The Key Point from the Lean Daily Management for Healthcare Field Book.
When applying Lean in Healthcare, the traditional focus of waste shifts dramatically.
Posts tagged lean
Mentor or Coach
Over lunch a couple of days ago, we were discussing the subject of mentors and coaches and started to highlight the difference in the roles. Sometimes people can seemlessly operate in both roles at once, so the roles do not seem distinctly different, but they are.
We discussed a few items that seem to differentiate the two roles:
One of the items was Blind Spots. Coaching is designed to identify blind spots, where mentorship is more designed to overcome blind spots once identified. Sometimes the coach can guide the coachee in ways to overcome the blind spot, while in other situations they might recommend they obtain training or a mentor.
Another item was Proximity. Coaches are generally involved with what they are coaching you on, whereas a mentor is someone you mostly meet with to discuss things with. Coaches tend to actively participate in the thing they are coaching you on so they can witness your actions and provide advice and direction if improvement is needed.
Another item was Selection and Appointment. Although some organizations have more formal mentorship programs, generally coaching relationships are formal and assigned for a specific reason. Mentors are normally sought out to discuss and close a gap.
When we were discussing the subject, we discussed two different types of coaches–Lean Six Sigma and Executive. Both of these are very specific roles where an individual is involved with what is going on in a coachee’s life. In Lean Six Sigma, for example, the coach is engaged with every step of a coachee’s project, guiding them in the application of the skills they should have learned already. If the coach recognizes that the coachee has difficulty in running meetings or presentations, they might suggest that the coachee obtain additional training in those areas. If the coach notices that the coachee has trouble with time management, they might suggest establishing a mentorship relationship with someone that they know is particularly good at time management. If the coach is good at time management, they might quickly switch into that mentor role, but this is outside of the original coaching arrangement.
This is why people often see coaches and mentors as the same thing–they can cover more areas than what they are specifically coaching for. In the case of an executive coach, the coach might be able to provide all kinds of advice and assistance on leadership and employee motivation. However, they probably would suggest the executive have a mentor if the coachee is trying to learn how to navigate the company’s culture toward promotion.
When you think about the roles, this should help you better delineate what each does and which you need.
Being Agile
Agile…
This is quickly becoming the management buzzword of 2015. Just another magic pill for industry to improve what they do with what they believe is little work.
Agile, as a process (yes folks, it is normally a process), usually starts in an organization with IT in software development. Soon after companies get the “agile bug” and they want everything to be agile. Lean quickly becomes the Agile way to be.
Agile, by itself, is just a word describing a state of being. I’m sure there are many definitions, but in its basic sense, Agile is being able to adjust, change, or respond quickly. It’s being resilient and flexible. Agile approaches are based on quick incrimental iterations. Agile, at its core, is organic and a state of being, not a program.
How do you become Agile?
Look at how you are organized and how you make decisions in your company. Is your company fairly flat and accepting of risk or do decisions need to be collaborated up through many levels and do they take a long time to obtain approvals?
Does your system, to get things done, have to go through annual processes with multiple approvals and significant roadblocks, or are employees empowered at the lowest levels to embark on projects when needed to make things happen?
Do you focus on managing change (I e., reactive) or are your employees ready and actively looking for change opportunities and making them happen?
Agile cannot become the way you are without significantly addressing your culture and operating models. If you are slow to make decisions and change as a company and if you are reactive to changes after they occur, then you are not Agile.
Employing Agile methodologies like Agile Software Development or Lean are only programs…they do not make you Agile as a company.
Being Agile means fundamentally changing everything about your company…
Will that work for your company’s culture?
Continuous Improvement Development for Leadership and Professionals
Train your leaders first to change the culture
Oftentimes we get leadership support to an initiative to change the culture, but they don’t have the actual skills to implement the changes they’re supporting. Before you can expect your front-line employees to live a culture of continuous improvement, you have to develop your leaders, managers, and professionals. Everything we’ve discussed over the past six blogs have built to this. See how building a culture of continuous improvement starts with developing leadership and professionals.
What’s best for who…Lean, Six Sigma, Design for Six Sigma
Lately this item has come up for discussion. What is the best approach to process improvement, should we teach all, how much of each should you employ?
