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“Kaizen” Mentioned in Dilbert Cartoon, but in a Warped Way

by Mark Graban on June 23, 2011 · 10 comments

The word “kaizen” appeared in last Friday’s Dilbert strip. It’s a funny portrayal of how some might misinterpret kaizen or Lean approaches.

125104.strip Kaizen Mentioned in Dilbert Cartoon, but in a Warped Way lean

What’s wrong with Wally’s thought process?

Kaizen means continuous improvement or “change for the better.” As Imai says, it’s about everybody improving everywhere, every day.

In the first panel of the cartoon, Wally is making the mistake of wanting to fix that other department. This happens a lot, especially in healthcare. The E.D. wants to fix the lab, radiology wants to fix the registration department, etc. Merely pointing out inefficiencies or problems in another department will likely lead to a lot of defensiveness and pushback.

I’ve always found it helpful to, first off, fix inefficiencies in your own area first, THEN reach out to engage other departments. The systemic bottleneck might truly be in that other department, but nobody likes to be scolded by another department, especially when it’s likely to come across as finger pointiing.

Let’s say the lab is upset with people in the E.D. for not properly labeling specimens or for holding specimens too long before sending them to the lab. The lab could first make other improvements, especially to turnaround time, then presenting those improvements to the E.D. as if to say “here’s what we have improved, now we are asking for your assistance.” This is more likely to create buy in and teamwork.

Another thing that’s effective is pulling together a real team that includes representatives from the “value stream” of work that goes across departmental boundaries. If the team is looking at data, including a value stream map, and doing so in a “no blame, no shame” mindset, you’re more likely to get improvements than if you’re just calling another department inefficient.

In the second panel, Wally does stumble across the catch-22 that’s so common in healthcare:

  1. We know there’s waste and processes are broken, but
  2. We’re too busy fire-fighting and dealing with the waste, so
  3. We can’t really fix anything…

Wash, rinse, repeat. This is a tough cycle to get out of, but it can be done. In the short-term, you have to create capacity for improvement, in terms of time and knowledge. Lean training alone won’t do it, if people don’t have (or aren’t making) the time to improve. We might have to create time by allowing some short-term overtime, making time available for an initial kaizen event, or an initial Lean transformation project. If you can restructure the work and reduce enough waste, you can create enough time to be able to make improvements each and every day.

The third panel highlights the risk of letting “fresh eyes” run rampant in a project. I’ve found that it’s critically important to have process experts AND fresh eyes (people with a new and/or outside perspective). But having fresh eyes, shouldn’t be an excuse for “ignorance” to run rampant, as Wally suggests. Outside eyes can help challenge conventional wisdom, but you wouldn’t want a kaizen team composed entirely of outsiders.

You need balance. The conventional wisdom that might say “well, we’ve always done it this way, so we can’t change things.” Fresh eyes can push and challenge, asking questions including “what if?” At the same time, fresh eyes might propose changes that are truly unrealistic, needing to be tempered by those who really know the process.

Lots to think about from a single cartoon, eh?

Do you see more people running around like Wally in your organization, or do you see some good kaizen thinking?

And then there is yesterday’s gem on “buy in” and the sometimes circular logic involved:

125506.strip Kaizen Mentioned in Dilbert Cartoon, but in a Warped Way lean


Mark Graban 2011 Smaller Kaizen Mentioned in Dilbert Cartoon, but in a Warped Way leanAbout LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Innovation and Improvement Services for KaiNexus.


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A Collection of Dilbert Cartoons on Lean and/or Six Sigma — Lean Blog
June 29, 2011 at 5:02 am

{ 9 comments… read them below or add one }

1 Synfluent
Twitter:
June 23, 2011 at 8:34 am

Mark, how do hospital departments assess the efficiency, or inefficiency, of one another?

Is there a common vision or understanding among them all along with a visibility?

Reply

2 Mark Graban
Twitter:
June 23, 2011 at 9:34 am

Synfluent – before people learn about lean, there’s often a lot of finger pointing and blame. They might not have any basis for judging efficiency or effectiveness. Hospital leaders might rely on narrow (and oft dysfunctional metrics) like units of service per labor hour.

The common vision with lean comes back to the patients and trying to create shared common visibility of all the things that matter – right care, right time, right place, no errors – including minimizing time in the entire patient journey (or the value stream).

