Jaded Julie Learns the Language of Hoshin Kanri

"Time for a vocabulary lesson, Julie. Then we’ll learn how the words are used.”

“Okay, Curmudge, but I sure hope that when a new word goes into my brain, an old word doesn’t come popping out.”

“Don’t worry, Julie. That only happens to senior citizens. Let’s start by talking about matrices, which is the plural of matrix.”

“So what is a matrix?”

“I don’t think you want me to say that a matrix is a rectangular array of numbers, so why don’t we just use an example. A calendar is a simple matrix; it shows days of the week across the top and weeks of the month down the side. If you go out for fish every Friday, you’ll be doing it on October 5, 12, 19, and 26 in 2007. That’s pretty important information, don’t you agree?”

“I’m getting hungry already. Go on, Curmudge.”

“In Hoshin Kanri Planning there are several types of matrices. Each one has a name, and each name has an abbreviation.”

“I sense that this conversation is going down hill, but I haven’t bailed out yet.”

“Good! These are the names and abbreviations of the two main types of matrices: Policy Deployment (PD), and Planning Matrix (PM). Note that when ‘P’ is followed by ‘D’ it stands for Policy, and when ‘P’ is followed by ‘M’ it stands for Planning.”

“That sounds a bit inconsiderate of students, but at least it’s in English.”

“Don’t complain. There are similar idiosyncrasies in Arabic, and they have been learned by millions of children. Let’s gain an understanding of these terms by devising a simple scenario. Call the company the Curmudgeon Company with my wife and me the co-CEO’s.”

“I presume that you each make some of the important corporate decisions.”

“Right. She decides where we live and how the house is furnished, and I decide what color shirt to wear to work every day. Anyway, back to the scenario. We have developed two long-term goals, Move to a Warmer Climate and Sell the House. Our strategies for selling the house include Remodel the Interior and Upgrade the Exterior to Improve Curb Appeal. One of our hoshins (short-term essential achievements) to further the ‘Upgrade the Exterior’ strategy is to Improve the Appearance of the Yard. Although this is all hypothetical, I hope it helps clarify the terms we introduced last time, Goals, Strategies, and Hoshins.”

“It’s not bad, Curmudge. Whenever I get discouraged, I think of little children trying to learn Arabic.”

“Remember, Julie, the reason for the scenario is to help us understand the two main types of matrices used in hoshin kanri planning, the Policy Deployment Matrix (PD), and the Planning Matrix (PM). The Planning Matrix is simpler, so we’ll start with that one. Every hoshin has a planning matrix that shows the hoshin’s measure of success, the individual projects undertaken to support the hoshin, and the progress of those projects. Shown below is the planning matrix (PM) for our ‘Improve the Appearance of the Yard’ hoshin.”

"Well, Julie, I hope our example makes the Hoshin Planning Matrix appear straightforward. Next time we’ll tackle Policy Deployment Matrices.”

“I agree, Curmudge. Sometimes you do make complex topics easier to learn.”

“When do you want to hear my lectures on thermodynamics, Julie?”

“How about in ten years?”

“Bye, Julie.”

Affinity’s Kaizen Curmudgeon

Jaded Julie Begins to Learn about Hoshin Kanri Planning

“I’m sorry, Jaded Julie, but we’re going to have to deviate from our Lean transformation theme. The new topic is Hoshin Kanri Planning.”

“That’s okay, Curmudge. As Yogi Berra said, ‘If you come to a fork in the road, take it.’ But it sounds as if I’m going to have to learn two new Japanese words. You know that I’m not very good at foreign languages.”

“There’s nothing to fear, Julie. There are only two Japanese words that we’ll be learning; everything else is in English. Besides, every trade and profession has its own language. You have already learned the language of nursing. If someone says ‘Foley catheter’ to you, you immediately know what they mean. Those words mean nothing to the average person on the street, and those folks who recognize them simply shudder.”

“So you’re saying that learning Hoshin Kanri is essentially the same as learning a foreign language or the specialized English vocabulary of a profession?”

“Exactly. Learn the most essential words and the rules for their usage; then practice, practice, practice. Soon you’ll be thinking in Hoshin Kanri.”

“I’m shivering with anticipation. By the way, Curmudge, why are we doing this?”

“Every corporation needs to plan how it will improve its performance. Affinity has determined that Hoshin Kanri is the best planning process. It can be translated as policy deployment, goal deployment, or policy management, but Affinity has adopted the Japanese terms. In this process, the leadership team identifies goals for the corporation, develops strategies for achieving the goals, and then specifies essential achievements needed to further the strategies. In this context, the essential achievements are called ‘hoshins’. Sorry about the additional Japanese, but it’s just a rule of the game—sort of like learning to roll your ‘r’s to be understood in a foreign country.”

