shortages of patience and skill, so it's critical that we tackle both deficiencies in the most effective and efficient way possible.  We have to be better at making things better.  Here are some strategies to do that (again, there is no one-size-fits-all approach):
  1. Don't delegate process improvement work to PI specialists.  Operational managers should lead improvement efforts.  This is the only way they will get better at it.
  2. But, make sure operational managers are properly supported and coached as they lead improvement efforts.  Owning a process improvement project can be challenging and even intimidating for newcomers.  They need to be guided so they can mess up without sinking the project.
  3. Utilize PI specialists prudently to occasionally lead complex improvement efforts.  These projects can be great opportunities to demonstrate these advanced techniques to operational managers, but we don't want the specialists to become a crutch.
  4. Bend the learning curve.  Give your people a straightforward technique, such as the Plan-Do-Study-Act (PDSA) cycle and let them get started on improvement work quickly.  Batching up a bunch of improvement tools into a complex technique such as DMAIC and delivering via months of formal training delays the "learning by doing" that results in the most profound insights and behavioral changes.
  5. Treat the building of improvement capacity in your organization as a PI project in and of itself.  Measure the # of improvement practitioners, # of coaches, # of PDSA cycles, etc.  Not just to feel warm & fuzzy and report some nebulous employee engagement success to the Board, but to actually test your hypothesis of what will increase the improvement bandwidth of your organization.  It's also a great way for senior leaders to practice what they preach.
That last recommendation is critical, because the previous four may or may not work in your organization.  We have to test our hypotheses.  If you do so and stick to it, you will increase the improvement capacity of your organization, will allow you to begin addressing the root causes of problems so that you don't have to rely on band-aids (navigators, coordinators, customer service advocates, etc.).

One Last Word on the Waffle House Story...

I opened with praise for the Waffle House, and I stick by my story.  They do a great job with what they have to work with the majority of the time.  They can get better too....if they address root causes of waitress workload imbalance, inefficient processes, etc.  Ideally, the waitresses would themselves have the ability to use PDSA to test new routines, always looking to get better.

Sound unlikely that a Waffle House waitress would ever get involved like that?  Well, they used to say the same about nurses, physicians, Kentucky auto workers, Latin-American laborers, and just about anybody else that wasn't Japanese.  But we've shown over and over again that just about everybody is capable of being engaged in meaningful improvement work.  It just takes resolve and endurance.  Oh, and coffee.  Lots of coffee!