June 25, 2013
New Location For GembaWalkabout

I’ve moved the location for Gembawalkabout to this web address:

www.gembawalkabout.com

Check it out.

Mike

June 22, 2013
Guest Post - Lean Healthcare Certification

gemba walk” (lean thinking term) to go to the actual place where value is added + “walkabout” (Australian aborigine) a short period of wandering bush life engaged as an occasional interruption of regular work . Mike Stoecklein . mstoecklein@createvalue.org . my employer gave me that e-mail address, but the ideas and opinions below are mine. ——————————————————————————————————————

This post is from my friend, Melissa.  She (and I) would be interested in your thoughts:

Lean Healthcare Certification: The Irony of Lacking Universal Certification Standards

 

            As an individual who has recently been introduced to lean healthcare, I have learned that there are a few foundational concepts about lean healthcare that are discussed in most texts. First, identifying and removing waste is imperative. Second, continuous improvement based on the Plan-Do-Study-Act methodology is the foundation that is necessary to achieve and maintain results. Lastly, and potentially the most important aspect to learn for a lean beginner, standard work and processes are crucial; without standard processes waste cannot be identified, variation will be unchecked, and there is not a process to study.

            My curiosity about lean healthcare led me to search for “lean certification” programs. I expected to find different certification courses that all offered similar end results. In higher education, there are many providers of degrees, but we expect the end result will be of comparable value without regard to the institution. If two individuals have graduate degrees in Public Health Administration, they will have learned basic competencies that are taught universally, and colleagues can easily know what that degree means and what education they likely received. However, I quickly learned that lean certification is not analogous to higher education because much variation exists in the courses, and no standard exists for what is considered lean healthcare certification or training.

            Lean healthcare has the ability to transform the healthcare industry by shifting the paradigm to be patient-centered while simultaneously decreasing costs and improving the quality. There is one larger caveat; lean healthcare needs lean practitioners who are trained with the best practices in order to implement best practices in their work. Thus, it seems intuitive that lean healthcare certification courses would be standardized in some fashion to promote the best practices. Instead, lean healthcare certification is promoting standard work for healthcare organizations through classes and workshops without having an industry standard for certification. This appears to be one of the most ironic gaps between lean education and lean implementation in healthcare.

There are many courses that offer green and yellow belt lean certification, but the processes and curriculum for the programs all differ. Additionally, the lean certification programs are mainly focused on the implementation of lean in manufacturing, and are typically designed for businesses, rather than individuals. There is an intuitive answer for why programs cater to businesses; teaching lean to everyone at an organization helps facilitate lean thinking at all levels and fosters continuous improvement. This means, however, that individuals that are looking to learn more about lean, gain credentials in lean, or recent college graduates—like myself—who wish to build their practical skills and knowledge are left with few options.

Lean healthcare is about data driven continuous improvement based in performing the best practices. That is why it is painfully ironic that lean healthcare certification programs vary immensely and that lean healthcare education lacks standard requirements for lean certification.

If we look to other industries and certifications, the standard for certifications are usually established and enforced by the government or an accrediting agency. Lean healthcare education should not wait for standards to forced upon them; lean healthcare education should embrace the lean concepts that they are teaching and develop recommended curriculums for lean certification programs based off of the best practices for teaching lean for healthcare.

            Consumers of lean healthcare education should seek out programs that have the best results. In order to determine which lean healthcare certification is appropriate, consumers should be able to compare different programs based on outcomes of those training programs, and by comparing the curriculums to a recommended standard. Without a standard for curriculums, consumers are not able to determine if the course they will be paying for will teach the core competencies lean practitioners and facilities want employees to know. In order for consumers to gain and learn the best lean healthcare practices, they must ask for lean certification programs to raise their standards. The institutions that offer lean healthcare certification must walk the talk and determine the best practices for teaching lean healthcare.

            Until the certification is standardized and best practices are determined, lean healthcare certification will continue to be the most ironic incongruity between lean healthcare education and lean healthcare in practice.

June 21, 2013
A Great Gemba Visit

gemba walk” (lean thinking term) to go to the actual place where value is added + “walkabout” (Australian aborigine) a short period of wandering bush life engaged as an occasional interruption of regular work . Mike Stoecklein . mstoecklein@createvalue.org . my employer gave me that e-mail address, but the ideas and opinions below are mine.

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We help our Network member organizations host visits with each other to showcase their application of lean thinking in healthcare, and to give each other feedback on the work to date and ideas for improvement.

