ARE YOU LISTENING ? - How to judge if your organization is ready for Change

Health care reforms are here to stay and the pace of change is accelerating as State and Federal budget deficits continue to put pressure on government to reduce the cost of Medicare and Medicaid services. These “reforms” mean less and less revenue will be available to Hospitals and it’s going to force all Hospitals to squeeze out efficiency from their processes while simultaneously improving quality and service levels.  The challenge is substantial and it requires a clear and focused strategy as well as the ability to execute that strategy quickly and effectively. Unfortunately “strategy execution speed” is not the hallmark of health care.   

Can your organization successfully execute key strategic objectives with great speed? Can your organization react quickly to change? Here is a quick exercise that I suggest you try.  Consider the phrases outlined in this article and then take note of how often you hear them said in “hallway” and “water-cooler” conversations; take special note when you hear these phrases uttered at standing committee meetings and/or at meetings whose purpose is “solve problems” or manage new initiatives.

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“We already tried that and it didn’t work”

This phrase is very typical and very troublesome. If this is an often uttered phrase by your key managers, you can be assured that you have serious barriers to organizational improvement.  It denotes a resistance to change and innovative thinking and it’s a clear sign that the organization has not encouraged the right behavior in managers.

A variation of this phrase is used in best practice organizations but the context and intent are completely different.  In those organizations you will hear the phrase said like this: “We tried that and had problems; what can we do differently this time?  What did we learn from that experience? “

Need I say more?

The “we already tried that” phrase is often accompanied by another related common phrase: “You don’t understand how this place works”

What exactly does that mean?  Well loosely translated it means “Listen idiot, we operate in silos and we like it that way, you worry about how your department operates and I’ll worry about how mine operates. I’m not about to change”.

Did that translation make sense?  By the way if you are an executive you probably don’t hear this phrase as much as your underlings but keep your ears perked as you walk by conference rooms and you will hear it enough.  It’s a clear reflection of behavior that you need to start changing, today! That change happens by setting an example. People don’t care what you say they see what you do and then they behave accordingly.

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“I’m working on that issue and we should resolve it soon”

This phrase is somewhat related to the “We tried that before and it didn’t work” phrase.  Some organizations have learned that an outright resistance to change is not acceptable so they massage the message a bit; a more sophisticated and nuanced way to say “bug-off”. Translated it means “Listen buddy, I’m aware of the issues but they are overblown, my department does a great job. It’s not a big problem; we will work it out ourselves or you will realize that it’s a minor problem and quit bugging me.” 

This phrase is indicates your leaders are looking buy more time, after all if they keep promising that results are on the way and time keeps dragging on, sooner or later folks will lose interest and some other big issue will grab their attention – You buy some time and avoid accountability.

An easy foil to this delaying behavior is to ask that person to give you (in writing) the specific goals, related actions, and due dates for the resolution of that “issue”. It won’t be long before you see the issue resolved or that manager admitting that they need help to solve the problem.   

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“We already have a policy and/or a procedure regarding that issue”

Using this phrase is another great way to differ action. Never mind the fact that no one follows the policy or procedure – the important fact is that we have one!   Why fix something that already “in theory”, is “fixable” via an existing policy or procedure?  

Once Again trouble is brewing. Your employees use procrastination and road-block techniques to avoid needed change. The organization needs to do a better job in setting clear expectations and holding people accountable for specific metrics, if that was occurring, they would not have time to delay action.

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Let’s consider two phrases often spoken by leadership or to leadership that indicate executives have to make more effort towards understanding change management and then encourage the right behavior.

“I know we need to change but we need to make sure we don’t get people upset, they have to want to change”

If you are a leader and you utter this phrase to your staff (especially if those staff are charged with making change happen) then you need to rethink how change management works and rephrase the message.  Change is hard and you will often upset people. It’s also likely that the people who are the most upset are the people who truly need to change their behavior in order for the organization to succeed.   A better conversation would go like this: “We have had plenty of input regarding this change and it’s clear that it is needed so we need to articulate the change very clearly, let’s make sure we all give the same message.  I want the message the same and I want clear time lines and accountability for action, we need to get feedback and while we might make slight course corrections this change needs to occur as planned. I will give you whatever support you need to get this done.”

 “We have way too many initiatives”

Take this one to heart as it probably your biggest hurdle in achieving a best-practice culture.  Almost every health care organization has far too many initiatives. This tendency to create an unachievable list of initiatives and workload creates “martyr leaders”, leaders who feel that they carry the weight of the world on their shoulders and have so much to do that they have no time to think but only time to keep the great wheels of the organization churning.  It becomes a culture that rewards actions for actions sake; there is no better example of this than the tendency of health care organizations to use only one metric when installing very expensive software – Did it get installed when we said it would be installed? Better to have the software installation hit the due date then to worry about if it added any business or patient value; let’s face it “We don’t have time to think about those complexities”.   

Best practice organizations have few annual initiatives (objectives) because they realize the organization needs strategic clarity and focus.  Better to get a few things done very well than to work on 50 objectives and accomplish very little. With dozens of annual objectives it is common practice for deadlines to slip, objectives to be watered down, and burn-out to occur across the management ranks.  When the organization create focus and clarity of purpose  by concentrating on a few key annual objectives it can hold people accountable for executing them as promised.  The whining stops, the seriousness of hitting objectives sinks in, and the organization achieves a “can do” attitude.

There are many more phrases I could list but by now I think you get the message.  Put on your listening caps and you just might discover some organizational “attitude” that needs correcting.

Turning the Aircraft Carrier - Using 5S to improve Strategic Planning

Many of you may be familiar with a Lean process called 5S and when most Lean practitioners think of applying the technique they are likely to consider an inventory or assembly scenario; maybe a messy supply room or a disorganized sterile processing department but if you are an executive or in a position to advise your CEO/COO maybe you should consider how 5S can work to help your organization develop a better Strategic Plan. 

