I recently gave a talk at a healthcare organization about Lean and continuous improvement. There were so many questions, we ran out of time.
So, here are three questions that were sent to me afterward, along with my thoughts, shared for broader discussion.
Q: Many CI projects seem to come to a conclusion where some resources are needed. When this happens and large and small requests are made but then get caught up in enterprise wide holds or capital requests or another larger project on a very different time frame. These quickly lead to disengagement. How do we, as leaders, continue to keep interest and excitement and keep solutions in local control?
A: When I think of CI, the word “projects” isn't the first to come to mind. Every organization (probably in the history of mankind) has taken on big projects. Big projects are often quite necessary and important. Big projects tend to be selected in more of a top-down way, being strategic, compared to small Kaizen improvements that, by their nature, must be initiated by staff.
If employees have ideas that require spending approval or the capital budgeting process, that's sometimes necessary. What's unnecessary is for SMALL requests to be held up in any sort of bureaucracy. Decisions about moving forward to test a small improvement should be kept under local control. For one, you get better decision making and, secondly, you get faster improvement without rejections or delays that are going to, of course, demoralize people.
If all you're getting, within a team, is big, expensive solutions to big problems, try to redirect them to small improvements that can be kept under local control. Once people know where to look, it's said that 80% of an organization's improvement potential comes from small, staff-driven ideas. This was their realization at ThedaCare over time (after starting with bigger Rapid Improvement Events as the only model for improvement). Research from Robinson & Schroeder also points to a fairly consistent 80% number. You can hear my podcast with Robinson about their book:
Q: What mechanisms do large health systems have to disseminate best (or better) practices across the system?
A: I've seen a wide range of tools and methods used by large organizations to help spread and share improvements – “better practices” is indeed a best practice term here :-)
Many organizations try shared drives with Word or PowerPoint files to share ideas, and Excel spreadsheets to tabulate results. Even with a small, local team, this approach breaks down very quickly and requires a lot of manual work by a CI function.
Some have used Sharepoint to build a more robust solution, but that can take a while to build and can be very expensive. Some, like my Healthcare Kaizen co-author's health system have built a home-grown web-based database for tracking completed Kaizen improvements and to help tabulate results (we wrote about this in our book). This can work, but is dependent upon your ability to create and maintain software over time… harder and more expensive than it would seem to be.
There are, now a days, some solutions available on the market. Some are more Six Sigma project oriented, instead of employee-driven continuous improvement. Some are basically “electronic suggestion boxes” and those have the same dysfunctions as paper boxes. Why digitize a fundamentally broken model there? See Robinson and Schroeder's work that pretty much proves that suggestion box systems don't work.
I'll state my conflict of interest here as a contractor and part owner, but I have been involved with a software company called KaiNexus for almost six years now. It was started by an ER doc who, like Franciscan, was practicing Kaizen and had a home-grown web tool built to help manage ideas. That was eventually spun off as KaiNexus, a product that I think is best suited for a wide range of continuous improvement needs. You can check out the KaiNexus website, if you wish.
Q: What are some tips to engage disengaged teams? In a large team, some smaller subsets are very engaged and others don't want to participate in kaizen.
A: If I understand the question right, you're asking about disengaged individuals within a team of people who are otherwise (mostly?) participating in Kaizen?
While the Kaizen mindset says that everybody is capable of being creative and being able to participate in improvement, a common reality is that not everybody will WANT to participate.
From my experience, if you're trying to build a culture of continuous improvement and you have a team where some people don't want to participate at first, my advice is to “let them be.” Engage with the early adopters and the volunteers. Effective Kaizen is always, at its heart, voluntary anyway.
Quotas, targets, and forced participation will probably just result in compliance and ideas that aren't very meaningful or impactful.
Over time, as the early adopters show that Kaizen is beneficial and those people get praise and recognition, some others will typically choose to start participating.
If somebody doesn't want to participate after Kaizen participation has become the norm, we should ask “why?” Why don't they want to participate? What are their barriers or concerns at a very individual level? Some people have a lot of mental or emotional scars built up after, perhaps, a few decades in a typical culture that doesn't engage people in continuous improvement. Sometimes, again, I think you have to let some people be. Managers should try to engage them. Don't give up on them too quickly. But, some people will make it clear that they just want to show up and do their job well… and you can probably accept that, even if it's not ideal. Sure, we'd like everybody to have “two jobs” – doing work and improving work… but you can't force the issue.
Engage with those who are willing to engage. If there's 10% who exclude themselves, it's probably a better use of leader time to engage the willing 90% in more improvement than it is trying to force every single person to participate.
Feel free to add your thoughts, comments, and responses to what, I think, are some fairly common questions that people ask…
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