“Jaded Julie, during my days in industry there was an organization, supported by the industry, whose mission was the development of knowledge regarding the industry’s impact on the environment. This knowledge was for use in the near term, and it was developed in response to process changes and proposed government regulations. Basic research was done elsewhere, and an industry association handled government lobbying.”
“That’s all very nice, Curmudge, but why are you telling it to me?”
“I thought that for once I’d start by discussing a topic about which I knew something.”
“Well, that’s a switch, and it’s better than your usual prattle. But what does it have to do with health care?”
“Fortunately, there are similar organizations—developers and purveyors of knowledge—serving health care. People in hospitals are too busy with patient care, daily management (ready-to-serve time), hoshins (discretionary time), and other local issues to contemplate a global near-term future. That has created the need for outfits like the Institute for Healthcare Improvement (IHI), The Advisory Board, Sg2, and others. They are supported by membership dues and/or fees for participating in educational offerings and consortia devoted to specific issues.”
“These groups sound valuable, Curmudge. I understand that they are staffed by highly competent people whose job is to study, think, listen, talk, and write on behalf of the health care industry. Health care administrators are probably aware of the problems they will be facing, but they might feel overwhelmed by all of the countermeasures they could be implementing. According to their literature, these specialized consultancies help support and steer our thoughts in the direction of viable results with evidence and data to support them. Can you give me more specifics about these outfits?”
“As we said once before, IHI’s web site is a bit like a supermarket. If you have a problem, push your cart down the aisle; and you might find a solution. On our crystal ball timeline, IHI deals mostly with the present. However, its teachings will help organizations improve their near-term future. ‘IHI focuses on motivating and building the will for change; identifying and testing new models of care in partnership with both patients and health care professionals.’ IHI’s work is funded through their fee-based program offerings and services, and also through the support of foundations. Their reports, such as White Papers and Improvement Stories, are available to the public. Among the many subject areas are Office Practices and Patient-Centered Care. Here is an example of one of their forward-looking, fee-based colloquia to be held in 2011, ‘Thriving in an Era of Health Care Reform.’ ”
“Curmudge, I like your term, ‘purveyor of knowledge.’ Did you ever get paid for ‘purveying’ knowledge?”
“Not much, Julie, and any knowledge that I still have is free to a good home.”
“So what other purveyors of knowledge for the near term do we have for health care?”
“According to The Advisory Board, they are ‘the leading provider of comprehensive performance improvement services to the health care and education sectors—including operational best practices and insights, business intelligence and analytic tools, management training, unbiased technology evaluation, and consulting support.’ Note that they don’t work for health care exclusively. They have recently acquired Southwind, a ‘management and advisory firm focused on hospital-physician alignment and physician practice management.’ “
“It’s been awhile since we reminded our readers that a blog is not an encyclopedia or a textbook; all we hope to do is stimulate the readers’ interest. We can put them ashore, but they will have to explore the island by themselves.”
“For example, Julie, these are some of the programs accessible to corporate members of the Health Care Advisory Board: Strategy and Operations Research, Clinical Research, Leadership Development, Business Intelligence and Analytics, and Physician Performance. In our case, an Affinity employee can simply guide his mouse to the information of interest.”
“Curmudge, I understand that The Advisory Board has developed a lot of information on accountable-care organizations (ACOs). What’s an ACO anyway?”
“Good question, Julie, to which the answer is not completely defined. Here is the March 28, 2011 Wall Street Journal’s answer: ‘In broad outline (ACOs) propose to unite doctors and clinics or hospitals in groups that pool their resources with the goal of trimming spending while boosting the quality of care. When the group can show that it is improving care and delivers it for less than the cost projected—arrived at by crunching historical patient data for that market—a share of the savings goes to the ACO’s bottom line.’ This concept is part of the 2010 health care law and is not yet fully developed. It initially only applies to Medicare patients and, you’ll note, contains some features reminiscent of the medical home.”
“So what’s next, Curmudge?”
“What’s next will be in our next posting on this topic. Anyone who has read much about accountable-care organizations looks forward to quitting for the day, and c’est moi (that’s me). See you next time, Julie.”
Affinity’s Kaizen Curmudgeon
Wednesday, April 27, 2011
Monday, April 18, 2011
The Old Men's Table
“When I arrive early for the weekly meeting of our service club, I get my food at the buffet and find a spot at a table that’s occupied by other old guys who came early. Although it’s not official, this has become a sort of Old Men’s Table. Looking around the room, I can identify the unofficial Politicians’ Table, the Successful Women’s Table, and several tables of younger men and women on their way up in the community.”
“So, Curmudge, what’s so special about the Old Men’s Table? I presume that it is populated by old codgers like you.”
“Sometimes, Jaded Julie, I am the youngest. Sadly, our tablemates tend to die off. Then we hear, ‘Carl died on Saturday? But he was sitting right in that chair last Tuesday. I can’t believe he’s gone.’ Well, my wife died three months ago, and I can’t believe she’s gone. Then someone else says, ‘My wife died four years ago, and I think about her every day.’ “
“That certainly sounds depressing; but I suspect that you are headed toward some sort of lesson, so I’ll keep listening.”
