“Curmudge, you should be distraught, but of course you never are. You arrived at work at 9:15 today, and I know that you intended to be here by 9:00. Fortunately, work hours are not a big deal with volunteers.”
“I had an appointment with a physician across town at 8:15 this morning, and I felt certain that it would be over and I’d be here by 9:00. I’m usually with the doc for five minutes at the most, and that was the case today.”
“Oh-oh. Something must have been messed up at the office. Would you tell me about your experience? Perhaps we can learn something from it. But please, no profanity or histrionics.”
“To begin with, Julie, I think the doc is great, and the receptionist has always been very accommodating. The first sign of a problem was when I arrived at the multi-specialist office building at 7:55; the line of people waiting to register stretched out the door. Ultimately, I got inside and registered by 8:10 after having confirmed all the personal information that was already in their records.”
“Since you didn’t get here until 9:15, that must not have been the end of your delays. Obviously you spent some time in the waiting room.”
“Finally the nurse (name unknown—she didn’t introduce herself) took me back to an exam room. Per our well-practiced drill, I removed my shirt and froze until the doc arrived. As expected, she was there and gone in five minutes. I stopped at the desk on the way out, made my return-in-six-months appointment, and headed for work at 8:55.”
“So, professor, what is today’s lesson, other than ‘don’t take off your shirt in a cold exam room’?"
“There was a very pertinent posting on daily kaizen last November. The title was Getting In-Flow, and it details what the author did to improve her office. To a patient, flow means moving through the appointment smoothly without needless periods of waiting. To the office staff, flow is a day without surprises, disruptions, or highs and lows in work load.”
“As we have learned, Curmudge, the office needs to practice heijunka, or level loading. If they can’t have more patient registrars at 8:00 a.m., maybe they can eliminate the operation and use registration kiosks. And in addition, they should plan ahead and not schedule potentially long appointments at the beginning of a day. I remain puzzled at how a physician’s office can be one-half hour behind by 8:15. They seemed to accept the fact that delays and lack of flow were normal.”
“Good observations, Julie. Would now be an appropriate time for me to share my observations about patient waiting?”
“It would. True flow means no waiting. Isn’t it incongruous to realize that health care facilities are still being designed to accommodate a waste—waiting—by having ‘waiting rooms’?”
“Back to reality, Ms. Perfectionist. Except for OB and Peds, a major fraction of our patients are senior citizens. We often assume that because they don’t have employment obligations or a crowded social calendar, they shouldn’t mind waiting. That may be true in the short term but quite inaccurate in the long term. By definition, a senior citizen’s days are numbered—with the number often quite unknown. If there’s something he/she wants to accomplish while still on this earth, he’d better get busy on the task. There’s no time to wait.”
“So what do you conclude, Curmudge?”
“Health care providers should implement flow and try to make their waiting rooms obsolete. Of course, my specific conclusion from my most recent office visit is that the practice of Lean in health care is not yet universal.”
Affinity’s Kaizen Curmudgeon
Friday, January 13, 2012
Wednesday, January 4, 2012
Motivation
“Hey Jaded Julie, would you like to hear some anecdotal evidence that supports an obvious conclusion?”
“If the conclusion is obvious, it doesn’t need evidence; but I’m always willing to listen to your strange stories.”
“In a stateside Army unit with no immediate plans for deployment, more soldiers show up for sick call than in a deployment-ready light infantry unit or in a Special Forces unit that deploys regularly. Soldiers in the stateside unit apparently want to be relieved from heavy duty or outside work.”
“Well, I know where you got that factoid. Obviously, the stateside soldiers aren’t motivated. It’s also obvious that you have some more examples.”
“In early 19th century warfare, when battles were won by conquering fortified cities, a unit of volunteers called the Forlorn Hope would be the first to charge through the first breach in the city’s defenses. Although the soldiers faced almost certain death (thus the name Forlorn Hope), they would be promoted if they survived.”
“That sounds like insanity, Curmudge. But it’s not limited to long ago. Think of the suicide bombers in Afghanistan. That is certain death, but their motivation has something to do with virgins in the afterlife. Apparently they never heard Professor Harold Hill (in ‘Music Man’) sing, ‘a sadder but wiser girl for me.’ But enough of this banter. What does this have to do with Lean?”
“For Lean’s ongoing existence, motivation has to be continuously refreshed. If we lag in our motivation to continuously improve, it will be reflected by a lag in our Lean transformation. Maybe that’s what happened in those organizations that suffered Lean burn-out.”
“I’ve got it, Curmudge. Fresh ideas are needed to help us maintain our patient focus. Acronyms like C.A.R.E. and AIDET. Personalized Care is more than just a marketing theme; it’s what we do. The newest motivators are the ‘Always’ teams. This term comes from the choices about recommending Affinity found on patient surveys: Always, Usually, Sometimes, Never.”
“Some of our motivational reminders are more enduring than acronyms or slogans. Consider Affinity’s Values: service, integrity, teamwork, justice, creativity, stewardship. They are lettered on the wall of our team room. One should take a moment and consider whether they are guiding our actions.”
“It’s time for the bottom line, old guy. What is it?”
“Motivation is more than slogans, acronyms, or programs developed by committees. It must happen every day in gemba, and it’s the responsibility of leaders at every level. Workers will be motivated when they see that their daily improvements are paying off in efficiency, less waste, and better patient safety and outcomes.”
“Hey Curmudge, what keeps you motivated?”
“As I said long ago, I am an inveterate learner and teacher. But most of all, it’s the people.”
Affinity’s Kaizen Curmudgeon
In case you missed it earlier, this year’s holiday story from Curmudge and Julie may be accessed elsewhere.
“If the conclusion is obvious, it doesn’t need evidence; but I’m always willing to listen to your strange stories.”