Here’s an example of what you will see on a visit hosted by one of our member organizations on July 25-26, 2013 - MemorialCare Health System in Orange, CA: http://www.youtube.com/watch?v=iY8XkHSYlDU

They are going to feature some cool posters about their work.  Here’s one:

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If you are a member of the Healthcare Value Network, you’re gonna want to check out this gemba visit.  If your organization is not (yet) a member of the Healthcare Value Network, you can learn about membership by going to this link: http://createvalue.faculte.com/bpb/OTQzODg2NDc 

…. and read our white paper about our peer-to-peer learning network: http://www.createvalue.org/docs/PeertoPeer_HVN_010213v2.pdf  

June 21, 2013
WE Did This! Joy In Work!

gemba walk” (lean thinking term) to go to the actual place where value is added + “walkabout” (Australian aborigine) a short period of wandering bush life engaged as an occasional interruption of regular work . Mike Stoecklein . mstoecklein@createvalue.org . my employer gave me that e-mail address, but the ideas and opinions below are mine.

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I’m lucky.  I get to work with some great people.  Let me tell you about two of them, because I think they deserve a “shout out”.

image 
This is Catherine (Cat) and Jamie.  Catherine recently stepped up and took on a major role with our annual Lean Healthcare Transformation Summit that we co-produce with the Lean Enterprise Institute.  Big event, big job, well done!  Jamie works closely with Catherine in our work (not just the Summit).  On the Friday before the Summit, I asked Cat how she was doing.  She said, “I’m doing just fine.  And do you know why I’m doing just fine?  Jamie.”   She was acknowledging the great support that Jamie was providing to help Catherine pull it all together.  They bring out the best in each other and make us all shine.

So, as with everything else we do, we dedicated some time to “reflect, study and adjust”.  In true PDSA fashion, Cat got the team together and solicited everyone’s input - including the “red dots” …. especially the red dots.  And it true fashion, Jamie pitched in.  It was great teamwork in action.

In preparation for the feedback session, they asked me, “can we have fun?” (could the incorporate an element of “fun” in the process).  Yes, by all means, yes.  And we did have fun.  Everyone got a special award.  Here’s a clip featuring mine “The Social Storm”: http://www.youtube.com/watch?v=GR__ZGKVIwA 

It got me thinking.  In the brief time I knew Dr. Deming, he always emphasized this.  He would ask, “Why are we here?”  And people would respond with some ideas.  And he would listen, then he would say, “Possibly … but we are here to learn, to make a difference, and to have fun.  Let’s take joy in our work and joy in learning.”  He took great joy in learning from others and in having fun.  Check out this link to the Deming Institute Blog managed by John Hunter and to a great video that Mark Graban made: http://blog.deming.org/2013/06/we-are-here-to-learn-to-make-a-difference-and-to-have-fun/ 

I was also thinking about accomplishing things with others (like Cat and Jamie, but also our entire team).  It reminded me of this video clip (also from the Deming Institute Blog) featuring Bill Bellows: http://blog.deming.org/2013/06/how-did-we-do-on-the-test/

Although it is mostly about grading and evaluation, I think it also emphasizes that in almost any endeavor, the achievements we make are through and with others … not alone.

June 19, 2013
Fast Thinking & Slow Thinking

gemba walk” (lean thinking term) to go to the actual place where value is added + “walkabout” (Australian aborigine) a short period of wandering bush life engaged as an occasional interruption of regular work . Mike Stoecklein . mstoecklein@createvalue.org . my employer gave me that e-mail address, but the ideas and opinions below are mine.

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I came across this from one of my favorite websites: http://www.youtube.com/watch?feature=player_embedded&v=yanow4fcYg0 
It’s worth watching.  Here’s a related one: http://www.youtube.com/watch?feature=player_embedded&v=0zMbtamP8_E 
The website I am referencing is: http://blog.deming.org
The topic of slow thinking and fast thinking makes good sense to me and is something I am trying to learn more about.  I found this book: Thinking, Fast and Slow by Daniel Kahneman (a Nobel Laurette – in economics)

Some excerpts from the book (so far, I’m not done reading it):

