Lean Healthcare Exchange

It’s was a typical Tuesday morning in the Outpatient Service department. By 6:30am, the staff members have already pulled the supplies needed for the day, and organized their workstations to fit the needs of the patients. Patients’ orders and schedules, which were pulled the day before, have been verified and checked for errors or to see any potential delays that might be caused by lack of information, missing information, incorrect information, or orders that needed clarification. The smell of fresh brewed coffee and the sound of the morning news broadcast put calmness in the department. Everyone seemed calm, focused, and ready to “win”.

I couldn’t help but notice that everyone first checked with a nurse named Samantha before signing off to their work stations or assigned areas. Her role seemed to be the “captain of the ship” so to speak. Like everyone else, I too checked in with Samantha. I introduced myself and proceeded in asking Samantha a few questions. She replied, “Follow me, young man, and talk to me as we walk.” Wow! I like Samantha already.

I asked her about the processes and if she could walk me through the Value Stream.

“Sure,” she said, looking at me with a smile. “You see, things weren’t like this several months ago. Our patients were complaining that they were waiting too long to get registered and processed. Things were really disorganized, the staff was frustrated, and it just seemed that we couldn’t ‘win’ on a daily basis.”

My antennas went up when I heard the word win. “‘Win?’ What do you mean by ‘win,’ Samantha?” I could tell that Samantha was well aware of all the potential breakdowns and how easily things can become undone.

“Well,” she said, “one of the first things we did was to fix the things that were very obvious and we could fix right away—the low hanging fruit. We also relied on an internal patient survey. We wanted to know what our patients were saying and where to spend our energy. Alex, please excuse me while I help this patient.”

As Samantha proceeded in assisting a patient, I started glancing around the department and noticed evidence of improvements. The one that really caught my attention was a small board that indicated each patient time from arrival to completion of registration. The board also indicated the reasons for delays, who, when, what, where, and other features that told the staff if they were winning or losing per their set goals. All this information was available at a glance. What really impressed me was the simplicity of the board. The staff updated it, communicated through it, and managed it. It clearly highlighted the areas for improvement. Very little to no technology was needed to maintain the board. No worries if someone forgot their password or the system was down, the staff just kept on marching. All that was needed was a marker and pen to generate the information to execute action.

I started having déjà vu from my many Lean events which I have facilitated and teams I have coached over the years on similar solutions and outcomes. Often in Lean Healthcare, many teams and leadership members feel or believe that the solutions will become too expensive to solve or too deep to dive into, that adding more staff would be the most helpful, or that installing the latest technology device on the market will completely resolve the issues.

While these concerns may be valid in some circumstances, in many cases the opposite situations are true. This team demonstrated that by visually posting metrics so the entire department can see where attention is needed, a target was set for each member to want to achieve the set goal. The board itself may only be a board, but the information it exposes are real issues in real time that navigate and guide the staff in which direction to shift or study the process to “win.”

“What do you think?” Samantha asked me with a confident smile.

“About what, the board or the information?” I replied.

“I mean the entire process, and especially the board.”

“I really like it, Samantha,” I said. “I’m proud of you guys for exposing the data and making the numbers visible for the entire staff to see.”

“Well, Alex,” she replied, “I will be honest with you. At first it was difficult to get the staff to see the need for posting the information and updating the board. They thought it would take more time and cause further delays in the processes by writing down information and managing the board. However, it was the only simple tool that we could try immediately and see if the changes were working or not, without adding cost and resources. We went from patients waiting an average of 22 minutes to now only waiting an average of 6 minutes. Today no one in the department has to ask another for information and data or wait for the monthly staff meeting to get this information.”

“Samantha,” I asked, “Were you and the staff a little hesitant at first about posting the data? And, was the staff worried about you posting information?”

“Yes, and yes! However, when they saw that we were acting on the issues and involving them in the improvements, and the numbers started to improve, their beliefs started to change. The board and information input is owned and managed by the staff, and in fact they have also added others’ information that they thought would be helpful and important. It did take some time, Alex, and there’s still much more to do. But you can see that some standards have been put in place.”

Posting metrics or exposing issues in the work areas can be an uncomfortable practice to do. The fear of people knowing what your breakdowns are—or that you might highlight that your department is the bottleneck in the process—is a scary thing, and you may feel that it may insinuate that you’re a poor leader. In fact, it’s a big part of a leader’s development. Samantha and her team made a decision that they were going to do everything to improve and exceed patients’ expectations.