“In a stateside Army unit with no immediate plans for deployment, more soldiers show up for sick call than in a deployment-ready light infantry unit or in a Special Forces unit that deploys regularly. Soldiers in the stateside unit apparently want to be relieved from heavy duty or outside work.”
“Well, I know where you got that factoid. Obviously, the stateside soldiers aren’t motivated. It’s also obvious that you have some more examples.”
“In early 19th century warfare, when battles were won by conquering fortified cities, a unit of volunteers called the Forlorn Hope would be the first to charge through the first breach in the city’s defenses. Although the soldiers faced almost certain death (thus the name Forlorn Hope), they would be promoted if they survived.”
“That sounds like insanity, Curmudge. But it’s not limited to long ago. Think of the suicide bombers in Afghanistan. That is certain death, but their motivation has something to do with virgins in the afterlife. Apparently they never heard Professor Harold Hill (in ‘Music Man’) sing, ‘a sadder but wiser girl for me.’ But enough of this banter. What does this have to do with Lean?”
“For Lean’s ongoing existence, motivation has to be continuously refreshed. If we lag in our motivation to continuously improve, it will be reflected by a lag in our Lean transformation. Maybe that’s what happened in those organizations that suffered Lean burn-out.”
“I’ve got it, Curmudge. Fresh ideas are needed to help us maintain our patient focus. Acronyms like C.A.R.E. and AIDET. Personalized Care is more than just a marketing theme; it’s what we do. The newest motivators are the ‘Always’ teams. This term comes from the choices about recommending Affinity found on patient surveys: Always, Usually, Sometimes, Never.”
“Some of our motivational reminders are more enduring than acronyms or slogans. Consider Affinity’s Values: service, integrity, teamwork, justice, creativity, stewardship. They are lettered on the wall of our team room. One should take a moment and consider whether they are guiding our actions.”
“It’s time for the bottom line, old guy. What is it?”
“Motivation is more than slogans, acronyms, or programs developed by committees. It must happen every day in gemba, and it’s the responsibility of leaders at every level. Workers will be motivated when they see that their daily improvements are paying off in efficiency, less waste, and better patient safety and outcomes.”
“Hey Curmudge, what keeps you motivated?”
“As I said long ago, I am an inveterate learner and teacher. But most of all, it’s the people.”
Affinity’s Kaizen Curmudgeon
In case you missed it earlier, this year’s holiday story from Curmudge and Julie may be accessed elsewhere.
Thursday, December 15, 2011
Choices
“It used to be said, Julie, that the only things certain in life are death and taxes, but that’s wrong. Some people don’t pay taxes. The correct statement is, ‘the only things certain are death and choices.’ " (1)
“At the time many choices are made, people tend not to appreciate their significance. For example, one’s choice of a job and its location affect the environment in which one’s children will grow up. For that matter, one’s choice of a mate impacts the very existence of one’s children.”
“Fortunately, a lot of these are two-party choices. In the distant past Mrs. Curmudgeon vetoed some of my job location choices with two words, ‘too rural.’ In many cases, if one fully comprehended the future impacts of a choice he had to make today, he would be paralyzed with indecision.”
“Curmudge, we have been reading a book about choices; it is James C. Hunter’s The Servant (2). It’s not about the kinds of choices described above. It’s about moral choices and the fact that it is up to us to make them.”
“You’re right, Julie. If I were to list the five best books that I have read in the past ten years, it would be on the list.”
“I’m not sure that you have read five books in the past ten years. But no matter how you count, it’s a great book. Without its intent being obvious, it introduces the principles of servant leadership in the form of an allegory involving six people meeting for a week with a teacher at a retreat center.”
“Perhaps we should explain why our title is Choices and not Servant Leadership. In his epilogue, Hunter includes this quote, ‘it is of no profit to have learned well if you neglect to do well.’ It is our thesis that to gain value, one must choose to put to use what he has learned. If one puts down this book and says, ‘Ho hum, that was interesting,’ he is both insensitive and foolish.”
“But Curmudge, we’ve addressed servant leadership in several Kaizen Curmudgeon postings. There were three in May 2008 and two last November, on 11/11/11 and 11/03/11. Do we need more?”
“We certainly do, for two reasons. Hunter’s 2004 book (3) was sort of a textbook, but The Servant grabs your heart and mind. The second reason is that we need to hardwire Hunter’s eight essentials of good character: patience, kindness, humility, respect, selflessness, forgiveness, honesty, and commitment.”
“Well, at least the words aren’t in Japanese. My guess is that today we’ll pick off the high points that haven’t already been addressed, and as before, quoted material will be from Hunter’s book.”
“Fortunately, Julie, all of Hunter’s words are in English, and the first one we’ll mention is paradigm. Paradigms are the psychological maps we use to navigate our way through life. ‘The outside world enters our life through the filters of our paradigm.’ You can bet that the paradigm of the traditional command-and-control manager is different from that of the servant leader.”
“I’ve got it, Curmudge. In order to improve, the traditional boss who wants to become a leader has to change his paradigm; and Hunter’s teachings describe how he can do it. For starters, the leader has to identify and meet the legitimate needs of his people, and that is what serving is all about. In case you wondered, legitimate needs are those listed, in order, in Maslow’s hierarchy: food, water, shelter; safety and security; belonging and love; self-esteem; self-actualization. Self-actualization is being all you can be. Sound familiar?”
“Let’s pick love off Maslow’s list and use it in a leadership sense. This is the agapé-type love as used in the Bible. It is the ‘love of deliberate choice rooted in behavior toward others without regard to their due.’ Agapé love and leadership are synonymous, and the properties of agapé love are that same list of Hunter’s eight essentials of good character. Are you surprised, Julie?”
