Recently, while facilitating a Lean Healthcare Kaizen Event in which we focused on the Medical Imaging department of a mid-sized acute care facility, I learned the hard way, about a failure in my own facilitation approach. 

At the outset of every Kaizen Event, I spend a couple of hours introducing the participants to the fundamentals of Lean Healthcare.  One of the fundamentals is a thorough explanation of the types of waste.  Since the definitions of these eight types of waste are a bit unconventional in the healthcare environment, we spend a good bit of time ensuring that the participants know them well.  This understanding is a foundational building block for them as they learn to see the processes around them differently and identify improvement opportunities that they have, until now, been unaware of.

During this event, I followed the same model.  Assuming that the participants had a thorough understanding of the eight types of waste, we moved on to evaluating the current state of their processes.  We went to the Gemba and collected lots of meaningful data through observation.  Then, the participants began to identify the waste within their process.  One of the most obvious was the waste of “Defects” in the image quality that was captured during exposure.   Great!  Now we have an opportunity to improve the process.  But wait, one of the techs in the room is visibly upset by this characterization of “Defects”.  Her body language tells me that she is not on board with making this reduction in defects a high priority or even placing an emphasis on it during our current state mapping.  My facilitator intuition tells me that continuing down this path without consensus among the participants that defects are important focus area is certain to cause issues and dissention later.  So, I offer the group a chance to quantify the impact of defective images.  Still the upset participant is not convinced.  So, I ask her to help the group understand how she perceives the frequency of defective images. 

Fortunately, for me, she is willing to share with the group that she is deeply offended by the use of the term “defects”.  She takes ownership in her work and feels that she and her co-workers do the best job possible.  Ah!  A Breakthrough!  Now I know that I have not adequately communicated to this participant, and perhaps others, that when we use the term “Defect”, we are not pre-judging the cause of the defect.  We are simply identifying that the process is not delivering what the internal or external customer expects or needs.  It’s a completely safe term.  We know that when a defect occurs, there can be myriad root causes.  But, there seems to be a proclivity, particularly among folks in healthcare, to assume that the very next step is to blame the worker.  I then explained to the participants that in the practice of Lean Healthcare, the contrary is true.  We always look first to how the process failed the worker rather than how the worker failed.  With this understanding, my very upset participant found comfort and agreement that we could and should focus on the frequency of defects.  She now knows that we will look beyond the typical blame game and seek the root cause of defective images.  (She also did make a compelling argument for using a term other than “defect”.)

So, how should I, as one who facilitates Lean Healthcare events regularly, respond to this experience?  It is an opportunity for me to practice what I teach.  I will start with a simple, non-judgmental statement of the problem:  My explanation of the term “defect” did not yield the understanding of the term that my participant should expect and needed.  Simply put, my process of explaining the term “defect” yielded a defect.  So, now I am perfectly situated to respond to this defect with the problem solving tools that we use when applying Lean in Healthcare or any industry.  Fortunately, I have standard work for explaining the eight types of waste.  The process will begin with an assessment of whether I followed this standard work.  If so, then I will evaluate the effectiveness of the standard work and revise, if necessary.

Maybe in another blog posting, I’ll talk about how this turns out.  But for now, I need to get busy improving my facilitation processes. 

This week’s blog was written by Jeff Wilson. Throughout Jeff’s career, he has delivered and applied progressive management and process improvement tools to help organizations reach new levels of performance. The industries span from healthcare to manufacturing, financial consulting and accounting. His experience with Six Sigma and Lean goes back to the early days of his career while working with Colgate Palmolive. Jeff had the opportunity to use process improvement tools as a participant on project teams and was so impressed with the effectiveness of these tools he began to further develop his understanding of and expertise in the implementation and use of them.  Throughout his career as a front-line Supervisor, Materials Manager, Logistics Manager and Plant Manager, Jeff has used and championed the use of Lean tools to deliver exceptional results.  Most recently, Jeff served in a consultant role with the Manufacturing Extension Partnership where he had the opportunity to support other organizations as they seek to improve processes by implementing Lean.  He has developed Lean transformation plans, facilitated Kaizen events and developed training materials for numerous client companies. Jeff has a Bachelors Degree in Economics from Western Kentucky University.  He also holds a Certified in Production and Inventory Management (CPIM) designation.

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