Operational Excellence Mixtape: December 20, 2019


Healthcare – Creating Value for Patients

It's been 20 years since To Err is Human, the seminal report from the Institute of Medicine, was released, estimating, to many people's surprise, that almost 100,000 deaths per year in hospitals could be prevented.  How much has it improved since then?  The good news is that culture and attitude towards “zero harm” has greatly improved and that there are pockets of excellence in prevention, but your hospital is still more dangerous than it needs to be

An Ontario hospital CEO provides a masterclass in how NOT to go to gemba. Southlake Regional Health Centre CEO Arden Krystal spends a 12-hour shift to observe the actual work in her hospital and then proceeds to publicly blame staff for poor working conditions on her blog.  She acknowledges staff and patients being too cold, narrow hallways and cluttered conditions, and staffing rotations that require naps, and takes no ownership of these issues, but rather chastises staff for their workarounds.  I see her point of view, but sheesh, what did she hope would happen?

Burnout is increasingly becoming the norm in healthcare as insurers, governments, and healthcare organizations add work without changing its systems, while demanding cost reductions.  Dr. Paul DeChant explores six drivers of burnout and how to deal with them. Here's his first installment on Work Overload – the First Driver of Burnout

The bad news: we're still trying to figure out how to get healthcare providers to wash their hands almost 200 years since Semmelweis rang the alarm on its importance.  The good news: physicians, nurses, and medical students are using lean principles to help drive some modest improvements rather than simply creating more signs and micromanaging individuals, as this team at Baylor did.  These improvements are necessary but not sufficient to close the gap.

A disposable duodensoscope has been developed, preventing deadly infections.

Operational Excellence

Sustainable lean transformations usually transcend tools and roadmaps seeking operational excellence and are instead anchored in a deep understanding of principles developed through practice.  Scania, a Swedish manufacturer, transformed itself over the last 15 years where “people were allowed to develop a deeper understanding of their own, and each other's, work, including how they connected with their internal and external customers and how they cooperated with their internal and external suppliers”.  Read more in this insightful article from Planet Lean,  A lean transformation is a cognitive transformation.

As more information is released about the Boeing 737 Max debacle, the classic and predictable consequences of failing to uphold operational excellence principles are revealed.  Former Boeing manager Ed Pierson reveals the many warnings and risks he raised to senior leadership, including the board of directors, that described an overburdened system at risk of creating catastrophic defects. 

If you had to pick one lean behaviour or tool to adopt, what would it be?  Grasping the Situation (or GTS) would be Jon Miller's choice, as discussed at Gemba Academy blog.  I wholeheartedly agree with his choice. 

Pascal Dennis shows us why we learn more from what didn't work.

One of the greatest challenges of getting supervisors and middle managers to embrace lean is that they often consider improvement, learning, and thinking as non-work activities or something that has to be done “on top” of regular production activities.  As the nature of work continues to evolve, organizations all agree that continual learning is essential to recruit and retain talent while creating value.  Learning for a Living describes how to make space for learning and the differences between incremental and transformative learning

Most people will associate lean with “waste”, but operational waste is a symptom of poor processes, not a cause. Ken Eakin reminds us that Taiichi Ohno identified three wasteful categories: muda (operational waste), mura (variation), and muri (overburden), and that a focus on addressing variation is often quicker to reveal cause, in “What Ever Happened to Mura?

A Stanford experiment suggests that we often reject our best initial ideas in favour of a more “concrete” second favourite idea.

 A nice story of engineering students from Oklahoma using lean design to improve the operations for non-profit homelessness transition centre Humble Design.

Leading & Enabling Excellence

Larry Culp, CEO of GE, has brought his leadership and expertise in continuous improvement and lean thinking to the industrial behemoth after sustained success at Danaher.  For the 2020's, the perfect industrial CEO would fully encompass Culp's precision-focused continuous improvement techniques over Jeff Immelt's focus on big macro bets

A great and noble purpose is a good thing for an organization, but purpose alone is insufficient for transformation. 

Google has long been envied for its ability to foster employee engagement by listening to employees and fostering a deep sense of mission, but those days appear to be over as internal dissent and tension spreads due to the perception that Google is abandoning its strong sense of mission.  

Empathy has been a trend in recent years as a management concept, often described as a key characteristic of the modern day leader.  More recently, people have been wondering if high degrees of empathy can lead to blind spots.  High empathy may drive antipathy for other groups and increase polarization according to American Political Science Review, and instead calls for greater rational concern for people different from us

If you want to create a unique and strong organizational culture, create some “shocking rules”

Coaching – Developing Self & Others

Fear and humiliation are ineffective and kill morale.  These “old school” tactics need to be retired.  Mike Babcock, coach of the Toronto Maple Leafs, lost the trust of his highly talented young team. resulting in his firing.  It has since been revealed that he ruled by fear and shaming young players with humiliating tactics in a misplaced attempt to motivate young players.  A reminder to managers who think public insults or comparisons create “healthy competition” between staff members – it doesn't.  It does reduce morale and create destructive behaviours. 

Performance reviews can kill your culture.  

Less is more: 5 ways to resist the urge to do too much.

KaiNexus shares an excellent piece on The Art of Asking Good Coaching Questions.

Kata to Grow shares a toolkit to add scientific thinking using simple kata to your child's learning routine.

Books, Podcasts, Videos

Quint Studer follows up his excellent book The Busy Leader's Handbook with an excellent podcast of Tips for Busy Leaders with Mark Graban.

Science VS compares US health systems to NHS (UK) health systems in an attempt to understand how to fix healthcare.

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Ryan McCormack
Ryan is an operational excellence professional with over 18 years experience practicing continuous improvement in healthcare, insurance, food manufacturing, and aerospace. He is an avid student of the application of Lean principles in work and life to create measurably better value.


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