“After a few more comments about Old Carl, we return to our old-guy jokes. ‘I’m so old that I have to pre-pay when I order a three-minute egg.’ ‘I never fill my car’s gas tank because I’m afraid I won’t live long enough to use it all.’ ‘Who wants to live to be 90? Someone who is 89.’ “
“Curmudge, I surely hope you live long enough to get to the point of this story.”
“Don’t leave yet, Julie. Our old-guys group is about evenly divided between widowers and those with a living wife. The outlooks of the two groups are dramatically different. Those with a wife are concerned about dying and leaving their wife to fend for herself.”
“Of course we all know that widows fare better than widowers, but it’s easy to appreciate why a husband would be worried.”
“I certainly was. My wife couldn’t even stand on a ladder and change a light bulb. And because she was almost three years younger, it never occurred to me that I might outlive her. We even joked about the traveling she would do with her second husband.”
“So Curmudge, how does one’s outlook change when he becomes a widower?”
“Death is always worse when it disrupts the ‘orderly march to the grave,’ i.e., older people are expected to die first. So when one loses a younger wife, his grief is doubled. But he also is freed from his worry about his wife living by herself.”
“Perhaps, Curmudge, that explains why you appear cheerful on the outside but are grieving on the inside.”
“Another difference in the widower’s outlook is that death has lost much of its sting. We don’t fear death as long as it is not slow. One of the ‘old guys’ recently suffered a disabling stroke; everyone fears that. But at the same time, we don’t seek death either. We are not like Job, who ‘long(s) for death but it comes not,’ (Job 3:21). We are more like my mother who said long ago, ‘It doesn’t matter when I die…but not today.’ “
“So do we have a lesson to take home, Curmudge?”
“A Muslim friend said to me a few years ago, ‘Death is a part of life.’ There will be times in your life when you’ll need to remember that simple truth.”
Affinity’s Kaizen Curmudgeon
“So, Curmudge, what’s so special about the Old Men’s Table? I presume that it is populated by old codgers like you.”
“Sometimes, Jaded Julie, I am the youngest. Sadly, our tablemates tend to die off. Then we hear, ‘Carl died on Saturday? But he was sitting right in that chair last Tuesday. I can’t believe he’s gone.’ Well, my wife died three months ago, and I can’t believe she’s gone. Then someone else says, ‘My wife died four years ago, and I think about her every day.’ “
“That certainly sounds depressing; but I suspect that you are headed toward some sort of lesson, so I’ll keep listening.”
“After a few more comments about Old Carl, we return to our old-guy jokes. ‘I’m so old that I have to pre-pay when I order a three-minute egg.’ ‘I never fill my car’s gas tank because I’m afraid I won’t live long enough to use it all.’ ‘Who wants to live to be 90? Someone who is 89.’ “
“Curmudge, I surely hope you live long enough to get to the point of this story.”
“Don’t leave yet, Julie. Our old-guys group is about evenly divided between widowers and those with a living wife. The outlooks of the two groups are dramatically different. Those with a wife are concerned about dying and leaving their wife to fend for herself.”
“Of course we all know that widows fare better than widowers, but it’s easy to appreciate why a husband would be worried.”
“I certainly was. My wife couldn’t even stand on a ladder and change a light bulb. And because she was almost three years younger, it never occurred to me that I might outlive her. We even joked about the traveling she would do with her second husband.”
“So Curmudge, how does one’s outlook change when he becomes a widower?”
“Death is always worse when it disrupts the ‘orderly march to the grave,’ i.e., older people are expected to die first. So when one loses a younger wife, his grief is doubled. But he also is freed from his worry about his wife living by herself.”
“Perhaps, Curmudge, that explains why you appear cheerful on the outside but are grieving on the inside.”
“Another difference in the widower’s outlook is that death has lost much of its sting. We don’t fear death as long as it is not slow. One of the ‘old guys’ recently suffered a disabling stroke; everyone fears that. But at the same time, we don’t seek death either. We are not like Job, who ‘long(s) for death but it comes not,’ (Job 3:21). We are more like my mother who said long ago, ‘It doesn’t matter when I die…but not today.’ “
“So do we have a lesson to take home, Curmudge?”
“A Muslim friend said to me a few years ago, ‘Death is a part of life.’ There will be times in your life when you’ll need to remember that simple truth.”
Affinity’s Kaizen Curmudgeon
Friday, April 15, 2011
The Crystal Ball 1
“Today we’re going to play one of our ‘Curmudge-and-Julie-make-believe’ games.”
“Ooh, Curmudge, the last time we did that I was seriously ill.”
“Don’t worry, Jaded Julie. This time the outcome will be better. Your role is to be a middle manager in a health care organization—one whose operating philosophy is command-and-control and where everything is done the way it has always been done.”