“I am not; please remember that I read the book. Note also how well that list correlates with the list of characteristics that people look for in a good manager: ‘honest & trustworthy, good role model, caring, committed, good listener, held people accountable, treated people with respect, gave people encouragement, positive & enthusiastic attitude, and appreciated people.’ When we think more about that list, we realize that ‘love is not how you feel toward others but how you behave toward others.’ “
“One item on the list represents an almost universal weakness—being a good listener. ‘Active listening requires a disciplined effort to silence all our internal conversations while we are attempting to listen to another human being.’ We should attempt to see and feel things as the speaker sees and feels them, and to empathize—be fully present—with the speaker.”
“I guess, Curmudge, that requires you to do more than just turn up your hearing aid.”
“Another common oversight is neglecting to give praise to people. People need to be appreciated. Your praise should be specific and sincere. Catch people doing something right. I think I’m better at it now than I was 40 years ago, but it doesn’t mean much coming from a volunteer.”
“In the past we have managed to bring several postings on servant leadership to a logical conclusion, Curmudge, but what is the real bottom line? What should we shout from the top of the parking ramp?”
“Becoming a true leader is a choice. Servant leadership is not inborn; it must be learned and then practiced. As we have said before with different wording, ‘we are more likely to act ourselves into a feeling than to feel ourselves into action.’ (4) So here’s what to shout: ‘Servant leadership. Just do it.’ “
Affinity's Kaizen Curmudgeon
(1) Soren Kierkegaard
(2) Hunter, James C., The Servant (Crown Business, 1998)
(3) Hunter, James C. The World’s Most Powerful Leadership Principle (Crown Business, 2004)
(4) Jerome Brunner
Note: This year’s holiday story from Curmudge and Julie may be accessed elsewhere.
“At the time many choices are made, people tend not to appreciate their significance. For example, one’s choice of a job and its location affect the environment in which one’s children will grow up. For that matter, one’s choice of a mate impacts the very existence of one’s children.”
“Fortunately, a lot of these are two-party choices. In the distant past Mrs. Curmudgeon vetoed some of my job location choices with two words, ‘too rural.’ In many cases, if one fully comprehended the future impacts of a choice he had to make today, he would be paralyzed with indecision.”
“Curmudge, we have been reading a book about choices; it is James C. Hunter’s The Servant (2). It’s not about the kinds of choices described above. It’s about moral choices and the fact that it is up to us to make them.”
“You’re right, Julie. If I were to list the five best books that I have read in the past ten years, it would be on the list.”
“I’m not sure that you have read five books in the past ten years. But no matter how you count, it’s a great book. Without its intent being obvious, it introduces the principles of servant leadership in the form of an allegory involving six people meeting for a week with a teacher at a retreat center.”
“Perhaps we should explain why our title is Choices and not Servant Leadership. In his epilogue, Hunter includes this quote, ‘it is of no profit to have learned well if you neglect to do well.’ It is our thesis that to gain value, one must choose to put to use what he has learned. If one puts down this book and says, ‘Ho hum, that was interesting,’ he is both insensitive and foolish.”
“But Curmudge, we’ve addressed servant leadership in several Kaizen Curmudgeon postings. There were three in May 2008 and two last November, on 11/11/11 and 11/03/11. Do we need more?”
“We certainly do, for two reasons. Hunter’s 2004 book (3) was sort of a textbook, but The Servant grabs your heart and mind. The second reason is that we need to hardwire Hunter’s eight essentials of good character: patience, kindness, humility, respect, selflessness, forgiveness, honesty, and commitment.”
“Well, at least the words aren’t in Japanese. My guess is that today we’ll pick off the high points that haven’t already been addressed, and as before, quoted material will be from Hunter’s book.”
“Fortunately, Julie, all of Hunter’s words are in English, and the first one we’ll mention is paradigm. Paradigms are the psychological maps we use to navigate our way through life. ‘The outside world enters our life through the filters of our paradigm.’ You can bet that the paradigm of the traditional command-and-control manager is different from that of the servant leader.”
“I’ve got it, Curmudge. In order to improve, the traditional boss who wants to become a leader has to change his paradigm; and Hunter’s teachings describe how he can do it. For starters, the leader has to identify and meet the legitimate needs of his people, and that is what serving is all about. In case you wondered, legitimate needs are those listed, in order, in Maslow’s hierarchy: food, water, shelter; safety and security; belonging and love; self-esteem; self-actualization. Self-actualization is being all you can be. Sound familiar?”
“Let’s pick love off Maslow’s list and use it in a leadership sense. This is the agapé-type love as used in the Bible. It is the ‘love of deliberate choice rooted in behavior toward others without regard to their due.’ Agapé love and leadership are synonymous, and the properties of agapé love are that same list of Hunter’s eight essentials of good character. Are you surprised, Julie?”
“I am not; please remember that I read the book. Note also how well that list correlates with the list of characteristics that people look for in a good manager: ‘honest & trustworthy, good role model, caring, committed, good listener, held people accountable, treated people with respect, gave people encouragement, positive & enthusiastic attitude, and appreciated people.’ When we think more about that list, we realize that ‘love is not how you feel toward others but how you behave toward others.’ “
“One item on the list represents an almost universal weakness—being a good listener. ‘Active listening requires a disciplined effort to silence all our internal conversations while we are attempting to listen to another human being.’ We should attempt to see and feel things as the speaker sees and feels them, and to empathize—be fully present—with the speaker.”
“I guess, Curmudge, that requires you to do more than just turn up your hearing aid.”
“Another common oversight is neglecting to give praise to people. People need to be appreciated. Your praise should be specific and sincere. Catch people doing something right. I think I’m better at it now than I was 40 years ago, but it doesn’t mean much coming from a volunteer.”
“In the past we have managed to bring several postings on servant leadership to a logical conclusion, Curmudge, but what is the real bottom line? What should we shout from the top of the parking ramp?”
