“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
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Operational excellence cannot be achieved through top-down directives or piecemeal implementation of tools. Something more is required. The Shingo Model for Operational Excellence appears to be one of the best approaches available. It has two elements: 1) the “house” (the principles, the “what”), and 2) the “diamond” (the method, the “how”). The “who” is everyone, beginning with top management. Achieving operational excellence requires a widespread commitment throughout the organization to execute according to the principles of operational excellence. I’m going to describe my understanding of the 10 guiding principles (described in the house element) two at a time and also describe how top management might use these to transform culture using the diamond element of the model.
Last time, I discussed the two principles at the base of the house element - Lead with Humility and Respect Every Individual. This time I will describe “Focus on Process” and “Embrace Scientific Thinking”.
Focus on Process
A process focus recognizes that all outputs - whether product or service - are created by processes acting upon inputs. This simple truth is often overlooked: good processes will produce the intended output, as long as proper inputs are provided.
Process focus also helps focus problem solving efforts on process rather than people. A complete shift to process focus eliminates the tendency to find the culprit (person) who made the mistake, but rather leads to a pursuit of the culprit (process) which allowed the mistake to be made. Thus, process focus also supports the cultural enablers, creating an environment where learning from mistakes can become a powerful element of continuous improvement.
In my experience, healthcare seems to have antibodies directed against using a process focus. When something goes wrong, the tendency seems to be to blame the person (usually the one closest one around). The blame and shame environment seems to focus on “who screwed up?” rather than, “what went wrong with the process?”
A simple flow diagram is easy to make, but finding a pencil and paper to make one seem to be the rarest elements in healthcare. A process diagram need not be complex - the most useful ones are not.
Dr. Deming’s red bead demonstration was an simple and profound example of the consequences of not having a process focus. Dr. Deming played the role of the foreman of a bead factory where he blamed the workers for producing red beads. The defective beads (as well as the good beads) came entirely from the process, not the worker. It’s getting more and more difficult to find people who saw Dr. Deming perform this demonstration, or who saw him do it on videotape. The links that I found on youtube were OK (people trying to do what he did), but not the same as watching Dr. Deming. I added a video to rectify this: http://youtu.be/UpIz1fgRqSM
Embrace Scientific Thinking
A focus on process lends itself to scientific thinking - a natural method for learning and the most effective approach to improvement. Everyone can be trained to use scientific thinking to improve the processes with which they work, creating a culture that provides common understanding, approach, and language regarding improvement.
There are two of Dr. Deming’s teachings that come to mind when I think of “embracing scientific thinking”. The first is what he called the Shewhart Cycle, and others have called the Deming cycle or Plan Do Study Act (PDSA) cycle. Dr. Deming saw this as a cycle for improvement, but also as a cycle for learning. Although it seems simple and straightforward, there are many subtle nuances to a full understanding of this cycle, as well as one of Dr. Deming’s components of a system of profound knowledge - the “theory of knowledge”.
I had the good fortune to watch John Shook lead a reflection exercise using the PDSA cycle (his slides used the word “check”), but he admitted he prefers “study” - as did Dr. Deming. The first slide that John showed was this:
He called it the “p-D-p-D Firefighting Cycle” and that sounds about the way most people seem to think of it. The next slide that John showed was this one:
This seems closer to what Dr. Deming was talking about, and relates to his description of “theory of knowledge” in his system of profound knowledge.
The second teaching from Dr. Deming related to scientific thinking seems to have been lost by many lean practitioners. I am talking about “understanding variation”, in particular the understanding of the difference between common causes of variation and special causes of variation. When people don’t understand these differences, the consequences are disastrous and costly. Treating common cause (random) variation as if it deserves immediate action is called tampering, and we do it all the time. It’s what the red bead foreman (played by Dr. Deming) was doing every time he rewarded a worker for lower defects or punished him for more defects. It appears that many people think the use of common cause and special cause variation applies only to control charts and processes that produce measurable results. They are wrong. The most important applications of an understanding of variation has to do with the management of people. This is an important part of embracing scientific thinking.