Since then, they have not looked back.

This week’s blog was written by Alex Maldonado, an associate with HPP. Alex’s professional experience includes process improvement, operational, and leadership positions in the medical delivery systems and appliance manufacturing industries with Baxter Healthcare and Whirlpool. Alex has had a successful track record in improving results-driven processes with an emphasis in personnel training, project leadership, and operating systems designed to improve customer service and sustainability. He has led the development and implementation of processes to support Lean initiatives that reduce critical path lead-time, reduce expediting costs, capital improvement projects, inventory reduction, and trained and educated staff/employees in Lean Methodology. He has a B.S. in Industrial Technology Engineering from Mississippi State University and has also completed the Six-Sigma black belt program.

Management of any kind can get so tied up in their job that they can overlook the foundation of their role: the people that report to them.  When we are driving to work we don’t count the houses with red roofs because we are not looking for them.  In the same way, we can forget to talk to our employees because we may not see them.  This is one of the great principles of Lean Healthcare, direct employee communication.

The employees doing the work — the nurses, unit secretaries, orderlies and others — want to hear from management and want to have contact with them.  Toyota and other successful Lean businesses have the mindset that every employee is important to the business. This contributes a lot to their success. When employees feel like they have a relationship with their management, they are more likely to be happy in the workplace. Happy workers make for a happy and more successful work environment.

So, let’s make them feel important!

Establishing more open lines of communication can become the greatest asset to eliminating waste and building trust within the organization for any manager. This strengthens a company’s overall performance and employee base.  This also increases employee satisfaction and reduces turnover.  I can remember spending hours observing a particular process in search of a root cause, yet oftentimes having a 10 minute dialogue about the process with the “experts” doing the work will have ideas and answers popping up like popcorn in the microwave.   

How do I start?  Get out of the office.  Pick one place to go and force yourself to go there.  Pick out one individual, introduce yourself and get their name and then ask the following questions: 1) How is it going? 2) What’s going well? 3) What’s your biggest problem? 4) What are you doing about it? 5) How can I help?  Start doing this once a week and then make it once per day and in time you will not only meet many employees but you will know exactly what is going on.  You will have direct contacts for communication.  These are people with whom you can now share your information about how the hospital is doing overall, what areas are strong, and where improvements need to be made. One of the biggest outcomes to this communication practice is that the staff then feels that you are truly partnering with them and their frustration and issues are being supported by upper management.

One of the hardest things for human beings to do is change habits.  A long time is spent creating habits.  A long time may be spent changing habits.  This is how we improve as managers, workers, and as humans.  We can become addicted to the desk, computer, meetings, and telephone.  Getting away from these habits can be tough but the results will be tremendous and rewarding for everyone, as well as the organization.

This isn’t a final answer.  This is a simple start to a great end.  A baby learns to turn over, then crawl and then to walk.  Changing management habits are the same way.  We are getting out of the comfort zone that we’ve established.

We all know communication is important.  And in a Lean Healthcare organization it is essential. Take a moment to reflect on how you like communication. Establishing direct communication with the people actually doing the work is so very important.  Try it, you might be surprised by what the reports and meetings you sit through are not telling you. 

“‘Management by walking around’ is hardly ever effective. The reason is that someone in management, walking around, has little idea about what questions to ask, and usually does not pause long enough at any spot to get the right answer.”
–W. Edwards Deming, “Out of the Crisis,” MIT Press, 1982

This week’s blog was written by Alex Maldonado, an associate with HPP. Alex’s professional experience includes process improvement, operational, and leadership positions in the medical delivery systems and appliance manufacturing industries with Baxter Healthcare and Whirlpool. Alex has had a successful track record in improving results-driven processes with an emphasis in personnel training, project leadership, and operating systems designed to improve customer service and sustainability. He has led the development and implementation of processes to support Lean initiatives that reduce critical path lead-time, reduce expediting costs, capital improvement projects, inventory reduction, and trained and educated staff/employees in Lean Methodology. He has a B.S. in Industrial Technology Engineering from Mississippi State University and has also completed the Six-Sigma black belt program.

As leaders we often refer to waste as what is happening or not happening out there “The Floor”.  The key focus then becomes what processes, individual(s), or areas are in need of improvements. Although that may be true, we fail to acknowledge that we ourselves are key contributors to the creation of waste and lack of improvements.  This mind set often clouds the true understanding of what the lean principals and methodology are meant to construct.