When executives are asked “Why did you start a process improvement programs?” most cite the need to create a more responsive and “change embracing” culture. Easier said than done! As you know there are libraries full of books about culture change and how to motivate work teams and while there is no doubt that deploying a process improvement methodology such as Lean-Six-Sigma is a good start it will, by itself, fail to deliver what you desire unless you understand the larger picture of culture change. Changing culture is a complex process but let’s start by explaining a critical concept: You don’t really change culture but instead you change behavior. The culture change comes via the constant reinforcement of desired behaviors   

The analogy often used in describing a culture change involves turning an aircraft carrier. How do you change the course of an aircraft carrier? You had better plan well and be methodical and careful or you may create a disaster.  Executives should view attempts to change or modify an organizations culture in the same way that a Navy Captain considers changing course of a massive aircraft carrier.  First understand your ship. The aircraft carrier’s bridge crew understands the carrier’s capabilities, the turning radius, speed ability, and listing tendencies.  Other factors must also be considered such as the way the craft is loaded, the crews experience level, the surrounding condition of sea and subsea terrain.  In essence an aircraft carriers Captain and crew have dozens of variables they must consider in a course change.  An executive team maneuvering an organization through significant culture change has no less of a daunting task; especially if time is of the essence, 

So where does the 5S concept come into play?  Well the first task in 5S is sort. Sort involves removing the clutter.  You need to understand what is and is not important to the organization in terms of accomplishing the Strategy.  Too many organizations try to do everything - When explaining why the organization needs 50 strategic initiatives executives will say:   “All this stuff is important!” Really?  Let’s talk reality.  When everyone’s plate is overflowing most initiatives get half-done and some initiatives never even get started. Having 30, 40, or 50 strategic initiatives and lofty goals creates a lot of “buzz’ and hyper activity but it is not long before the organization starts to confuse the activity revolving around initiatives as an important success factor VERSUS the RESULTS that those activities produce.  That is why you often see annual strategic initiatives occurring over 2 or 3 years and yielding poor or unsustainable results. If an organization uses careful and logical analysis most will find that most of their 30+ “strategic initiatives” have little or no impact on customer value and even fewer deliver critical financial benefit.

So before you finalize your next Strategic plan put the draft of that plan through the first S – SORT; you need to remove the clutter. The first task of an executive team is to develop Strategic Clarity and Focus.  This can be done in a variety of ways however the best technique is to use a very tough and selective prioritization methodology that is ruthless and unemotional in eliminating initiatives that don’t meet strategic criteria and/or can’t be adequately resourced to ensure success.  For example you may think that increasing surgical revenue by 5% is a great strategy but if you can’t find the resources to FULLY and PROPERLY staff and fund capital equipment, bring on new surgeons, and market the program then why would you proceed?  You can use a decision matrix to list out all your initiatives and then rank them by your importance factors, for example how does each proposed initiative rank on Strategic Fit, Financial Benefit, Community/Mission Benefit, Patient Satisfaction, and Future Growth criteria? After the first pass you can then take the top scorers and then consider resource issues, cost to implement, and probability of success to further reduce the initiatives to no more than 3-5 “initiatives that are critical to your strategic plan.  These “true north” initiatives must have the full support of the entire organization. Seems a little scary doesn’t it?  Focusing on only 3-5 initiatives scares the hell out of most Hospital executives.  What about all those other things that must get done?  They are still on the list and they still can be part of your overall performance metrics but they are not referred to as “strategic” and they must take a back-seat to the 3-5 Key Strategic Initiatives (Goals). Here is the reality check that I have seen over and over that backs up my comments in this article - Even when an organization has only 3-5 Key Strategic Initiatives they struggle mightily to get those few initiatives done. It begs the obvious question – If it takes incredible focus to get 3-5 initiatives done well, what happened in the past when the focus was spread across dozens of strategic initiatives?  Not as much as most organizations would like to believe.

Stay tuned for the next 5S application of straighten and shine regarding your Strategic Execution Plan.

TRUST is more than a buzzword - Learn from The 5 Dysfunctions of a Team

I wanted to give a brief overview of one of my favorite management books.  Although I have read hundreds of these types of books there are only about 10 that truly stand out as “Must reads” and “Must keep for reference”; one of these is The 5 Dysfunctions of a Team by Patrick Lencioni.  While Lencioni has written many books none are as good as this one. Why do I consider this book one of the best?  Because the author has kept it short and to the point and has made the reading interesting by explaining some rather complex team building concepts in an interesting story format (similar to The Goal, another one of my top 10). 

The story is about a new CEO who refuses to get bogged down as a referee in the many battles between her staff and instead, chooses to spend a great deal of her time building a team.  Even though the organization she leads is faced with some serious financial issues she realizes that without an engaged and cohesive executive team everything she does to “fix” problems will just be a stop-gap measure and fall apart at some point.  Just as in true life, her executive staff can’t believe that she is wasting so much precious decision making time on team building – “Why can’t we just get to work and fix our problems” is the common lament. 

In the story we follow the actions of CEO Kathryn Petersen as she makes the courageous decision to deal with the root cause of the organizations problems – a completely dysfunctional executive team.  We learn that there are 5 team dysfunctions that must be addressed before a TEAM can be created.  The 5 dysfunctions in order of hierarchy are: Absence of Trust (Invulnerability), Fear of conflict (Artificial Harmony), Lack of Commitment (Ambiguity), Avoidance of Accountability (Low Standards), and Inattention to Detail (My Status and Ego take precedence over team needs). 

While I could detail all five dysfunctions let me briefly talk about the first dysfunction referred to as Absence of Trust because it is the foundational base of a great team. I doubt that you will find many executive teams who are willing to admit that the organization lacks trust however you would be lucky to find more than 20% of all organizations that have made a serious commitment to build trust and even fewer that have declared such a competency a core organizational need (beyond lip service) and in-turn have dedicated the time and resources to achieve a high level of Trust.  Saying you have “Trust”  is not the same as having it and when you are a process improvement expert you can spot whether an organization has a culture of “Trust” within the first few days of executive and staff interviews. While there are many organizations that have good margins and “succeed in spite of themselves” there are only a few that consistently stay at the top of their game in terms of financial and quality results. It is a guarantee that those firms at the top of their game admit there is work to be done regarding the 5 dysfunctions and they work at improving core team-work capabilities every single day. 

My experience is that the most difficult barriers to overcome are the first two; Absence of Trust and Fear of Conflict.  Both require a significant and committed effort by the CEO because without his/her involvement politics will win out. I’m sure many of you have heard the phrase “Culture trumps Strategy” and it is very true. An organization with “Team Trust” and the ability to handle “Constructive Conflict” requires certain behaviors (which in turn become culture) that the CEO needs to make a priority.  If you have an organization that wants to become “world class” I suggest you find a way to make this book required executive reading.            

Preventing self-deception is about playing hard ball versus soft ball

In various studies scientist have found that all of us practice self-deception.  When asked to rank how well we do our job versus how others do their job, most of the time, we rank our performance as superior to our peers. This known bias is what gave birth to the 360 degree performance feedback system that is used by many organizations.  By using 360 degree feedback (subordinates assessing the positive or negative characteristics of their bosses) the theory is that bosses will often get feedback that tempers their assessment of their own performance and gives them a realistic assessment of their own performance. 

In practice, getting honest feedback and assessing our performance is tricky business.  Even though we have an awareness of our own self-deception, over time it can act as a drug that we are addicted to. We know this drug is bad for us but “it feels so good” it becomes easier and easier feed the beast within; this is especially true as you rise in position and influence. We convince ourselves that everything is great; our department is great, we are great, we control all problems, and we never need help.  We discourage any thoughts or discussions to the contrary and it is not long before our staff learns to suppress bad, and/or controversial news, not offer new ideas, and overall, be less than honest regarding feedback.  “Trouble-free” days become the norm.  This type of management behavior is more common than we would like to believe and it often leads to hiding or ignoring problems. The constant congressional and celebrity indiscretions and subsequent incessant denials and lies that follow are great examples of self-deception.