From a practitioner’s point of view, this matters, but in reality, out on the floor, managers and workers need Common Process Sense. Recently, one of the managers I work with went through Lean Six Sigma Yellow Belt training which is much more Six Sigma than Lean. She had already taken Green Belt because that was all that was available, but that course overwhelmed her.
What she came back talking about we’re tools. That’s great, but I realized that she’s not going to be a practitioner, she needed real world ideas that she could apply immediately when she returned to her office.
I believe that true Lean has more common sense approaches, but they can be just as confusing, especially when they use odd names and such, like Huddleboards, Gemba Walks, Ohno Circle, 5S, A3, Hoshin Planning, etc. Let’s face it, true Lean requires a Rosetta Stone course to fully understand.
Long ago, the Air Force created the Air Force Quality Program. They had some very basic courses that focused on Awareness of the program, how to manage Teams and use Basic Tools. The Air Force program was around from about 1990 to 2000–about 10 years. The basic common sense training that I started with is what really got me involved. I understood it and was able to apply it every day.
These are the basic skills that people working on the front lines need to know…they need to be taught and then mentored through application.
Process Mapping. Everyone needs to know how to write down their step-by-step process so that anyone can pick it up and follow it. I’ve said it before that leaders tend to say “Map to X level,” but that’s based on a belief that process improvement practitioners are doing the mapping…no. Everyone that works in a repetitive process should have a process map that outlines every single step of the process written in narrative form and if it uses a computer, the narrative should include screen shots and file locations. If there are physical steps that need to occur, then photos of those physical activities should be included. In Lean you would call that Visual Work. No one can tell me that this is a waste of time for the person doing the work. Additionally’ no one but the people doing the work and the managers that manage the work need these process maps. You don’t need any special software to do this…you can write it down with paper and pencil or use a simple word editor.
Basic Workload Data. Now that I know exactly what I do, I can actually identify key workload data that I would like to capture. There are three things that I want to know…they never vary from process to process.
Time: What is the average time it takes to perform this process from start to finish. Every cell phone today has a stop watch, use it. Here is the very simple way that I recommend you time your process. Assign an individual that will time an individual that will perform the process. Don’t change these people until you’re done. Every day the process is performed, take three timings of the process every hour that the process is performed. Unless only one person does the process, collect timings from at least two people and a maximum of four if a lot of people perform the same process. Make sure the person timing is the same every time. This seems like a lot of work, but it really isn’t and if you don’t know the true average time it takes to do the process, you really have no idea what is happening. Add up all the timings and divide by the number of timings you have…simple average. Find someone that knows how to analyze data, preferably with Minitab, and have them analyze the data–they will provide you a great deal more information that you can use.
Volume: You need a way to collect the number of times that the process is completed. Also, you need to know by individual the number of times they performed the process if more then one person performs the process. Truly you want to know how many times the process is performed and the actual volume of the finished product that left the work center. The reason is to know how much rework occurred–in other words, they performed the process more times because of errors than the number of finished products that went out. But, for basics, you need to know how many times the process was performed or the total number of finished products from the process that went out. If you don’t know how much work you do every day, well, I really don’t know what to tell you. By combining the amount of work every day and the average time it takes to perform the process, you now know the productivity of your process. If you perform the process 1000 times in the day and it takes 1 minute to perform the process, then it takes 1000 minutes to perform that process. That’s 16.66 hours of work, which equates to just over 2 full time positions working 8 hours a day. If on Monday’s the volume doubles, then you know you need staffing that equates to about five people.
Defects: When you write down every single step in the process, you will probably run into this situation where there is an “if then” statement. If the product received is incomplete, then send it back; if the the paper printed is blank, reprint; if the expected block isn’t filled out, call so and so; etc. Normally, we just treat those things…those if thens…as part of the process. They are not. Those are “exceptions,” which are better known as defects. As you write down the steps, document these exceptions to your “clean” process and then create a way to collect the number of times that these exceptions occur. By simply looking at the totals for the various process defects over a period of time–maybe a month–you identify which ones are the most frequent. Common sense can tell you how much time each of these defects actually takes or how much impact these defects cause in your process. This gives you enough data to determine what you want to work on to improve your process. Otherwise, you might work on improving the wrong thing just because it’s easy or more glaring/visible.
