Mark Graban LEI Lean Talk 2014


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Kaizen Success: From Making Excuses to Solving Problems

We often hear people say that continuous improvement is important (often stated on websites, mission statements, etc.) but when it comes down to it, leaders say things like “we don’t have time for kaizen.” The most effective organizations don’t let things like that become as an excuse… they turn those into problem statements. If kaizen is important, how can we CREATE time for kaizen? I can share some examples from healthcare organizations that are moving from excuses to action, turning everybody into a problem solver every day.

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  • Hi, I’m Mark Graban and I want to talk about creating a culture of continuous improvement, a culture of Kaizen, by turning excuses we hide behind into problems we solve. What do we mean by Kaizen? The word doesn’t mean only “week long team-based event” – it means any good change or improvement that’s done through a PDCA or PDSA cycle.
  • Here’s a classic Kaizen idea from a hospital… a nurse notices that nauseous patients ask for ginger ale and the nurses either can’t provide it or they waste time walking upstairs to get it. The Kaizen fix is simple – the manager asks food services to start stocking ginger ale. People speak up and things get fixed. This is a classic just do it that’s good for everybody involved. It doesn’t have any sort of ROI but that’s OK… some Kaizens will.My co-author’s health system does and documents 4,000 a year, saving millions of $ a year and improving patient care. I’m probably preaching to the choir here… but why doesn’t everybody do this?
  • Organizations, including hospitals,SAY they have a culture of continuous improvement… or they aspire to it, tt least if you believe mission, vision, and values statements you find on hospital websites – and I’ve got a collection of these at They’re all well intended, they’re talking the talk, but the key question is
  • Are leaders doing everything they can to set an example and to create this culture of continuous improvement? It doesn’t happen magically. It takes work.
  • A more honest statement of vision and values might say this:As we’re taught in Lean problem solving…
  • We have to Mind the gap. Is there a gap between reality – the reality being very little improvement taking place and the goal being a culture of continuous improvement where we have everybody participating every day… Why is there a gap? That’s a good lean habit too. Honestly identify the gap… and ask why
  • Why? If we’re on a Lean journey we have to ask why and look for causes, why don’t we have improvement?… not to lay blame, but to find things we can change… to test improvements that would take us closer to this culture of continuous improvement. Root cause analysis doesn’t stop with the identification of root causes. These aren’t called “root excuses.”
  • People often talk about barriers to Lean or barriers to Kaizen. Are we finding these barriers as if they’re naturally occurring or are we erecting them ourselves through our own policies?? We have a long list of barriers in our Healthcare Kaizen book, such as lack of time, lack of executive commitment, lack of budget. Some organizations treat these barriers as excuses. They make excuses… here’s why we can’t do it. The successful lean cultures view these barriers as problems to solve. We’ve identified a gap. Let’s close it. Let’s work at it. We’ve identified a problem. Great. Let’s solve it and close that gap. We shift from a mindset that says “here’s why we can’t do it” but instead asks “how can we make that happen?”
  • Let’s use the Kaizen process that we use to solve small problems, like not having ginger ale for patients. Here’s a Kaizen card that addresses one cause of the Kaizen gap. Problem: staff don’t have time to do kaizen. The excuse mindset says: Oh, OK… never mind, I guess we won’t create a culture of continuous improvement… there’s a lot of self-defeating excuse making…
  • The problem solving mindset asks “how do we create time?” Why don’t we have time? What can we do about that?Presentation from SHS  “It’s the manager’s job to create time.” I’d add that managers aren’t paid to give excuses, they are paid to solve problems. They are paid to LEAD.When I take San Antonio healthcare students to the local Toyota plant, they ask “how do you make time for Kaizen?” Toyota says “If it’s an idea worth working on, we schedule overtime.” Or you fit in Kaizen when you can. I know a hospital lab director who schedules “Lean days” for staff members to work on bigger improvements that aren’t being done adhoc, which is possible with small improvements. If it’s important, create the time. Find a way. Think long-term instead of short.
  • Managers don’t have time to help? Is this an excuse? No. It highlights a problem. One of those problems is that managers feel like they have to do all of the kaizen work themselves, but that’s not true… it’s not kaizen unless you engage employees in more than coming up with ideas.
  • Find a way. Smart managers realize they can delegate Kaizen work and they don’t have to (and shouldn’t) do it all themselves. Cancel some useless meetings or make them shorter. Be like ThedaCare and create a two-hour no-meeting zone. Solve the problem. Create time. If this is important, you’ll do so.
  • If managers are creating time to work on Kaizen, they sometimes complains that it hurts their productivity measures. “Having to hit our daily productivity measures is exactly the thing that keeps us from improving our productivity! Is this an excuse?
  • It’s a problem we can solvef. You can work with your senior leaders to help them realize that today’s short-term productivity is not the only thing that matters. It’s worth spending 15 minutes today to save hours each week over time. Stop the tyranny of short-term metrics. Or, create short-term relief by creating a special Kaizen charge code for scheduled Kaizen work.
  • I heard a healthcare leader say to make change we need the will, good ideas, and effective execution. If we’re not creating our culture of continuous improvement, we can ask “Do we not know how to do it? The ideas or the method. Are we not executing on a prove kaizen model that we said we’d adopt? That’s execution. Or do we just honestly not have the WILL to create this culture? It’s important, but it’s not quick and easy. Do we have a choice? We have to do it. Are we making excuses (which might show a lack of will) or are we solving problems?
  • I like to ask… when we face barriers… are you being a victim or being a leader? Are you counting up excuses or solving problems?
  • As the legendary nurse Florence Nightingale said: We need to do the same if we’re really going to create a culture of continuous improvement in healthcare or in any type of organization. Call to action – when you hear excuses, can you challenge folks and turn these into problems to solve?
  • Mark Graban LEI Lean Talk 2014

    1. Kaizen Success: From Making Excuses to Solving Problems Mark Graban • President, Constancy, Inc. • VP of Innovation and Improvement Services, KaiNexus • Faculty, Lean Enterprise Institute & ThedaCare Center for Healthcare Value
    2. www.MarkGraban/walk
    3. Are we walking the walk?
    4. Continuous Improvement: We’d like to have a culture of continuous improvement, but our workers have been beaten down, our leaders don’t trust them anyway, and we don’t make time for improvement. It’s a nice idea, but honestly not a priority for us right now. We’ll get there someday – or probably not.
    5. WHY?
    6. Identify Barriers Make Excuses Solve Problems
    7. Will Ideas Execution
    8. Are you a victim or a leader?
    9. “I attribute my success to this – I never gave or took any excuse.”
    10. Q&A / Contact Info • Email: – • Twitter: –@MarkGraban • Web: – –