Lean Facilitator Skills: Applying Psychology in the Moment

Facilitator Skills: Applying Lean Psychology “In the Moment” January 21, 2010 Company LOGO

Learning Objectives Participants will learn how to:       Establish the environment for honest and, yes, sometimes emotional discussions. Read body language and behavior to assess buy-in. Address both overt and covert resistance. Gain consensus every step of the way. Spark innovation in risk-adverse environments. Help leadership create a worker-initiated improvement environment. © 2010 Karen Martin & Associates 2

Facilitator: Defined Facilitator – one who facilitates fa·cil·i·tate (verb) 1. to make easier or less difficult; help forward (an action, a process, etc.) 2. To assist the progress of (a person or activity). © 2010 Karen Martin & Associates 3

Improvement Facilitator Roles & Responsibilities Teaching skill sets Advocating improvements Facilitating design and implementation activities Mediating disagreements between functional areas Encouraging behavioral changes Coaching teams Convincing leadership to allocate necessary resources Driving execution Selling the need for improvement © 2010 Karen Martin & Associates 4

The Facilitator’s Many Hats © 2010 Karen Martin & Associates 5

The Facilitator as Psychologist Figuring out each person’s “what’s in it for me” Figuring out each person’s “currency” Figuring out the root of each person’s resistance Reduce cynicism Generate momentum for change © 2010 Karen Martin & Associates 6

The Facilitator as Salesperson The need for improvement. How improvement will benefit your customer. How improvement will benefit the organization. How improvement will benefit the individual. Why you need what you need.   Time Resources Why you need to do things a certain way. © 2010 Karen Martin & Associates 7

Improvement Facilitator Necessary Traits  Skills / Knowledge      Lean tools Root cause analysis Project & time management Team building / facilitation People effectiveness – from front line workers to execs  Authority / Respect    Designated change agent / influence leader Trustworthy Comfortable removing obstacles & reaching out to senior leadership  Personality / Energy    Challenging, yet supportive Positive, upbeat, energetic Pushy without irritating  Objectivity / Fairness  Not directly affected by the improvements being made © 2010 Karen Martin & Associates 8

Scope carefully Clear goals & objectives People need to clearly understand what they’re allowed to do… …and what they do NOT have permission to do Eases leadership apprehension Clarifies direction Charters provide “Freedom with Boundaries” © 2010 Karen Martin & Associates 10

Psychology at Work: Improvement Team Selection No more than 10 Be very strategic   Include a strong influence leader or two Include a representative of an area that’s likely to resist (a particular department, unions, etc.)  They often become your greatest advocates.  Don’t avoid “whiners.” © 2010 Karen Martin & Associates 11

Psychology at Work Forming Improvement Teams No more than 10 Cross-functional composition            Process workers Upstream suppliers (internal) Downstream customers (internal) Subject matter experts Outside eyes External suppliers / contractors External customers Administrative support (if needed) Union representatives (if relevant) Maintenance / facilities representatives Management (limited representation) © 2010 Karen Martin & Associates

Embrace Complainers Complainers can be your most valuable resource. • Give them the proper forum to be heard • Invite them to play an active role in implementing solutions. © 2010 Karen Martin & Associates

Reducing resistance to sequestration Sell the virtues of focus. Ask about how the department functions if someone is on jury duty, is ill, or goes on vacation. Remind them how long the process has needed improvement. Ask if the current improvement approach is effective. © 2010 Karen Martin & Associates 14

Ground Rules  The team starts and ends the day together.  Being on time is critical.  The team stays 100% committed and 100% focused; no interruptions.  All wireless devices on silent mode or off. No vibration.  Rank has no privilege.  Finger-pointing has no place.  No veto power from outside the team.  No silent objectors. Don’t leave in silent disagreement.  Seek the wisdom of ten, rather than the knowledge of one.  What’s said in the room stays in the room.  It’s okay and encouraged to disagree; it’s not okay to be disagreeable. © 2010 Karen Martin & Associates 16

Customer Demand: 15 patients per Day (Takt Time = 32 minutes) 8 hours per day Current State Value Stream Map Outpatient Imaging Services Pre-register Patient 5 CT=Cycle Time LT=Lead Time %C&A=% Complete & Accurate Schedule Appointment 4 3 6 Lead T ime = 990 mins. Cycle T ime = 30 mins. Lead T ime = 990 mins. % C&A = 100 % Refer Patient (Physician) 2 Lead T ime = 12 mins. Cycle T ime = 11 mins. Lead T ime = 12 mins. % C&A = 98 % Patient 2 1 % C&A = 65 % Auto Fax 50% Us Mail 25% MD Mailbox 25% Symposium E Pay Excel ADS Internet Meditech Waiting Room Management System Fax Order Solutions Rework Loop via Fax 25% of the time PACS Lead T ime = 10 days Check-in Patient (Admitting) Check-in Patient (Imaging) 5 mins. 5 5 5 mins. Cycle T ime = 2 mins. % C&A = 90 % 0.0833 hrs. 3 80 mins. 6 Cycle T ime = 1 mins. % C&A = 98 % 0.0833 hrs. 2 mins. 7 2 2 9 365 mins. Cycle T ime = 15 mins. % C&A = 95 % 4.13 hrs. 28 mins. 8 960 mins. 2 Lead T ime = 5 mins. % C&A = 75 % 6.08 hrs. 15 mins. Print Reports (Imaging) Review / Sign Report (Radiologist) T ranscribe Report (MDI) 248 mins. Cycle T ime = 28 mins. % C&A = 90 % 1.33 hrs. 1 mins. Read/Dictate Exam (Radiologist) Prep Patient, Conduct Exam, T ransmit Images (T ech) 10 110 mins. 16 hrs. 1.83 hrs. 1 mins. 11 120 mins. Cycle T ime = 1 mins. % C&A = 99 % Cycle T ime = 1 mins. % C&A = 95 % 5 mins. 2 Send Reports (Imaging) 6 12 Cycle T ime = 3 mins. % C&A = 90 % 2 hrs. 1 mins. LT = 32.5 hrs. 3 mins. CT = 56 mins. CT /LT Ratio = 2.87% Value Stream Champion: Paul Scanner Created July 19, 2005 LT = 16 hrs Rolled First Pass yield = 30%