Jon Miller, in his January post “Top 7 behaviors to change in 2010” makes a defining statement to one of the biggest obstacles to success which all of us face ourselves. As Jon puts it “The human mind is an incredibly powerful thing, the means to control which is in our hands, yet we use it to delude, divert and distract ourselves in various ways.”  Our behaviors are a clear reflection of what’s really happening or not happening on the floor.  Here are a few key personal behaviors to consider changing or improving on in the form of DOWNTIME.

Defect(s) / Error(s): Tolerating them to continue: I’m not saying that we are all ok with defects or errors, but we often see the same defects/errors over and over again.  I myself have been in the same boat. I can recall a time of being in my own department and being aware of an error for months and not acting on it in a timely manner.  In my lack of daily management and Plan Do Check Act (PDCA), I made every excuse that I had bigger fish to fry and diverted my time and energy elsewhere. It’s essential for us as leaders to lead and develop our staff and teams as problem solvers to find the root cause to these errors.  Start with one, and together with your team beat on it with no mercy.

Over Production:  This one hides very well.  It appears as if it is contributing to the overall business process and adding value for the patient and staff, when it’s really robbing time and adding potential cost from our daily work.  We as leaders must value stream our work to better understand the deeper purpose of the work we do on a daily basis. Ensuring that every valuable minute is allocated to the patients’ needs.

Waiting:  waiting for the right moment to act on improvements.  It’s never too late or too early to start with process improvements. We are often fearful to act due to the potential exposure of issues and setbacks that might surface or in some cases the mammoth that is front of us.   Waiting is often at the top of patients’ dissatisfaction list. Be the first to lead the change you want to see in your organization. This beast must be handled one lean event at a time, big or small.  

Not Clear:  I believe this is the mother of them all.  Unclear communication about where the ship is going and the purpose of the journey falls on us as the “Captain”.  Poor communication, lack of standardization, little to no visual controls, lack of team work in the department, and unclear and undefined direction as to the outcome of each process is a rust that will feast on your ships’ (organization) purpose to grow and keep you from sailing the high seas.

Transport: Walking by waste and doing nothing.  Ouch!! This one hit me hard. Within 5 minutes of the floor tour my sensei stopped me and asked me why I have failed to recognize and accepted waste as the norm. In my mind I was thinking “well this is not my area and my plate is full” but I knew better than to state such a cynical remark.  He then asked me if my counterparts did the same.  We often forget that we are all connected to the success and failure of the patient’s outcome experience.  I believe Team do should be the new theme.

Inventory:  Too much, too little, or none at all equals no control.  Identifying what staff members’ real needs are to perform their tasks with confidence and reliability each time is a measure of daily management working just in time.  Not supplying your team with the right tools, training and guidance will lead to chaos.

Motion: Convoluted process and wasteful motion.  As Jon puts it; “we may be working on the right things, however, we may be working on too many things”.  If you’re like me, sometimes I think I can work on multiple things at the same time and be very successful at them all every time.  Wrong!  Have you ever reflected on your day from the time you walked in the door till the time you made it home and asked “what did I really accomplish today?”  Well, you might think…   I took care of a lot of employee issues, made all of my meetings, responded to all my emails, took care of patients complaints, and was available to everyone if I was needed. It was a typical day at work.  So the question is, what real impact did we have on eliminating waste, building system thinking, what was the root cause of the complaints and how can we get employees to see the true value of ownership of their own processes and outcomes?  Well! This one will take time.  But here’s a small step. You must lead, act, and listen differently!  Boy, I still have some work to do.

Effective follow up of the process: Not following up on the follow up. I mention earlier that “Not Clear” was the mother of all waste; well this one is the grand daddy of them all. Leadership’s standard work includes verifying that the standards created with the team are being followed; members are not deviating from the standards, or determining if a new standard is needed.  A standard follow up also indicates that we as leaders are truly committed and have made the event and engagement a priority in our daily work.  The success of the department lies on how well we follow-up on the follow- up. 

Each time I write a post I will try to recommend a book that  might be helpful to you and your team in your lean journey. In “Results From The Heart” Kiyo Suzaki talks about building a “mini-company” within your company that can have a positive impact on employees to ultimately establish ownership of the processes and outcomes. It’s a fresh new way of thinking to find both the purpose and the meaning in the way we work and can contribute to the success of the people we lead.