I wish I had a dollar for every time when I discussed a potential improvement project with a department-head I heard these comments: “The problem was already fixed”, “Our new process will soon take care of that”, and “This issue is a problem caused by another department, not us” Of course, I started the conversation because everyone else in the organization agreed that there was a problem (except those closest to it). 

How do we avoid such self-deception?  Ask the hard questions, not only to your staff but to your peers.  For example: When was the last time you went out of your way to ask the departments you support: “What can I do to help you?”  “What does my department do well and what can we do better – be 100% honest with me”   How about asking your employees a direct question like “What do I do well and not so well?” Do you encourage or stifle employee push-back. I’m talking about constructive push-back versus whining.  For example when an employee indicates that your idea needs more resources or more refinement and they are making thoughtful and valid points that’s constructive push-back versus whining at random with s comment like: “We tried that before and we could not get it to work”.  Don’t make this a “soft-ball” exercise. For example, asking such questions in a by-the-way manner as you pass someone in the hallway – That is rarely the forum to get an honest or thoughtful answer. You need to set some time up and discuss specific metrics and expectations. 

I have worked or consulted in many organizations and I have noticed a strong negative correlation between the practice self-deception and organizational excellence; the greater the self-deception the lower the performance and the greater the hidden cost of inefficiency.  If your organization is going to get to the next performance level maybe it’s time to ask some hard questions.      

Do you dig wells or channels?

10 yards wide and 200 feet deep versus a mile-wide and 20 feet deep

What’s better?  A hole as described in the title that is 10 yards wide and 200 feet deep or the channel that is a mile-wide and 20 foot deep?   Well that depends on what you’re after, if all you want is some water then the former is a good choice but if you want to build a channel that can transmit water, people, or goods then the latter is more appropriate. 

I believe that in the area of health care too many organizations are digging wells versus channels.  What I mean is that they engage in process improvement efforts within a few key departments or within the Hospital setting yet our patients only spend a short time in either setting.  If you think about the entirety of the health care continuum, it is more like the mile-wide analogy.  Our patients utilize a wide variety of services beyond the hospital walls: Home Health Care, Visiting Nurse, Rehab Facilities, Pharmacies, Social Services, and Long Term Care Facilities to name a few.  If we truly want to make a positive impact on patients we must take our Operational Excellence efforts to the next level and engage all the health care partners.

Let’s face it, you have to start somewhere regarding Operational Excellence so digging a well is not a bad idea, as a start.  People hit water, they drink, and they are quenched but at some point we need to move beyond our own easily visible needs and problems and move with the patient through all the “healthcare” places they visit or live in.  We need to form true working collaboratives with key community providers in our area and we need to collect the voice of the patient all along the health care continuum. 

If your organization has been digging wells for the last 2-4 years it might be time to rethink your OE strategy.  It’s great to have plenty of water but sooner or later you need travel beyond your small world and for that, you need to build a channel.

Traits of Great Leaders

With my apologies to Jason Jennings (Best Selling author - http://www.jason-jennings.com) for paraphrasing his work. Here is a summary of Jennings take on the traits of GREAT LEADERS.

Great Leaders stand their ground on core values regarding how their organizations must operate; they do not waver and they turn their values into causes.  These causes provide Big and Bold direction that gives the organization purpose. They are not focused directly on financial results but instead, are focused on giving purpose to the work done, fueling passion, and driving momentum.

Great Leaders let go of yesterday’s success, ego, and conventional wisdom because it allows the organization to deal with change, promote innovation, and outdistance rivals.

Great Leaders make sure that everyone knows the Strategy and that all are held accountable.  They never play “favorites”, allow corners to be cut, or allow managers to engage in improper behaviors.

Great Leaders reward performance based on value created.

Great Leaders share information, are accessible, don’t adhere to superficial symbols of power, are coaches and mentors, and believe in Servant Leadership.

The 4 top reasons that Operational Excellence programs fail

#4) The CEO and executive staff thinks that the road to Operational Excellence involves a “silver bullet” tool or concept.  

  Organizations with a silver bullet mentality often get very excited when an improvement programs start but lose interest quickly because they have not taken a comprehensive approach to operational excellence.  They think that one or two process improvement tools (i.e. Lean) are they key to success instead of realizing that they must develop a comprehensive Strategy Deployment process that utilizes many OE tools in order to become a top performing organization.

#3) The Operational Excellence Department does not have a seat at the “strategy table”, does not have adequate resources, and does not have support from other critical departments such as Finance and HR. 

The OE department needs to work closely with the CEO and executive staff to integrate operational excellence thinking into everyday tasks; this involves making sure that projects flow from the strategy and are not just “one-off” cost reduction exercises.  It also means that other departments support the OE implementation. Ffor example, HR must ensure that the performance evaluation process creates the proper alignment and incentives that encourage OE behaviors.

#2) The organization has a “strategy” but it lacks strategic focus and there is no structure and strategy deployment methodology in place to ensure execution.

Many organizations have strategies that are nothing more than “wish lists”. There are too many initiatives, they are poorly resourced, and there is little buy-in from the organization.   Because most initiatives do not have firm metrics and are not tightly aligned with driving actions there is poor strategy execution and little accountability. The organization needs to understand and deploy a strategy deployment methodology (ie Hoshin Kanri).

#1) The CEO and Board of Directors are involved with the Process Improvement effort but are not committed to success of the effort. 

“Committed” means that executives must spend a substantial amount of time and effort on promoting the Operational Excellence Program and supporting the efforts behind building an operational excellence culture. There efforts must go well beyond maintenance of the program and instead constantly work to expand the program so that it is embedded in the organizational culture.  CEO’s who are committed realize that their direct staff and all other employees don’t listen to what they say but rather, watch what they do.

Having an "employee of the month" does not Maximize Human Capital

There are a lot of organizations that tout the “value of their employees” and how their employees are the organizations “most valuable resource”. But when you dive into the way many health organizations operate it becomes pretty obvious that these claims are nothing more than lip service. Sure, it’s true that many Hospitals are very hesitant to engage in mass layoffs and they tend have the walls littered with nurse of the month or employee of the year posters but is that an indicator of success in maximizing your most important, and most costly asset?

For sure, treating people fairly and not resorting to “knee-jerk” cost cutting solutions like mass layoffs do show a sign respect for employees but it’s only one small piece of maximizing your human capital. Consider one of the most important drivers of organizational success- retention rates.  If you are not significantly beating your peers on voluntary retention rates than you can be sure that your best employees are heading to your competitors.  It’s a critical driver in efforts to maximize human capital yet it rarely gets focused attention at executive meetings and board of director meetings.   

