My Video Webinar with Gemba Academy

A few weeks back I had the honor of collaborating with Mike Rother on a SlideShare titled "Top 10 Toyota Kata Lessons" based on my real-world lessons learned from practicing the Toyota Kata approach for about a year.  Just this past week, I was fortunate enough to share those same lessons learned via a video webinar with Gemba Academy.  Here's the recording (available to the public for 30 days until ~late April 2014):

Gemba Academy webinar:  "Michael Lombard - 10 Lessons from Practicing Toyota Kata"

Delivering this webinar was a challenge for me personally.  Figuring out how to make the slides as eye-catching and minimalist as possible was difficult, as was trying to maintain "eye" contact with the camera while speaking to the slides.  Another great learning experience for me.

Video Version of "My 3 Best Coaching Kata Mistakes"

With encouragement and guidance from Mike Rother, the great lean thinker and author of Toyota Kata, I turned the "My 3 Best Coaching Kata Mistakes" blog post into a voice-over presentation/YouTube video.  It was harder than I expected to produce this little 10-minute video, but I got plenty of lessons learned from it.  Here it is...

My 3 Best Coaching Kata Mistakes

Over the past few weeks I've started capturing my lessons learned from practicing the Toyota Kata approach.  First, I posted my top 10 lessons learned to my blog.  This led to some incredibly helpful feedback from the great Jeff Liker over at the Toyota Way group on LinkedIn.  It also led to the equally great lean thinker, Mike Rother, guiding me to the creation of a SlideShare version of my top 10 lessons.  The latest news is that I will have the opportunity to share what I've learned via a webinar later this month on Gemba Academy.

What's valuable to me about all this activity is that it supercharges my learning. Probably 95% of my Kata skill-building comes from real-world application (learning by doing).  But to capture that last 5% requires some reflection and external feedback, which is why it's great to have a coach or sensei as you move forward on your learning journey.  I ask you, how would Daniel-san have fared in that tournament without Mr. Miyagi?

The Challenge

Unfortunately, many of us will not have access to an experienced sensei that truly understands how to coach the Kata approach.  Most of our in-house PI folks like me (Black Belts, etc.) are great at solving problems, but aren't the ideal Kata coaches for myriad reasons, including but not limited to the following:

• They aren't trained on how to coach in general
• They aren't familiar with the Kata approach at all
• They're judged based on the ROI of their projects, not how well they spread kaizen habits

This is problematic because high-quality external senseis can be hard to find and fund.  Internal leaders outside of the PI department can be great coaches eventually, but during the early "incubation" period of the Kata approach they will need room to grow as Improvement Kata practitioners before they can be effective coaches.

In this common scenario, all you can do is move forward and treat your initial foray into coaching as a PDSA experiment.  You will have a hypothesis about what constitutes good Coaching Kata; you will be wrong.  And wrong again.  And again.

For me personally, it took performing about 100 coaching cycles with about 10 clinical leaders from across the hospital just to know what I didn't know about the Coaching Kata.  Now, after about 300 coaching cycles with about 20 people I'm finally just now starting to "get" it a little bit.  Yeah, it has been a humbling experience.

But let me share with you some of my most humbling coaching mistakes so that maybe you can move along that learning curve a bit quicker than me.  Here are my 3 best Coaching Kata mistakes ('best' because they have yielded the most insights for me):

Mistake #1:  Being Too Rigid

The Coaching Kata provides a wonderful framework for coaching.  Specifically, there are two routines we perform:

1. Instruction/Coaching:  this is the general guidance, teaching, moral support, etc. that is provided while the Learner is performing the first three routines of the Improvement Kata that make up the planning phase.
2. Daily Coaching Cycles:  this is the structured routine guided by the 5 Questions that is performed frequently while the Learner is performing the fourth routine of the IK that makes up the execution phase (we call it "being on the staircase").

My main mistake was in conflating and confusing these routines.  Because the 5 Questions Pocket Card was like a warm blanket during times of uncertainty, I would revert to it too early on in the IK process.  I was trying to do routine #2 (daily coaching cycle) while the Learner was still in the planning phase.

