Posted by: knightbird | September 15, 2013

The Picture is Very Clear

As I prepare to start my new job, I have a very clear vision of where I think we will be in 3 years. Why, because I have been there before. Only before, it took me five years to get there. Experience has told me that if I focus on a few things, I can accelerate achievement of this vision.

Resistance must be met head on. In my first lean conversion, I didn’t recognize resistance as fast as I should have and take action. Fortunately, some of the resisters chose to leave. The ones I had to help leave cost me a lot of time. This time I have heard most of the excuses that can be made for not implementing Lean. Many of you have heard these before. We are not a car company. It won’t work here because we are different. We have always done things this way. My co-workers won’t buy into it. I am not going to practice cookie cutter medicine. Innovators are very rare and not well understood. I know that I need to find the “Early Adopters.” According to one source, 13.5% of the population is early adopters. This means I have to find about 90 people and convince them of the benefits of Lean. They will convince another 50-60% of the remaining workforce. The early adopters need to be:

Trained and motivated to use the tools of lean. Teaching and coaching are critical skills for a lean leader. The Early Adopters must see success through Kaizen. With 6 to 10 people engaged in Kaizen on average, it will take 10-15 Kaizen in total to give each a total of 90 Early Adopters experience with success. They will talk about their success and engage the 50-60% they talk to.

The workplace needs to eliminate blame and shame and become a Just Workplace. We need to build pride of workmanship into the workplace and eliminate the blaming and shaming culture. Dr. Deming found that poor processes cause 94% of defects in the workplace. 6% are caused by people’s behaviors. A workplace where defects are acknowledged and celebrated is required. This means that mistakes cannot be hidden, but instead brought out into the open and dealt with. A second level of behavior, Assumption of Risk, cannot be tolerated after standard work is in place. Employees who assume a bad risk, such as failure to wash hands between Patient Encounters, must be counseled and trained to avoid the risk. And finally, those who are reckless must be convinced not to be reckless, or dismissed from the workplace.

The Workplace needs to become Visual. Quite frankly, Employees are Competitive by nature, and when their accomplishments are highlighted, they want their accomplishments to be the absolute best possible. If their commitments are displayed, along with an Andon system, they will do everything possible to assure that their work stays in the green.

Within a short period of time, I should be able to tell which managers are not encouraging the spread of Lean Behaviors. As I discovered at Chugachmiut, I have to help non-productive managers to Get Off The Bus. My tardiness in doing so at Chugachmiut cost me a couple of years of effort at Chugachmiut. I didn’t remove the obstacles to progress. I cannot afford to pull dead weight along, and that is what a non-productive manager is-dead weight that pulls along employee dead weight.

So there are 5 tasks I must concentrate on in order to reach my vision in 3 years. Am I stretching far enough on this goal? Maybe. I will need a single-minded focus to achieve it. But, I do have a clear vision and an experienced understanding of what it takes to realize my vision. It is worth it for the huge gains in productive results for our customers. In another 9 days, I need to figure out a way to explain this to 11 managers and start them on their first Lean Journey. Along the way, I will need to learn  new skills myself. Off I go.

Posted by: knightbird | September 14, 2013

Use of Control Charts in Suicide Prevention

Suicide is a rare occurrence, but it’s an act that releases strong emotions. The State of Alaska experiences a high rate, particularly in a number of rural areas. And despite millions of dollars spent on suicide prevention activities, the suicide rates, overall, have not changed much. A comment made in a report by the Alaska Suicide Prevention Council was provocative. A report stated: “The decrease in the number of lives lost in 2011 is promising.” A caution was included about the historical range of suicides. I decided to construct a control chart using the data given. The results are interesting.

AlaskaSuicideRate

After calculating the average, the range and entering the data into a formula for calculating Upper and Lower Control Limits, I ended up with the chart shown here. What’s interesting is that there is no discernible trendlines indicating either a worsening or improvement in the suicide rate. All data points are stable and most appear to be within the 1 sigma range. According to this analysis, there is no support for the optimism contained in the report statement. Improvement is not happening.