“Hey, that outfit is suffering from organizational obsolescence. They are really behind the 8-ball. Don’t they read or use computers? They must think that Google is a character (Barney Google) in a silly song. But say, Curmudge, I thought we were going to explore the future, and here we are talking about an organization living in the past.”
“We have to start somewhere, and even today there are probably command-and-control organizations out there. It wouldn’t be proper to just blow right by them. Their first need is to realize that employees are more productive when they are respected and that problems are best solved by the people in gemba…”
“…and that traditional hospitals tend to be wasteful, and that systems are best understood and improved after they are mapped. I’ve got it, Curmudge. Making these improvements is just common sense. Understanding this is where a traditional organization has to start if they want to join the rapidly changing world of health care.”
“One problem, Julie. People have their own, unique concept of common sense. We would have chaos if every person went his own way making improvements. People’s creative energies need to be harnessed and focused by using a structured program like Lean. We’ve talked about Lean in this blog for the past four years. However, for the total neophyte’s remedial reading we recommend a review of similar programs in the April 14, 2011 posting in Curmudgeon’s Wastebasket. ”
“People use lots of names for their improvement program, including those that are unique to their organization. Most of them are based on the principles of the Toyota Production System. But tell me, Curmudge, how should the wayward outfit whose role I am playing get their culture change under way?”
“Since Affinity began their Lean journey several years ago, a ton of books have been written and an army of consultants have come out of the woodwork. However, the absolute least expensive way to learn about Lean is to read Kaizen Curmudgeon. You’ll also want to benchmark organizations that have been describing their Lean successes at meetings. At some point you will probably want to contract with a sensei (honored teacher) for guidance. The best way to find such a person is to talk with people who have been where you want to go.”
“After I have done a lot of reading and become a dedicated change agent, what’s my next step?”
“Julie, leading from the middle of an organization is like pushing a rope. Nevertheless, it’s essential that those higher in the organization—especially at the top—become emotional, vocal, and physical supporters of the proposed new culture. However, your task should not be impossible if these (paraphrased) comments from a recent meeting of the American College of Healthcare Executives are valid: ‘They have heard, and hopefully understand, that they are going to have to change their organizations in major, cataclysmic ways especially if they haven’t started to do so already. Leaders in general are now much more knowledgeable about the steps they will have to take. They understand they have to adopt Toyota and Lean manufacturing strategies.’ “
“Whew! That helps. Let’s assume that I am successful and that the organization has set sail on its Lean journey. Can I sit back and relax?”
“No way! It may have taken herculean efforts to get the flywheel turning, but it is not frictionless. Maintaining a Lean program requires dogged determination and almost religious dedication. And ideally, it never ends.”
“Perhaps it’s a bit like marriage, Curmudge. You’d better hardwire the whole concept, because it’s going to be your partner for a long time.”
“In addition, Julie, as the resident futurist you will want to expand your horizon. Instead of thinking how better to organize a supply closet, you’ll want to know what’s coming down the pike that will impact your organization.”
“Wow! That’s a gigantic expansion. I assume we’ll talk about that next time. By the way, Curmudge, are you a futurist?”
“Of course I am, but for me the future is tomorrow. That’s why if I wake up in the morning, every day is a beautiful day.”
Affinity’s Kaizen Curmudgeon
“Ooh, Curmudge, the last time we did that I was seriously ill.”
“Don’t worry, Jaded Julie. This time the outcome will be better. Your role is to be a middle manager in a health care organization—one whose operating philosophy is command-and-control and where everything is done the way it has always been done.”
“Hey, that outfit is suffering from organizational obsolescence. They are really behind the 8-ball. Don’t they read or use computers? They must think that Google is a character (Barney Google) in a silly song. But say, Curmudge, I thought we were going to explore the future, and here we are talking about an organization living in the past.”
“We have to start somewhere, and even today there are probably command-and-control organizations out there. It wouldn’t be proper to just blow right by them. Their first need is to realize that employees are more productive when they are respected and that problems are best solved by the people in gemba…”
“…and that traditional hospitals tend to be wasteful, and that systems are best understood and improved after they are mapped. I’ve got it, Curmudge. Making these improvements is just common sense. Understanding this is where a traditional organization has to start if they want to join the rapidly changing world of health care.”
“One problem, Julie. People have their own, unique concept of common sense. We would have chaos if every person went his own way making improvements. People’s creative energies need to be harnessed and focused by using a structured program like Lean. We’ve talked about Lean in this blog for the past four years. However, for the total neophyte’s remedial reading we recommend a review of similar programs in the April 14, 2011 posting in Curmudgeon’s Wastebasket. ”
“People use lots of names for their improvement program, including those that are unique to their organization. Most of them are based on the principles of the Toyota Production System. But tell me, Curmudge, how should the wayward outfit whose role I am playing get their culture change under way?”
“Since Affinity began their Lean journey several years ago, a ton of books have been written and an army of consultants have come out of the woodwork. However, the absolute least expensive way to learn about Lean is to read Kaizen Curmudgeon. You’ll also want to benchmark organizations that have been describing their Lean successes at meetings. At some point you will probably want to contract with a sensei (honored teacher) for guidance. The best way to find such a person is to talk with people who have been where you want to go.”