This made for awkward, rigid coaching.  This is because when the Learner is still trying to see the overall direction, grasp the current condition, and establish a target condition, the path forward is too cloudy to be able to concisely answer the pointed 5 Questions.  During the early planning phase, we should give the Learner a slightly wider birth.

Also, regardless of which of the two coaching routines we're performing, we should remember that these are person-to-person encounters.  Take the time to "break the ice" before jumping into the Kata.  Help the Learner get over the discomfort of a new, foreign management routine.  Acknowledge the inherent awkwardness of two novices trying to pretend like they know what to do next. It's okay!

Mistake #2:  Short-Changing True North 

The first step of the Improvement Kata is to understand the overall direction of the improvement effort.  The overall direction can be comprised of several elements, including but not limited to the following:

• Ideal Condition (perfection)
• Long-term strategy
• 1-2 year challenges
• Future-state value stream maps
• Key performance indicators

Taken together, these elements provide a True North by which we can guide our improvement efforts.  Taking the time to properly understand how our individual PI initiatives fit into the the big picture is incredibly important.  Not performing this routine properly increases the risk of poor organizational alignment, ineffective strategy deployment, "scattershot management", etc.  Bad stuff.

Yet, I still find myself to this day doing an inadequate job of coaching Learners on this first step of the IK.  We typically end up spending about five minutes just verifying that "yes, this particular PI project will help improve patient safety, and therefore, it's well-aligned with the overall direction."  That's pretty much a waste of time; we need to do a better job of connecting individual PI projects to the big picture in a less platitudinous and more concrete way. 

On the surface, this appears to be an easy coaching mistake to fix.  It would seem straightforward enough to help the Learner put together an A3 that shows the Ideal Condition, long-term strategy, KPIs, etc. of their PI project.  But in many organizations, it's not so easy because strategy is not transparent or hasn't been cascaded down to the level of the Learner.  We can't expect the Learner to plug & play without a port, no matter how good their dongle is.

What I'm learning as of late is that even if we don't have a mature strategy deployment system yet, we can still harness the fractal nature of the Kata approach (see page 21 of this presentation).  The target condition of a big, strategic improvement initiative can provide the big, longer-term challenge for a smaller PI project.  A practical approach to making this happen could be to have the Learners for the big, strategic initiatives be the coaches for the small PI projects related to them.

In experimenting with this approach, I've seen my ability to recognize potential synergies and detect potential misalignments improve.  It's not a perfect solution (we ultimately need something like hoshin kanri to systematically drive alignment), but it's a start.

Mistake #3:  Not Utilizing Judo

In that Karate Kid clip above, Mr. Miyagi did a great job of using the testosterone-fueled aggressiveness of the Cobra Kai against them, judo style.  He had mastered the art of leveraging momentum in a productive manner.  The same approach should be taken when practicing the Coaching Kata.

One of the toughest things for me as a Coach has been to know when to hold the Learner back a little bit and when to encourage them to move forward with change.  Any good PI professional knows that blindly implementing countermeasures before properly understanding root causes is foolishness.  This is so much a part of the Lean canon that it's self-evident.

However, in practice, it's not always clear if we have properly understood the root causes of our problems.  At some point in our analysis, we hit the limits of our knowledge frontier.  At that point, we have a big batch of root cause analysis work that needs to be validated, and as with any form of batch production, there's always a risk of delayed detection of defects (in this case, the errors would be in the form of incorrect root causes being identified).  Therefore, as Coaches, we need to be adept at sensing when the RCA batch size is getting too big and needs to be validated through some PDSA hypothesis testing.

One way to look at this is as 'mini-cycles of PDSA embedded within the Plan phase of a bigger PDSA cycle.'  It's testing, as opposed to implementing, countermeasures.  Another way to look at this is that it's the recursive nature of the Improvement Kata, with the learnings of the execution phase informing and refining the work of the preceding phases.

However you choose to see it, just know that it's one of the hardest things to get a feel for as a Coach.  You'll need plenty of Coaching Kata repetition and hopefully some secondary coaching from a sensei.  You'll also need to know your audience.  In hospitals, we have some ER nurses that would put this guy to shame in terms of being "action-oriented"...