How can improvements occur? I have thought about it for the past few years and came up with a theory. Using my lean training, I observed that current suicide prevention programs rely on identifying individuals with suicidal thoughts or suicide attempts, and attempting to counsel the individual. It’s similar to having inspection, and when you discover a defective product, fix or repair it. Real improvement comes when you attempt to find the reason, or root cause, for the defect in the first place. (Please understand that I am not referring to suicide thoughts or attempts as defects) I had a real insight about what the root cause for suicidal behaviors might be when I was introduced to the Adverse Childhood Experience Study (ACES) in 2008. For study participants who had experienced 7 or more adverse experiences as children, as a group 35% attempted suicide at one time during their life. For study participants with 0 adverse experiences, the rate was around 2%. Brain research has demonstrated a increased fear response among traumatized children that increases stress, tension and anxiety among the population. It’s my belief that unresolved childhood trauma causes the increase in suicidal behavior, which gives us an opportunity to address the behaviors much earlier, and most likely with better results. By identifying children of trauma, we can help them identify the symptoms of stress, and teach them tools to reduce it. I won’t go into a full explanation of the strategy I developed here. My purpose in writing this is to explore how a tool like a control chart may be able to assist us in understanding how to address some of the behavioral challenges that face us.

Posted by: knightbird | September 13, 2013

A New Challenge

On Wednesday, I was offered the position of President/CEO of the Maniilaq Association headquartered in Kotzebue, Alaska. I accepted the challenge even though it requires me to relocate to Kotzebue, located about 30 miles north of the Arctic Circle. The people in the region have always been impressive for their hard work and intelligence. Early in my career, I had the opportunity to work with 2 outstanding legislators from Kotzebue. Frank Ferguson and Al Adams were the State Senator and Representative from Kotzebue. Bot were outstanding legislators. Willie Hensley, an influential architect of the Alaska Native Claims Settlement Act, is also a friend and former state legislator. I have so much to learn, but the board hired me because I have so much to teach, especially about lean management. Accepting the job was easy. And because of lean, I know how to help fix the problems and issues facing Maniilaq. The great challenge is getting employees to adopt the new culture.

Maniilaq does the same type of work that Chugachmiut does. It administers both the Indian Health Service (IHS) and Bureau of Indian Affairs (BIA) Compact. A Compact is an agreement with the federal government that allows Indian Tribes to administer programs funded for their benefit. This is generally referred to as self-governance. When I was a young man, the federal government administered IHS and BIA services. Now all tribes in Alaska exercise self-governance, for the most part through regional non-profit organizations like Maniilaq.

With annual revenue of $92+ million, with over 800 employees, Maniilaq is over six times larger than Chugachmiut. They serve 11 Villages with a variety of services, including health care services. And the challenge of logistics is significant. The only transportation in and out for people is by air. Goods can come in during the summer by water, but access is only available for about 5 months before Kotzebue Sound freezes. After that, all freight comes in by air as well.

As with any organization that has not implemented lean thinking, there is lots of room for improvements. My initial walk through the President/CEO’s office area and Human Resources after I was hired demonstrated the need for 5S. The three employees giving me the tour were excited to hear my plans for 5S and are anxious to learn. When I began as the Executive Director for Chugachmiut, I didn’t know what waste was. During this tour, I could see waste everywhere. I was also unaware of the incredible resistance that employees can put up when I started at Chugachmiut. Now I fully understand that there will be resistance, and I am prepared and preparing to meet it.

One tool that is advancing rapidly is the art of persuasion and communication. I am reading and practicing the advice contained in a book titled Influencer: The New Science of Leading Change, by Joseph Grenny, Kerry Patterson, David Maxfield, Ron McMillan, Al Switzler. The advice makes a lot of sense based on my past experience in trying to change the way things were done at Chugachmiut. The Lean transformation there took about 5 years to take hold. I am hoping that I can find a way to make the change start happening quickly. At Jabil, a company that acquired Nypro Precision Plastics, a Sealaska partner, their lean transformation took place over 2 years. Art Byrnes new book, the Lean Turnaround, demonstrated that immediate action by the CEO with their acquisitions at Wiremold  helped produce quick results.

Its exciting to be able to lead a new Lean focused turnaround. I will write more frequently about my new adventures in the Arctic.

Posted by: knightbird | September 2, 2013

Boeing and Airbus

I have used Boeing as an example for lean implementation in the past. I decided I needed to know more about their lean conversion, so I picked up “Boeing versus Airbus” by John Newhouse. The book gives a fascinating explanation of the competition between 2 strong companies. Boeing has a long pedigree. Airbus is an upstart. Both companies use lean manufacturing as a competitive strategy, but Airbus was first to the table.

Newhouse states that Boeing leadership was a huge impediment to productivity.  Phil Condit, President of Boeing in the 1990’s, was indecisive. His second in command probably made decisions too quickly and focused on sales by wringing unrealistic budget concessions by the production executives, then blaming them for not meeting their projections. Sounds familiar to me. Boeing engaged consultant Jim Womack between 1995 and 1997 to help them with their lean transition. Boeing executives were sent on a rapid leaning trip, both figuratively and literally. At the time, Boeing had $3.5 billion in inventory and more than twice as much factory space as Airbus.  Airbus has a 12-15% cost advantage over Boeing at the time. Boeing suppliers were no better, often unable to deliver product when they had committed to.