“After I have done a lot of reading and become a dedicated change agent, what’s my next step?”
“Julie, leading from the middle of an organization is like pushing a rope. Nevertheless, it’s essential that those higher in the organization—especially at the top—become emotional, vocal, and physical supporters of the proposed new culture. However, your task should not be impossible if these (paraphrased) comments from a recent meeting of the American College of Healthcare Executives are valid: ‘They have heard, and hopefully understand, that they are going to have to change their organizations in major, cataclysmic ways especially if they haven’t started to do so already. Leaders in general are now much more knowledgeable about the steps they will have to take. They understand they have to adopt Toyota and Lean manufacturing strategies.’ “
“Whew! That helps. Let’s assume that I am successful and that the organization has set sail on its Lean journey. Can I sit back and relax?”
“No way! It may have taken herculean efforts to get the flywheel turning, but it is not frictionless. Maintaining a Lean program requires dogged determination and almost religious dedication. And ideally, it never ends.”
“Perhaps it’s a bit like marriage, Curmudge. You’d better hardwire the whole concept, because it’s going to be your partner for a long time.”
“In addition, Julie, as the resident futurist you will want to expand your horizon. Instead of thinking how better to organize a supply closet, you’ll want to know what’s coming down the pike that will impact your organization.”
“Wow! That’s a gigantic expansion. I assume we’ll talk about that next time. By the way, Curmudge, are you a futurist?”
“Of course I am, but for me the future is tomorrow. That’s why if I wake up in the morning, every day is a beautiful day.”
Affinity’s Kaizen Curmudgeon
Thursday, April 7, 2011
The Crystal Ball--Prologue
“Curmudge, in this turbulent world, how were you able to stay employed so long?”
“Well Jaded Julie, I kept reinventing myself. I was always looking for ways in which my experience matched my employer’s needs. Often it was difficult to anticipate what those needs would be. Ultimately I became ‘retired’ when I ran out of inventions.”
“The outlook for health care in the U.S. appears to be even murkier than what you experienced in industry. Nevertheless, are there people or organizations who are trying to foresee our admittedly cloudy future?”
“Of course, Julie. But forecasting becomes more risky as one tries to peer farther into the unknown. Let’s start with the near term. Because most everyone already knows that we must become more efficient tomorrow, next month, and next year, we can forge ahead with process improvements with no concern that we might be wasting our effort. But planning ten or twenty years ahead is much more difficult.”
“C’mon, Curmudge, at your age planning ten years into your future is overly optimistic and twenty years out would be a waste of time.”
“Regrettably, that’s true. As you already know, I don’t even buy green bananas. However, for those folks like you anticipating a long and successful career, let’s try to look ahead anyway. Of course, you are not going to make it into the future unless you can make it through today. So we’ll start by describing resources that every health care organization should be using right now. And along with being contemporary, this knowledge is used locally, i.e.; it’s applied by the workers in gemba.”
“It sounds as if you are talking about Lean, which all of our readers should understand pretty well. But why should I, a nurse, push my knowledge horizon out into the future?”
“Be optimistic, Julie. In health care, nursing can be the gateway to most anything in the organization. The business unit and corporate leaders of the future had better understand what will be going on around them.”
“I’m convinced, Curmudge. May I sign up for your trip over the rainbow?”
“Of course. Pack your carry-on; we depart in a week or two.”
Affinity’s Kaizen Curmudgeon
“Well Jaded Julie, I kept reinventing myself. I was always looking for ways in which my experience matched my employer’s needs. Often it was difficult to anticipate what those needs would be. Ultimately I became ‘retired’ when I ran out of inventions.”
“The outlook for health care in the U.S. appears to be even murkier than what you experienced in industry. Nevertheless, are there people or organizations who are trying to foresee our admittedly cloudy future?”
“Of course, Julie. But forecasting becomes more risky as one tries to peer farther into the unknown. Let’s start with the near term. Because most everyone already knows that we must become more efficient tomorrow, next month, and next year, we can forge ahead with process improvements with no concern that we might be wasting our effort. But planning ten or twenty years ahead is much more difficult.”
“C’mon, Curmudge, at your age planning ten years into your future is overly optimistic and twenty years out would be a waste of time.”
“Regrettably, that’s true. As you already know, I don’t even buy green bananas. However, for those folks like you anticipating a long and successful career, let’s try to look ahead anyway. Of course, you are not going to make it into the future unless you can make it through today. So we’ll start by describing resources that every health care organization should be using right now. And along with being contemporary, this knowledge is used locally, i.e.; it’s applied by the workers in gemba.”
“It sounds as if you are talking about Lean, which all of our readers should understand pretty well. But why should I, a nurse, push my knowledge horizon out into the future?”
“Be optimistic, Julie. In health care, nursing can be the gateway to most anything in the organization. The business unit and corporate leaders of the future had better understand what will be going on around them.”