“It seems reasonable so far, but it sounds as if it involves only management. So why do I have to learn this?”

“You’re right in that the folks most directly involved with Hoshin Kanri are those from top management on down to directors and managers. But you might be called on to help. As I’ll point out later, Hoshin Kanri will permeate all of Affinity; and you will want to understand what is going on around you. Furthermore, achieving a Lean transformation is one of our corporate strategies. Hoshin Kanri is the means by which the Lean transformation that you have been studying will be accomplished.”

“So it will relate to me. I was about to lose interest. Proceed, Curmudge, but go slowly.”

“Let’s wrap up this session by mentioning that the business units—each hospital, Affinity Medical Group, etc.—commit to hoshins (remember—essential achievements) that further the corporate strategies that are within their purview. They also develop their own business unit strategies and hoshins. The result of this is that everyone is focused long term on achieving the corporate goals.”

“Whew! Are we finished for the day?”

“Yes. We’ll tackle more Hoshin Kanri Planning next time. Meanwhile, think how easy it was to learn the special terminology of sports, like ’first down’ and ‘offside’ in football…”

“…and throwing a ‘Hail Mary’ pass from your own 10-yard line.”

“You’ve got the idea, Julie. And I’ll make sure that learning Hoshin Kanri is not ‘unnecessary roughness’.”

Affinity’s Kaizen Curmudgeon

Jaded Julie Learns More about a Lean Transformation

“Hey, Jaded Julie, my shadowing you for a day last month certainly convinced me of the potential value of Lean for nursing.”

“No problem, Curmudge. You were not in the way, and you seemed to have a lot in common with the older patients.”

“But remember the critical difference, Julie. I was standing up.”

“I’d like to learn more about Lean, Curmudge, especially the Lean tools that you mentioned.”

“Let’s not get ahead of ourselves. The tools and techniques used in Lean are only half the story. We first need to learn the basics of a Lean transformation. Using Lean tools without knowing the basic philosophy would be like putting you to work on Four South without first learning physiology.”

“Go ahead and teach, Curmudge, as long as it’s not biochemistry.”

“Lean has two basic principles. We have already learned about the first one, Continuous Improvement or Kaizen. The second principle is Respect for People.”

“That’s easy. We already show respect for our patients in our caring for them.”

“There’s more to it than that, Julie. In a Lean transformation the organization respects all of its people, including everyone in gemba. I’m sure you recall that gemba is everywhere in the hospital where services are performed for our customers, the patients. Remember the upside-down organizational pyramid. A major focus of Lean is to help workers realize their full potential. This is very different from traditional management systems.”

“I hesitate to ask, Curmudge, but is there more to Respect for People than professional fulfillment?”

“I’m glad you did ask. An essential part of a Lean transformation is a ‘no lay-off’ policy as a result of process improvement and standardization. That means if your unit becomes so efficient due to application of Lean that not everyone is needed, the extra person will have opportunities elsewhere with Affinity.”

“Wow! That sounds great. Is there anything else?”

“Eventually there will be. When there are gains to share, a ‘gainsharing’ program will be started. Gainsharing means that when the hospital exceeds predetermined performance levels, the monetary gains will be shared with everyone.”

“Curmudge, all of this Lean stuff sounds super, but I know there is no free lunch. What can go wrong?”

“As usual, Jaded Julie, you have keen perception. When we get together next time, we’ll chat about potential pitfalls. See you then, Julie.”

“Ciao, Curmudge.”

Affinity’s Kaizen Curmudgeon

The Curmudgeon Shadows Jaded Julie

“Thank you, Jaded Julie, for allowing me to shadow you last week. I learned a lot.”

“Well, you weren’t much trouble. You didn’t get in my way, and only a few patients asked, ‘Who is the old guy?’ Why did you need to shadow a nurse, anyway?”

“Remember last month’s saying from Gemba Kaizen about going to where the action is—‘Go to Gemba.’ If I hope to teach you anything useful, I need to know what a nurse does. So I took my own advice and went to gemba.”

“So what did you learn in my gemba?”

“Good things first. You do a great job of caring for your patients. Despite having a lot to do, you were always compassionate and responsive to the patients’ needs.”

“Thanks for the kind words. Did you see anything that we should improve?”