Womack wanted them to cut production time in half, reduce costs by half and eliminate a lot of executives. Because Womack was rather blunt in his assessments to Boeing leadership, he left Boeing in 1997. Boeing made a huge mistake, but it was a part of their learning curve and was to be expected. It still had too many traditional business leaders. It took another five years before Boeing because serious about lean.

Boeing has since achieved substantial lean improvements. They assemble airplanes by continuous flow. Their airplanes move at a pace of 2 inches per minute. The understand Takt time and cellular construction. The line is the beneficiary of 5S. Work is handled using carts of inventory delivered just in time. Andons are all around the plant. One story I heard about years ago involved an employee seeing a conveyor used for harvesting vegetables in Eastern Washington and thought about how it might help Boeing install seats during the assembly process. This YouTube video shows how an airplane flows through assembly. The conveyor can be seen stating with the staging of seats at about 3:20 in the video.

As a lean consultant, my primary challenge is to convince executives of the benefits of lean. And then to guide them through the hard work to change their management culture, learn the tools and reap the benefits. In my experience, and it was initially inexperience, the gains can start rolling in within a couple of years. It took me five years to be comfortable that we had achieved a cultural transformation. I am not sure that parts of the gains aren’t being dissipated. I was working on leaning our accounting functions when I left. It takes particular dedication to make progress in improving accounting, but it can be done. I just need to convince potential clients of the huge potential.

Posted by: knightbird | September 1, 2013

“Evidence Based” and “Best Practice”

I see both phrases used often in the social sciences and healthcare. One definition I found about evidenced based practices (EBP) states: “EBP is ‘the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.’ ” (Sackett D, 1996). A best practice has been defined as “a method or technique that has consistently shown results superior to those achieved with other means, and that is used as a benchmark.”

Yet the context in which I typically see EBP advocated for use in an organization is a statement that the tool or technique must be used because it has been proven to be the best way to do things. It is akin to a BP. So it often seems that we advocate using a best practice because it is evidence based and we must benchmark our results against that best practice. In other words, we must learn from others through their best practices that have achieved excellent results for them. And how do we learn about the best practice? We hire consultants, of course.

The consultants then come in and teach us how to do something. I have seen many examples of this. For a period of time at an Alaska Native health organization, I kept hearing about rounding and thank you letters. I blogged about this before. The practice did not lead to world class result, and employees resented it. Why? Probably because it added no value to the processes they were introduced to.

A second example involved a significant commitment of time by my staff to implementing a specific process as a best practice. We left the group after a short period of time because we were learning nothing. Other groups had to go through the learning a couple of times because it didn’t really resonate with their employees.

Yet both efforts took huge resources including employee time and money.

What did I do instead? You guessed it-Lean Thinking. The consultant led efforts told employees what to do, how to do it and when to do it. And none of the advice was based on the unique circumstances and structure of the client’s specific process. They were told that emulating this best practice would achieve great results for them. And they did not.

A lean practitioner does learn from best practices. That’s what the Toyota Production System is, an organization’s learning based upon what was successful at other organizations. Toyota took its flow concepts from Henry Ford. Just in Time was influenced by the Piggly Wiggly inventory management system. Takt Time came through Junkers Aircraft in Germany that found its way to Japan and manufacture of aircraft by Mitsubishi. Training at Toyota came from the Training within Industry protocol developed in the United States and used during World War II. And of course, one cannot dismiss the tremendous influence of Dr. Deming on the mechanism of continuous improvement through control charts and the PDSA cycle, among many others.

My point is that best practices and evidenced based practices are a big help. They give us insight into what has worked elsewhere and that can advance our learning tremendously. But it has to be our learning. It has to go into our system and our system, whoever and wherever you are, is unique to our circumstances. Our health care practice management needs to reflect our resources, our people and our customers. When we use lean thinking by teaching it to our employees, we don’t order them to adopt a best practice or evidence based practice. We teach them about it, and talk about what the practice might add to the way we deliver value to our patients, clients or customers. We use the culture of lean to focus on the needs of our customers and respect the desire of our employees to deliver value to the customers. We connect the 2 by the tools of lean, and we should always be willing to add new learning to our toolbox of knowledge. But should we adopt something because it is EBP or BP? I say no. We are unique, and EBP and BP should be added to our knowledge so we become better able to value our customers and employees.

