Lean & the “Work-Out” Process in Healthcare – Success, My Questions, and Your Experiences
In the past few years, I've heard of the “Work-Out” process that has origins at GE. This consultant's website gives a good overview and it squares up with what I've been reading in the book The GE Work-Out : How to Implement GE's Revolutionary Method for Busting Bureaucracy & Attacking Organizational Problems.
I've never used this methodology, but I know of a few healthcare organizations that have used it. For example, a KaiNexus customer recently used this approach to get some great results (see below).
I'm curious to learn if my readers have experience with this process and thoughts or experiences to share as a comment.
Vanderbilt University Medical Center recently did a “100-day workout” process, using our KaiNexus software to facilitate and track the improvement ideas that were implemented. The classic “work-out” formula says to do a 90-day process, but Vanderbilt modified it because they thought 100 days worked better to create consistent scheduling for the monthly meetings that took place. I like the idea of modifying a methodology as it makes sense, as I wrote about yesterday.
Here is a video that Vanderbilt produced, as part of a blog post they wrote (Vanderbilt has an ownership stake in KaiNexus, since the prototype for our platform was developed there and they helped commercial our technology). They generated over $800,000 in cost savings and revenue increases in those 100 days.
The results are certainly impressive and we thank Vanderbilt for sharing them.
While reading more about this “Work-Out” process, here's what it seems to be (at a really high level):
- Form a team including a lot of front-line employees
- An executive kicks off the session and then leaves, as to not influence the discussion
- Conduct a facilitated one to four-day session where employees brainstorm what should be improved
- The executive comes back and has the best ideas presented to him or her
- The executive decides “yes” or “no” on ideas
- The ideas get implemented
- The team reports out after 30, 60, and 90 days
The book describes the process as:
Large groups of employees and managersâ€”from different levels and functions of the organizationâ€”come together to address issues that they identify or that senior management has raised as concerns. In small teams, people challenge prevailing assumptions about “the way we've always done things” and come up with recommendations for dramatic improvements in organizational processes. The Work-Out teams present their recommendations to a senior manager in a “Town Meeting,” where the manager engages the entire group in a dialogue about the recommendations and then makes yes-or-no decisions on the spot. Recommendations for changing the organization are assigned to “owners” who have volunteered to carry them out and follow through to get results. That's Work-Out in a nutshell.
I like the involvement of front-line staff and the Work-Out book says that the experts are the people who really do the work.
I'm not sure if I really like the idea of the executive leaving the initial meeting. The book I'm reading says:
In general, we strongly recommend that neither the champion nor the Sponsor remain at the Work-Out session after the teams begin their work… even the most adroit senior people exert subtle influence on participantsâ€”either inhibiting certain ideas or channeling the thinking in a particular direction. Part of the power of Work-Out is that senior people get to hear relatively unadulterated, unfiltered ideasâ€”and not just what they want to hear, or what people expect them to want to hear.
I guess that's a good goal of wanting honest, unfiltered feedback. But, I'd rather see executives work toward a culture where employees can be honest and unadulterated with them in the room. I'd rather see a “Kaizen Event” approach, where we ask executives to participate but to “check their titles at the door.” This is perhaps easier said than done, to the Work-Out point.
I also don't really like the idea that the executive gets to make all of the yes/no decisions. I guess if I were running a Work-Out process, I'd rather see these decisions be made by consensus, with input and recommendations from the team members AND the executive working together on that. The executive can help explain the organization's strategy and objectives, while guiding the employees to make good decisions instead of doing it for them.
But, who am I to question the method if it brought great results at Vanderbilt?
Do you have any first-hand experience with Work-Out? I'm curious to hear about your experiences. Do you find this approach can be compatible with Lean thinking and Lean practice?