Endnote: Jon Miller; from Gemba Research LLC in his January post “Top 7 behaviors to change in 2010”                                                                      

This week’s blog was written by Alex Maldonado, an associate with HPP. Alex’s professional experience includes process improvement, operational, and leadership positions in the medical delivery systems and appliance manufacturing industries with Baxter Healthcare and Whirlpool. Alex has had a successful track record in improving results-driven processes with an emphasis in personnel training, project leadership, and operating systems designed to improve customer service and sustainability. He has led the development and implementation of processes to support Lean initiatives that reduce critical path lead-time, reduce expediting costs, capital improvement projects, inventory reduction, and trained and educated staff/employees in Lean Methodology. Alex is well recognized in the following areas: Value Stream Mapping, Hoshin Strategic Planning, Office and Floor 5S, Total Productive Maintenance (TPM), Process Failure Modes and Effect Analysis (PFMEA), Quality Improvements and Mistake Proofing, Six Sigma, Cellular Design, Standardize Work, Pull Systems (kanb an), Equipment Design and Installation (DFLMA), and Safety Programs. He has a B.S. in Industrial Technology Engineering from Mississippi State University and has also completed the Six-Sigma black belt program.

A few years ago I was discussing plans for an upcoming 5S event with an area supervisor whose department was pretty well run on a daily basis. The supervisor stopped me in the middle of the conversation and asked me the following. “What is 5S? No really, what is 5S and what will it do for me and my staff?” She continued by adding  that her time and the staff’s time was very valuable to the organization, and allocating time for an event would have to be carefully planned and defined before moving forward. She showed me all of the previous 5S training material and even stated each “S” and what all she learned from the events and other lean training. I stopped and thought for a second before responding. It was evident that the department has had some success and the tool 5S was nothing new to them. No one had ever asked me about 5S in that manner before. Most of the leaders I have talked to have heard about 5S before, and they have done an event with little to no success. I asked the supervisor if she had a few minutes to walk on the floor and I would try to show her a better example of how 5S could work. She agreed. On our way to the floor, she quickly stated the 5S (Sort, Set in Order, Shine, Standardize, and Sustain) and noted that for the most part, most of the staff had embraced the 5S tool, but there was a few who always seemed to challenge the system.

Once on the floor, the first thing I asked her to do was to walk me through the system (as it was called) on a very high level. This took less than 10 minutes.  At the end of the process, I then told her that the both of us would spend about 5 minutes observing the process and each of us would write down what waste we saw and ask ourselves what is normal and what is abnormal. After the 5 minutes, we had written down a combination of 20 items we observed and agreed that they added no value or were just simply waste. We then categorized them into the 8 waste categories. Before I could even go into discussing what 5S was and what we as a team should focus on for the event, the supervisor looked at me as if saying “Alex I get it” you don’t even have to say anything. She started pointing out and showing me the current labeling and cleaning processes, some organized shelves and rooms, tape on the floor and racks to mark where items should be or belong, and even a 5S communication board that showed the departments’ accomplishments and score trends. What she said next is what really got me thinking and excited, “We did 5S, well the first three “S’s” very well. However, we really did not set or have a solid foundation to build on.” I asked her what she meant by that. She said, “Well, we did a 5S event and then washed our hands from it so to speak, hoping everyone would follow the new changes and hoped for the best.  Some of the items we wrote down were highlighted during the 5S event. We did a poor job planning the event; in fact we called a meeting and did everything in a conference room. Alex, P for “planning to see” should be the first S and O for “Ownership” should be the last S in 5S. The event should have been clearly planned on: what will be sorted, how things should and will be straightened, how, who, and when to do shining, how to simplify the standards so defects and errors are clearly visible and noticeable, and establish an owner(s) for the new changes to ensure sustainability. If our objective from our first 5S would have focused on improving 5 key things that added value to the process and sustain them, it would have been better than changing 15 things we are not even able to follow or sustain. Five improvements are so much easier to manage and follow-up on than 15 changes. We never established owner(s) in each step of the process and I never gave them the support to become presidents of their process. If each team member, including myself, would just own one improvement and educate the others on it, we would be so much farther along.” I thought she was a little too hard on herself, but it was very clear that she wanted to move the department from good to great. We set a follow-up meeting to come back to the floor at another time to complete the planning. 

I thought about what all she had said and especially the P and O in 5S. I couldn’t have agreed with her more. 

