Here is a 10-minute talk I gave at the 2014 Lean Transformation Summit. I'm introduced by Jim Womack and we do Q&A at the end.
Looking at your own organization today, do you hold yourself back by making excuses or do you get creative and find new ways of doing things? Many organizations aspire to a culture of continuous improvement… at least for a while, until it gets difficult. Leaders say things like, “We don't have time for improvement.” Is that an excuse that leads you to give up or is that a problem that you can solve with a bit of moxie and creativity?
Mark Graban: Thank you for being here. My name is Mark Graban. People often asked, sometimes with a smile, “What do you do? What do you do?”
Real quick in terms of my background, I'm an industrial engineer. I worked in manufacturing for the first 10 years of my career. For about the last eight and a half, I focused on healthcare. I do consulting and other disreputable things through my own company, Constancy, Inc.
I worked as part of the team at a startup software company called KaiNexus, which you may see as Kaizen and Nexus. We see the connections here. I've written some books, which sometimes people think, “OK, if you've written books, you can get up in front of an audience and speak.” I don't know if that's always a good assumption.
Jim Womack: No, no. [inaudible 0:53] .
Mark: They're probably counter-indicated, but we'll give this a shot anyway. I'm going to try to be provocative in a friendly way on this theme of Creating a Culture of Continuous Improvement to ask ourselves to reflect — I try to do this myself — are we making excuses or are we solving problems when we talk about creating this culture?
Now, we might recognize this in other industries. We might recognize it within our own industry or our own organization. We might recognize it if we look in the mirror and say,
“Well, we're facing challenges about creating this culture of continuous improvement. How are we reacting? What are we doing about it?
I think just a level set, when I use the word Kaizen, I'm taking a pretty direct translation from Japanese. The word that I've been taught does not translate to mean week-long-team-based project with a sensei being involved. It really just means good change or improvement.
We think about how do we create a culture of continuous improvement? How do we get people engaged in this process? When we work with people in hospitals and we ask them, “What problems are you facing in your daily work? What can we do better?”
Here's an example from a hospital where a nurse very quickly pointed out, “Our patients who are nauseous ask us for ginger ale and we don't have ginger ale stocked in our unit. We have to run upstairs to go get it or we tell the patient, ‘Sorry, you're out of luck. Just lay there and be nauseous.'”
Well, their idea was a pretty simple one and it might sound sacrilege, but you don't always have to do root cause analysis. This was a simple, “Just do it.” Could somebody please help us get ginger ale stocked on the unit? Why? Because it would help our patients. We would waste less time.
A manager made a simple call to nutrition services and the next day, they started stocking two cans of ginger ale. If we look at this type of improvement on a PDSA cycle, hundreds, if not, thousands of small improvements being made in an organization. Why don't we have this happening more often?
My co-author's health system in Indianapolis is implemented and documented 4,000 small Kaizen improvements each of the last four years. They keep going. They have a culture of continuous improvement or, at least, they're working there.
It's really easy to go to hospital websites and see mission, vision, and value statements that talk about either we have a culture of continuous improvement, or we strive for it, or we're working at it.
When you actually talk to people, I had to get an MRI done and there was a big sign in the lobby that said,
“We are a culture of continuous innovation and continuous improvement.”
I asked the woman at the front desk about this and she just rolled her eyes at me. She didn't know what that was about.
We have to ask. If organizations are talking the talk, are we walking the walk? Are we living up to that statement on the website or on the sign in the lobby? Are we really living this day to day?
I think if organizations were being honest, sometimes their statement might say this,
“We would like to have a culture of continuous improvement, but our workers have been beaten down. Our leaders don't trust them anyway. We don't make time for improvement. It's a nice idea but honestly, not a priority for us right now. We'll get there someday or probably not.”
As we learn good Lean problem-solving, we might want to look maybe less cynically than that. At the reality of our culture, is there a gap? Mind the gap. Can we honestly say there's a gap between today's culture and where we would like to be? If there's agreement that there's a gap, we can ask, “Why?” Using another good Lean mindset.
Why is there a gap? Why do we not have everybody participating in continuous improvement? My co-author's health system measures each year. They have about 36 percent of their employees who contribute, implement, and document at least one Kaizen improvement. Their credit, they don't blame or look down upon the 64 percent who aren't participating.
They're asking, “Why? Why are they not? What can we do as leaders to get them engaged? What can we do to get them involved?” They might identify barriers. We dedicated a whole page in our book to a laundry list of barriers to continuous improvement. “We don't have time. Our senior leaders aren't on board. We don't have connection to our metrics. We don't have the budget.”
