![Lack of Lean Leadership
“This [lean] is not the
standard model executive
being produced by U.S
business schools, much
less American medical
schools.”
– Toussaint and Gerard, On the Mend
15](https://image.slidesharecdn.com/michiganleanconsortiumwebinarforslideshare-100407175956-phpapp01/85/Mark-Graban-Lean-Leadership-at-the-Front-Line-Gemba-Walks-15-320.jpg)
Uploaded byMark Graban
Mark Graban - Lean Leadership at the Front Line & Gemba Walks
(Note- Q&A was edited out of the recording) The Michigan Lean Consortium presented a free webinar with Mark Graban of the Lean Enterprise Institute on April 7. Author of the Shingo Prize-winning book “Lean Hospitals: Improving Quality, Patient Safety and Employee Satisfaction,” Graban will be speaking on the topic of “Leadership presence on the front line: A critical success factor for Michigan’s regrowth.” Graban will discuss how leadership presence on the front line can and should be done in order to improve business and employee morale. He will show how a leader can be productive while on the front line and what happens in between doing these “walks” with the information gleaned from the employees. Graban will also share his experiences on the importance of these walks to the culture of an organization and how they encourage effective problem solving and a no-blame environment. All of this can help in Michigan’s regrowth in securing existing businesses and attracting new ones. Prior to joining LEI, Graban was most recently a senior consultant for ValuMetrix Services, a part of Johnson & Johnson. In that role, Graban served as a consultant to many health care organizations across North America and in the United Kingdom. He taught and led teams of hospital personnel and leaders involved in multi-month lean transformation engagements in departments including laboratory, radiology, primary care and nursing settings. Before moving into health care, Graban worked in manufacturing for 10 years with companies including General Motors, Dell and Honeywell. Graban is also a popular blogger and has created almost 100 podcasts with lean leaders from different industries. Graban has a B.S. in industrial engineering from Northwestern University and an M.S. in mechanical engineering and an M.B.A. from the Massachusetts Institute of Technology’s Leaders for Global Operations Program. He was raised in Livonia, Mich. The mission of the MLC is to offer a diverse network of knowledgeable lean professionals who come together to share innovative practices. The organization aims to create a lean culture in Michigan to ensure sustainable competitive advantage, which could translate into healthier businesses that offer more job opportunities leading to economic growth in the state. The charter members of the MLC include: Amway, Blue Cross Blue Shield of Michigan, DTE Energy, Johnson & Johnson, The Lean Learning Center, Northwestern Michigan College, the Pawley Learning Institute at Oakland University and the Michigan Shingo Prize through The Right Place. About the Lean Enterprise Institute (www.lean.org) Lean Enterprise Institute, Inc. (LEI) is a nonprofit education, publishing, conference, and research organization founded by James Womack, Ph.D. in 1997 to promote and advance the principles of lean thinking in every aspect of business and across a wide range of industries. Through its publications, summits, conference
Mark Graban - Lean Leadership at the Front Line & Gemba Walks
- 1. “Leadership presence onthe front line: a critical success factor for Michigan’s regrowth” Mark Graban Senior Fellow, Lean Enterprise Institute Author, “Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction”
- 2. Agenda • Transferring Lean from Automotive to Healthcare, etc. • Focus on the Front Line • Lean and “Respect for People” • Gemba Walk Guidelines • Engaging Staff in Continuous Improvement 2
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- 5. Lean is FundamentallyAbout: People doing People facing People managing work problems other people 5
- 6. “Gemba”: The ActualPlace “Toyota managers should be sufficiently engaged on the factory floor that they have to wash their hands at least three times a day.” Taiichi Ohno 6
- 7. “Gemba is forEveryone” “…Kaplan tours the hospital daily looking for problems and solutions. Everyone is encouraged to look for changes to make work more efficient.” - Virginia Mason CEO Gary Kaplan 7
- 8. Patients (Gemba) Walkway over tracks Parking Garage Executive Offices 8