I adopt terms originally proposed by the psychologists Keith Stanovich and Richard West, and will refer to two systems in the mind, System 1 and System 2. System 1 operates automatically and quickly, with little or no effort and no sense of voluntary control. System 2 allocates attention to the effortful mental activities that demand it, including complex computations. The operations of System 2 are often associated with the subjective experience of agency, choice, and concentration.
When we think of ourselves, we identify with System 2, the conscious, reasoning self that has beliefs, makes choices, and decides what to think about and what to do. Although System 2 believes itself to be where the action is, the automatic System 1 is the hero of the book. I describe System 1 as effortlessly originating impressions and feelings that are the main sources of the explicit beliefs and deliberate choices of System 2. The automatic operations of System 1 generate surprisingly complex patterns of ideas, but only the slower System 2 can construct thoughts in an orderly series of steps. I also describe circumstances in which System 2 takes over, overruling the freewheeling impulses and associations of System 1. You will be invited to think of the two systems as agents with their individual abilities, limitations, and functions.
In rough order of complexity, here are some examples of the automatic activities that are attributed to System 1:
Detect that one object is more distant than another.
Orient to the source of a sudden sound.
Complete the phrase “bread and…”
Make a “disgust face” when shown a horrible picture.
Detect hostility in a voice. Answer to 2 + 2 = ?
Read words on large billboards.
Drive a car on an empty road.
Find a strong move in chess (if you are a chess master).
Understand simple sentences.
Recognize that a “meek and tidy soul with a passion for detail” resembles an occupational stereotype.
The highly diverse operations of System 2 have one feature in common: they require attention and are disrupted when attention is drawn away. Here are some examples: Brace for the starter gun in a race.
Focus attention on the clowns in the circus.
Focus on the voice of a particular person in a crowded and noisy room.
Look for a woman with white hair.
Search memory to identify a surprising sound.
Maintain a faster walking speed than is natural for you.
Monitor the appropriateness of your behavior in a social situation.
Count the occurrences of the letter a in a page of text.
Tell someone your phone number.
Park in a narrow space (for most people except garage attendants).
Compare two washing machines for overall value.
Fill out a tax form.
Check the validity of a complex logical argument.

In all these situations you must pay attention, and you will perform less well, or not at all, if you are not ready or if your attention is directed inappropriately. System 2 has some ability to change the way System 1 works, by programming the normally automatic functions of attention and memory.

June 16, 2013
Still “All In” … and could use some help

gemba walk” (lean thinking term) to go to the actual place where value is added + “walkabout” (Australian aborigine) a short period of wandering bush life engaged as an occasional interruption of regular work . Mike Stoecklein . mstoecklein@createvalue.org . my employer gave me that e-mail address, but the ideas and opinions below are mine.

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So, I met this by (by phone) and now I’ve met him on skype.  I wrote about him some weeks ago:

http://gembawalkabout.tumblr.com/post/48848011399/t-minus-41-days-until-the-lean-healthcare

He’s doing some amazing stuff in Tanzania.  Here’s a link to his latest work:
http://www.linkedin.com/groups/Using-Lean-thinking-reverse-Maternal-3880443.S.245123890?qid=a3a90646-ead7-40a0-928e-3fdb47172628&trk=group_most_popular-0-b-ttl&goback=%2Egmp_3880443

It’s from a Linkedin group he started - Lean4NGO 

This link will also connect you to this “Mentors For Africa” blog: http://mentorsforafrica.blogspot.com/2013/05/my-first-79-days.html?goback=%2Egmp_3880443%2Egde_3880443_member_245123890 

He also corrected me on the information I provided about him - he did not sell off all of his possessions … but, pretty darn close.

He’s doing amazing stuff, he’s still “all in” and he could use some help.  Any help.  What he’d really like is “boots on the ground” (people who have some lean skills and could help him in Tanzania).

But he’ll talk to anyone about any help they can give.

So . contact him.  I’m sure he won’t mind if I make a connection for you.  So, here’s my contact information.  mstoecklein@createvalue.org  If you reach out to me, I’ll help you reach out to him.

He’s “all in”.  We should all be “all in”.  He’s showing us what “all in” looks like. 

June 14, 2013
Optimize & Suboptimize

gemba walk” (lean thinking term) to go to the actual place where value is added + “walkabout” (Australian aborigine) a short period of wandering bush life engaged as an occasional interruption of regular work . Mike Stoecklein . mstoecklein@createvalue.org . my employer gave me that e-mail address, but the ideas and opinions below are mine.

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My job is to optimize a peer-to-peer learning network.  What does that mean?

We have member organizations all over North America.  Not everyone can get together all of the time face to face (we do our best once a year with our annual Summit - see last 50+ posts).  In order to optimize the experience for all, we design and redesign systems and processes that facilitate learning, sharing and connecting between all of the members.