Does the organization have a robust and comprehensive employee development plan that includes 360 degree feedback?  Data shows that 80% of employees leave their positions because of conflicts with their supervisor.  Some of these conflicts are unavoidable but the vast majority can be addressed so that the conflict is managed and no attrition results.  Why doesn’t’ every organization employee such systems?

When a good and talented employee leaves an organization you can figure that the cost of finding a replacement plus the cost of lost productivity amounts to at least one times that person’s salary. So every time you lose a talented nurse or administrator making, say $75K per year, you really just incurred $75K of added cost to run the organization.  You won’t see that cost show up anywhere on an income statement line but you will see it eventually wind its way to the bottom line.  And worse than that, when your retention numbers start an upward trend it becomes difficult to stop the trend quickly because it’s really an accumulation of many past practices that are now bearing sour fruit and any corrective actions will take many months if not years to have an impact.   

A Guaranteed Method to Stop Team Wheel Spinning

I have sat through hundreds of unproductive meetings over my many work years and I would say that the great majority of team “wheel-spinning” could have been avoided using one simple tool: The Critical-to-Quality Tree which I now call the Critical-to-Success Tree because I think that name resonates better with most people.  I know I’m preaching to the choir in explaining this to my lean-six-sigma trained brethren but for those not familiar with the tool I can only say this; LEARN IT TODAY! It’s critical to any improvement project and should be the first tool you use before you go out and purchase any software or information system. 

In essence this is a tool used to take a "Big Goal" and convert it into sub-goals and the related metrics, which in turn can be converted into action items that will help you achieve your "Big Goal" . It’s on my top 5 must-use process improvement tool list.  

Take a look at my simplified example below:

We can say our "Big Goal" is to arrive at work on time but until we layout what that entails it is not going to happen.  In this example we take this rather simple goal of "getting to work on time" and work through the specific actions that will make that happen. For this goal many people could figure out the requirements and specifications by trial and error but using the tool eliminates that need.  The tool is completed from left to right with the left side showing a broad need or want and as you move to the right you get more and more specific about how to drive that goal. When complete it becomes clear that unless you are successful in meeting the specifications (far right)  you will not accomplish the broader goal (far left). Note that the specifications may require more detailed action items.

Consider a much more complex issue. Rather than getting to work on time consider a more complex problem that you think you can solve by installing a certain expensive software program or by completing a Lean project. Maybe you want to improve patient flow, reduce the cost of a surgical process, or increase MRI utilization.  Do you think you would understand the drivers and specifications of these complex processes without going through this exercise?

Lets use a complex “real life” problem that every Hospital is facing: How will the Hospital reduce Congestive Heart Failure 30 day readmissions? This is critical because starting in 2012 they will not be paid for additional services within 30 days of the first admission and related discharge.  Before you read further why don’t you grab a piece of paper and jot down what you believe are the drivers and specifications for such a project. If you get all of the drivers and specifications you see below I submit to your genius however my experience is that few individuals and almost no teams can layout the critical success factors without using this tool.  Now, with your “guess” by your side take a look at a recent Critical-to-Success diagram a team of ours is using for that specific goal.

While some may disagree on the exact format to complete this exercise and while there might be some minor quibbling about the exact drivers it is clear that the tool allows any team to bring much more focus to large and complex issues.  Before we did this exercise our team was trying to solve the problem in a semi-accurate (most people understood the basic issues) but random manner and we were not making very good progress. After allowing the team to struggle for a few meetings I intervened (with the facilitator), explaining the tool and its benefit. The facilitator was also frustrated with the team’s progress and being a very smart person he immediately gleaned the value of this tool and we worked on it together and then later with the team.  Once the team created this CTS diagram the dynamics within the team changed dramatically.  Armed with clear objectives the team members and the facilitator could spend their time accomplishing specific actions that will drive success. The team is making good progress and the wheel spinning has stopped.

 

CULTURE CHANGE - It's really about ice-cream versus chicken fingers & vegetables

In my last Blog I discussed the fact that a process improvement program should be geared towards creating an operational excellence culture.  Unfortunately many executives don’t fully grasp the fact that you can’t change culture, you instead, change behavior, which in turn changes culture.

As an organization you want to develop behaviors that promote the best-practice behaviors of top-performing organizations. Behaviors like trust, teamwork, reliance on data, open dialog, and transparency. When many organizations talk of starting an operational excellence program they talk about changing culture but they don’t spend enough time talking about changing behavior.  Many don’t make the connection.  Teaching your employees about Lean, Six Sigma, Balanced Scorecard and other improvement methodologies has value but unless the executive team exhibits correct behaviors and insists that all employees practice behaviors that align with the organization mission and vision, there will be no culture change. 

Many executives mistakenly think a dysfunctional culture creates bad behavior however when an organization is a poor performer you can always trace the root-cause back to poor behaviors, which in turn creates the dysfunctional culture. Too many executives think that culture change is achieved through training, and lofty “rah-rah” speeches and events.  Top performing executives understand that staff soon forget what is said at these canned events and training sessions, instead, they intently watch what executives do and model their own behavior accordingly.

Behavior alignment is probably the single most important concept that executives must understand if they intend to develop a continuous improvement culture.  Why?  Because you do not change culture directly, you can’t.  What you can do is influence and change behaviors and then, once the desired behaviors are reinforced (over and over again) you begin to change culture.  It’s not a “chicken and egg situation”, changing behavior always comes first.  Every effort must be made to ensure that executives and senior managers enforce behaviors that support the organizations goals and objectives and that they discourage behaviors that are contrary. 

Let’s take a classic parenting example.  It’s dinner time and your child really does not want to eat her chicken fingers and vegetables, she wants ice cream for dinner.  She can be quite insistent about the ice cream, crying, screaming, pouting, and refusing to eat.  For parents this behavior can illicit a wide range of emotions, from incredible sympathy (they don’t like to see their child upset) to anger and frustration.  The parent has really two basic choices, give in and let the child have ice cream or make it clear to the child that dinner is important and unless the child eats dinner and behaves appropriately there will be no ice cream.  If the parent chooses to allow ice cream before dinner what do you think happens at the next night’s dinner?  Of course, the child tests the rules again; after all, it worked once.  This testing goes on for many more nights until the child understands the exact rules of the house.  If the parent keeps allowing ice cream before dinner then that behavior becomes the norm and ingrained in the household culture. Soon there are no more tests by the child on this matter, no more tantrums; ice cream is eaten before dinner every night.  The parent did not develop the household culture directly, they established what the child perceives as acceptable behavior and in turn it becomes a cultural norm. Why would a parent allow such behavior? It’s pretty obvious that most nutritionists would cringe at such a choice, however the parent is making a trade off, they have determined that a little bit of ice cream and potentially poor eating habits are less of a concern than an upset child.  Humans are the masters of justification and CEO’s are no different.    