In lean healthcare, caregivers and leaders often relay to me that during a 5S event there’s always a high level of energy and everyone feels that things are really going to change and the improvements will be sustained, just to find out that the new changes must be managed somehow and by someone. Very little time is spent and thought is given in planning the outcome of the event. In fact, I can remember a time or two were I could have done a better job at planning. My sensei once told me that he has spent more than 50 years planning and doing 5S and he is still on the 4th S (standardize). He said that 80 percent of your time should be spent planning, 10 percent should be spent executing, and 10 percent follow-up. You should think about every process as a mini company and every company has a president. This is where the ownership is established so that when one improvement is made, the outcome benefits the company and ultimately the patient as well. 

5S events should be seen and managed as eliminating defects, errors, and confusion, and most importantly be about building a lean culture in your organization, even if it’s just 1 or 5 key improvements at a time. There’s much more than just pretty labeling, tape on the floor, or getting rid of unneeded items. It’s about system thinking, and waste should have no part in it. Cultivate a plan that will set in order ownership in your 5S program that will shine throughout the workplace. 

This week’s blog was written by Alex Maldonado, an associate with HPP. Alex’s professional experience includes process improvement, operational, and leadership positions in the medical delivery systems and appliance manufacturing industries with Baxter Healthcare and Whirlpool. Alex has had a successful track record in improving results-driven processes with an emphasis in personnel training, project leadership, and operating systems designed to improve customer service and sustainability. He has led the development and implementation of processes to support Lean initiatives that reduce critical path lead-time, reduce expediting costs, capital improvement projects, inventory reduction, and trained and educated staff/employees in Lean Methodology. Alex is well recognized in the following areas: Value Stream Mapping, Hoshin Strategic Planning, Office and Floor 5S, Total Productive Maintenance (TPM), Process Failure Modes and Effect Analysis (PFMEA), Quality Improvements and Mistake Proofing, Six Sigma, Cellular Design, Standardize Work, Pull Systems (kanb an), Equipment Design and Installation (DFLMA), and Safety Programs. He has a B.S. in Industrial Technology Engineering from Mississippi State University and has also completed the Six-Sigma black belt program.

Observation is where it should begin for any event or anyone trying to do problem solving. Often it’s one of the most crucial steps left out or paid very little attention to when trying to solve an issue. Most of us in healthcare are problem solvers, and start right away in what we believe will make the problem go away. A friend once told me that this approach is like squeezing a balloon from one end and finding that it will just pop up at the opposite end. I really don’t believe people intentionally go around squeezing balloons just to clear the problems from their area(s) or that they don’t care where it pops up. But often I see that most people really don’t observe the issues as they happen within the flow of work. Not having enough time to observe is the issue that I often hear, and observing the process is replaced by holding a meeting to discuss the solution. So why is it that we don’t do it every time an issue arises?

A question I ask when someone is describing issues about process flow is “Did you observe the process or are you just relaying what you have heard from others about the issues”. My intent is not to put them on the spot, but to see if they are closely engaged in the process. If you are closely engaged to your process and have first-hand knowledge of issues through observation, then your discussion making and the redesign work is more concrete. Observation is about learning how to make things better and not about evaluating employee’s performance. You should clearly see or hear what really doesn’t make sense in the process. Find what the bottlenecks are, and the 8 wastes should not be present in the process anywhere. Here are some tips you can use when performing an observation:

• Let area staff members know what you are doing and ask for their input.
• Observe and listen first before writing things down.
• Find what safety and quality opportunities need attention immediately.
• What visual controls are needed or need improvements?
• How request for service and the delivery of the service takes place?
• Is standard work in place or followed?
• Ask and observe what frustrates staff members on a daily basis.
• Who or what is making decisions for smooth flow?
• Teach others to observe.

Continually honing in on the process to see what other waste can be removed is important. Once the process is standardized and clear and you have achieved the outcomes, make sure you measure it. Making observation and data collecting part of your daily problem solving will construct a solid sustainable platform where you can at a glance see opportunities and not issues.

This week’s blog was written by Alex Maldonado, an assoicate with HPP. Alex’s professional experience includes process improvement, operational, and leadership positions in the medical delivery systems and appliance manufacturing industries with Baxter Healthcare and Whirlpool. Alex has had a successful track record in improving results-driven processes with an emphasis in personnel training, project leadership, and operating systems designed to improve customer service and sustainability. He has led the development and implementation of processes to support Lean initiatives that reduce critical path lead-time, reduce expediting costs, capital improvement projects, inventory reduction, and trained and educated staff/employees in Lean Methodology. He has a B.S. in Industrial Technology Engineering from Mississippi State University and has also completed the Six-Sigma black belt program.