Courtesy of www.giphy.com

The Big Batch Theory

Don't you love those moments when you make a connection between ideas that on the surface have nothing to do with one another?    I hate the term "aha moment" but it is appropriate in this case, and it does make me think of this hilarious Eddie Murphy moment (language slightly NSFW):

Okay, so anyway, there's an aha moment insight to be gained from analyzing the batch sizes of different types of work we do and discussing how lean principles such as pull, just-in-time, one-by-one flow, etc. can help us improve our work.  The following paragraphs will dive into three different work scenarios:  1) Big-Batch Production, 2) Learning in Big Batches), and 3) Big-Batch Root Cause Analysis.  Here goes...

1) Big-Batch Production

aka the "Yeah-I-Learned-That-In-Lean 101" example

This is the good old-fashioned example of the Welding Dept. in Ohio producing 10,000 widgets in one huge batch and shipping them to the Assembly Dept. in Michigan, who finds that the whole batch is defective because of one inaccurate measurement or whatever.

The well-understood principle at play here is that we shouldn't push big batches because it obfuscates the connection between customer demand and production.  It's the waste of overproduction, which in turn leads to myriad other wastes:  whole batches of undetected defects, out-of-control inventory, etc.  Instead of this big-batch push approach, we should strive for a target condition whereby downstream processes can pull from upstream processes in pursuit of a True North of perfect one-by-one just-in-time flow that perfectly matches customer demand with production supply.

Those ideas are part of the lean canon; no need to rehash them further.  However, there are so many other scenarios to which we could apply the same logic and benefit from the same lessons learned.  Unfortunately, based on my observations in healthcare anyway, we frequently fail to apply these lean principles to other types of work.  That's what I'll explore in the next two examples...

2) Learning in Big Batches

aka the "Intuitive-When-You-Think-About-It" example

So, applying the aforementioned lean principles of "pull, don't push" or "match supply with customer demand" and so forth, we can analyze our approach to learning.  Specifically, we can look at how we PI specialists teach Lean to the people in our organizations.

The Challenge...

I've been guilty pretty much my whole career of producing large batches of lean training.  I think just about every PI specialist has designed and or delivered all-day or all-week workshops where we cover a broad range of lean tools and principles.  It's pretty much de rigueur in the healthcare world to send Green Belt candidates off for weeks of training at a time.

This "big-batch learning" approach can be quite effective at building awareness of and excitement for the lean approach in general, but I've seen little evidence in my personal practice of this leading to a change in daily habits.  And just to be clear, my belief is that if daily habits don't change then it's extremely difficult to create a culture of continuous improvement.

But why does the big-batch learning approach not lead to habit-building?  It's the same fundamental principle at-play from the previous manufacturing example:  we're obfuscating the connection between supply & demand by pushing tools and principles via classroom training.  This pushing/overproduction leads to all sorts of learning waste:  defects (not remembering how to perform a certain technique because there was too much lag time from exposure to first real-world use), excessive inventory (tools sitting on our mental shelf that may never be used), over-processing (e.g. using five types of graphs when one would do just fine), and on and on, ad nauseum.

The Idea...

Just as in the previous example, the countermeasure here is to establish a target condition of letting the learner pull* lean tools and principles in the course of their improvement work, in pursuit of a True North of just-in-time learning that perfectly matches the supply of learning with the demands of the situation.

* Actually, it's the gap between the target condition and current condition that is doing the pulling.  The learner may not have the wherewithal to know when or what to pull.  This is where having coaches with plenty of coaching cycles under their belt is critical, as they have the pattern recognition ability needed to be the "voice of the gap" so to speak.

It's interesting to think about why we so frequently resort to big-batch learning instead of the just-in-time approach.  I think a root cause might be that most of the time our PI folks don't have a systematic mechanism for delivering just-in-time learning the way we do for big-batch learning (i.e. classrooms, trainee rosters, syllabi, PowerPoint slides, group exercises, simulations, etc.).  Of course, the Toyota Kata system provides a highly-effective mechanism for just-in-time learning, but there are significant barriers that prevent us from adopting this approach universally.*

*Hint:  it seems to come down to whether senior leadership can accept that the future is unknown and unknowable, and that certainty can only come from building strong, repetitive habits that allow us to cope with whatever change comes our way (Carol Dweck's book can provide more explanation).