Here’s an example.  Just yesterday, we sponsored a webinar that featured an organization in Indiana and one in New York.  They described their approaches to education and training around lean concepts.  During the webinar, one of the participants (from Pennsylvania) acknowledged and thanked one of the presenters for some things he and learned.  The presenter thanked the Pennsylvania guy in return.  As it turns out, the New York folks paid a visit to the Pennsylvania folks.  This would not have happened without the systems and processes that support the network.

After the webinar, the two presenters and I exchanged some e-mails.  Both presenters mentioned and expressed thanks for what they had learned from each other.  This would not have happened without our help (the webinar), and it will lead to future interactions and sharing.

The system works.  But what does “optimization” mean?  Sometimes, ideas are put forth by members to make things better.  We ask for these ideas all of the time and specifically during our advisory council meetings.  We try to act on as many of the ideas as we can, but we can’t act on all of them.  My job is to optimize the whole, not the parts.

Dr. Deming talked about this a lot.  And you can read about it in his books.  In The New Economics, he illustrates the concept of optimizing the system as follows:
image
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Dr. Deming proceeds to illustrate with a simple 3-part system (company).
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This is a simple (3-part) system.  The system I oversee has 50+ members, so the grid would be much bigger.

The table below shows the idea of optimization.
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This shows that, without thinking about impact on the overall system (all members), there are some winners, but also losers and the net effect for the system as a whole is a loss.
With some understanding of optimization of the system, the benefits are shared by all, even though (for some), they may not see it as a “win”.  By definition, optimization of the whole system means that some of the parts will be suboptimized.
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And the process continues with exploration of further ideas - for the benefit of all.
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June 13, 2013
Best Conference Ever! … till next year, It’s Thursday, not too late to start that experiment

gemba walk” (lean thinking term) to go to the actual place where value is added + “walkabout” (Australian aborigine) a short period of wandering bush life engaged as an occasional interruption of regular work . Mike Stoecklein . mstoecklein@createvalue.org . my employer gave me that e-mail address, but the ideas and opinions below are mine.

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One year ago, to the date, I posted this:

http://gembawalkabout.tumblr.com/post/24714920664/best-conference-ever-till-next-year 

I thought it was true, and turned out I was right.  Now the 4th Annual Lean Healthcare Transformation Summit was the best conference ever.

Some favorite tweets (more to follow in the days ahead):

"It might be a crappy standard, but let’s prove we can hit it 100% and then move to a better standard." Craig from Packard

Lean’s place in strategic planning? Macfie:Not only in finance, quality or culture discussion; lean surrounds the entire process!

don’t treat patients as idiots, treat them as partners, with respect

In Sweden, surgeons are offering FIVE YEAR warranty on knee-replacement surgery. If ANYTHING happens, payer doesn’t pay.

"We have to change how we deliver healthcare if we want to stop impoverishing American families" says Francois deBrantes at

Toussaint - don’t just Plan and Do and Run - focus on Study and Adjust!

If you think your system is doing well today, wait a month. Reimbursement is changing

Toussaint: first question he asks on any Gemba visit: ‘How is your existing process working?’. Do you know?

We spend millions of $ on electronic medical record & what do we have? A system that produces faster crappy data

Can we at least thank people for what they do? Even if we thank them for great workarounds

"Most of what we call mgmt consists of making it difficult 4 ppl 2 get their work done." Toussaint quoting Drucker

We are off & running

June 12, 2013
Best Conference Ever! … till next year, It’s Wednesday, How’s that Experiment Going?

gemba walk” (lean thinking term) to go to the actual place where value is added + “walkabout” (Australian aborigine) a short period of wandering bush life engaged as an occasional interruption of regular work . Mike Stoecklein . mstoecklein@createvalue.org . my employer gave me that e-mail address, but the ideas and opinions below are mine.

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One year ago, to the date, I posted this:

http://gembawalkabout.tumblr.com/post/24714920664/best-conference-ever-till-next-year 

I thought it was true, and turned out I was right.  Now the 4th Annual Lean Healthcare Transformation Summit was the best conference ever.

Some favorite tweets (more to follow in the days ahead):

RT : O’Neill: “Compare everything you do to what perfect looks like. It’s like draining the swamp.”

Why is it so hard to call a defect a defect?

Irony. RT : Paul Oneill: health care injury rates are highest of any industry in US

O’Neill: “You can’t get to zero safety incidents with cheerleading or writing it on the wall”

Yes. Events are episodic, not continuous. Events alone cannot create a “culture of continuous improvement.”