Well what’s the purpose of meetings anyway? I am sure you have been in a meeting or two that were just a waste of time.  Most of the meetings I have attended or observed didn’t start on time, and I often see some of the invitees strolling in at their own pace.  At times, it even seems that the true purpose of the meeting is lost or unknown by those who attend them.  You can often hear side conversation, not about the meetings topic, but rather what’s going on outside.  If you glance around the room you might see one or two participants practicing their favorite patterns or some form of animal drawings.  Others are working or catching up on their paper work.

The biggest offenders, including myself, are those that are constantly checking, texting, and replying to emails on blackberries or cell phones during the meeting.  I believe that we can agree that these examples are truly disrespectful to the person leading the meeting, disrespectful to the team, but really disrespectful to those whom we are serving.  I’m not saying that I have not participated in well run meetings or observed meetings with great results.  In fact, one of the best, well run, lean healthcare meetings I recently observed was conducted and led by a small OR team.  The first thing that caught my attention was that everyone was on time and the meeting was lead by the employees, even though the department’s director was present.   The second observation was the location of the meeting.  Everyone was gathered around a small communication board that tracks daily/weekly metrics.  Each person owned a small part of the board and each person was encouraged to contribute to the meeting even if it was just a small part.  The purpose of the meeting was very clear, and the expectation was laid on the entire team.  Potential problems were pointed out with a plan and support to ensure the process flowed smoothly.  Finally, all this was done in less than ten (10) minutes.  It was very obvious that the meeting was truly value added time and the team’s expectations were realistic. It wasn’t a race to see if they can beat the clock, but a well managed and structured meeting, with true results.

Healthcare staff members often tell me that they are always bombarded with meeting after meeting only to be frustrated later that a real solution was never agreed upon.  They feel that their time was robbed from them, rather than using the time for problem solving or addressing the issues that they care for.  I often wonder the true cost of inefficient, poorly managed and non value added meetings.  I think that the inadequate preparations, unrealistic and nebulous decision making, and the poorly structured meeting are left with us to blame as leaders.
 
Here are a few guidelines that can help you lead a simple but effective lean healthcare meeting:

1) Prepare the meeting:  what value will the meeting create and will the intended results be met? Who really needs to attend? Is everyone clear about the agenda and expectation?

2) Meet at the communication board:  This gives you no excuse that a room is not available.  Standing meeting only. Meeting on the floor helps everyone see the real issues as they happen. 

3) Lead by Leading: Set the standard of the meeting.  Improve the standard if needed. Poor leadership equals poor results.

4) Listen, No! Really listen: this can be hard for some of us, but everyone can add value to the organization.

5) Tempo: Meetings must be timely and have flow (what, who, when, outcome).

6) Summarize: Always summarize what was questioned and agreed on.
Everyone must leave the meeting understanding the implementation plan and goals.

7) Communicate the plan:  communicating the plan is essential to sustaining the process.

Using lean principals to construct lean healthcare meetings can be rewarding for you and your organization. Utilization of staff time and productivity at work can become significant. So “How much are your meetings costing you”?     

This week’s blog was written by Alex Maldonado, an assoicate with HPP. Alex’s professional experience includes process improvement, operational, and leadership positions in the medical delivery systems and appliance manufacturing industries with Baxter Healthcare and Whirlpool. Alex is well recognized in the following areas: Value Stream Mapping, Hoshin Strategic Planning, Office and Floor 5S, Total Productive Maintenance (TPM), Process Failure Modes and Effect Analysis (PFMEA), Quality Improvements and Mistake Proofing, Six Sigma, Cellular Design, Standardize Work, Pull Systems (kanb an), Equipment Design and Installation (DFLMA), and Safety Programs. He has a B.S. in Industrial Technology Engineering from Mississippi State University and has also completed the Six-Sigma black belt program.

 By now you might have a couple of Kaizen or 5S events under your belt as part of your lean healthcare journey.   Some teams might have established sustainable measures in their areas and Leadership is conducting gemba walks regularly.  The 30-60-90 day follow-up and the lean momentum are progressing and visible.  There is clear evidence that the objectives set by the team(s) are being met and the metrics are headed on the right track.  Small teams are solving problems using A3 thinking.  So what’s next? Continue with the lean improvements? Absolutely.  Spread the lean healthcare methodology throughout the organization, most definitely. Lean is a never ending journey and your focus should always be the goal of zero waste.   In all this good news there should be more good news. Could there be more? Yes, celebrate!  Celebrating wins and successes are just as important as achieving a target.  It’s a common step that I often see organizations leave out of the events and the entire transformation.  I don’t believe it’s done intentionally, but rather that so much focus and energy is directed on meeting the objectives or that there is little belief that lean will work or that lean can really work in a well established organization.

