Latest Webinar: "The Kaizen/Kata Nexus"

I had a great time with my good buddy, Mark Graban, yesterday doing this webinar.  It was an experiment, actually.  We were attempting to articulate the ways in which Kaizen & Kata reinforce and enable one another.  They're not just complementary, and they're certainly not in competition with one another; rather, we believe them to be symbiotic.  This is just one attempt at reconciling this in our heads, and we'll continue these types of discussions so that we have a stronger grasp of how Lean systems interact.

Habit-Building

I'm really liking The Power of Habit:  Why We Do What We Do in Life and Business by Charles Duhigg.  Taken along with the Mike Rother's Toyota Kata, you have the basics of what it takes to create a continuous improvement culture.

For clarity's sake, I define a continuous improvement culture as an environment in which we strive to improve every process, every day, with everybody involved.  No improvement is too small, we don't batch all our improvements into big projects, and anybody in the organization can be an improvement leader.  For more information on this concept applied to healthcare, see Graban & Swartz' book Healthcare Kaizen.

Anyway, in Duhigg's book, the habit-building loop is presented.  It has three components:

1. Trigger:  this is the cue to perform a routine
2. Routine:  this is the standard steps performed to arrive at the desired result
3. Reward:  this is the payoff for performing the routine on-cue

When these three elements are in-place and clearly related, a craving eventually forms.  This craving causes the habituated person to anticipate the reward at the trigger point, even before performing the routine.  This phenomenon is the indicator of a well-formed habit (for better or for worse!).

While Duhigg's book is about the science behind habit-forming, Rother's book is about the habits needed to drive continuous improvement.  Specifically, he emphasizes two habits (he uses the term 'kata'):

• Improvement Kata:  this is a 4-step routine that helps us 1) see the ideal condition to which we strive, 2) study the current condition to see our gaps, 3) set a short-term target condition to pursue that is on the path to the ideal condition, and 4) pursue the target condition using PDSA (another 4-step routine).
• Coaching Kata:  this is a routine, drawing upon the Socratic Method of teaching (asking questions instead of giving answers), that is designed to reinforce the proper execution of the aforementioned Improvement Kata.

So, how do we put in place the three elements of the habit-building loop for the two kata?  How do we create a craving for the kata?  The routines (element #2 of the habit-building loop) are established by Rother's book.  The other two elements, triggers and rewards, are TBD for me personally.  Some thoughts:

• Triggers:  eventually, the ideal would be that the trigger is the detection of a problem/gap/opportunity for improvement, but in the short-term, more artificial triggers may be needed (i.e. require each manager to perform one PDSA cycle per month...not a long-term solution, but can get the ball rolling in the short-term).
• Rewards:  eventually, the ideal would be that the reward would be the intrinsic motivators of mastery, autonomy, and purpose (see Daniel Pink's Drive), but in the short-term, more artificial rewards may be needed (i.e. gamification:  badges, achievements, recognition, compliance tracking, small gifts, etc.)

This type of habit-building is tricky business.  Culture change is hard.  It takes a wide range of knowledge, organizational finesse, and a lot of trust and patience on the part of senior leadership.  But the payoff is huge.  A culture of continuous improvement is the best, most sustainable competitive advantage available.

3 Quick Thoughts on Copycatting Hospitals

Mark Graban over at the Lean Blog got me thinking about the pros and cons of copycatting (using what works somewhere else to fill a need of your own). I'm not talking about plagiarism, intellectual property theft, or anything like that; I'm just talking about one hospital copying the tools and techniques of another, as opposed to coming to solutions independently. Here are three quick thoughts on copycatting:

1. Copycatting is supported by the "no need to reinvent the wheel" principle, which is logical and intuitive, especially for hospital folks who are busy saving lives and whatnot.
2. However, copycatting is a barrier to creative thinking and the building of the problem-solving muscles hospital teams need to foster continuous improvement.
3. Copycatting precludes the emergence of innovative ideas that other hospitals have not thought of yet

One last thought...there's something about copycatting that makes me think we are sometimes too scared of failure.  Maybe our risk aversion prompts us to go with what other hospitals have used, as opposed to trying something new and failing.  Does this mindset stem from traditional management philosophy that encourages us to hide problems?

Top 3 Insights from Jim Womack on the Lean Blog Podcast

I just listened to Jim Womack's interview on Mark Graban's Lean Blog Podcast.  Really good stuff, especially the part where Mr. Womack talks about healthcare.  Here are the ideas/concepts that really resonated with me...

1. Healthcare is not scientific.  Mr. Womack says we think of the practice of medicine as a scientific endeavor, but when you go to the gemba of a healthcare organization, you often see a highly craft-oriented culture.  Process variation between physicians is sometimes the norm, rather than the exception.   The decision to perform a process differently is often not based on outcomes data, but rather on the way the process was taught to the physician by her mentor.  Scientific, this is not.
2. Physicians are the front-line workers.  Whereas in manufacturing the "touch labor" employee might be an entry-level blue collar worker, Mr. Womack discusses that in healthcare this role is performed by highly-trained, highly-compensated physicians.  This creates all sorts of unique situations that we must be aware of when trying to promote kaizen in a hospital setting.
3. Nurses are the main ones thinking about process.  When I came to healthcare as a newcomer less than a year ago, I was surprised that the nurses are pretty much the ones running the show, from a process perspective.  As previously mentioned, the physicians are the touch labor employees.  Mr. Womack indicates that his leaves the nurses as sort of the stewards of the horizontal flow of patients across our processes.  Of course, nurses are also touch labor employees, so horizontal flow often gets pushed aside when the nurses have to focus on performing a touch labor task.

I highly recommend listening to the interview with Jim Womack.  He talks a lot about his new book, his approach to walking the gemba, and other insightful tidbits.  Check it out.