When you hire a Lean Sensei as a consultant, it should not be for the purpose of introducing a specific practice. It should be for the purpose of changing your management culture. A good Sensei will teach you the strategic value of Lean. You will learn the tools of lean at the same time as you are learning about respect for your customers, partners and employees. Then when you write a letter or note to an employee thanking him or her for their good work, it will have meaning because you understand all that employee did to deliver value to your customer. When you design services to fit your customer, it will be based on information you got directly from the customer while you were “rounding.” When you are improving customer flow through your clinic, it will be based on a solid grounding on what promotes flow based on an understanding of demand you gain from analysis involving Takt time. And your goal will be to deliver quality services to your customer when they need it, where they need it, and in the appropriate quantity-nothing more, nothing less.

EBP and BP are important. Toyota learned from both, but integrated them into a management system that continues to grow and learn. You should do the same. The process of continuous improvement will incorporate EBP and BP until something better comes along.

Posted by: knightbird | August 19, 2013

Politicians Don’t Seem To Get Lean

At a banquet held in Juneau by the Central Council of Tlingit & Haida Indians of Alaska, I sat next to a State Representative and a staffer. As the evening progressed, I steered the conversation to lean thinking, as I do frequently when talking to politicians. I can get pretty flip when doing this, and good naturedly tell the politician that they are a huge part of the problem because of their constant meddling with process results that are within control chart limits (common cause). Of course they have no clue what I am talking about. My theory is that politicians curry good will through meddling with under control processes by calling the manager and demanding results. This meddling only creates greater variance and keeps the process complained about in a state of chaos. I shared a bunch of lean government efforts pursued throughout the country with the staffer. I had also shared this same information with a State Senator by email and in person. The in person contact was accompanied by a commitment “to get back to me.”

When the conversation was ending, the politician promised (and of course you know what value a political promise is) to contact me in the first couple of weeks of June to talk more about lean thinking for government. It is now the third week in August and true to form, the politician did not keep that promise. This politician is not the only one lacking curiosity about a management system that delivers on its promises of high quality performance with fast results. I have had this conversation with any number of politicians in the past with similar results.

What can lean government deliver for citizens? Exactly the same thing it delivers for other organizations. If implemented properly, lead times for services decline precipitously. Instead of waiting weeks or months for actions, a citizen waits hours or maybe days. The quality of the decision improves. The number of employees required to deliver the service declines by 25% to 40% so the cost goes down.

Information about services improves substantially so the politicians can make better judgments. And in a true lean culture, the improvement start within one week. Not years, but a week. I know many nonprofits receiving federal funding who have to submit GPRA data. (Government Performance and Results Act). They are very proud when they collect and submit the data on time and are recognized as compliant. They tout this recognition on their web sites. I have said it many times. GPRA is worthless. It gives no management useable data. It is essentially “Report Card Charting.”

Will the politician ever contact me to learn more about the potential for lean thinking in Alaska State Government? Most likely not. As I have discovered, being an advocate for lean thinking in Alaska is a lonely, lonely job. Any politician that takes it on is bound to be frustrated by the limited thinking of our chief executives (governor, commissioners, mayors, superintendents). I had been talking to a young special assistant to a commissioner, but haven’t heard of any initiatives from that department yet.

Politicians, like most executives, just don’t get lean.

Posted by: knightbird | July 9, 2013

Bounce: The Art of Turning Tough Times Into Triumph

 

I came across this book by Keith McFarland and decided to pick it up. The book is in story format as told by Mike Maloney, a division manager for a company in the throes of decline. On occasion I find a book that intrigues me so much I end up reading it in a couple of sittings. This story is short so that didn’t take too long. Lean Management is one of the sub themes in the book, and is not covered in any significant detail. The story is instead one of engaging your employees in the mission (not a board directed mission statement, but more of a military mission-one immediate and tangible) of your company.

Mike learns some lessons from a soldier he works out with at a local gym, and the takeaways were compelling. As any cultural lean practitioner will recognize, lean starts with respect. However, the way the message of respect was given impressed me.

The first lesson is to embrace the bounce, thus the title of the book. The bounce is the recovery that follows a period of disintegration in an organization. If you have an engaged, learning staff, and management encourages these behaviors, disintegration is followed by reflection, thinking and a period of reintegration. I will let you read the book for the other 5 principles the author discusses.