Just think if everyone at the lowest level were doing this? Problems would be identified and solved at the lowest levels. Work would constantly be improved and everything would operate smoother in the work center.
Those experts in Lean and Six Sigma are there to help you analyze all this data you’ve collected around your process. They can help you build key charts to examine and analyze and they can recommend some just in time methods. If you run into a major process issue that spans multiple parts of the organization, they can develop a full blown process improvement effort and can facilitate everyone to solve the problem.
Bottom line, process improvement is simply business common sense with a fair amount of elbow grease thrown in. It’s the way you should act every day and you’ll take these basics to every job from here forward.
Are you leaning out the value of your call center?
What is the focus of your call center? What are the metrics that you look at and what behaviors do these metrics drive?
Is your call center focused on answering calls quickly, providing a quick call turn over, and getting to the next call? If so, I hope that the sole purpose of your company is to answer questions for customers as quickly as possible.
If your company’s business to to do pretty much anything else, then you’re not focusing on the value of your call center and you probably are not looking at managing all your channels to drive the right calls to your call center.
See, many companies, as they’ve dealt with scalability and capacity issues, they’ve moved to a very lean model in their call centers. Many business process outsourcing firms have jumped on this opportunity to provide less expensive and very manufacturing-like processes around call centers. On shore, near shore, and off shore, there are people answering phones for all kinds of companies.
Because we have to answer calls and as we grow the number of calls significantly increase. Thus, we search for ways to deal with the increased call volume without significantly increasing our staff. Instead, we focus on really leaning out the operation, because it’s seen as not having value.
So let’s talk about that for a moment–value.
Value in a process is defined pretty much as, “what a customer is willing to pay for.” When a customer has a problem, question, concern, etc. with a company, they want to be able to pick up the phone and speak to a real person to resolve and respond to their issue. I know that as a customer, the value I expect and pay for is someone answering the phone and someone responding to my needs on the phone. So, if this is a value to a customer, are we diminishing it by forcing computer automated responses and focusing on getting them off the phone as soon as possible?
Let’s look at the “other type of value”–business value. Sometimes there are activities and steps in a process that aren’t of value to the customer, but are of value to the business. In other words, the customer won’t pay for it, but we clearly will. Again, unless your company’s sole purpose is to answer customer questions, anytime you have your customer on the phone is an opportunity to learn more about them, to deepen your relationship with them, to provide them advice, and to sell them other key products that they might need, but didn’t even know you offered.
Unfortunately, when you are focused on managing the call volume in a traditional lean approach, value tends to be over looked. Both value to the customer and value to the business.
What’s worse is that our other channels tend to drive the wrong kind of calls to the call center and not the right ones. Many times, your physical mail channel, your web channel, your mobile channel, your social channel, etc., deliver inconsistent and non-integrated messages. These create confusion and drive up call volume from concerned customers. Thus, the reason they’re calling is to clarify, complain, and the like. So, you see the call center as a necessary burden to literally deal with communication rework answering questions that should have been clear and consistent in all channels in the first place. When it’s seen as a burden, then you try to minimize the expense and time involved in it.
Change your way of thinking…
You have your customer–the most valuable person to your organization–on the phone. Do you realize how hard it is to get someone on the phone these days? Take advantage of that!
Figure out what is driving your call volume and focus on eliminating the communications rework–answering something that should have been answered by another communication. Focus on other channels to drive the right call volume to your call center–volume that increases your relationship, understanding, and sales with your customer.
When you have the customer on the phone, don’t focus on answering quickly, getting them off the phone, and moving on to the next call. Focus on building your relationship, deepening your understanding of your customer, and providing them with information they didn’t have about your products so they might buy something else they need or want from you. Measure that–customer and business value of each phone call–and see how your behaviors around your call center change.
Simply put, the day you stop having meaningful conversations with your customers is the day that you go out of business. This will happen no matter how lean your call center is.