To Sample or Not to Sample

Image courtesy of Stanford School of Medicine

I'm sitting in Six Sigma Black Belt training this week, learning all about two-sample t-tests, ANOVA, and other statistical analysis techniques.  One thing I noticed is that these techniques are based on sampling.  Basically, you collect data based on a sample, not the whole population.  An example from a hospital would be randomly picking 10 patients from a census of 100 and looking at their infection rates.

Obviously, data from a sample is not as thorough as that of a population, but often it's thorough enough to be statistically reliable.  The benefit of sampling, of course, is that we don't have to go through the time and expense of collecting data for the entire population.  However, thanks to powerful database software available to us in healthcare and pretty much any industry nowadays, we can easily pull all the data for all the patients in our system, at virtually no marginal cost.  This begs the question--why bother with sampling if we already have the population data?

I guess we wouldn't, unless there was some added value in sampling beyond the data that we gather.  If we're sampling by just pulling data out of a database, then there's probably not much value beyond the data.  But, if we're sampling by directly observing a process, then there's a lot of additional value:  we see the process with our own eyes, we get direct feedback from those involved with the process, we often get to directly hear the voice of the customer (the patient), and we get the opportunity to collect data that we didn't even know was relevant by looking at a database.

So, basically, it's not a question of "to sample or not to sample" but "to go & see or to not go & see."

3 Lean Coaching Tactics for Project Managers

I'm fortunate to be a project manager who works almost exclusively on lean/six sigma projects.  I say fortunate, because it gives me the chance to be a lean coach, as well as a project manager.  Of course, it's challenging to try to mix in lean coaching within a traditional project management setting.

Anybody who has sat for the PMP Exam or perused the PMBOK knows that traditional project management as a field of study is very, very light on lean/agile concepts.  So, as a project manager who loves lean coaching, I get to find creative ways to sprinkle in some lean learning throughout my projects.  Here are three tactics I utilize:

1. Genchi Genbutsu...In traditional project management, we might be tempted to accept whatever project assumptions are indicated on the project charter.  But as a lean coach, we should encourage our project team to go to the gemba and see for ourselves.  We don't rely on data either; we prefer facts, observed with our own eyes when possible.
2. Small-Batch PDCA...In traditional project management utilizing the 'waterfall' approach, we might be tempted to get a big batch of project planning done, then move into the project execution phase and execute a big batch of deliverables.  But as a lean coach, we should encourage our project team to instead perform many turns of the PDCA wheel, constantly testing, constantly iterating, in small batches of planning and execution.  This has all sorts of benefits, one of the biggest being we get a chance to uncover flaws in our plan much quicker than with 'waterfall.'
3. Visual Collaboration...In traditional project management, we might be tempted to conduct meetings the old-fashioned way, relying mostly on verbal discussion and taking notes down on paper.  But as a lean coach, we should encourage our project team to utilize visual collaboration techniques.  Use whiteboards, sticky notes, flip charts, etc. to visualize topics of discussion.  Once we visualize the discussion, we can structure it into affinity diagrams, fishbone diagrams, or whatever structure makes sense.  You can't do that if the discussion vanishes into thin air or is only captured on our individual note pads.

Utilizing these tactics and several others, we are able to sprinkle in a little lean into all of our projects.  This will not only help us project managers on our projects, but it will also help our project team members in their day-to-day.

When the Gemba is an ER

As any student of Toyota knows, going to the gemba is step one when investigating a problem.  This principle is often referred to as genchi genbutsu, and lean thinkers know why it's such a powerful and almost mandatory concept.

But what about when the gemba is an Emergency Room?

My first thought is that all workplaces are different, but what we're looking for pretty much stays the same.  In other words, a gemba is a gemba.  But, having spent enough time in ER's recently, I think there are a few differentiators that we can take into account:

1. The doctors are the touch labor.  Whereas in manufacturing, we sometimes see the problem of the touch labor employees not being respected and their voices not being heard, we sometimes have the opposite problem in healthcare.  Doctors are so well-respected, and sometimes so feared, that they can have an almost unwieldy amount of influence.
2. Everybody is at a computer.  No, they're not playing solitaire or checking Facebook.  They're working extremely hard to enter their patient encounter information into the system.  In modern healthcare, it feels like everything is dependent upon electronic information management.
3. Flow is hard to see.  Many ER's were not designed with one-piece flow in mind.  Or cellular flow.  Or pull systems.  Or level loading.  Or visual management.  Or any of the other concepts that help improve flow and make flow visible.  The structural design of many ER's can make it almost impossible to see the flow of patients through the system.

If you're a lean thinker looking to make the move to healthcare, these are just a couple of thoughts to keep in mind.  But, if you're a lean thinker, you've probably been to many gembas and you probably know that each one has their own set of differentiators.  An ER is still a gemba, just one that maybe requires a little extra patience and finesse.