I did particularly like a few short mental attitudes encourage by Mike under the tutelage of the soldier. “See reality clearly” is something few businesses do. I have lived through this. Executives will see what they want to see, and it’s not always reality. During my lean implementation at Chugachmiut, we talked about recognizing problems as treasures, and the knowledge about defects as important information to know. As has been said, No problem is problem. The second mental advice is to “Treat causes, not symptoms.” In other words, use the 5 why’s and conduct a root cause analysis. The third piece of advice is that “We Control, not They Control.” Too often we blame others for the circumstances we find ourselves in. I see this all the time in the Alaska Tribal Health System. The problems they experience are caused by a lack of funding. By accepting control, and using the tools of lean, the problems become under their control. The fourth piece of advice is to “Hold Hands in Public.” Or in other words, stick together.

Despite being a lean coach, mentor and teacher, I find that the learning never stops. Because of the many different ways Executives think, and the experiences they have had, it takes many different ways of teaching to get points across. I have to be nimble, observant and willing to change my teaching approach. Bounce helped me to some of that.

Posted by: knightbird | July 9, 2013

National Congress of American Indians Workshop

 With the issues caused by the Sequester in Congress, many Tribes have experienced funding problems. Added on top of the recession that started in 2008, and from which we are still recovering, the funding problems are having a substantial impact on services. Faced with this nationwide impact, NCAI put together a panel to discuss “Tribal Operations & Business During Tight Times.” I was honored to serve on that panel. My title was “Finding Value Through Lean Thinking in Indian Country.”

In a very short presentation, I shared the story of the lean transformation I presided over while I was Executive Director at Chugachmiut. As I struggled with implementing the 14 points articulated by Dr. W. Edwards Deming, we built a culture of respect, and one that allowed us to recognize problems and defects without anger or blame. My knowledge increased with every mistake I made, and I let the audience know that. I spent most of my time on how to build a culture of respect.

The remaining time I spent on the tools of continuous improvement. I asked the audience whether they believed it was possible to improve a process by 1600%. Most were skeptical. The example I used was posted on my friend Mark Graban’s blog, and very clearly showed more than a 1600% improvement in preparation of food boxes for distribution to victims of Hurricane Sandy in New York. The staff improved the time it took to prepare food boxes from 3 minutes on average to 11 seconds. You can do the math. Lean did the improvements.

I also shared a couple of examples from my own experience with significant improvements.

The message was clearly received. Approximately 10 tribal leaders sought me out after the presentation to learn more. I shared my PowerPoint with each of them. Indian Country can benefit enormously from the adoption of lean thinking in their tribal and business operations, and I hope to spread the practice in the next 5 years.

Posted by: knightbird | June 10, 2013

Lean Transformation at Jabil

I have been extremely impressed by the lean transformation at Jabil, an assembly, manufacturing and plastics molding company that announced it’s potential acquisition of Nypro Precision Plastics, a partner of Sealaska. Starting it’s transformation in 2010, in 3+ years, Jabil has advanced rapidly through its transformation steps. With a total equity of $1,883,823 in 2011, Jabil has increased its shareholder equity to $2,177,990 in 2012 according to its last SEC filing. 

But the excitement for me is the intense effort spent on the lean cultural transformation. According to its website, Jabil conducted 22,000+ Kaizen in 2012, an increase of 7,000 over 2011.

My estimate has previously been that it takes approximately 5 years for a company o achieve a cultural transformation to Lean. And that is with a heavily invested CEO and board of directors. Jabil has a long way to go, but its cultural transformation is well on its way. It’s clear why they are purchasing Nypro. A review of Nypro’s last annual report listed no references to its “High Velocity System.” That was Brian Jones lean implementation started many years ago. It was not a cultural transformation, and apparently has not truly succeeded. 

Posted by: knightbird | June 10, 2013

2013 Lean Coaching Summit

I have not been fully accepted as a Lean Management expert in Alaska, despite leading a successful cultural transformation of a non-profit organization here over 9 years. The year I left the organization, I led an effort and freed up about $700,000 in cash. The effort was not well understood or appreciated at the organization. Over the course of 9 years, we freed up almost $3.0 million in value from a budget of about $10.5 million to start with. This is a concept I will try to explain more fully at the Summit.

The story I tell about how to accomplish similar results at other organizations is, however, well accepted in the lower 48 (what we call the contiguous 48 states). I will be telling that story once again at the 2013 Lean Coaching Summit in Hilton Head, South Carolina on July 24th. In the past, I have presented the lean transformation I led at conferences on lean healthcare, the National Congress of American Indians and the TWI Summits. The story is real, and can be replicated elsewhere.

I am also incredible excited to hear the other stories that will be told at the Summit. I still have a lot to learn, and this is one phenomenal place to learn at.

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