If an organization has dysfunctional management, a top-down command and control structure, a lack of flexibility, and overall poor financial performance it is very likely that this organization encourages or tolerates poor behavior which has created a poor performance culture.  Poor performance drives the need to change culture and this can only be accomplished by encouraging desirable behavior, thus as a first step the organization must understand what type of behavior it desires.  Desired behavior is driven by the organizational strategy and from that strategy the organization’s objectives and goals. 

Remember the parent with the ice cream loving child?  You are now that parent.  The children are used to ice cream - They want their way and they need an authority figure (CEO/Parent) to reconfirm that you agree.  Like any parent, you can avoid conflict and all the pouting and hurt feelings that go with refusing the ‘wants’ of your child or you can insist that both parties focus on the proper corporate goal and related behavior.  If you choose the former you have just violated your behavior alignment plan and even worse, you have encouraged the bad behavior and in turn reinforced the current culture model.  

Don’t think this can happen to you?  Let’s take a typical problem - Two VP’s are not getting along on a large project. Their issues involve typical bad behaviors involving rivalry between their “siloed” organizations and mind-sets that are far from flexible; they have a meeting with the CEO to discuss their issues. The CEO hears them out but defers any resolution; after the meeting the following occurs:

Scenario One

The CEO thinks through the issue this way: George has been here for 20 years and is a valued employee and the same goes for Susan; both have bailed the company out of tough situations.  I don’t think this battle is worth fighting I need to get them to move on to some less controversial issue and let them run their departments as they see fit.

The CEO arranges separate meetings with George and Susan and tells both of them this: “Try to get along and work out your differences, I don’t think you should make a big deal of this, just concentrate on improving your areas and do the best you can”

Scenario Two

The CEO realizes that behavior modification is needed. The CEO calls a joint meeting with George and Susan:  “George, Susan, I really value your contributions to this organization and I realize you have strong opinions but you need to stop focusing on what is comfortable for you and start thinking about what is best for the organization.  I want you to get back to the team and use others to help you see this issue from a different perspective, a perspective that subjugates your needs to the organizations needs.  I want this issue resolved by the end of next week.  You are both highly competent and need to use the team and facilitator to help you determine the best solution.  Please set up a meeting with me next Friday, I expect that you will not let me down.” 

In this second (desired) scenario the CEO stuck to her behavior alignment plan – Develop cross-departmental cooperation (teamwork).  Next, she strongly discouraged the “old” and bad behavior and made it clear the importance of adopting the “good” behavior.  At the same time she acknowledged that the she valued both employees but was not going to value the “old” behavior.  When George and Susan return next week with a solution the “good” behavior will be reinforced with high praise.  After this pattern is repeated with others it will not take long before it becomes understood that the COO values teamwork and we all better learn how to cooperate and work together.   Once the behavior is repeated enough times the culture will begin to change; from a siloed, self-serving culture to a teamwork culture.   That is the power of behavior alignment. 

Executives need to take note.  If you fail to be vigilant and constantly work at behavior alignment you will not be able to achieve your goal of creating a culture of continuous improvement but even worse, you will be perceived as a poor leader because you promised change but did not deliver. 

A Process Improvement Program by any other name would smell as sweet

There are a multitude of names given to process improvement programs. Some organizations like to use: Six Sigma, some use Lean, Lean Six Sigma, Operational Excellence, Organizational Effectiveness, Process Improvement, Process Innovation, and Process Transformation to name a few.   Some organizations use lean six sigma but don’t call their experts Black Belts or Senseis; they may refer to them as “XYZ Process Expert Level 1”

While many organizations spend an inordinate amount time thinking of the best name of their programs or their experts, the names have little meaning when it comes to developing a good program that delivers results. That said, my personal prejudice is to use a program name that is more generic and does not reflect a specific methodology. For example you can see that my blog involves the term operational excellence. The problem with using program names such as “Lean” is that people immediately assume that all answers lie in that particular tool set and it does not take long to shoot holes in the methodology if it is applied like peanut butter to every problem.

Back to the “name does not matter” idea.  In order to deploy a solid process improvement program you must concentrate on changing behavior in order to create a desired culture.  You don’t change culture; you change behavior (I’ll cover this in more detail in another blog).  Most organizations don’t develop a culture-centric program but instead they develop a project-centric program. Try this experiment: Ask a CEO that has a process improvement program in place to tell you what the program does.  Most of the time they will tell you “ We have had great results, we have cost reduction projects, patient satisfaction projects….” and on and on about projects and project results.  Now ask that same question to the CEO of an organization that is a top performer; the answer you get will be much different.  They will say something like this “ Our program is helping us develop a culture of excellence so we can meet the challenge of the next decade and provide our employees with greater opportunities.” Do you get the difference?  Of course the top performer CEO has a program that is running projects but they understand WHY they are running projects. 

Now back to the “name issue”.  When an organization tells employees they are going to be a Lean Hospital or a Six Sigma Hospital they are missing the point.  Lean, Six Sigma, Balanced Scorecards, and Theory of Constraints are methodologies and tools that help change behaviors but they are not by themselves the only drivers of culture change. These methodologies contain powerful tools and methods that can help an organization solve problems, improve processes, remove constraints, and create accountability but none of the by themselves are the “silver bullet” that creates a culture of continuous improvement. 

Team Diversity makes for better project outcomes

Have you ever wondered how a team works in spite of the diverse personalities?   We have all been in a team meeting where we find ourselves screaming (hopefully only on the inside) because of our frustration with a team member’s inability to comprehend a concept or with a team members disjointed ramblings off topic.  In my early years these situations truly bothered me and created a lot frustration but as I facilitated more and more meetings I finally realized that everyone is not like me!  And they don’t think like me either!

Diversity of personalities and thinking styles are critical to a great team and helps avoid group-think. As facilitators we need to embrace the differences and use those differences to an advantage, I like to categorize my team members into 5 personality types and I always try to get 4 out of the 5 types, read on and you can guess which type I try to avoid:

The “Thinker”: This is the person who does not talk much and is a good listener; they often come up with great solutions based on the various inputs from other team members. They can keep you out of trouble because they tend to be balanced in their approach and while they believe in stretch goals they also keep the tam from "over reaching". Always try to get a “thinker” on your team; they often have the respect of other team members and thus help you build credibility.

The “Emotion Train”: This person brings heavy emotion to the group and if left unchecked, they can be become a speeding freight train, destroying everything in their path.  However, if controlled, they can bring great value to the team.  While they often take “side trips”, can sometimes get “personal”, and often start off somewhat negative, they often provide a vivid unadulterated recollection of past mistakes and cultural norms.  If you listen closely you will learn about barriers to change, past failures, and also get a flavor for where certain key mangers stand on project efforts.  For logical folks like me it is sometimes frustrating to listen to “emotion trains” however they provide great information. They are a good personality type to have on the team but you have to make sure they do not become a distraction (AKA an out of control freight train), I often enlist the next personality type to help me in that endeavor.

