The word “kaizen” appeared in last Friday’s Dilbert strip. It’s a funny portrayal of how some might misinterpret kaizen or Lean approaches.
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:
- We know there’s waste and processes are broken, but
- We’re too busy fire-fighting and dealing with the waste, so
- 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:
Key Tweets 6/22/11
- Read and Commented: Everyone Wants Better. No One Wants Change http://lnbg.us/1zK
- Take a hospital leader to lunch to talk #lean – IndustryWeek : How You Can Help Reduce the Cost of Medical Care http://lnbg.us/1zM
- When someone says “we need to reduce cost” let’s also put the focus where it belongs, on quality and #ptsafety. Cost will follow. #lean
- @AMEConnect Why is the conference agenda (days/times) so hard to find on the website? ameconference.org
About 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 Chief Improvement Officer for the technology company KaiNexus.