“I’m convinced, Curmudge. May I sign up for your trip over the rainbow?”
“Of course. Pack your carry-on; we depart in a week or two.”
Affinity’s Kaizen Curmudgeon
Thursday, March 24, 2011
I've always done it that way.
“Curmudge, today’s title looks as if it might be a sequel to last week’s We’ve always done it that way.”
“Very perceptive, Jaded Julie. Let me give you a ‘heads up.’ Today’s lesson is that standard work is more efficient, less costly, and usually easier than when everyone does things as they have always done them in his or her own way. Most importantly, standard work enhances patient safety.”
“That sounds intuitive, Curmudge, but I’ll bet that you have some evidence to back it up.”
“You recall my mentioning my senior citizen friends that I see every Independence Day. Although it’s depressing, we often talk about health issues. It is discouraging to learn that among that group and my other friends and acquaintances, many people have incurred surgical site infections. Of course these people were the fortunate ones, because they lived to tell about their experience. My circle of close friends is small (and its diameter is being reduced by the Grim Reaper); but even without hard data, the frequency of these presumably preventable infections is shocking.”
“So much for anecdotal evidence. There must be some information out there that supports your thesis that standard work makes patients safer.”
“Have patience, Julie, we’ll get to it. It’s my understanding that individual surgeons favor specific instruments, sutures, prosthetic devices, and other replacement parts for a given procedure. This is called their ‘preference list.’ So surgeon A would have his/her preference list for procedure X, while surgeon B might have a different list for the same procedure.”
“That doesn’t sound like standard work to me. But it’s not surprising, because surgeons A and B might have learned the procedure from attending surgeons in institutions hundreds of miles apart. In each case, the surgeon might say about his technique and preference list, ‘I’ve always done it that way.’ That must be pretty common, Curmudge, but how does it relate to surgical site infections?”
“In his leanblog.com posting on March 7, 2011, Mark Graban cited a study of a procedure that historically yielded from 2 to 5% frequency of surgical site infections. At the start, the study group members used 14 different pre-printed order sets for the same procedure. After weeks of deliberations, the surgeons and anesthesiologists reached consensus on standard order sets.”
“Wow! Those meetings must have required a talented facilitator. What was the outcome of their having adopted standard infection control procedures?”
“The study group went 11 months without a single occurrence of the target infection. And when a single infection ended their record, the group was able to investigate its root cause without blaming an individual. Overall, their surgical site infection rate dropped 63%. Furthermore, the team agreed that they would make changes that are best for the patient rather than the provider.”
“That’s really impressive. It’s critical to realize that the changes were made by the physicians themselves. They most likely would not have been adopted if they had been imposed on the physicians by someone else. By the way, Curmudge, do you have a standard procedure for writing this blog?”
“Sometimes I ruminate on a topic for weeks; sometimes for only a few minutes. Then I just sit at the computer and write. I’ve always done it that way.”
Affinity’s Kaizen Curmudgeon
“Very perceptive, Jaded Julie. Let me give you a ‘heads up.’ Today’s lesson is that standard work is more efficient, less costly, and usually easier than when everyone does things as they have always done them in his or her own way. Most importantly, standard work enhances patient safety.”
“That sounds intuitive, Curmudge, but I’ll bet that you have some evidence to back it up.”
“You recall my mentioning my senior citizen friends that I see every Independence Day. Although it’s depressing, we often talk about health issues. It is discouraging to learn that among that group and my other friends and acquaintances, many people have incurred surgical site infections. Of course these people were the fortunate ones, because they lived to tell about their experience. My circle of close friends is small (and its diameter is being reduced by the Grim Reaper); but even without hard data, the frequency of these presumably preventable infections is shocking.”
“So much for anecdotal evidence. There must be some information out there that supports your thesis that standard work makes patients safer.”
“Have patience, Julie, we’ll get to it. It’s my understanding that individual surgeons favor specific instruments, sutures, prosthetic devices, and other replacement parts for a given procedure. This is called their ‘preference list.’ So surgeon A would have his/her preference list for procedure X, while surgeon B might have a different list for the same procedure.”
“That doesn’t sound like standard work to me. But it’s not surprising, because surgeons A and B might have learned the procedure from attending surgeons in institutions hundreds of miles apart. In each case, the surgeon might say about his technique and preference list, ‘I’ve always done it that way.’ That must be pretty common, Curmudge, but how does it relate to surgical site infections?”
“In his leanblog.com posting on March 7, 2011, Mark Graban cited a study of a procedure that historically yielded from 2 to 5% frequency of surgical site infections. At the start, the study group members used 14 different pre-printed order sets for the same procedure. After weeks of deliberations, the surgeons and anesthesiologists reached consensus on standard order sets.”
“Wow! Those meetings must have required a talented facilitator. What was the outcome of their having adopted standard infection control procedures?”
“The study group went 11 months without a single occurrence of the target infection. And when a single infection ended their record, the group was able to investigate its root cause without blaming an individual. Overall, their surgical site infection rate dropped 63%. Furthermore, the team agreed that they would make changes that are best for the patient rather than the provider.”