Reich: it’s exciting to see what’s happening in healthcare. What’s the ideal state for the culture of your HC organization ?

O’Neill Alcoa market value increased 800% in 13 yrs by paying attention 2 NON-financial measures… finances took care of self

Paul O’Reilly If God is not keeping you from doing it, do it! Just strive to be perfect with no waste

There will be a lot of quotes coming from this years summit. Amazing! Still love the Transparency analogy.

O’Neil: It takes 5 months to close our books at the treasury. It should take 2.5 days

Paul Oneill: It is fascinating to see how accounting view distorts economic view, creation of human value view.

Leader of Paul O’Neill’s stature (Secretary US Treasury, CEO Alcoa) working on HC improvement great sign. Wonderful presentation

O’Neill at “Working to do things perfectly leads to better financial results than any sort of financial engineering.”

O’Neill at “the goals [like 0 injuries] aren’t from on high, but from a discussion about what the aspirational goals SHOULD be”

Show me organization with a Vice President of equal opportunity & I’ll show you an organization without equal opportunity

O’Neill: Can your employees say: “I am treated with respect and dignity by every person I encounter every day”

paul o’neill . Belief we can’t afford to be better than we are . Don’t want to set goals we feel we can’t achieve

Paul O’Neill: Does your org really value its employees? Does your org publicly report real-time days lost to workplace injury?

Paul O’Neill: If you want to be best in the world at what you do, you must start by caring about people in your institution

Organizations are either habitually excellence or they are not paul O’Neill

Nice job by all the presenters at the ‘Experiments Around the Network’ afternoon track

June 11, 2013
Best Conference Ever! … till next year, keeping the buzz alive

gemba walk” (lean thinking term) to go to the actual place where value is added + “walkabout” (Australian aborigine) a short period of wandering bush life engaged as an occasional interruption of regular work . Mike Stoecklein . mstoecklein@createvalue.org . my employer gave me that e-mail address, but the ideas and opinions below are mine.

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One year ago, to the date, I posted this:

http://gembawalkabout.tumblr.com/post/24714920664/best-conference-ever-till-next-year 

I thought it was true, and turned out I was right.  Now the 4th Annual Lean Healthcare Transformation Summit was the best conference ever.

Some favorite tweets (more to follow in the days ahead):

CEO summit within the we need more experiments that manage across the silos avoid more problems like tish’s story

CEO summit within the it’s important to have access to a mentor . When you hit the wall

Healthcare Business Performance. Mindset, skill set, tool set. Analytics tools are only as good as your ability to analyze.

One persons waste is another persons revenue said Mark Hallet @ be respectful when asking questions.

Standard work is the best known way to do the work TODAY. Today being an important word. Always room for improvements.

we didn’t know what we didn’t know when you don’t know what you don’t know you need a consultant

A3 thinking is not an individual sport. It is a team sport that requires coaching.

established candor with respect use a3 thinking to make progress CEO summit within the summit

Hallett: “Quality is a process… but when there’s a problem, people don’t sue a process”

We have not established the competences for management . The standards . We need to change the way we train . Not to groups

The problem of deselecting - what we agree we will NOT work on the CEO summit within the . need a process & follow it

Teaching and coaching is an executive responsibility. CEOs should be CBRs (Chief Barrier Removers)

Wish I had gotten a pic of all the MD hands going up in air… about 1/3 of this breakout session audience. Great to see

Henry Hawthorne CEO @ carolina lean collaborative puts you in the baseball position to be ready for what is next

@ quality improvement without payment reform is shooting yourself in the foot. FFS payment is barrier to progress.

CEOs @ governance of a lean organization is different they need education too . Gemba visits for the board helping

Don Shilton CEO @ st Mary’s Kitchener Ontario 2 days with paul O’Neill like 2 days with Knute Rockne Working on board education

Alan Aviles CEO union environment not that different . Have discovered leaders we did not know we had

All 3 CEOs @ CEO panel have foundation of engaged employees to identify & remove waste

Henry Hawthorne CEO @ Carolina lean collaborative catharsis in truth telling with transparency on how we are doing

Shilton: we set & achieved goal of becoming safest health system in Canada

You can’t improve if you don’t know what your current state is

H. Hawthorne Columbus Reg. CEO: We had fallen into tolerance w mediocrity. We were ‘habitually good’ & we were ok w that.

Lean can be threatening to middle managers because they’re trained to be problems solver instead of coaching/empowering staff

alan Avila CEO ion the CEO panel not likely candidate for let 1000 flowers bloom to get engagement


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