Fisher’s Master of Business Operational Excellence degree program runs a health care-focused cohort on a parallel track. Following her recent recap of a week in the life of the industry cohort, Fisher Senior Lecturer takes a look at the other track through the remainder of the week.

To close out the week, let’s look at some additional concepts covered in our recent MBOE Healthcare session:

Sustaining the gains

James Hereford Palo Alto

James Hereford

“Transformation,” Palo Alto Health Foundation COO James Hereford told students, “is not for the faint of heart. Hence a lot of organizations do no prefer transformation.” Transforming the organization, Hereford said, involves leaders making changes themselves. He presented his top-ten list of strategies for sustaining the gains.

  1. Lean is not a program, it is the culture to which everyone in the organization must adapt. It is not a “flavor of the month,” it is the philosophy everyone must abide by.
  2. Executive leadership plays a key role in the change.
  3. The changes must have relevance to the organization’s strategic plan.
  4. It is a huge change to what frontline staffs have been doing until now. It is important to have systems to support this change. Middle managers need to change how they manage. Instead of solving problems for the frontline staff, they must coach and train their front line team to perform systematic problem solving.
  5. Iterative problem solving is key. Having the attitude that 50% improvement now is better than 80% later takes the organization long way.
  6. It is important that managers have standard work, a standard way to support ongoing improvements and response to unusual occurrences. There must also be a system in place to check that standard work is being followed.
  7. Develop internal resources. You may hire consultants but ensure that they are teaching you to fish and not fishing for you. Use your best and brightest and demonstrate that this is the path to success.
  8. There must a linked checking from top to bottom and bottom to top. Require senior leaders to mess with their most precious resource: Time.
  9. The board should understand and support when executive leadership demonstrates change in thinking and hold senior leadership accountable. There should be a succession plan in place.
  10. There must be supporting systems in place e.g. HR or IT to embrace and facilitate the new changes.

Can creativity be taught?

On the last day of the latest session, Barb Bouche, senior consultant and department director for the Continuous Performance Improvement (CPI) department of Seattle Children’s Hospital, along with Beth Carrington and Toni Brenner from the W3 group walked the students through the process of coaching and problem solving at the frontline level. They used a simple exercise using dominoes to experience the concept called ‘kata’. ‘Kata’ is a means for making creative work teachable. The iterative problem solving process is key to engage, motivate and empower people to sustain and enhance the gains from lean deployment.

So what are the kata patterns to be practiced?

Improvement kata:

-          Understand the direction i.e. how does the improvement relate to the strategic plan
-          Grasp the current situation: What are the gaps between now and the strategic goal?
-          Establish the next target condition: What is the goal you want to achieve?
-          Use the PDCA process to achieve the target condition: Using Plan, Do, Check, Act iteratively to achieve the desired goal.

The supervisor focuses on asking the right questions rather than providing solutions. The supervisor uses visuals to make the improvement visible and easy to understand for the front line people as well as the leaders.

Coaching kata: The process involves first coaching the supervisor. The manager coaches the supervisor. A master coach observes the process and gives feedback to the manager.

The improvement and coaching kata becomes the standard work for all involved.



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