“That’s really impressive. It’s critical to realize that the changes were made by the physicians themselves. They most likely would not have been adopted if they had been imposed on the physicians by someone else. By the way, Curmudge, do you have a standard procedure for writing this blog?”
“Sometimes I ruminate on a topic for weeks; sometimes for only a few minutes. Then I just sit at the computer and write. I’ve always done it that way.”
Affinity’s Kaizen Curmudgeon
Friday, March 18, 2011
Kaikaku, a countermeasure for "We've always done it that way."
“Jaded Julie, here’s a new Japanese word for you to learn. It is kaikaku, meaning radical or transformational change.”
“Another word! Curmudge, I thought we topped off my Japanese vocabulary years ago.”
“Now Julie, you’ve known for a long time that there are single words—in several languages—that substitute for phrases, sentences, or even paragraphs in English. Often there is no comparable English word, and the foreign word says exactly what we want to express.”
“I get it, Curmudge. We have already learned that gemba is the workplace or ‘where the action is,’ and muda is waste that comes in at least eight varieties. And of course, kaizen, ‘continuous improvement’ or ‘small changes for the good,’ is one of the central principles of Lean. So why kaikaku? Doesn’t kaizen cover all the changes that need to be made?”
“Not always. Think of the all-too-common expression, ‘We’ve always done it that way.’ That statement usually represents a historical practice that was implemented without a lot of forethought and has been ‘grandfathered’ into everyone’s thinking. To a change agent, that is abhorrent and is a candidate for immediate evaluation and perhaps radical change.”
“Okay, armchair insurgent, please provide an example.”
“Julie, we talked about this back on July 16, 2009. It was part of our series of postings on queuing theory and level loading or heijunka. Scheduling—especially in hospitals—tends to follow tradition and leads to hills and valleys in people’s workloads, i.e., poor heijunka. Because this is a big, always-been-done-that-way problem, it would require a big, kaikaku countermeasure.”
“Does kaikaku always refer to a big change applied to a big problem?”
“Not always, Julie. The critical difference between kaikaku and kaizen is timing. Kaikaku is quick and total; kaizen is continuous and incremental. Not all processes can be changed incrementally. For example, if you are taking your car through the ‘chunnel’ from France to Britain, you drive on the right in France and immediately change to the left in Britain.”
“Okay Rick Steves, but do you have a Lean example?”
“If a three-day or one-week small-team ‘kaizen’ or rapid improvement event yields a clear, definitive solution to the problem at hand, that’s a kaikaku. We’ve heard about a lot of these in our monthly kaizen report-outs. On the other hand, if a favorable outcome will require incremental improvements and several plan-do-check-act cycles, that’s kaizen.”
“Let’s get real, Curmudge. Does it truly matter which word we use, kaizen or kaikaku?”
“Probably not, but it might if you are Japanese. Here’s a different sort of problem. Suppose you are involved in an effort that ends up with neither a kaikaku nor a kaizen. Unfortunately, some of these might begin as a kaizen event, get bogged down because the traditions are so strong, and end up where they started—doing it the way it’s always been done.”
“And do the Japanese have a name for those?”
“Very likely, but as in English, it would be too profane for posting in Kaizen Curmudgeon. Maybe we should call those ‘teachable moments’ and return later in our Lean journey to tackle the seemingly intractable problems.”
“Old Guy, it has occurred to me that not all traditions are bad. Here’s a good example of something that has always been done that way. On Fridays we’d knock off work early and enjoy some Gemütlichkeit, ‘good living’ in German, at a local oasis.”
“At my age, Julie, my kaikaku for traditional Gemütlichkeit is to go home and go to bed early.”
Affinity’s Kaizen Curmudgeon
“Another word! Curmudge, I thought we topped off my Japanese vocabulary years ago.”
“Now Julie, you’ve known for a long time that there are single words—in several languages—that substitute for phrases, sentences, or even paragraphs in English. Often there is no comparable English word, and the foreign word says exactly what we want to express.”
“I get it, Curmudge. We have already learned that gemba is the workplace or ‘where the action is,’ and muda is waste that comes in at least eight varieties. And of course, kaizen, ‘continuous improvement’ or ‘small changes for the good,’ is one of the central principles of Lean. So why kaikaku? Doesn’t kaizen cover all the changes that need to be made?”
“Not always. Think of the all-too-common expression, ‘We’ve always done it that way.’ That statement usually represents a historical practice that was implemented without a lot of forethought and has been ‘grandfathered’ into everyone’s thinking. To a change agent, that is abhorrent and is a candidate for immediate evaluation and perhaps radical change.”
“Okay, armchair insurgent, please provide an example.”
“Julie, we talked about this back on July 16, 2009. It was part of our series of postings on queuing theory and level loading or heijunka. Scheduling—especially in hospitals—tends to follow tradition and leads to hills and valleys in people’s workloads, i.e., poor heijunka. Because this is a big, always-been-done-that-way problem, it would require a big, kaikaku countermeasure.”