The “Politician”:  This is the person who does not contribute a great deal of new ideas; instead they frequently repeat with others have said making sure that they understand what that person needs and where they are heading.  They are hesitant to offend anyone so they rarely come up with anything controversial or “out of the box” however they help bring a certain sense of clarity to the group and can often be helpful in smoothing any ruffled feathers when someone takes offense at a comment. Together with the “emotion train” personality they help you understand the culture of the organization. They are good communicators so make sure you enlist them to help garner support for team efforts.

The “Passive Resistor” This person is the toughest to deal with when you are a facilitator because they are impossible spot quickly.  They tend to agree with the direction of the team and avoid group disagreement; therefore you don’t always determine their nature until several meetings have gone by. As we all know once the “passive aggressive” member is out of the meeting they either ignore the action items or sabotage team efforts at improvement.  These are highly experienced “stone-wallers” so you rarely win by trying to deal with them head-on. They are essentially insecure so you may be able to uncover their insecurities and build their confidence but unfortunately this may take a long time. You need to be persistent in getting them onboard usually by providing them with minor tasks that you make seem very important but if that fails, you go to plan B; minimize their team involvement.

The “Workhorse”: This person is semi-interested in the dialog and creativity but their real talent lies in doing things.  Give them a task and they will get it done.  Because they don’t tend to quickly comprehend the bigger picture you need to be careful and patient in order to get them onboard with ideas and concepts but once they buy-in they will carry a lot of the workload and require no special “stroking” as they tend to have low ego levels however, they very much appreciate recognition within the group.

Sometimes dealing with many personalities can be frustrating however the frustration is worth every “tums” you chew because you always end up with better results when you work with a diverse team.

Operational Excellence for Hospitals: May the "Force" be with you

Operational Excellence for Hospitals: May the "Force" be with you: "Are you a fan of star wars? Ever think that you might be living the movie? The other day I thought about how life as a process improve..."

Operational Excellence for Hospitals: Metrics are dangerous - Be careful what you wish f...

Operational Excellence for Hospitals: Metrics are dangerous - Be careful what you wish f...: "Is there a manger out there who would say they operate without metrics? NOT. After all everyone knows that what gets measured ge..."

Metrics are dangerous - Be careful what you wish for!

Is there a manger out there who would say they operate without metrics?  NOT. 

After all everyone knows that what gets measured gets done, right?  Here is the problem, most managers either use the wrong metrics or only use one dimensional metrics to drive behavior. 

Let’s take a recent example I have seen first hand.  A Materials Manager is being measured on order fulfillment rate.  They have a goal of filling orders 99% of the time; they currently are at 99.4% fulfillment. Is this a good thing?  Does this make the organization more profitable or efficient? 

How about if I told you that over 4,000 individual orders a month are processed. How about if I told you that the number of orders being processed is going up every year but the volume of supplies is relatively flat. How about if I told you that our cost of expediting shipping has risen by 30%?

Here is another prevalent example common in many Hospitals. 

The Hospital employees a physician liaison to build bridges with community MD’s and to produce more referrals. The metric for this person is the number of visits to community MD’s.  Do you think monitoring such a metric will drive the desired results?   Can you come up with some other metrics that might be useful?  Does quantity over quality ring a bell? With this one metric how long will it take you to determine the effectiveness of the program?

I think you get the picture.  Be careful what you measure because it may just get done

Captain Kirk of Star Trek fame is a good role model

For those of you who are Star Trek fans you already know the main characters of the Star Trek series but for those of you who are not let me elaborate (you “Trekies” can skip to the next paragraph).  Star Trek is about the adventures of the star ship U.S.S. Enterprise and their diverse crew who are involved in space exploration.  These future space travelers zoom through the Galaxy at light speed seeking out new life and exploring new worlds. There are three main characters on the Enterprise: Captain Kirk, Commander Spock, and Dr. “Bones” McCoy.  If you watch the series you quickly realize how different these three good friends and crew mates are.  Spock is a Vulcan, born of an alien race that believes in pure logic without emotion.  Dr. McCoy (AKA Bones) is the star ship’s medical doctor and is a study in pure human emotion.  Their leader, Captain Kirk is a man who seems to blend the two other personalities.  He is fairly logical but is often willing to put logic aside when his “gut” tells him to do otherwise. 

These three very good friends face a lot of scary moments together during their many exploratory missions.  When faced with a dilemma where a crucial decision needs to be made Kirk will ask for advice and inevitably Spock gives advice based on logic and “Bones” gives advice based on emotion. As expected Spock and “Bones” often disagree on a solution and there are often many arguments between the two, many of these  involve “Bones” emotionally hurling various insults at Spock (good naturedly of course).  After listening to his crewmates Kirk sometimes chooses the logical path and sometimes the emotional path but more often, he takes a middle ground because he sees the value of utilizing both logic and emotion in his decision-making.  As Operational Excellence leaders we frequently venture into uncharted territory - new projects where we often face hostile “alien” team members.  I have seen all kinds of facilitators from the emotional to the purely logical and everything in between however I think the most effective OE leaders have characteristics similar to Captain Kirk.  They keep their cool even under the most extreme pressure and while they never lose sight of the end game and the need for logic they understand the emotional side of human nature and don’t ignore its power. During the course of a project they are willing to take a few detours in order to satisfy the emotional needs of those hostile “aliens” who tend to mellow as their emotional fervor subsides. At the same time, good OE leaders don’t let emotions get out of hand; they deftly keep the team away from any emotional “death spiral”.  Every team has its characters, the Spocks (usually my engineer or research friends), the “Bones” characters (usually my nursing or marketing friends), and all the in-betweens.  A good leader (and Captain Kirk is one of the best) must carefully utilize the strength of each personality and talent without allowing one to overwhelm the other.  OE leaders need to be an orchestra conductor. One instrument, by itself can make great music, but when a conductor harnesses the power and brings balance to the many instruments of an orchestra the positive effects of the music are multiplied 10 fold.   

For Captain Kirk failure is never an option, the lives of his crew often depend on his decision-making. The crew of the Enterprise is a diverse bunch with many faults but directed by Captain Kirk, they work together and become a powerful and unbeatable force.  At the start of the Star Trek shows Kirk is heard describing their mission:  Space... the Final Frontier. These are the voyages of the starship Enterprise. Its continuing mission: to explore strange new worlds, to seek out new life and new civilizations, to boldly go where no one has gone before.  Doesn’t that sound a lot like your job as an Operational Excellence Leader? 

Quick process improvement hits can have a BIG impact!