“Becoming a true leader is a choice. Servant leadership is not inborn; it must be learned and then practiced. As we have said before with different wording, ‘we are more likely to act ourselves into a feeling than to feel ourselves into action.’ (4) So here’s what to shout: ‘Servant leadership. Just do it.’ “
Affinity's Kaizen Curmudgeon
(1) Soren Kierkegaard
(2) Hunter, James C., The Servant (Crown Business, 1998)
(3) Hunter, James C. The World’s Most Powerful Leadership Principle (Crown Business, 2004)
(4) Jerome Brunner
Note: This year’s holiday story from Curmudge and Julie may be accessed elsewhere.
Tuesday, November 22, 2011
The Most Recent Kaizen Curmudgeon Postings
On December 22, 2010 the Kaizen Curmudgeon blog celebrated its 150th posting by listing the titles and posting dates and supplying links to the 50 most recent postings. Provided below is the same information for each posting since December 29, 2010. This is in celebration of the “almost 200th” posting.
Kaizen Curmudgeon Blog Title—Date Posted
Stan’s Story Redux—12/29/10
Autonomy—1/06/11
Autonomy 2—1/27/11
What shall we do with you?—2/02/11
The Middle Years—2/09/11
Way to go!—2/17/11
Way to go! 2—2/24/11
Complacency—3/03/11
Complacency 2—3/10/11
Kaikaku, a countermeasure for “We’ve always done it that way.”—3/18/11
I’ve always done it that way.—3/24/11
The Crystal Ball—Prologue—4/07/11
The Crystal Ball 1—4/15/11
The Old Men’s Table—4/18/11
The Crystal Ball 2—4/27/11
The Crystal Ball 3—5/05/11
The Crystal Ball 4—5/12/11
The Crystal Ball 5—5/19/11
Happy Fourth Birthday—5/20/11
The Crystal Ball 6—5/31/11
The Crystal Ball 7—6/03/11
The Crystal Ball 8—6/13/11
The Laboratory—6/30/11
The Laboratory 2—7/07/11
The Laboratory 3—7/14/11
The Laboratory 4—7/21/11
The Laboratory 5—7/28/11
Conventional Wisdom—8/08/11
Hardwiring—8/12/11
Hardwiring 2—8/18/11
Sepsis—8/26/11
Sepsis 2—9/07/11
Sepsis 3—9/15/11
The Bad, Good Medication—9/23/11
Series Contents—9/29/11 This contains subtitles or keywords for individual postings in series posted between April 1, 2010 and September 15, 2011.
How Things Happen—10/06/11
The Need for Lean Leadership—Entropy—10/13/11
Lean Leadership 2—10/20/11
Lean Leadership 3—10/28/11
Lean Leadership 4—Servant Leadership—11/03/11
Lean Leadership 5—Links Between Lean Leadership and Servant Leadership—11/11/11
Affinity’s Kaizen Curmudgeon
Kaizen Curmudgeon Blog Title—Date Posted
Stan’s Story Redux—12/29/10
Autonomy—1/06/11
Autonomy 2—1/27/11
What shall we do with you?—2/02/11
The Middle Years—2/09/11
Way to go!—2/17/11
Way to go! 2—2/24/11
Complacency—3/03/11
Complacency 2—3/10/11
Kaikaku, a countermeasure for “We’ve always done it that way.”—3/18/11
I’ve always done it that way.—3/24/11
The Crystal Ball—Prologue—4/07/11
The Crystal Ball 1—4/15/11
The Old Men’s Table—4/18/11
The Crystal Ball 2—4/27/11
The Crystal Ball 3—5/05/11
The Crystal Ball 4—5/12/11
The Crystal Ball 5—5/19/11
Happy Fourth Birthday—5/20/11
The Crystal Ball 6—5/31/11
The Crystal Ball 7—6/03/11
The Crystal Ball 8—6/13/11
The Laboratory—6/30/11
The Laboratory 2—7/07/11
The Laboratory 3—7/14/11
The Laboratory 4—7/21/11
The Laboratory 5—7/28/11
Conventional Wisdom—8/08/11
Hardwiring—8/12/11
Hardwiring 2—8/18/11
Sepsis—8/26/11
Sepsis 2—9/07/11
Sepsis 3—9/15/11
The Bad, Good Medication—9/23/11
Series Contents—9/29/11 This contains subtitles or keywords for individual postings in series posted between April 1, 2010 and September 15, 2011.
How Things Happen—10/06/11
The Need for Lean Leadership—Entropy—10/13/11
Lean Leadership 2—10/20/11
Lean Leadership 3—10/28/11
Lean Leadership 4—Servant Leadership—11/03/11
Lean Leadership 5—Links Between Lean Leadership and Servant Leadership—11/11/11
Affinity’s Kaizen Curmudgeon
Friday, November 11, 2011
Lean Leadership 5
Links Between Lean Leadership and Servant Leadership
“I trust, Jaded Julie, that you are still willing to play the role of a front-line leader in a generic hospital?”
“No sweat, Curmudge. That’s as easy for me as it is for you to play the role of a cantankerous old codger. I believe last time we promised to describe how servant leadership can be tied with Lean leadership. To me, the most obvious connection would be through the Lean principle of respect for people.”
“Good observation. In manufacturing the Lean manager respects the knowledge and ability of the workers to solve—with coaching—the problems that arise in their process. This should be easier in a hospital, where most of the people in gemba are professionals. In your role, Julie, achieving mutual respect might be the most important element of respect for people. In your unit the ‘people will not care what you know until they know that you care, and they won’t believe the message until they believe the messenger (1).’ “
“I agree, Curmudge. As Hunter has said, ‘Management is what we do; leadership is who we are. Simply knowing how to do the job well has little to do with developing the skills necessary to inspire others to do the job well.’ “
“In our lesson on becoming a servant leader back on May 22, 2008, we mentioned the need to get feedback from one’s direct reports. In doing so, you might tell your people about servant leadership and your efforts to become one. Hopefully they will acquire a stake in your success.”