“I didn’t see, but I heard…a very noisy TV set in a patient room. In my opinion, that’s not a healing environment. If I were a patient, I’d want to get well quickly just to get away from the noise.”

“To live up to your name, Curmudge, I suppose you found other things to complain about.”

“Let’s call them opportunities, Julie, not complaints. Nurses spend too much time writing, and you do it by hand. And you are seemingly in constant motion. It might be good exercise, but I’ll bet that a lot of it isn’t value added.”

“Okay, Curmudge, but what can we do about all this writing and running?”

“Our need for better technology is dire, but you can’t do much about that personally. Ultimately, you’ll be able to use Lean tools to make your processes more efficient.”

“Lean tools? Is that like a skinny monkey wrench?”

“No, they are techniques you can use to remove waste from your processes. We’ll talk about them later. Meanwhile, keep up the good work. Perhaps I’ll even return for another visit.”

“If you do, I’ll warn everyone that ‘The Kaizen Curmudgeon Is Coming’.”

“At least the patients won’t wonder who the old guy is.”

Affinity’s Kaizen Curmudgeon

Jaded Julie Learns About "Gemba"

“Hi, Jaded Julie. I see you decided not to wear your kimono at work.”

“The kimono might have been okay, but I couldn’t see myself clop-clopping down the hall responding to a ‘code’ wearing those wooden shoes with blocks on the bottom.”

“Those are ‘geta,’ Julie. I agree with your good judgment.”

“You said last time that we’d learn a new word today—something like ‘gumbo’.”

“Not gumbo, Julie, ‘gemba.’ We’re doing Japanese, not ‘Cajun. Gemba means ‘the real place.’ It’s your workplace.”

“But I thought my workplace was called Four South.”

“Julie, in a hospital gemba is any place where services are performed for our customers, the patients. The OR, ED, lab, radiology, examination rooms, patient care units, and lots of other places are all gemba. But not executive offices or the gift shop.”

“I get it. Gemba is where the action is no matter where it’s at.”

“I couldn’t have said it better. Without all of these gembas Affinity couldn’t fulfill its mission of providing services that promote the health and well being of the communities we serve. In Gemba Kaizen®, an older brother of Lean, the organizational pyramid is inverted with gemba at the top. The role of all of the managers and directors is to support the workers in gemba. To help with solving problems or making improvements, managers are told to ‘go to gemba’.”

“That sounds great to me, Curmudge. I always wanted to be at the top of the pyramid even if it’s really the bottom.”

“You’re the top, Julie. You and the rest of the folks in gemba. Masaaki Imai said, ‘If we call the customer king, we should call the gemba people Buddha’.”

“I’m for that, Curmudge, as long as I don’t have to sit cross-legged on the floor.”

“’Bye, Julie.”

“’Bye, Curmudge.”

Affinity’s Kaizen Curmudgeon

Profile Change

The Curmudgeon and Jaded Julie Talk About Names

“Hey, Jaded Julie, I have a new name. It’s The Kaizen Curmudgeon.”

“I liked your old name, Affinity’s Quality Curmudgeon. And the columns you wrote on patient safety, standards, and Lean were easy to find in Quality Management’s home page on the Affinity intranet. Why the change?”

“I’ve got a new home, in Affinity’s Kaizen Promotion Office, and I’m going to write a blog instead of intranet columns. So it’s new geography, a new communication medium, and of course, a new name.”

“But with your old name, I at least understood one of the words.”

“My last name wasn’t so bad. Although the dictionary says that a curmudgeon is a nasty old person, I prefer to think of him as a grouch possessing a significant amount of perspicacity.”

“Thanks for the help. At least I know what a grouch is. But what’s that Kaizen stuff?”

“Kaizen is a Japanese word meaning ‘change for the better’ or ‘continuous improvement.’ It's one of the principles of the Lean transformation that we are initiating at Affinity Health System."

“So why use Japanese words? They are all Greek to me.”

“Lean was first used in Japan. It's their game, so we use their words. It’s sort of like the way they use our words for our game, baseball, or besuboru in Japanese. Other baseball terms that the Japanese have adopted (sort of) are pinchi hitta (pinch hitter), rukii (rookie), and senta (center fielder).”

“Hey, that Japanese stuff is a great idea. Maybe I can wear a kimono at work instead of my blue scrubs.”

“We’ll see. Julie, next time we get together I’ll introduce another Japanese word, gemba (the workplace), and we’ll talk more about what is involved in a Lean transformation.”

“I can’t wait, Curmudge."

"Sayonara."

Affinity's Kaizen Curmudgeon