- 9. “Convis became thefirst North American to head a Toyota manufacturing plant when he was put in charge of the Georgetown facility. He responded to the promotion by moving his office from the admin building adjacent to the Georgetown plant to the center of the factory floor.” 9
- 10. Toyota’s Chairman Fujio Cho Three Keys to Lean Leadership • Go See – “Senior Management must spend time on the front lines.” • Ask Why – “Use the “Why?” technique daily.” • Show Respect – “Respect your people.” 10
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- 12. It’s The System “Yourespect people, you “Human error is listen to them, you inevitable. We can work together. You never eliminate it.” We don’t blame them. can eliminate problems Maybe the process was in the system that make not set up well, so it it more likely to was easy to make a happen.” mistake.” – Gary Convis, President TMMK – Liam Donaldson, WHO World Health Alliance for Patient safety 12
- 13. “I’ve worked herefor six years and this is the first time anyone has asked me what I think about anything.” Registered Nurse 15 yrs experience 13
- 14. ThedaCare’s Lean LeaderTraits • For ThedaCare’s “steady state” – Patient – Inquisitive – Keenly interested in problem solving – Good communicator – Mentor who likes to see people success and wants to be in the middle of the action, not behind a desk – Calm, deliberative problem solver • Source: On the Mend (2010, Lean Enterprise Institute) 14
- 15. Lack of LeanLeadership “This [lean] is not the standard model executive being produced by U.S business schools, much less American medical schools.” – Toussaint and Gerard, On the Mend 15
- 16. What Gemba Walksare NOT • NOT “Management By Walking Around” (MBWA) • NOT “Undercover Boss” 16
- 17. Gemba Walk Guidelines •Carve out time, stick to it • Regular schedule / rotation • Have a “theme,” not a random walk • Walk with an employee • Ask questions • “It’s OK, I have the time” (Studer) • Share what you learned • Learn by doing www.wiilean.com 17
- 18. A Gap inUnderstanding • Meetings • Reports • Conference Rooms Go To Gemba • “Gemba” © 2009 Ortho-Clinical Diagnostics 18
- 19. Henry Ford -1922 “In the ordinary hospital the nurses must make useless steps. More of their time is spent in walking than in caring for the patient.” 19
- 20. “No Problems isa Problem” • Examples: • Nursing software problem • Lack of thermometers • Carpeted hallways 20
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- 22. ThedaCare Leadership Example •“If a unit is struggling, I’m there to help them. And it doesn’t mean that unit is doing a bad job. With our standard work routines, nobody is alarmed to see the V.P. on the floor anymore.” 22
- 23. Daily Improvement • Leanimprovement is not a bureaucratic process 1. Associate has an idea 2. Talks with team leader 3. Experiments with idea 4. If idea works, standardize it and share the idea with others • Focused on improvement, not # of ideas or $$ 23
- 24. Employee Ideas Why alocked box? Sources: Creating a Lean Culture, Mann Lean Hospitals, Graban 24
- 25. Dealing with “Bad”Ideas • “Treat each idea as a gift” – Norman Bodek • If an idea seems impractical: – Make sure there is a clearly defined problem statement – Creativity over capital? 25
- 26. Documenting Improvements • “KaizenWall of Fame” • A method for: – Documenting changes – Celebrating improvement – Sharing ideas across departments Hard copy blank templates
- 27. Livonia Before &After Before After • Corner Office & Meetings • More time at Gemba • “Urgency & Intensity” • Systems & Process • Workers are the problem • Management is the problem • Yelling and screaming • Listening • Being the boss • Building Trust • “Worst of the worst” • Top quartile 27
- 28. Data From Children’s MedicalCenter Dallas Before Lean 12 Months After Starting Lean 3. I have the opportunity to do what I do 3.11 3.92 best every day. 8. I feel free to make suggestions for 2.84 3.48 improvement. 10. I feel secure in my job. 2.32 3.42 13. Stress at work is manageable. 2.43 3.23 17. I am satisfied with the lab as a place to 2.51 3.43 work. 18. I would recommend my work area as a 2.38 3.46 good place to work to others. Grand Average 2.96 3.69
- 29. Leadership’s New Habits •Help define the problem to be solved instead of jumping to solutions • Ask questions instead of providing answers • Think of problems as golden nuggets instead opportunities to blame • Teach subordinates how to solve problems • Mentor subordinates • Be Humble From John Toussaint, M.D.