When you start to work on a project don’t forget to look for quick hits that may make an impact without the need for any detailed process improvement methodology.  For example: I’m working on a fairly significant redesign of how our Periop area operates and as we delved into the current process and opportunities we uncovered many small changes that could help the process immediately.  One of those changes involved standardizing how we review the Operating Room (OR) and Ambulatory Surgery Unit (ASU) surgical schedules.  The daily routine is supposed to involve a daily review of the next day’s surgical schedule.  In our situation the two areas are 1700 feet apart yet they both share some limited quantities of very expensive equipment and surgical sets. The daily schedule review is critical because there may be conflicts with surgical set usage, the schedulers may have under or overestimated surgery times, or the Surgeon may have not sent over critical information regarding supplies and sets needed (we often use loaner sets from our vendors).  It is also important that the Surgical Nurse Managers and our Sterile Process Supervisor talk about the schedule together as each has a specialized expertise that is needed.  A typical problem might be:  A surgery scheduled in ASU at 8AM that is using a scope that must be sterilized and sent to the OR for a surgery at 9:30AM; this is a problem because it will take at least 2 hours for the scope to be processed therefore an unrealistic schedule conflict has been created.  

While each Surgical Nurse Manager always reviewed the schedule daily, they did not do it at a consistent time, they did not always do it together, and they did not include Sterile Process in the review (although they occasionally called Sterile Process regarding specific problems assuming they remembered and/or did not get distracted).  We determined that the three key players must meet every day at 11:30AM to review the schedules together and then note issues on a check list to make sure all problems were addressed before the next day’s surgeries.  The results of this simple change have been dramatic: We have eliminated “emergency” scrambles regarding needed surgical sets or equipment (these use to happen at least 3 out of 5 days); the surgeons are noticing that the coordination is cutting their surgical times, and the three departments are developing a camaraderie that was lacking.   There is still a lot of project work needed for us to gain significant efficiency gains but these small victories give a boost and provide greater credibility to the larger project efforts. 

A Process Improvement Lesson from the Libyan Rebels

The recent events in Libya remind me very much about how highly charged emotions always trump logic. At the beginning of the rebellion the Libyan rebels were flush with excitement and had an over-confident sense of invincibility.  I remember watching news clips and listening to the radio about how the rebels refused to be trained in the basics of marching and military tactics by the professional and experienced military pro-rebel leaders. Instead they were screaming “Just give me a weapon, I need to go fight, this training is a waste of time!”  Most grabbed weapons they had never used before and rushed off to the “front”.  It reminds me of the situation we face within process improvement as we try to teach an inexperienced project team to use a DMAIC methodology and the proper process improvement tools in order to solve complex problems.  Many of our trainees are frustrated by the methodology and the perceived slow pace.  They fail to see the value in defining the problem and working out potential solutions on paper and within a small pilot before implementing the improvements throughout the organization.  

Until the recent intervention by NATO the rebels faced almost certain defeat at the hands of the experienced Qaddafi forces. They were being slaughtered by the hundreds and thousands; they were completely unprepared to face a disciplined and well supplied army.  Before reality struck the rebels perceived the world through a very narrow lens – “We had no freedom now we are free so we must be powerful”. There was no thought to past history in their own country or in nearby countries were dozens of rebellions are crushed every year. Organizations, like the rebels, often look at success through a narrow lens that only reflects their small world: “Our costs are down 5% from last year, gosh we are awful smart and successful”; never mind that our main competitor’s costs are down by 15%.    

Many teams we coach are quick to forget the many years they have spun their wheels on the same problem over and over again. Past failures are often marginalized and excused away, blaming any problems and failures on specific individuals or on a “lack of management commitment”. 

I doubt there was even one experienced rebel military leader in Libya who thought the rebel’s impetuous actions had any hope of success and yet, they also knew that trying to stop their illogical initial actions was futile.  A good process improvement leader needs to strike a delicate balance; helping a team exhaust highly charged emotions while also using the right tools and methodology to help them see reality and to open their eyes to a much broader perspective. Unlike the situation in Libya, no lives are in danger (although sometimes it is a close call), but the revelation that the rebels experienced a few weeks ago when they were quickly defeated by Qaddafi’s forces has some relationship.  As process improvement facilitators we must present our team with many unpleasant but irrefutable facts so they are shocked back to reality; sometimes it is the only way that logic can gain a foothold and we can start to bring ego and unrealistic expectations under control. It’s too early to see if the reality of the recent conflicts will changed the way the Libyan rebels approach their future actions but one thing is certain, if they don’t learn to keep emotions in check and apply sound strategy and tactics they will not succeed.  The same goes for the many healthcare organizations that choose to mimic the “Libyan rebel methodology” which can be summed up as a fire, aim, hope methodology. 

Considerations BEFORE you install the next Great Technology

In today's highly competitive business environment executives often settle for shortcuts.   CEOs are under constant pressure from the Board of Directors to tell them what is changing in the organization – “give us examples of change” is a common request. Of course most of these changes are relayed via a very polished once-a-month PowerPoint presentation. These presentations are highly scripted and of course, manipulated to present the best picture of the organization and the CEOs accomplishments. It is a rare day when bad news is presented in the boardroom.

Executives often become obsessed with checking the box versus doing what's right. One major waste in every organization but especially Hospitals is the tendency to install the latest and greatest software that will “solve all our problems and put us in the forefront of medicine”.  The exercise usually goes like this:

 One of the senior managers or executives keeps hearing about process issues; maybe the lack of good cost accounting or the shortfalls in our patient management system.  They discover several vendors who can offer solutions and they bring them in for demonstrations.  These vendors wow the group with the software capabilities and everyone buys-in because this system seems to be able to eliminate the headaches caused by the current process and/or current software. IT is pulled into the mix to asses the technology needs and Purchasing sends out an RFP and beats up the vendors on price.  Soon the capital is approved and a rough plan is assembled with emphasis on launch dates, hardware upgrades, and a few slides about the business benefits.

And the problem begins….most of the effort upfront is about what software to pick based on the best technology and little if any time is spent developing a detailed analysis of the current process, user needs (voice of the customer), and the desired future process.  Sure, everyone knows the current process is broken but few really understand why, they just think they know why.  Users are so bogged down in the day-to-day process that when they sit in on a vendor demonstration everything looks better than what they have and of course, the vendors paint a picture of seamless software that is so easy to use a child can operate it.  Studies have shown that best-practice organizations spend at least 30% - 40% of their effort on defining the business needs of the organization before purchasing and installing software solutions yet, on average, most organizations spend only 10% of their efforts in this area.  I have seen multi-million dollar software installs with ill defined user needs, poor or no metrics, and little upfront involvement of the user community.   The result is predictable; due dates and budgets are hit because that is where the focus was concentrated but there is a complete failure to deliver on the business needs.

Installing state-of-the-art software makes a great slide for the Board Room and probably creates a certain sense of accomplishment but business results are what matters and sooner or later the piper comes calling.  As these bad technology decisions accumulate they have a way creating tremendous process inefficiency and hidden (but real) costs,  users start creating more and more work-arounds and  side-systems in their efforts to get around the business road blocks created by a poorly executed software or new technology launch.  It’s not long before everyone is back in the conference room looking at another software/technology demonstration and living the fantasy one more time. 

