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)