There's a laundry list of things we could look at and say, “Well, are we identifying barriers? Or maybe we're erecting barriers based on our policies and what we're doing every day.” I think the question to ask is, “Are we making excuses from these barriers, or are we solving problems?”
There's a very funnel mindset here. When we've identified a barrier to not give up and quit, but to think, “All right, team. What are we going to do about it? Let's solve that problem.”
Let's apply Kaizen thinking to some of these gaps, to some of these problem statements. Problem — staff don't have time to do Kaizen.
If we're in excuse-making mode, “Oh, oh. [laughs] Yup, you're right. We don't have time. Forget that continuous improvement business,” we don't want to give up because that's an excuse. We say, “Well, what can we do about that?” We can ask our team members. We can ask our leaders, “What can we do to solve that problem?”
One very simple thing is to schedule time to work on Kaizen. I live in San Antonio. We're very fortunate to have a Toyota plant that lets people come through and do tours. We bring medical students and MHA students to come visit the plant. They see the words “Kaizen” all over the place.
When these future healthcare leaders ask, “Everyone's busy building trucks it seems. When do you do Kaizen?” The frontline staff member who's giving the tour says,
“You know what? If we have an idea, we talk to our manager. If it's a good idea, they schedule time to make that happen.” Now, you might think, “We don't have the budget for that.”
Is that an excuse, or is that a problem that we can solve?
I know managers who will actually schedule time after they've done Kaizen events and improve productivity. It's a scheduled time. “Today you're going to come in and work on Kaizen” just to two staff members. They solve that problem instead of making an excuse.
Managers will say, “I don't have time to help with Kaizen.” Is that an excuse that makes us give up, or is it a problem that we solve? What can we do about that? For one, managers sometimes have the wrong mindset that Kaizen is employees giving you ideas to go, investigate, and implement. Well, no. We can delegate and empower our team members. We can solve that problem.
We could cancel that stupid nine o'clock meeting that doesn't really have any purpose anymore. That's just become a habit. We can free up time. We can solve that problem. I think one of the most interesting barriers that I've run across was people saying, “Working on Kaizen hurts our productivity numbers. We have a daily productivity target that we have to hit.”
Hitting that daily productivity target is ironically the biggest barrier to improving productivity. What can we do about that? We could blame senior leaders for not being enlightened. We could make excuses. We could give up, or maybe we embrace that as a problem to solve.
Maybe we educate our leaders about longer term measures or a more balanced set of measures and say, “Hey, don't micromanage my daily productivity. Let me do what I need to do to improve productivity over time.” Maybe that's the better thing to be rewarding.
Maybe we can have a charge code where if we assign time for Kaizen, it doesn't hurt your department's productivity. That might be a short-term countermeasure, maybe not a habit we don't want to develop forever, but it's a way we can solve that problem.
I've heard people in health care say, “What we need for change in any type of setting, large or small, is both the will to do it, the will to create a culture of continuous improvement, some ideas or methodology for, ‘OK, gosh. How are we going to get from here to there?' Then, we need the execution and the discipline to actually go make it happen.”
I see organizations that have that gap. It could be that they don't have a method, it could be that they're not executing that method in a disciplined way, or sadly, it could be they're just paying lip service to it and they don't have the will to change their culture. They don't have the will to create that culture of continuous improvement.
My question to everybody for reflection is to say, are we being a victim or are we being a leader?
When we find barriers that prevent us from closing a gap, are we a victim who makes excuses or a leader who solves problems?
A final thought, the great nurse Florence Nightingale once said,
“I attribute my success to this — I never gave or took any excuse.”
I try to practice that same idea and I hope all of us in this room would as well. At least, we can go back to our organizations and be a bit of what I would call a friendly pest, without jeopardizing your own paycheck or career. When you see people making excuses and hiding behind them, say, “Wait a minute, time out. Let's reframe that as a problem that we could solve.”
Jim: That was much better. You learned. There was a learning cycle from the previous [inaudible 10:14] that he only finished a minute early.
Jim: That's really good. Mark Donovan is our final speaker, so you're going to hit it just dead. I know you are because we're getting better. This is a collective improvement activity we got going on here. Let me ask how you react to the following, bearing in mind that you yourself are a professional problem-solver. What I see going on is… Let me describe what I saw last week.
I went to a real icon of the Lean movement that I will not name, and I walked in to see what they were doing after many years of getting leaner and leaner and leaner. I must say, it was just appalling, it was just horrible. Everything was broken, busted, and out of control and so forth. That's another story.
