What you Learn by Just Observing


    Recently, I spent a few days doing some current state assessment work with a healthcare billing environment. I spent my time shadowing employees, observing the process, looking for waste, and asking them about problems they face in the course of doing their job.

    A few powerful things were observed:

    1. A majority of each employee's time was spent on fixing errors and reworking the process
    2. Employees complained of having to log “the same errors over and over again”
    3. Multiple employees in the process were responsible for inspecting the paperwork, but errors got through to every step in the process, even after four or five “inspections”

    Another key lean issue I saw was individual employees working in highly specialized silos, separated from the upstream and downstream steps in the overall process. Like most pre-lean factories, the building was laid out in a departmental layout, with large batches separating the operations in the process.

    One benefit of value stream mapping is getting people to see the whole process and to start communicating with each other.

    Here's a simple example of how people worked in their own silos:

    • In a multi-step, multi-department process, Employee C (working operation C) was reviewing the patient charts and found multiple copies of a certain form. Employee C was taking the “extra” copies and throwing them into the shredding bin. Employee C thought they were doing the right thing as they thought there was a goal to keep the chart as thin as possible (saving storage space).
    • Employee D worked the next stage in the process, operation D. Employee D's cubicle was about 25 feet from Employee C's. The output of operation C was moved down to operation D once, maybe twice a day, in large batches.
    • Employee D was taking that one form and needed an extra copy to send back to the MD's office. Employee D was getting up, walking past Employee C's cubicle, to make a photocopy of the form, the same form that Employee C had just thrown away.

    Now the waste here was pretty obvious. The reason that I was able to discover this was because I directly observed both operations (all operations, actually). I was looking at the Value Stream, not just the individual operations.

    So, I pulled Employees C and D together for an impromptu meeting. I had them talk through the “extra” copy and they quickly discovered the solution — QUIT THROWING OUT THE EXTRA COPIES! They high-fived each other and felt good about identifying an obvious process improvement.

    So what were they saving?

    • Paper
    • Shredding cost
    • Employee D's motion to go make copies
    • Copier toner
    • Time

    Was any of this a huge $$$ savings? No, not really. But, it was a huge eye opener to the employees and to management. There were likely many many more kaizen opportunities like this, if they would get people together to look at the Value Stream together, rather than staying in their individual silos.

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    Mark Graban
    Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


    1. When I read stories like this, I always wonder about the *management* and what they have been doing all these years. What exactly did they think their jobs were?

      I suspect that in many cases, they have conceptualized their jobs as administering a process rather than managing to a result.

    2. Thanks for your comment. It’s probably more the case that management was managing the results rather than observing or managing the process.

      The lean assessment was a real wake up call to management, in terms of errors and waste in the process. Management started doing similar observation on their own, which will start leading them in the right direction — managing processes and people, the results will follow.

      This was, statistically speaking (and looking at benchmark results), a very good operation to begin with (as compared to their peers).


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