“Does kaikaku always refer to a big change applied to a big problem?”
“Not always, Julie. The critical difference between kaikaku and kaizen is timing. Kaikaku is quick and total; kaizen is continuous and incremental. Not all processes can be changed incrementally. For example, if you are taking your car through the ‘chunnel’ from France to Britain, you drive on the right in France and immediately change to the left in Britain.”
“Okay Rick Steves, but do you have a Lean example?”
“If a three-day or one-week small-team ‘kaizen’ or rapid improvement event yields a clear, definitive solution to the problem at hand, that’s a kaikaku. We’ve heard about a lot of these in our monthly kaizen report-outs. On the other hand, if a favorable outcome will require incremental improvements and several plan-do-check-act cycles, that’s kaizen.”
“Let’s get real, Curmudge. Does it truly matter which word we use, kaizen or kaikaku?”
“Probably not, but it might if you are Japanese. Here’s a different sort of problem. Suppose you are involved in an effort that ends up with neither a kaikaku nor a kaizen. Unfortunately, some of these might begin as a kaizen event, get bogged down because the traditions are so strong, and end up where they started—doing it the way it’s always been done.”
“And do the Japanese have a name for those?”
“Very likely, but as in English, it would be too profane for posting in Kaizen Curmudgeon. Maybe we should call those ‘teachable moments’ and return later in our Lean journey to tackle the seemingly intractable problems.”
“Old Guy, it has occurred to me that not all traditions are bad. Here’s a good example of something that has always been done that way. On Fridays we’d knock off work early and enjoy some Gemütlichkeit, ‘good living’ in German, at a local oasis.”
“At my age, Julie, my kaikaku for traditional Gemütlichkeit is to go home and go to bed early.”
Affinity’s Kaizen Curmudgeon
Thursday, March 10, 2011
Complacency 2
“Wake up, Curmudge! It’s too early for your afternoon nap.”
“I’m not napping, Jaded Julie. I’m concentrating on our colleagues’ one-page papers and trying to extract lessons that are worthy of being shouted from the roof of the hospital’s parking structure. As in last week’s posting we are sharing with our readers portions of our guest authors’ interpretations of John Kotter’s quotation, ‘Never underestimate the magnitude of the forces that reinforce complacency and that help maintain the status quo.’ Now it’s Rick’s turn. He focuses on the threat of complacency following a critical period in the life of an organization.”
“Kotter lists nine sources of complacency, but I want to briefly describe two that are intertwined. They are, ‘Absence of a major and visible crisis,’ and ‘Too much happy talk from senior management.’ I recall the story that our CEO told our Lean class, ‘Several years ago the threat facing the organization wasn’t how to take the next step in our growth as an organization, but rather how to avoid taking our last step as an organization.’ Wow! That really grabbed our attention. At that point, there was most definitely a major and visible crisis, and senior management certainly wasn’t bragging about the bright future of Affinity. There were tough decisions that were made and hard work that was done and Affinity is now in a stronger position. However, now that the existential danger is lessened, a new threat, complacency, may be present out there in the organization. We need to praise all the hard work and success that everyone made to get us to our current position. But by doing so, do we risk negating the sense of urgency within the organization that is needed to make the next step? The threat is that we might rest on our laurels because the danger of the organization’s collapsing appears to be no longer imminent.”
“The other part of our newer colleagues’ assignment was to explain how they would use Lean to manage their staff in challenging the status quo. In brief, they have been asked to present a problem with complacency—as they have done above—and then propose appropriate countermeasures. Since Rick just described his problem, let’s read how he will tackle it.”
“The challenge facing the organization is to make sure that we don’t lose our sense of urgency. We need to develop Lean leaders that have the self-motivation and internal urgency to be the best. With those qualities, they will retain our focus on the corporate vision.”
“I believe what he is saying is that middle managers’ dedication to Lean must be visceral.”
“My knowledge of anatomy is pretty sketchy, Julie, but I suspect that in this context, visceral is the same as hard-wired.”
“I believe we all agree with Justin, who feels that the most effective way to challenge staff in implementing change is to create a high sense of urgency.”
“To effectively change the status quo, you must start to change culture, which is typically is very difficult to accomplish. Escalating the sense of urgency counterattacks complacency in individuals who are not resistant to change. This escalated sense of urgency pushes individuals to the edge of their comfort zone and reiterates the need for change. The sense of urgency should also make it difficult for employees to revert back to their old habits, either by eliminating the possibility or by encouraging a need of abandonment.”
“Ieva maintains a sense of urgency not by injecting Lean into an existing system but by totally changing the system. In this case, the change is from traditional primary care to the Medical Home model.”
“In my role as a Lean coach, I have committed to bring this sense of urgency to life by teaching and helping our staff look at our processes with new eyes. I specifically have been blessed to work with our Medical Home sites in implementation of a new care delivery model. While it is easier to spot changes that need to take place at the new sites, I continuously challenge our existing Medical Home sites to look at the new and improved processes and evaluate and adjust as needed. We do not always figure out the best way first—there is always improvement to be had.”