Supporting Principles
There are eight supporting principles related to these two guiding principles:
Stabilize processes - First, identify and remove causes of special cause variation. Stability is a prerequisite for improvement, providing a basis for problem identification and continuous improvement.
Rely on data - Dr. Shingo emphasized the importance of being data-driven in the pursuit of continuous improvement.
Standardize processes - Standardization is the supporting principle behind maintaining improvement, rather than springing back to preceding practices and results.
Insist on direct observation - ”Going to see” is the first step of the scientific method.
Focus on value stream - Clearly understanding the value stream is the only way to improve the value delivered.
Keep in simple & visual - Making information visual is the supporting principle that when combined with simplification solves the information defects, which are often the causes of waste.
Identify and eliminate waste - This principle effectively engages the entire organization in the continuous improvement effort.
Integrate improvement with work - Every employee becomes a scientist with capability to continually assess the current state of processes and improve.
How does this relate to the “how”? - the Diamond Element
I’ll trace my understanding of how this works to affect and transform the culture in an organization. When individual leaders (top management) in an organization think in terms of the guiding principles of “focus on process” and “embrace scientific thinking”, they will design systems that are far different than managers who are not guided by these principles. For instance, they would model the problem-solving and improvement system that they would like to have everyone use.
The tools they would select would be used to enable the systems they designed which, in turn would drive an organizational focus on the principles. The tools would be used to achieve results (such as ideas tested and implemented), and the results would be used to refine how the tools would be used - Plan, Do, Study, Act. The results that are achieved would affirm the guiding principles, which would drive a focus on the results.
Over time and through the application of the guiding principles, the culture will change to one that achieves operational excellence. Culture is the sum of the behaviors that are exhibited in the organization (from the board room to the patient bedside). Two things drive behaviors: 1) systems and 2) what is measured.
Here’s another example. I recently visit a hospital where the Chief Operations Officer (also the CMO) was leading a daily huddle meeting in the hallway of the hospital. As they talked about what had happened in the last 24 hours, it was revealed that a cardiac patient’s surgery was delayed. Instead of asking “how did that happen?” or “who messed up”, the Vice Presidents and Directors who were assembled focused on the process. They actually had a simple flow diagram, and they proceeded to talk about the root causes (not one, but many) and - on the spot - identified potential countermeasures to address the root causes. They adjusted their tools, to use their system, which was guided by correct principles to get the desired results and behaviors. People were not afraid to bring up “bad news”.
Guiding principles are universal truths. They are like the laws of physics, like gravity. They govern the consequences of those who understand them and of those who do not. Managers who do not follow the principles of “focus on process” and “embrace scientific thinking” suffer the consequences in terms of the results they get and the culture they design - intentionally or unintentionally. For instance, they may wonder why people are afraid of bringing up problems, or why they excel at fire-fighting and jumping to solutions. The culture they have (exhibited by the behaviors they see) is a direct result of the systems that they designed (or allowed to prevail) which are a direct result of the principles they use.
If management wants better culture and better results, they need to understand and apply the guiding principles of “focus on process” and “embrace scientific thinking”. It’s that simple, and that hard. To understand and apply these guiding principles means letting go of practices in the past. Letting go of the incorrect notions we have been taught in management schools, by well-meaning managers who came before us (who were only doing their best) is what I believe Dr. Deming meant when he described the “transformation of management”.
In his 1993 book, The New Economics for Industry, Government and Education, Dr. Deming writes, “Once the individual understands the system of profound knowledge, he will apply its principles in every kind of relationship with other people. He will have a basis for judgement of his own decisions and for transformation of the organizations that he belongs to. The individual, once transformed, will: set an example; be a good listener, but will not compromise; continually teach other people; and help people to pull away from their current practices and beliefs and move into the new philosophy without a feeling of guilt about the past.”
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