The so-called “PICK chart” has become a pretty common sight in healthcare as a way of visualizing and prioritizing Lean or Kaizen improvement ideas. The concept was supposedly invented at Lockheed Martin, but it's a pretty common-sensical approach that's used to sort and rank ideas based on two dimensions:
- Impact the idea would have (low to high)
- Difficulty to implement the idea
While the PICK chart is used at health systems like ThedaCare, here's a picture that was recently tweeted by my friend Karl Wadensten at his manufacturing company, VIBCO:
Today we introduced our brand new Idea Board here at VIBCO: pic.twitter.com/cNJClpSGjP
— Karl Wadensten (@KDubsLeanNation) July 9, 2014
You can see the two by two matrix. Often the four quadrants are labeled as one of the PICK letters:
- Low impact, easy to implement – Possible
- High impact, easy to implement – Implement
- High impact, hard to implement – Challenge
- Low impact, hard to implement – Kill
Generally, you choose the Implement ideas first – easy to do and a high impact. People generally ignore the Kill ideas as being not worth the effort. The Possible and Challenge ideas fall somewhat in between in terms of priority.
At ThedaCare, being a nice, kind, healing environment, they decided that the word “Kibosh” was better than “Kill.” Kim Barnas included a diagram of a PICK chart in her recent book Beyond Heroes: A Lean Management System for Healthcare (listen to my podcast with her here).
In the book, Barnas makes a great point that ideas in the Kibosh quadrant shouldn't just be ignored. This is good advice for any Kaizen idea and it's one reason that traditional suggestion box systems failed… too many ideas are just ignored and blown off. That discourages people. Barnas writes:
I think a different teaching opportunity is to talk with an employee about why an idea is deemed to be of high difficulty. I've seen many PICK chart discussions (at hospitals other than ThedaCare) where the high difficulty ideas are dismissed, as if being put in that quadrant is the end of the road for the idea (even if the manager has a respectful discussion with the employee).
We Can Do Better Than Kibosh
Instead of letting things wither in the Kill/Kibosh column, I think leaders and team members can be more collaborative… working toward something that CAN Be implemented (as we teach in the Kaizen methodology). Effective improvement isn't just about ranking and sorting ideas — it's about finding something (or many things) to implement.
When something is in the Kibosh quadrant (and even in the Challenge quadrant), it's the leader's duty to ask questions like:
- What is the problem being solved by that idea that's difficult to implement?
- What would we have to do to make it easier to implement THAT idea? Are we willing to take those steps?
- Can we think of alternative ideas that would solve that problem, or at least make things a little better?
- Is there something easier that we an implement that has at least some impact? Do we need to implement a series of ideas to have the same effect?
We can break the problem down into smaller components. We can think about smaller ideas or countermeasures to implement.
Our goal should be to creatively shift things from right to left, finding ideas that are easier to implement, as illustrated below:
In our collaborative discussions, we might find new ideas that are easier AND have a higher impact (the diagonal red line that goes up and to the left). This is something I talked about last week in the webinar that Dr. Greg Jacobson and I did for Gemba Academy on what to do when you get lots of employee ideas.
Why Are We Prioritizing?
There are a few thoughts behind the PICK chart.
One is that there's always an explicit cost/benefit ratio that can be determined. How do we gauge if an idea is worth the effort?
The second assumption is that we have to prioritize ideas — that we can only implement so many.
Why is that?
We often have a bottleneck in the improvement process. That bottleneck is often the manager or supervisor. That bottleneck might also be a key staff member. The bottleneck person is the one who “has to” be involved in every idea. That creates a burden and it does limit how much improvement can be done.
In an effective Kaizen system, we spend LESS time on prioritizing ideas because we have MORE people involved. When the workload is distributed within a team… let's say everybody can be working on or taking the lead on one idea, then we're less likely to have a bottleneck. Instead of spending time prioritizing, we can spend time talking about problem solving and implementation.
That's one reason why I've never included a PICK chart in the “To Do” column of the Visual Idea Boards that we write about in our Healthcare Kaizen books. It's just a column that says simply “To Do” and different ideas get assigned to different people. A similar conceptual idea holds true in our KaiNexus software — when opportunities for improvement are assigned to people in a distributed way, you can focus on moving forward, not just prioritizing in place.
Here is an example of a Visual Idea Board where somebody did incorporate a PICK chart in the To Do area. That's not how I would do it, but I won't criticize them for doing so. If that works for them… that Kaizen of the Kaizen board, then great. I would just encourage them to find ways to make the PICK chart analysis and prioritization to be less necessary.
What Are You Doing?
Are you using PICK charts in your organization? How are they working? What mindsets and leadership actions exist to help keep things from getting “stuck” in the Kibosh or Challenge areas? Please post a comment and share your experiences, ideas, or questions.
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