“We haven’t quoted Jerry in this posting yet, but I believe he has a viable countermeasure for incorrigible resisters to change.”
“There are mindsets in organizations that are rooted so deeply that they are nearly impossible to change unless they are eliminated through a transformation, total renewal of mind, or in some cases radical surgery.”
“It sounds as if sometimes people just have to be asked to ‘get off the bus.’ That seems pretty harsh.”
“Congratulations, Curmudge. For once you used a five-dollar word, ‘harsh,’ when you might have used a ten-dollar word, ‘draconian.’ But tell me Curmudge, are we going to post our guest authors’ writings on complacency and change leadership without putting in our own two cents?”
“We have been there and done that three years ago, Jaded Julie. I hope you haven’t forgotten our postings on Change Leadership for Middle Managers.”
Affinity’s Kaizen Curmudgeon
“I’m not napping, Jaded Julie. I’m concentrating on our colleagues’ one-page papers and trying to extract lessons that are worthy of being shouted from the roof of the hospital’s parking structure. As in last week’s posting we are sharing with our readers portions of our guest authors’ interpretations of John Kotter’s quotation, ‘Never underestimate the magnitude of the forces that reinforce complacency and that help maintain the status quo.’ Now it’s Rick’s turn. He focuses on the threat of complacency following a critical period in the life of an organization.”
“Kotter lists nine sources of complacency, but I want to briefly describe two that are intertwined. They are, ‘Absence of a major and visible crisis,’ and ‘Too much happy talk from senior management.’ I recall the story that our CEO told our Lean class, ‘Several years ago the threat facing the organization wasn’t how to take the next step in our growth as an organization, but rather how to avoid taking our last step as an organization.’ Wow! That really grabbed our attention. At that point, there was most definitely a major and visible crisis, and senior management certainly wasn’t bragging about the bright future of Affinity. There were tough decisions that were made and hard work that was done and Affinity is now in a stronger position. However, now that the existential danger is lessened, a new threat, complacency, may be present out there in the organization. We need to praise all the hard work and success that everyone made to get us to our current position. But by doing so, do we risk negating the sense of urgency within the organization that is needed to make the next step? The threat is that we might rest on our laurels because the danger of the organization’s collapsing appears to be no longer imminent.”
“The other part of our newer colleagues’ assignment was to explain how they would use Lean to manage their staff in challenging the status quo. In brief, they have been asked to present a problem with complacency—as they have done above—and then propose appropriate countermeasures. Since Rick just described his problem, let’s read how he will tackle it.”
“The challenge facing the organization is to make sure that we don’t lose our sense of urgency. We need to develop Lean leaders that have the self-motivation and internal urgency to be the best. With those qualities, they will retain our focus on the corporate vision.”
“I believe what he is saying is that middle managers’ dedication to Lean must be visceral.”
“My knowledge of anatomy is pretty sketchy, Julie, but I suspect that in this context, visceral is the same as hard-wired.”
“I believe we all agree with Justin, who feels that the most effective way to challenge staff in implementing change is to create a high sense of urgency.”
“To effectively change the status quo, you must start to change culture, which is typically is very difficult to accomplish. Escalating the sense of urgency counterattacks complacency in individuals who are not resistant to change. This escalated sense of urgency pushes individuals to the edge of their comfort zone and reiterates the need for change. The sense of urgency should also make it difficult for employees to revert back to their old habits, either by eliminating the possibility or by encouraging a need of abandonment.”
“Ieva maintains a sense of urgency not by injecting Lean into an existing system but by totally changing the system. In this case, the change is from traditional primary care to the Medical Home model.”
“In my role as a Lean coach, I have committed to bring this sense of urgency to life by teaching and helping our staff look at our processes with new eyes. I specifically have been blessed to work with our Medical Home sites in implementation of a new care delivery model. While it is easier to spot changes that need to take place at the new sites, I continuously challenge our existing Medical Home sites to look at the new and improved processes and evaluate and adjust as needed. We do not always figure out the best way first—there is always improvement to be had.”
“We haven’t quoted Jerry in this posting yet, but I believe he has a viable countermeasure for incorrigible resisters to change.”
“There are mindsets in organizations that are rooted so deeply that they are nearly impossible to change unless they are eliminated through a transformation, total renewal of mind, or in some cases radical surgery.”
“It sounds as if sometimes people just have to be asked to ‘get off the bus.’ That seems pretty harsh.”
“Congratulations, Curmudge. For once you used a five-dollar word, ‘harsh,’ when you might have used a ten-dollar word, ‘draconian.’ But tell me Curmudge, are we going to post our guest authors’ writings on complacency and change leadership without putting in our own two cents?”
“We have been there and done that three years ago, Jaded Julie. I hope you haven’t forgotten our postings on Change Leadership for Middle Managers.”
Affinity’s Kaizen Curmudgeon
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