In the first two years of my lean journey we seldom stopped to “smell the roses” so to speak and celebrate all the wins and successes we accomplished in each event.  In fact, celebrating wins and recognizing team or members’ achievements was never in our yearly strategic lean plan or Hoshin pPanning.  I came to believe that part of the reasoning was because we have tried so many different tools, education programs, and process improvement projects in the past, and were not sure if each event was going to be a success or even if lean was going to work in our work environment.  It’s not that management did not want to recognize people or celebrate wins, we really did not know how or when, and by the time we got to it the teams the members had already moved on to another project or event.  A common phrase that I often heard and later I picked up myself was “you’re doing a good job but!”, and like many others, I too only remember the BUT part.  Leaving the team or members feeling that what was just accomplished was good but more is needed and not completely appreciated. 

A few years ago, I revisited a team who I had coached and trained on Standardized Work and the 5S tool.  The first thing that caught my eye was a 4 feet by 8 feet white board that the team placed in front of the department’s entrance that told the story of the department’s lean journey and where they were before the lean engagement, the current state, and what their ultimate future target was.  At a glance, I could tell that the team had integrated visual control and standardized their daily work.  A second board displayed leading metrics trends from inventory reduction to reducing lead time and the defects (waste) the team was working on. The supervisor proudly guided me to the 5S board which indicated that the 5S score had improved by more than 40%.  The supervisor also shared with me that both the work environment and morale had improved. As I listened and observed all the creativity the team had come up with to eliminate waste and sustain progress, I turned to the supervisor and asked if the team, along with management, had stopped to celebrate all these successes.  He looked at me and then paused before answering the question and, seconds later, he turned to the team apologizing to them. “You know, we really have not done that. Thanks have been said during events and follow-ups but not a celebration of recognition to the team and individuals who have gone beyond the call of duty.” I realized that I had unintentionally put the supervisor in a tough position but it allowed him, the team, and management to reflect on a wonderful story and transformation process the department had gone thru.  At first, little attention was devoted to improving the department’s process issues, and the department stuck out like a sore thumb on the overall Value Stream Map. However, today it was a different story, not because of what I did, but because what the team had done, and what the team was doing to take ownership of their area.  Before leaving the department, a time and date was decided by management and the team when and where the celebration would take place.

When celebrating wins and recognizing members, it’s more than just the delicious snacks, drinks, and the nice thank you speech.  You are celebrating a new beginning, the collaboration of team work, the success of each individual on the team who at one time might have had doubts about lean and the will to change.  By celebrating success, you are feeding the growth for change and cultivating a safe environment in which individuals would want to add more value to their daily work.  My mentor once told me that very little is mentioned about celebrating wins because most teams and organizations really do not believe they can win and they certainly do not believe they can succeed after a failure.

As you continue in your lean healthcare journey it is important to celebrate and share success from kaizen and 5S events, and A3 problem-solving. Don’t forget to involve the people whose jobs have changed. They helped make the organization better, and deserve to share in the celebration. There will always be more waste to eliminate and in turn more celebrations.  So stop and smell the roses every chance you and your team get.

This week’s blog was written by Alex Maldonado, an assoicate with HPP. Alex’s professional experience includes process improvement, operational, and leadership positions in the medical delivery systems and appliance manufacturing industries with Baxter Healthcare and Whirlpool. Alex has had a successful track record in improving results-driven processes with an emphasis in personnel training, project leadership, and operating systems designed to improve customer service and sustainability. He has led the development and implementation of processes to support Lean initiatives that reduce critical path lead-time, reduce expediting costs, capital improvement projects, inventory reduction, and trained and educated staff/employees in Lean Methodology. Alex is well recognized in the following areas: Value Stream Mapping, Hoshin Strategic Planning, Office and Floor 5S, Total Productive Maintenance (TPM), Process Failure Modes and Effect Analysis (PFMEA), Quality Improvements and Mistake Proofing, Six Sigma, Cellular Design, Standardize Work, Pull Systems (kanb an), Equipment Design and Installation (DFLMA), and Safety Programs. He has a B.S. in Industrial Technology Engineering from Mississippi State University and has also completed the Six-Sigma black belt program.