May the "Force" be with you

Are you a fan of star wars? Ever think that you might be living the movie?  The other day I thought about how life as a process improvement guru is a lot like being Obi-Wan Kenobi.  Everyone thinks you have all the answers and possess special powers.  On many days you can feel the power of “The Force” helping you achieve great things but sometimes you feel weak and depleted and you find that you must find a quite place to rejuvenate.  Everyday you face at least one, if not three, Darth Vader “like” opponents. They know how to use “The Force” and they are powerful but they use the Force for evil and they would not hesitate to destroy you.


You must hone your alliances and you need an ally like Yoda to help you stay focused on the path of good and you rely on him or her to protect you from any tendency on your part to move to the “Dark Side” as a means of gaining power or status. Yoda also alerts you to any surprise attacks from the your opponents.  Sometimes you are held captive by Jaba the Hutt that enormous blob of greed created by your COO or CFO  who cry  “Find me more savings, more savings!”. You deal with a CEO who’s personality alternates between Chief Chirrpa of the Ewoks and that of the Emperor (aka: The Dark Lord).

Every once and awhile you find a Princess Leia - A kind and fearless soul who shares the same passion for improvement that you do and is willing to follow you into battle no matter what the odds.  You probably have a young apprentice, your Luke Skywalker; eager and smart but sometimes a bit to impetuous and head strong so you sometimes find yourself in "damage-control mode" fixing some relationship problem that Luke created.  And of course you may run into Hans Solo that untouchable rogue that everyone seems to love even though he really gets nothing done. And as you work late into the night trying to complete a past due project it’s often just you and R2D2 pounding out financial models, spreadsheets, and stats.   In good times and bad but especially in your most desperate moments, remember one thing: "The Force will always be with you".

OE career move: Making the transition to a healthcare environment

 Because more and more process improvement professionals will start to move from non-healthcare roles (i.e. manufacturing and service) I thought I would give you my perspective on what it’s like on “the other side”. 

As you might suspect healthcare is a much more people centric environment. How could it be otherwise?  Although there are a fair share of selfish SOB’s in healthcare most of the folks are not here for the stock options (they don’t exist in non-profits) they are here because they want to help people and serve the community. That attitude is a double edge sword. On one hand it’s great to work with caring folks but on the other it’s the excuse many give to avoid change – “I’m here for the patient; you can’t standardize what I do”.     

In healthcare much of the work done regarding process improvement is openly shared.  The sources of this information vary, coming from organizations dedicated to process improvement like the Institute of Healthcare Improvement (IHI) but it is also readily available on healthcare websites and journals.  I have found that most of the authors are very willing to talk about their projects and give advice. This is a great source of knowledge that you must tap before you start a project as there are plenty of lessons learned and you can get a head start on most of your projects.  On the downside you will find a strong “we are unique” syndrome within the workforce and some groups will resist improvements even when there is proven success at a similar healthcare institutions.  I have found that emphasizing the similarities and making a few unique (often low impact) tweaks tends to satisfy the doubters.

You will not find an executive management group seeped in decades of process improvement experience.  While the landscape is slowly changing, it is not unusual to find that most of the executives have spent their entire careers with one healthcare institution and thus they need a lot of instruction about process improvement and they tend to oversimplify the effort.  You will likely find that they are either an eager sponge and absorb process improvement advice readily or they simply can’t get the concepts. Hopefully for your sake they exhibit traits of the former. 

Like in all new process improvement situations you need to start with the low hanging fruit.  In my opinion you should  start with parts of the organization that readily lend themselves to lean principals such as sterile processing (it’s very much an assembly line), or some of the administrative tasks such as billing where there are likely opportunities to reduce time and defects (such as under charging). 

I’m glad I made the transition as I think the health care industry is about 5-10 years behind other industries so the opportunities are more than abundant. Expect slow evolution versus revolution, you must have patience. Remember, this is one of the oldest professions and tradition has a strong hold.

Building a culture of improvement is a lot like riding a bike

Leading process improvement projects is both frustrating and rewarding. As many of my colleagues can attest, this is no easy job. You need to get things done, sometimes very big things, even though you are “not in charge”.

If we didn’t have a passion for process improvement most of us would probably have quit long ago and tried to find a less strenuous job.  Whenever I’m faced with a challenging project or resistant team member I think of raising kids. It can be the most difficult and trying time of your life, dealing with temper tantrums, poor friend choices, sibling rivalry, etc… but as the kids get older and show confidence in who they are you start letting go because you can see the growth and they can make you proud.   

Facilitating and coaching projects sometimes feels a lot like raising kids. You deal with teaching them how to “play together nicely”, how to accept “rules” aka standardization, and how think of others needs not just their own needs. There is nothing like that satisfying moment during a project when you see the light bulb go on for team members. When you notice that the group of individuals who at first, wouldn’t even look at each other, are now true teammates working together to achieve their mutual objectives – It can be the best part of your day.   

I was recently involved in a project with our Hospitals surgical department which included our sterile process group (the folks who assemble, sterilize, and deliver medical instruments).  We have been collecting loads of data and doing a lot of work to map the process and to understand some of the defects. One quick idea we came up with was to start using a root cause analysis (RCA) form. Previous to the RCA form problems were not documented, we just resolved them and moved on and of course the inevitable happened, the same problem keep reoccurring.

A few days after we started using the form it was put to good use because we had several big problems that cropped up. I ran into the Sterile Process supervisor in the hallway and she explained to me, that when she received the RCA form she immediately took the form to the assemblers since they needed to determine root cause of that particular issue. I was a bit surprised because in the past she or the manager would solve the issue and smooth over any ruffled feathers with the nurses and surgeons; hardly mentioning the problem to the assembly team.  However, she inherently knew that that was part of the problem and with this new process she needed to get her assembly team directly involved. and get them to solve the problem - She wasn’t going to give them the answer.  Her team was a bit put-off because in the past they didn’t have to get involved; the supervisor solved the problem and smoothed over the ruffled feathers with the operating room personnel. All of a sudden this simple form was creating a different attitude and developing important accountability. Thank goodness the supervisor was sharp enough to realize the appropriate approach; of course, I like to think my coaching influenced her actions. She pushed the team and they worked on a permanent solution so the problem was unlikely to repeat.

After she told me about the RCA and related team work I had a good feeling about the work I had been doing with this team.  I guess it’s like teaching your kids to ride a bike.. At first you steadied them, yelled encouragement, and explained the balance thing and comforted them when they fell. But in the end they needed to take the initiative and go for the “big ride”. Before you knew what happened they gained confidence and started riding faster and further, gaining independence in the process even if it sometimes gave you anxiety pangs. They were growing up and making more of their own decisions.

Helping an organization develop a culture of continuous improvement is sometimes discouraging and stressful but when the kids start maturing you sure do feel proud.