“Accountability is essential in Lean management, and it’s an important part of servant leadership. Of course, it should not be a problem if people are motivated. ‘Motivation is people moved to action because they want to act. We cannot change anyone; the best we can do is influence their future choices.’ “
“It’s clear to me, that while a servant leader will help his/her people be the best they can be, he will strongly influence them to do so. Here is what Hunter’s book says about accountability: ‘It is immoral not to fire those who can’t do the job. Think about the bad messages we send about our lack of commitment to excellence and our failure to do the right thing.’ ‘The biggest gap in leadership skills is failing to confront people with problems and situations as they arise and to hold them accountable.’ I’ve seen that at all levels, Julie, and I confess to not having acted promptly in at least one case. But that was before Hunter wrote his books.”
“I think I’ve got it, Curmudge. A servant leader is a person of high character who is willing to use ‘tough love’ to help his/her direct reports to be the best they can be. Now here’s a tough problem for you. What about the employee with family responsibilities who simply wants to work her shift and go home as soon as possible? She has little interest in ‘being all she can be.’ ”
“Let’s not overlook the possibility that she might already ‘be all she can be.’ If she really wants to leave promptly, she might be your strongest ally in improving the unit’s efficiently. People in health care usually believe on the day they are hired that what they are doing is important, that it serves a purpose, and adds value to the world. Perhaps between then and now something has caused her to become de-motivated. Your training as a servant leader should help you differentiate between a person with legitimate needs and one who is truly a detriment to the organization. Thus servant leadership doesn’t provide silver bullets; it develops the character to make difficult decisions.”
“Lean is based on continuous improvement, and Lean leadership—supported by servant leadership—is the way we make the improvements happen. Leaders are made, not born, and they don’t leap from the cradle as servant leaders. Becoming a servant leader, like Lean, requires continuous improvement.”
“That’s it, Julie. While one can read books on Lean and servant leadership, one can only accomplish the desired goals of each by continuous efforts in the workplace.”
“Well senescent senior, that’s a lot to learn. But if you can, anybody can.”
Affinity’s Kaizen Curmudgeon
(1) Hunter, James C. The World’s Most Powerful Leadership Principle (Crown Business, 2004)
P.S.—Back on May 22, 2008 we talked about how one might become a servant leader. Anyone who wasn’t reading our blog back then can click on the link and learn about Hardwiring What We Have Learned.
“I trust, Jaded Julie, that you are still willing to play the role of a front-line leader in a generic hospital?”
“No sweat, Curmudge. That’s as easy for me as it is for you to play the role of a cantankerous old codger. I believe last time we promised to describe how servant leadership can be tied with Lean leadership. To me, the most obvious connection would be through the Lean principle of respect for people.”
“Good observation. In manufacturing the Lean manager respects the knowledge and ability of the workers to solve—with coaching—the problems that arise in their process. This should be easier in a hospital, where most of the people in gemba are professionals. In your role, Julie, achieving mutual respect might be the most important element of respect for people. In your unit the ‘people will not care what you know until they know that you care, and they won’t believe the message until they believe the messenger (1).’ “
“I agree, Curmudge. As Hunter has said, ‘Management is what we do; leadership is who we are. Simply knowing how to do the job well has little to do with developing the skills necessary to inspire others to do the job well.’ “
“In our lesson on becoming a servant leader back on May 22, 2008, we mentioned the need to get feedback from one’s direct reports. In doing so, you might tell your people about servant leadership and your efforts to become one. Hopefully they will acquire a stake in your success.”
“Accountability is essential in Lean management, and it’s an important part of servant leadership. Of course, it should not be a problem if people are motivated. ‘Motivation is people moved to action because they want to act. We cannot change anyone; the best we can do is influence their future choices.’ “
“It’s clear to me, that while a servant leader will help his/her people be the best they can be, he will strongly influence them to do so. Here is what Hunter’s book says about accountability: ‘It is immoral not to fire those who can’t do the job. Think about the bad messages we send about our lack of commitment to excellence and our failure to do the right thing.’ ‘The biggest gap in leadership skills is failing to confront people with problems and situations as they arise and to hold them accountable.’ I’ve seen that at all levels, Julie, and I confess to not having acted promptly in at least one case. But that was before Hunter wrote his books.”
“I think I’ve got it, Curmudge. A servant leader is a person of high character who is willing to use ‘tough love’ to help his/her direct reports to be the best they can be. Now here’s a tough problem for you. What about the employee with family responsibilities who simply wants to work her shift and go home as soon as possible? She has little interest in ‘being all she can be.’ ”
“Let’s not overlook the possibility that she might already ‘be all she can be.’ If she really wants to leave promptly, she might be your strongest ally in improving the unit’s efficiently. People in health care usually believe on the day they are hired that what they are doing is important, that it serves a purpose, and adds value to the world. Perhaps between then and now something has caused her to become de-motivated. Your training as a servant leader should help you differentiate between a person with legitimate needs and one who is truly a detriment to the organization. Thus servant leadership doesn’t provide silver bullets; it develops the character to make difficult decisions.”
“Lean is based on continuous improvement, and Lean leadership—supported by servant leadership—is the way we make the improvements happen. Leaders are made, not born, and they don’t leap from the cradle as servant leaders. Becoming a servant leader, like Lean, requires continuous improvement.”
“That’s it, Julie. While one can read books on Lean and servant leadership, one can only accomplish the desired goals of each by continuous efforts in the workplace.”
“Well senescent senior, that’s a lot to learn. But if you can, anybody can.”
Affinity’s Kaizen Curmudgeon
(1) Hunter, James C. The World’s Most Powerful Leadership Principle (Crown Business, 2004)
P.S.—Back on May 22, 2008 we talked about how one might become a servant leader. Anyone who wasn’t reading our blog back then can click on the link and learn about Hardwiring What We Have Learned.
Thursday, November 3, 2011
Lean Leadership 4--Servant Leadership
“Jaded Julie, even though you couldn’t stay for the whole orchestra concert, did you enjoy what you heard?”