Don’t wait – Start now! Kaizen events are fast paced, exciting, and rapid improvements are set in place.  During the Kaizen week, one of the most notable features is a constant presence of team members observing the process as it happens.  But what happens the following week? Yes Monday.  Who will ensure the staff in the area will continue to be supported and encourage sustaining the improvements?  Often, they feel that everyone has forgotten or abandoned them, and they are left on their own to make it work.

So you might be asking or wondering when, who, and what is gemba? Well, let’s start with the word itself. What does gemba mean and what should take place during this process?  Gemba is a Japanese term meaning “the place where the work is done”.  In Lean Healthcare, gemba is where “the value-added activities that take place to satisfy the patient are carried out”.  The objective of going to the gemba is for leadership and key area members to review, listen, and support the improved activities on a daily basis.  Reviewing and observing the process could be the most important part of a manager’s job.   It can give leaders real strength and chance to bring out the best in others. This lets staff members develop and cultivate their talents and allows them to raise issues, solve problems, and run the business.  Your staff may be surprised when they see you walking the floor.  Having the feeling that you are being watched and that you are only on the floor because something is wrong can become a challenge in your overall purpose of gemba.  This may be because it has been a common practice in the past.

Well, this may be a good time to go back to the questions you might have being asking or wondering about gemba walks.

When:  Well, daily.  Activities and opportunities occur daily on the work floor and lean is about discipline.  Your employees must see that you have implemented discipline in your “standardized work” and this sets a good example for all to follow.  To start, spend 5-10 minutes every day in an area.

Where: Where work is happening on the floor.  Metric boards or any form of production report(s) (Safety, Quality, Core Measure, 5S scores, and lean action list) that inform all that are involved in the process is a great starting place.  Each walk should start in a timely manner and move forward even if some are absent.

What: The new changes and/or what needs improvements.  To start, select 2-3 changes to focus your walk.  You should be able to identify what’s working well and what may need extra attention.  What problems can you identify visually? Who is working on them and what lean tools are being used to solve the problems? Is 5S being utilized to maintain organization and work order?  Are metrics and reports up to date? What may be hindering the staff to perform lean improvements?  Has lean become a priority to solve problems?  If metric boards are not up and employees are really not aware of how and what’s going well, what changes have taken place and what changes will take place, then it is key that this is set as a priority to get these things done.

Who: Senior leadership, area management, lean team members, and anyone who may be interested in learning the “gemba walk” process. The walk gives everyone a chance to talk to employees and to hear and see what problems are not getting solved. One of the biggest mistakes that I often see the gemba team make is that they do not “Listen” enough to what the supervisor or area employees are really trying to say or allowing them to express their frustration.  Ask questions about what they think should be done to solve the problems or what action should take place. This gives you an opportunity to coach, learn, and listen.  If problems are not being solved after being identified, then delegation may be required.

Follow-up to see what progress has been made, and share what you have learned as you walk the floor.  You must make the time and standardize your work to see what the floor is really telling you or not telling you.  Your survival and sustaining the lean process depends on it.

My sensei always told me that the floor points out the sins of the manager, and that you’re more likely to get honest feedback at the gemba rather than relying on status reports.  As you and the organization progress in your lean thinking, your approach should change according to your overall goals. So don’t wait – start doing the “gemba walk” today!

This week’s blog was written by Alex Maldonado, an assoicate with HPP. Alex’s professional experience includes process improvement, operational, and leadership positions in the medical delivery systems and appliance manufacturing industries with Baxter Healthcare and Whirlpool. Alex has had a successful track record in improving results-driven processes with an emphasis in personnel training, project leadership, and operating systems designed to improve customer service and sustainability. He has led the development and implementation of processes to support Lean initiatives that reduce critical path lead-time, reduce expediting costs, capital improvement projects, inventory reduction, and trained and educated staff/employees in Lean Methodology. Alex is well recognized in the following areas: Value Stream Mapping, Hoshin Strategic Planning, Office and Floor 5S, Total Productive Maintenance (TPM), Process Failure Modes and Effect Analysis (PFMEA), Quality Improvements and Mistake Proofing, Six Sigma, Cellular Design, Standardize Work, Pull Systems (kanb an), Equipment Design and Installation (DFLMA), and Safety Programs. He has a B.S. in Industrial Technology Engineering from Mississippi State University and has also completed the Six-Sigma black belt program.