When you said to the Lean workers, “How are you doing? What kind of struggles are you engaged in? What are your problems?” They said, “There are all these problems, but we don't have any time to solve them because this thing goes down all the time and to make rate. We got to keep working.”
Then you say to the Lean managers, “Gee, why don't you solve the problems?”
They say, “We're busy dealing with the exceptions and also dealing with corporate metrics. We're looking up at metrics, and we're looking out at exceptions and that burns up all of our time, so we don't have any time to do better.”
I said, “What do you do?”
They said, “We've got this wonderful thing, the Lean team. We've got this [inaudible 11:38] .” Now, wait a minute.
Both the managers and the workers are happy, they've delegated the problem to these other characters, the Lean team. Wait a minute, and this is the final thing, that they had on the wall of things that the Lean team had done. All you had to do was look at these improvement activities to realize standing there looking, not one of them had been sustained.
I thought, “Whoa. This is even worse. This is a deeper circle of hell here that the workers are too busy to improve, the managers are too busy to improve, and the improvement team improves in a way that regresses the mean.” What do you do about that?
Mark: I think that's not at all uncommon or surprising. What you're describing there violates one of the two central tenets of the summit here of not just improving the way the work is done, but developing people. I see in a lot of organizations it's tempting in the short-term to say it will be faster and easier to have someone come in and fix it for us.
I'm always reminded of something John Shook always says in terms of if you gave someone an answer, you've robbed them of the ability to learn how to improve. I think that comes back to the notion of respect for people. I think it comes back to these tough challenges of short-term thinking versus long-term thinking that people struggle with.
Jim: For the consultant, I think this is a moral hazard for those of us who have been consultants that a, we like to solve problems. Got lots of experience that you can see pretty quickly. Ask a few questions, and you probably get there faster than the folks who are, again it's just there and they haven't thought about it.
You've not been there. You look at it, and it's pretty obvious what some likely causes are. By the way, it's very economically satisfying to be called back. You plumber, your carpenter, your electrician, they want to come over and fix your problem, but they're sure not going to tell you how you can avoid it in the future. I have never had that happen.
Because they live on callbacks, and repeat business is cheaper than conquest business. The world is full of moral hazards. For us improvers, that is a hazard because the easy thing to do is to fix the problem and move on.
The hard thing to do instead of being the doer is to be the coach that says, “Gee, would you mind if I help you figure out how to fix your problem in a way that's organizationally is sustainable.” When I say sustain, of course we mean improve. Just to think about.
By the way, to go back to that good-bad company that I looked at, amazing thing that you probably seen this too. This was a make-to-order business, so they couldn't work ahead. They incentivize the sales force in a way that the monthly sales look like that beginning of the month, end of the month, beginning of the month.
When I got there, they had run through all of the orders from the wave at the end of the previous month, but the incentives weren't yet pulling in sales for this month. They announced while I was in the plant that on the next Monday and Tuesday — I was there on a Wednesday — the next Monday and Tuesday, there would be no work, so just stay home.
I raised my hand and said, “Wouldn't those be good Kaizen days?” They said, “Oh, we're not organized to do that. Who would lead them? Our Lean team can't possibly run plant-wide Kaizen.” I thought, “My gosh, this just gets worse and worse. I need to get out of here.”
Jim: I did. I don't know that I'll be going back. It was not a good day.
Mark: On that point, one of my favorite excuses to try to poke sticks out is people in healthcare lead are saying we have to do that. There's a question of patient census is low with three hours left in the shift. What are we going to do? Send people home early. Why? Because we have to do that.
I'm like, “There's no such law at the state or federal level, and either the United States or Canada that says you have to.” Don't be a victim. Say, “We're choosing to send people home instead of having the alternative of choosing to invest time in improvement and developing people.”
Jim: The hardest part of that is suppose your organization actually has no track record of being able to improve. It's understandable how you're a manager. You say, “Don't send them home. Have them do improvement.” They say, “Well, the experience we've had with improvement is that we don't improve anything.” There's another vicious circle there.
Mark: This can't be the old GM jobs bank program that I saw firsthand of people staying in the cafeteria. That was a company problem. They didn't engage people in improvement.
Jim: Hey look, it's tough out there. We've been talking to each other for a long, long time. We've exchanged many, many stories over the years about how hard it is to do the right thing and get a good result. Keep on keeping on. It's always a pleasure.
Mark: All right. Thanks, Jim.
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