"It was great, and as you advised, I listened intently. The first violins all played the same melody, but sometimes the woodwinds or the brass played something different. But it fit together beautifully.”
“That was a countermelody. If the whole orchestra had played exactly the same notes, it might have sounded like a grade-school band. You have observed that when something extra is added to a simple theme, the combined effect is enhanced.”
“I’ve got it, Curmudge. But what does this have to do with Lean? If there’s no connection, this posting will end up in the wastebasket.”
“I used countermelody, Julie, as a metaphor for servant leadership. If you can combine servant leadership with Lean leadership, your performance as a Lean leader will be greatly improved.”
“We talked about servant leadership over three years ago, on May 8, 2008 and also on May 15 and 22. I agree that it’s time for a refresher.”
“Let’s skip the history of servant leadership and get right to today’s lesson. Most of what we will share with readers is found in books by James C. Hunter (1, 2). In fact, much of this posting will simply be quotations from Hunter’s second book. We’ll also reference the statements of authorities that Hunter quoted.”
“Curmudge, I understand that Lean and servant leadership are complementary, but how do they differ?”
“Pretty simple. Lean is organizational; servant leadership is personal. Lean is the organizational culture that we are trying to develop. Servant leadership describes the character that should be a part of a truly successful leader. If all of the managers in an organization were servant leaders, pulling off a Lean transformation should be a slam-dunk.”
“We know intuitively what character means, but how does Hunter define it in the servant leadership context?”
“ ‘Character is our moral maturity and commitment to doing the right thing regardless of personal costs. Character involves the will to respond to stimuli according to values and principles rather than to appetites, urges, whims, or impulses.’ Here are some of the essentials of good character: patience, kindness, humility, respect, selflessness, forgiveness, honesty, and commitment.“
“Presumably, these are also essentials of leadership. Here are some things that others have said about character and leadership: ‘Ninety-nine percent of leadership failures are failures of character (3).’ ‘Leadership is character in action (4).’ ‘There are no weak platoons—only weak leaders (5).’ “
“Julie, we must have said this back in 2008, but it’s worth repeating: Leadership is ‘the skills of influencing people to enthusiastically work toward goals identified as being for the common good, with character that inspires confidence.’ “
“Okay, we’ve tied leadership to character, but how does ‘servant’ enter the picture?”
“Here it is at the most basic level: ‘If you choose to lead, you must serve (6).’ It’s simpler if you consider The Law of the Harvest; you reap what you sow. ‘You sow service and sacrifice; you extend yourself for others and seek their greatest good; you will build influence with them.’ “
“But in the world of commerce and even health care, the word ‘servant’ sounds a bit wimpish.”
“Don’t confuse a servant leader with being a total ‘Mr. Nice Guy,’ Julie. Here’s what Hunter says: ‘The servant leader does not abdicate responsibility to define the mission, set rules governing behavior, set standards, or define accountability. Then the leader helps people meet their legitimate needs so they can become the best they are capable of becoming and effectively accomplish the mission.’ Note that Hunter said ‘needs’ and not ‘wants.’ He illustrates that in this way: ‘If you get your people what they need, they will get you everything that you need. Our leadership will be defined not by what we accomplish but by what we get accomplished through others.’ “
“Old Guy, it looks as if we’ve presented some of the most important elements of servant leadership. I trust that next time we’ll relate servant leadership more closely with Lean leadership.”
Affinity’s Kaizen Curmudgeon
(1) Hunter, James C. The Servant (Crown Business, 1998)
(2) Hunter, James C. The World’s Most Powerful Leadership Principle (Crown Business, 2004)
(3) Schwarzkopf, Norman
(4) Bennis, Warren
(5) Creech, William
(6) Book of Matthew (paraphrased)
"It was great, and as you advised, I listened intently. The first violins all played the same melody, but sometimes the woodwinds or the brass played something different. But it fit together beautifully.”
“That was a countermelody. If the whole orchestra had played exactly the same notes, it might have sounded like a grade-school band. You have observed that when something extra is added to a simple theme, the combined effect is enhanced.”
“I’ve got it, Curmudge. But what does this have to do with Lean? If there’s no connection, this posting will end up in the wastebasket.”
“I used countermelody, Julie, as a metaphor for servant leadership. If you can combine servant leadership with Lean leadership, your performance as a Lean leader will be greatly improved.”
“We talked about servant leadership over three years ago, on May 8, 2008 and also on May 15 and 22. I agree that it’s time for a refresher.”
“Let’s skip the history of servant leadership and get right to today’s lesson. Most of what we will share with readers is found in books by James C. Hunter (1, 2). In fact, much of this posting will simply be quotations from Hunter’s second book. We’ll also reference the statements of authorities that Hunter quoted.”
“Curmudge, I understand that Lean and servant leadership are complementary, but how do they differ?”
“Pretty simple. Lean is organizational; servant leadership is personal. Lean is the organizational culture that we are trying to develop. Servant leadership describes the character that should be a part of a truly successful leader. If all of the managers in an organization were servant leaders, pulling off a Lean transformation should be a slam-dunk.”
“We know intuitively what character means, but how does Hunter define it in the servant leadership context?”
“ ‘Character is our moral maturity and commitment to doing the right thing regardless of personal costs. Character involves the will to respond to stimuli according to values and principles rather than to appetites, urges, whims, or impulses.’ Here are some of the essentials of good character: patience, kindness, humility, respect, selflessness, forgiveness, honesty, and commitment.“
“Presumably, these are also essentials of leadership. Here are some things that others have said about character and leadership: ‘Ninety-nine percent of leadership failures are failures of character (3).’ ‘Leadership is character in action (4).’ ‘There are no weak platoons—only weak leaders (5).’ “
“Julie, we must have said this back in 2008, but it’s worth repeating: Leadership is ‘the skills of influencing people to enthusiastically work toward goals identified as being for the common good, with character that inspires confidence.’ “
“Okay, we’ve tied leadership to character, but how does ‘servant’ enter the picture?”
