Lean Leadership 2

“I suspect that all of us start each workday with standard work. I turn off the alarm clock and jump out of bed. Shave, do stretching exercises, and bring in the Wall Street Journal from the driveway. Eat breakfast, get dressed, and drive to work. Except for weekends, every day is essentially the same.”

“That was when you were working, Curmudge. Now that you are retired, you get out of bed more slowly and take time to read the front and editorial pages of the Journal. Everything else is pretty much the same as before.”

“My point, Jaded Julie, is that everyone knows about standard work, but each person has his/her own routine. That’s okay at home but not at work. Correcting this problem—facilitating the development of a unit’s standard work—is one of the most important tasks of a front-line supervisor. That’s the role I’d like you to play, Julie—a charge nurse or coordinator in a nursing unit of a generic hospital.”

“At least it’s better than my last role—a terminal patient in an ICU. If the nurses and techs haven’t taken a Lean Overview course, there’s a lot that I’ll have to teach. Kaizen events, value-stream mapping, A3 problem solving, 5S, PDCA, and more.”

“What the team members learn should stick with them, because they’ll be putting it to use right away. Remember that the standard processes will be developed by and owned by the team. A standard won’t fly if it is imposed from above.”

“Can you give me some ideas of things the team might achieve, Curmudge?”

“For inspiration, read about what other Lean hospitals have accomplished (1). Note that in every case their focus has been on enhancing the patient experience. Here are some of the things done at Virginia Mason Medical Center: made ‘taking report’ at shift change more efficient, reduced nurses’ time required for paperwork, instituted medical emergency teams, changed hourly rounding so that nurses would anticipate patient needs, and involved other departments in studies of systems to reduce the hospital’s ‘silo’ culture.”

“Those all sound good to me. They are excellent examples of Lean as it should be practiced in gemba. If I, as a front-line supervisor, could lead my team to accomplishments like those, you’d deem me an unqualified success.”

“You’ve made good progress, Julie, but there’s more. At this point in your fictional Lean leadership journey you are not doing what is needed to make those process changes endure. The problem is that some people in management—I hope not you—tend to leave standard work at the breakfast table. They arrive at work, check the day’s schedule for meetings, sometimes say a brief ‘good morning’ to the team members, and begin to fight the day’s most serious fire. They are attempting to manage a Lean team, but they aren’t practicing Lean themselves.”

“I’ve got it, Curmudge. Without Lean leadership, members of the team start drifting away from standard work and return to doing things ‘the way I’ve always done it.’ As we learned last week at Granddad’s farm, entropy is at work.”

“It’s also like a choir, where everyone might be singing a solo if it weren’t for each member reading from the same score…”

“…and an orchestra where we hear a bunch of toots and bleeps until the conductor taps his music stand with his baton.”

“Please note, Julie, that in both organizations the conductor can’t stop directing, walk away, and expect that the good music will continue. So next week we’ll return and play the next movement of the Lean Leadership Symphony.”

“I hope it won’t turn out to be a dirge. Bravo, Curmudge!”

“Brava, Julie.”

Affinity’s Kaizen Curmudgeon

(1) Kenney, Charles Transforming Health Care. (CRC Press, 2011)