- 30. ThedaCare’s Results • TrueNorth: – Customer Satisfaction, Safety/Quality, People, Financial Stewardship • Saved $27M in first four years • Increased margin from 2% to 6% • Improved “door-to-balloon” time 92 min to 37 min • Lower cardiac surgery mortality • Fewer babies born pre-term • Higher staff satisfaction 30
- 31. Contact Info • Email: – mgraban@lean.org • Lean Enterprise Institute: – www.lean.org • Healthcare Value Leaders: – www.healthcarevalueleaders.org • Blog: – www.leanblog.org • Twitter: – www.twitter.com/LeanBlog 31
- 32. About LEI • LeanEnterprise Institute, Inc. (LEI) is a nonprofit education, publishing, conference, and research organization founded by James Womack, Ph.D. in 1997 to promote and advance the principles of lean thinking in every aspect of business and across a wide range of industries. • Through its publications, summits, conferences, workshops, webinars, online forums, and website resources, LEI helps organizations transform themselves into lean enterprises, based on the principles of the Toyota Business System. 32
Editor's Notes
- #2 So why are we talking about this today? Leadership presence at the front line – a very underappreciated topic and practice. When people become a manager often they think that they've graduated away from having to be at the front line… and their executive position means that they have people to do that for them that they are world now it's all about meetings and conference rooms that become disconnected from the work that's done if they were ever connected to it in the first place. The biggest complaint is – “we don’t have time” or that the executives have staff and other managers to do that for them!
- #3 Key Message – leadership presence and the right type of engagement is KEY to a company’s success
- #5 When the NUMMI plant in Freemont CA started in 1984, people wondered how something “Japanese” was transferrable to America. This plant, previously closed by General Motors, quick became a huge success (quality and productivity) with basically the same workers and a new management system. Lean is often referred to like an iceberg – the stuff you can see above the surface is a very small part of it… the tools. What’s important is the culture and the management system. As described in the program, Toyota was very open with it’s factories because visitors from the Big 3 “asked the wrong questions.” They couldn’t see or take pictures of culture and mindsets. Copying an andon cord but having people who are afraid to pull it does you no good.
- #7 My old plant manager from the Livonia Engine Plant, Larry Spiegel, who was mentioned in the TAL program understood going to the Gemba and listening to people. The old plant manager only went out there when there was a problem (to scowl at people as if that would get the machine fixed faster.” Leaders need to get out of their offices, away from reports and spreadsheets and conference rooms. This is the new reality of a proven management system. Management by Objectives doesn’t work, we need Management by Gemba.
- #12 Might be a different meaning of “Respect”Lean <>“Nice” or “Stress-Free” TPS aims to:Raise problems to the surfaceCreate a challenging environment that forces people to create and growWhat is meant by “Respect”? “Respect for Humanity”
- #14 It’s not just “blame and shame” that’s a problem. It’s ignoring and not engaging with staff.
- #15 This culture change is critical – ThedaCare has measureable improvements in quality, safety, cost, productivity, and employee moraleVPs and other leaders – first two hours of the day walking the gemba in a structured way
- #16 Back slapping – supervisor who took pride in shaking everybody’s hand each morning – but never stopped to talkNot a sneaky endeavor – Kevin Meyer quote-- A real leader isn't scared of his operations - he knows they are critical to the organization's success and wants to spend every possible moment in the trenches.
- #17 Carve out time – tell your admin NO MEETINGS. Decide what NVA meetings you can remove from your schedule. Replacement update meetings or quality meetings with a gemba walkRotation – ThedaCare VP visits each unit once a week (this might mean you are visiting one every day)Theme – safety issues, checking on standardized work, asking employees what help they need (servant leader). Not just a random walkWalk with someone – great opportunity to coach and teach (and learn)Asking questions sends a very powerful message – what you ask about tells people what is important, sets an example for your leaders below you. It’s OK to NOT KNOW EVERYTHING!Share what you learned – easel board, memo, email, etc.
- #20 John Toussaint on gemba walk – no medication errors… “well, we aren’t entering them”When ThedaCare’s 10 senior executives first started a weekly gemba visit in 2006, we immediately saw a disconnect between our decisions and the reality of front line staffIt was a quick lesson in the arrogance of senior leadership.
- #21 “Gemba is for everyone”
- #22 Tell the Jim Adams story about how people would freak out and assume that something went wrong. It takes time to build trust with staff members.GM story about knowing how bad a machine breakdown was based on WHO was standing there, arms crossed, glaring, tapping footKim Barnas
- #25 Don’t be disrespectful to anybody’s idea, everEx: Don’t say “That’s a bad/dumb idea”Cost less moneyCan be implemented more quicklyCan be implemented with less risk Jim Adams story about measurement and the shift to “what I want” to “what we need for our customers”