“Here it is at the most basic level: ‘If you choose to lead, you must serve (6).’ It’s simpler if you consider The Law of the Harvest; you reap what you sow. ‘You sow service and sacrifice; you extend yourself for others and seek their greatest good; you will build influence with them.’ “
“But in the world of commerce and even health care, the word ‘servant’ sounds a bit wimpish.”
“Don’t confuse a servant leader with being a total ‘Mr. Nice Guy,’ Julie. Here’s what Hunter says: ‘The servant leader does not abdicate responsibility to define the mission, set rules governing behavior, set standards, or define accountability. Then the leader helps people meet their legitimate needs so they can become the best they are capable of becoming and effectively accomplish the mission.’ Note that Hunter said ‘needs’ and not ‘wants.’ He illustrates that in this way: ‘If you get your people what they need, they will get you everything that you need. Our leadership will be defined not by what we accomplish but by what we get accomplished through others.’ “
“Old Guy, it looks as if we’ve presented some of the most important elements of servant leadership. I trust that next time we’ll relate servant leadership more closely with Lean leadership.”
Affinity’s Kaizen Curmudgeon
(1) Hunter, James C. The Servant (Crown Business, 1998)
(2) Hunter, James C. The World’s Most Powerful Leadership Principle (Crown Business, 2004)
(3) Schwarzkopf, Norman
(4) Bennis, Warren
(5) Creech, William
(6) Book of Matthew (paraphrased)
Friday, October 28, 2011
Lean Leadership 3
“Continuing with our music analogy, Jaded Julie, what is the first thing that happens after you have arrived at a concert venue?”
“I go to the ladies’ room and ‘powder my nose,’ as my mother would say.”
“But right after that you would receive a program for tonight’s orchestra concert.”
“Right, Curmudge. I’ll need that to learn what’s going to be played and who will play it. Say, that reminds me of the visual controls—the dashboard or process status board—that we are developing for the unit back at the hospital. That makes our organization, efforts, and accomplishments transparent to our team as well as to passers-by.”
“I’m delighted that you are thinking about work, Julie, but you must not be enjoying the concert. So what goes on the board? I presume that it is updated at the beginning of each shift.”
“These are my thoughts, Curmudge. I will need to collect input from above and below me in the organization. Presumably this would include hospital-wide and unit measures of performance. Unit data would include census, patients (room numbers) of concern or likely to need special care, and anticipated discharges. Safety issues and the status of process improvement efforts should be included. Of course, it shouldn’t become so crowded that one can’t see the forest for the trees.”
“Good, Julie. Now that the dashboard is designed, let’s think about standard work for you, a front-line leader in a nursing unit. You might not have thought about it, but you closely resemble front-line leaders at Toyota. They have developed hands-on proficiency at all of the operations performed by their team. With all of your experience, you have developed comparable proficiency in nursing. Congratulations, you are a supernurse.”
“I won’t be a supernurse in this position very long if I don’t develop some leadership standard work. Each day (or shift) will start with a report from my predecessor and a tour of the unit to collect data to update the dashboard. This will be followed by a brief stand-up huddle in front of the dashboard with the nurses in the unit; of course, this can’t occur until they have taken report from their counterparts on the preceding shift. We’ll welcome any ‘float’ nurses and assure that they will be brought up to speed on our standard work. The focus of this short meeting will be the current data on the dashboard, especially that pertaining to current improvement projects.”
“At that point, I’d be ready for a coffee break, but I know that you don’t have time. It’s time to get out in gemba and see that the agreed-upon standard work is being followed. If the work had not been standardized, you wouldn’t be able to detect deviations. When you see a deviation, ask ‘why?’; it might represent a new idea to improve the process. Be alert for ‘workarounds’ and ‘treasure hunts;’ they are clear signals of problems to be addressed and corrected. As a supernurse, you will be the unit’s fount of knowledge and master of techniques. If a patient is a ‘hard stick,’ you’ll be able to insert an IV catheter on the first try. And even when special talents are not required, you can provide an extra pair of hands to fill in where needed.”
“Thus far, except for the dashboard much of my job doesn’t sound too different from what it was before Lean.”
“But now your front-line leader’s job has become standard work. Your tasks are very similar (standardized) to those of other leaders in other comparable units. Through your joint efforts, you have learned what works best and adopted it as standard work. All of you are coaching your teams in standard work, continuous improvement, problem solving, and respect for one another. This requires that you possess personal discipline and can impart—through coaching—discipline to each of your direct reports.”
“Before we leave Lean at my level of leadership, we must not forget my daily or weekly meetings with my supervisor or manager. Her standard work is to assess my accountability for providing the Lean leadership that we have been discussing. She fully understands the value of gemba walks and agrees that ‘the currency of leadership is presence.’ If I appear unenthusiastic about Lean, she will remind me that, ‘it is easier to act your way into a new way of thinking than to think your way into a new way of acting.’ That translates into, ‘just do it,’ or ‘try it and you’ll like it.’ “
“Our readings (1,2) have suggested that regular daily or weekly meetings of leaders and their staffs going at least three levels up the chain of leadership are essential in maintaining the momentum of a Lean transition. Remember Masaaki Imai’s admonition, ‘Kaizen is everyday improvement, everybody improvement, everywhere improvement.’ Remember also that Lean, like the flywheel we discussed back on March 26, 2008, resembles a bearing with lots of friction; it requires constant pushing. That puts a lot of responsibility for Lean’s success on the shoulders of middle managers who must adopt Lean leadership.”
“There’s a bundle of stuff that we front-line and middle managers have to know and do on a daily basis, Curmudge. Can you summarize from our reading?”
“From Kenney (1):
• ‘Know the status of daily work.
• Know if planned work is completed on time.
• Understand both upstream and downstream impact.