3) Big-Batch Root Cause Analysis

aka the "Somewhat-Controversial-But-Profound" example

The same big-batch/small-batch, push/pull, supply/demand concepts from the previous two examples apply to the work of root cause analysis (RCA).  Just to state the obvious, as any PI specialist worth their salt knows, we should always strive to properly define problems and identify root causes prior to implementing countermeasures.  This is another sacred element of the lean canon that requires little explanation to PI specialists.

However, the way we go about performing RCA can vary widely.  We have an array of RCA tools at our disposal in several categories:  statistical (linear regression, ANOVA, etc.), practical (5-Why, Ishikawa diagrams, etc.), or empirical (hypothesis testing via PDSA).  We can use any combination of these tools to identify the root causes of our problem, which gives rise to a significant amount of variation in the way RCA is done in the world.

Some interesting discussion regarding various approaches to RCA has been occurring recently on LinkedIn, including comments from the great Jeff Liker.  Here's the link to the discussion thread (you may need to be a member of the group).

The Challenge...

What this discussion thread and Professor Liker's coaching has forced me to do is think about how the RCA approach we select (the combination of statistical, practical, and empirical techniques we utilize) impacts the batch size of the RCA work.  The challenge for us is to figure out what batch size of RCA work will yield the best results for us.  To examine this question, let's look at two extreme batch sizes:

An excessively big-batch approach to RCA work might look like this:  we get a bunch of folks together for an all-day workshop during which we use the wisdom of the crowd to map the current-state process, identify opportunities for improvement, define the problems in a discrete way, and use a combination of statistical and practical RCA techniques to break those problems down to root causes.  At that point, we're ready to hand off that big batch of work from the Plan phase to the Do phase of PDSA.

This approach has the advantage of being efficient from a facilitation standpoint, but all the disadvantages of big-batch over-production as discussed above (but especially defects in the form of incorrect identification of root causes due to faulty assumptions, group-think, etc.).

An excessively small-batch approach to RCA work might look like this:  after engaging the team to do a small bit of current-state analysis, we identify a few potential root causes.  We then select the one we think is the most likely culprit and start testing countermeasures using mini-cycles of PDSA.  If the countermeasure isn't effective at removing our hypothesized root cause, then we try other countermeasures one-by-one.  If we find that a countermeasure is effective at removing our hypothesized root cause, but has no positive impact on the problem at-hand, then we select other potential root causes one-by-one.  Lather, rinse, repeat.

This approach has all the advantages of one-by-one just-in-time production as discussed above, but the significant disadvantage of being a nearly unmanageable process in the real-world due to the myriad factors that can distort, taint, delay, or otherwise invalidate our supposedly scientific experiments.

This is clearly a complicated challenge with no single answer.

The Idea...

It feels as if we will need to find the sweet-spot between these two approaches to be able to mitigate the risks of big-batch work while coping with imperfections of real-world testing.  I think in the current condition, the majority of PI specialists tend to error on the side of big-batch RCA work as described a few paragraphs ago.  Those of us practicing the Toyota Kata method in a strict way probably error on the other side.  Let's find the sweet spot in the middle and move forward, shall we?

Wrap-up

Whether it's our process for producing widgets, teaching Lean, or performing a root cause analysis, we can benefit from understanding how the concepts of pull, just-in-time, one-by-one flow, etc. impact the waste level of our system.  In healthcare, we PI specialists tend to be good at understanding these concepts in the context of the typical clinical process (e.g. a nurse pulling meds from a Pyxis machine, triggering a replenishment from the Pharmacy, etc.), but not so good at applying them to our own work processes.  A true lean thinker is consistent in applying lean concepts to any process.

I shudder to think of how many of my own work processes are poorly aligned with lean principles. Yes, the learning continues.

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.

Hypothesis?

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.

Analysis...

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.

Countermeasures...

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!