Much of the waiting (and many of the errors) come from poor handoffs between departments, which is a reason why somebody needs to be looking horizontally across the whole organization, not just staying in departmental silos.

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3 Synfluent
Twitter:
June 23, 2011 at 9:43 am

Tx.

Systems seem to fail mostly at their interfaces where some value is expected to be exchanged between two entities.

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4 PhysioWonk June 23, 2011 at 10:53 am

I have the “buy-in” strip posted on my wall and have used in presentations before. I work in that circular logic climate. In the end, very few things seem to get approved and most things get the “We see the value in what you are proposing, but we will have to hold off on making any decision on that for a while”.

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5 Brian Buck
Twitter:
June 23, 2011 at 11:29 am

As far as finger pointing to other departments, I love the following quotes from Liker/Ogden’s Toyota Under Fire (pages 214-215, 217-218).

“There is no value to the Five Whys if you stop when you find a problem that is outside of your control…When you reach a cause that is outside of your control, the next step is to ask why you didn’t take into account forces outside of your control-either by finding an alternative approach or by building in flexibility to adjust to those forces…How can we answer the next why in a way that will allow us to take positive action?…The point is that when you define the problem as something that is within your domain of control, when you take responsibility, there is always something you can do to improve the situation, but pointing fingers freezes innovative thinking. A true culture of responsibility allows you to perceive opportunities for improvement everywhere, even in areas that at first seem beyond your control.”

For outside eyes, I suggest getting patients & families involved in improvement. I have seen many teams have a facepalm moment when they thought they were providing value in a step and the patient says they don’t care about the activity!

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6 David M. Kasprzak June 23, 2011 at 2:59 pm

Hi, Mark,

Thanks for another good post. The “Naming, Blaming & shaming” isn’t unique to healthcare, as you know. In manufacturing, the Assemblers and operators blame supply chain, supply chain blames the Business Unit, the BU blames Engineering, engineering blames finance, finance blames contracts, etc., etc., etc. Regardless of the industry or environment, the same behaviors occur. I’ve heard a few prominent Lean folks out there state that embracing lean involves overcoming human behavior.

As far as spreading the correct behaviors, I also think it has to be something that goes deep in one area and then spreads to others in a sort of ever-widening vortex. I came across some PhD research from Robert Kucner last year that discussed this phenomenon, and wrote a guest post over at Mark Hamel’s Gemba Tales about it, called “Creating Gravity for Transformation.” Feel free to check it out: http://kaizenfieldbook.com/marksblog/archives/1767

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7 Mark Graban
Twitter:
June 23, 2011 at 5:16 pm

Ah, right. I forget that hasn’t been solved yet in manufacturing :-)

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8 Mark R Hamel
Twitter:
June 24, 2011 at 5:03 pm

Mark,

I was very tempted to post something on the Dilbert cartoon, but I correctly guessed that you would beat me to it! You did a better job than I would have anyway.

The cartoon? Funny, yes. Cynical, of course. But, unfortunately it reflects the reality of when kaizen goes bad and people get it done TO them.

My rough rule of thumb is a 1/3, 1/3, and a 1/3, when it comes to kaizen event team composition. (Here, I assume Wally’s talking about some sort of event. Maybe, I’m wrong.) Anyway, a 1/3 of the folks from the target process, a 1/3 from upstream and downstream the target process, and 1/3 fresh eyes.

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9 Richard Chapman June 26, 2011 at 6:36 pm

David wrote: ‘Thanks for another good post. The “Naming, Blaming & shaming” isn’t unique to healthcare, as you know.’

And welcome to Government!

the worst thing I see, in a Department commited to helping people in need, is staff blaming those very same people for their problems. For example, if only the ‘clients’ would….

Well they don’t, and if they did, we wouldn’t be here. A failure to see what the actual problem is, whether it is lack of staff skills, undefined procedures, whatever, the failures usually end up back at the ‘client’ – a convenient place to lay blame. They are too sick, too poor, too troublesome – but if they were none of those things (and I’m not a libertarian) we wouldn’t need a government.

I’m sure hospitals run better with no patients to get in the way – then all budgets would balance, targets would be met, committee meetings could proceed undisturbed, no adverse events.

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