• Know that standard work is being followed.
• Know when to take action and what action to take.’
From Mann (2):
• ‘Assessment based on data captured on visual controls.
• Assignment for corrective action and/or improvement.
• Accountability for having completed the previous day’s assignments.’ "
“All of that sounds pretty intuitive, Curmudge. As I’ve said before, ‘Lean is just organized common sense.’ Lean leadership is powerful because it enforces daily accountability. And if people do this every day for months or years, they will forget what they would slide back into if they had any inclination to back-slide.”
“By the way, Julie, whatever happened to that concert that you were attending?”
“I got so wrapped up in thinking and talking about Lean that I was asked to leave.”
Affinity’s Kaizen Curmudgeon
(1) Kenney, Charles Transforming Health Care (CRC Press, 2011)
(2) Mann, David Creating a Lean Culture (CRC Press, 2010)
“I go to the ladies’ room and ‘powder my nose,’ as my mother would say.”
“But right after that you would receive a program for tonight’s orchestra concert.”
“Right, Curmudge. I’ll need that to learn what’s going to be played and who will play it. Say, that reminds me of the visual controls—the dashboard or process status board—that we are developing for the unit back at the hospital. That makes our organization, efforts, and accomplishments transparent to our team as well as to passers-by.”
“I’m delighted that you are thinking about work, Julie, but you must not be enjoying the concert. So what goes on the board? I presume that it is updated at the beginning of each shift.”
“These are my thoughts, Curmudge. I will need to collect input from above and below me in the organization. Presumably this would include hospital-wide and unit measures of performance. Unit data would include census, patients (room numbers) of concern or likely to need special care, and anticipated discharges. Safety issues and the status of process improvement efforts should be included. Of course, it shouldn’t become so crowded that one can’t see the forest for the trees.”
“Good, Julie. Now that the dashboard is designed, let’s think about standard work for you, a front-line leader in a nursing unit. You might not have thought about it, but you closely resemble front-line leaders at Toyota. They have developed hands-on proficiency at all of the operations performed by their team. With all of your experience, you have developed comparable proficiency in nursing. Congratulations, you are a supernurse.”
“I won’t be a supernurse in this position very long if I don’t develop some leadership standard work. Each day (or shift) will start with a report from my predecessor and a tour of the unit to collect data to update the dashboard. This will be followed by a brief stand-up huddle in front of the dashboard with the nurses in the unit; of course, this can’t occur until they have taken report from their counterparts on the preceding shift. We’ll welcome any ‘float’ nurses and assure that they will be brought up to speed on our standard work. The focus of this short meeting will be the current data on the dashboard, especially that pertaining to current improvement projects.”
“At that point, I’d be ready for a coffee break, but I know that you don’t have time. It’s time to get out in gemba and see that the agreed-upon standard work is being followed. If the work had not been standardized, you wouldn’t be able to detect deviations. When you see a deviation, ask ‘why?’; it might represent a new idea to improve the process. Be alert for ‘workarounds’ and ‘treasure hunts;’ they are clear signals of problems to be addressed and corrected. As a supernurse, you will be the unit’s fount of knowledge and master of techniques. If a patient is a ‘hard stick,’ you’ll be able to insert an IV catheter on the first try. And even when special talents are not required, you can provide an extra pair of hands to fill in where needed.”
“Thus far, except for the dashboard much of my job doesn’t sound too different from what it was before Lean.”
“But now your front-line leader’s job has become standard work. Your tasks are very similar (standardized) to those of other leaders in other comparable units. Through your joint efforts, you have learned what works best and adopted it as standard work. All of you are coaching your teams in standard work, continuous improvement, problem solving, and respect for one another. This requires that you possess personal discipline and can impart—through coaching—discipline to each of your direct reports.”
“Before we leave Lean at my level of leadership, we must not forget my daily or weekly meetings with my supervisor or manager. Her standard work is to assess my accountability for providing the Lean leadership that we have been discussing. She fully understands the value of gemba walks and agrees that ‘the currency of leadership is presence.’ If I appear unenthusiastic about Lean, she will remind me that, ‘it is easier to act your way into a new way of thinking than to think your way into a new way of acting.’ That translates into, ‘just do it,’ or ‘try it and you’ll like it.’ “
“Our readings (1,2) have suggested that regular daily or weekly meetings of leaders and their staffs going at least three levels up the chain of leadership are essential in maintaining the momentum of a Lean transition. Remember Masaaki Imai’s admonition, ‘Kaizen is everyday improvement, everybody improvement, everywhere improvement.’ Remember also that Lean, like the flywheel we discussed back on March 26, 2008, resembles a bearing with lots of friction; it requires constant pushing. That puts a lot of responsibility for Lean’s success on the shoulders of middle managers who must adopt Lean leadership.”
“There’s a bundle of stuff that we front-line and middle managers have to know and do on a daily basis, Curmudge. Can you summarize from our reading?”
“From Kenney (1):
• ‘Know the status of daily work.
• Know if planned work is completed on time.
• Understand both upstream and downstream impact.
• Know that standard work is being followed.
• Know when to take action and what action to take.’
From Mann (2):
• ‘Assessment based on data captured on visual controls.
• Assignment for corrective action and/or improvement.
• Accountability for having completed the previous day’s assignments.’ "
“All of that sounds pretty intuitive, Curmudge. As I’ve said before, ‘Lean is just organized common sense.’ Lean leadership is powerful because it enforces daily accountability. And if people do this every day for months or years, they will forget what they would slide back into if they had any inclination to back-slide.”
“By the way, Julie, whatever happened to that concert that you were attending?”
“I got so wrapped up in thinking and talking about Lean that I was asked to leave.”
Affinity’s Kaizen Curmudgeon
(1) Kenney, Charles Transforming Health Care (CRC Press, 2011)
(2) Mann, David Creating a Lean Culture (CRC Press, 2010)
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