Waste creates avoidance behavior If it’s too hard to do, we will delay or avoid doing it.      Builds up work-in-process Prolongs lead time May increase process time May impact quality Often results in batching

Future State Value Stream Map Outpatient Imaging Services Customer Demand: 15 patients per Day (Takt Time = 32 minutes) 8 hours per day CT=Cycle Time LT=Lead Time %C&A=% Complete & Accurate Cross Training Standard Work Work Balance Co-locate Schedule appt Pre-register Patient Refer Patient (Physician) 3 6 Cycle T ime = 11 mins. Lead T ime = 45 mins. % C&A = 98 % % C&A = 85 % Standard Work Lead T ime = 5 days Risk Reduction (Joint Commision) Symposium E Pay Remove Redundant Check-in Excel Meditech Set-up Reduction Standard Work Prep Patient, Conduct Exam, T ransmit Images (T ech) Check-in Patient (Imaging) 5 mins. 3 4 60 mins. 0.0833 hrs. 5 2 Cycle T ime = 1 mins. % C&A = 98 % 120 mins. PACS Continuous Flow 6 Rework Loop via Fax 10% of the time 5S 420 mins. 2 7 Print Reports (Imaging) 2 mins. Cycle T ime = 1 mins. % C&A = 95 % 7 hrs. 15 mins. Standard Work Batch Reductions Review /Sign (Radiologist) Cycle T ime = 15 mins. % C&A = 95 % 2 hrs. 28 mins. Fax Order Solutions Waiting Room Management System Visual Workplace 2 Us Mail 15% Voice Recognition Read/Dictate Exam (Radiologist) Cycle T ime = 28 mins. % C&A = 90 % 1 hrs. 1 mins. Internet Auto Fax 80% MD Mailbox 5% Value Stream Alignment Pull System (Supplies Kanban) Reduce Data Entry Requirements 1 2 Lead T ime = 45 mins. 2 Send Reports (Imaging) 8 30 mins. Cycle T ime = 1 mins. % C&A = 99 % 0.0333 hrs. 1 mins. 6 0.5 hrs. 1 mins. 9 Cycle T ime = 3 mins. % C&A = 90 % LT = 11.4 hrs. 3 mins. CT = 49 mins. CT /LT Ratio = 7.14% Value Stream Champion: Paul Scanner LT = 7 hrs Created July 20, 2005 Rolled First Pass yield = 59%

Our “sphere of influence” is typically greater than we believe.    We absolutely can influence customer behavior! Rethink your true sphere of influence when when scoping improvement activities and selecting teams. Avoid victim thinking (“we can’t do anything about that”). © 2010 Karen Martin & Associates

Customer Demand: 15 patients per Day (Takt Time = 32 minutes) 8 hours per day Current State Value Stream Map Outpatient Imaging Services CT=Cycle Time LT=Lead Time %C&A=% Complete & Accurate %C&A = 65% Pre-register Patient 5 Schedule Appointment 4 3 6 Lead T ime = 990 mins. Cycle T ime = 30 mins. Lead T ime = 990 mins. % C&A = 100 % Refer Patient (Physician) 2 Lead T ime = 12 mins. Cycle T ime = 11 mins. Lead T ime = 12 mins. % C&A = 98 % Patient 2 1 % C&A = 65 % Auto Fax 50% Us Mail 25% MD Mailbox 25% Symposium E Pay Excel ADS Internet Meditech Waiting Room Management System Fax Order Solutions Rework Loop via Fax 25% of the time PACS Lead T ime = 10 days Check-in Patient (Admitting) Check-in Patient (Imaging) 5 mins. 5 5 5 mins. Cycle T ime = 2 mins. % C&A = 90 % 0.0833 hrs. 3 80 mins. 6 Cycle T ime = 1 mins. % C&A = 98 % 0.0833 hrs. 2 mins. 7 2 248 mins. 2 9 365 mins. Cycle T ime = 15 mins. % C&A = 95 % 4.13 hrs. 28 mins. 8 960 mins. 2 Lead T ime = 5 mins. % C&A = 75 % 6.08 hrs. 15 mins. 10 110 mins. 2 1.83 hrs. 1 mins. 11 Send Reports (Imaging) 120 mins. Cycle T ime = 1 mins. % C&A = 99 % Cycle T ime = 1 mins. % C&A = 95 % 16 hrs. 5 mins. Print Reports (Imaging) Review / Sign Report (Radiologist) T ranscribe Report (MDI) Cycle T ime = 28 mins. % C&A = 90 % 1.33 hrs. 1 mins. Read/Dictate Exam (Radiologist) Prep Patient, Conduct Exam, T ransmit Images (T ech) 6 12 Cycle T ime = 3 mins. % C&A = 90 % 2 hrs. 1 mins. LT = 32.5 hrs. 3 mins. CT = 56 mins. CT /LT Ratio = 2.87% Value Stream Champion: Paul Scanner Created July 19, 2005 RFPY = 30% Rolled First Pass yield = 30%

Future State Value Stream Map Outpatient Imaging Services Customer Demand: 15 patients per Day (Takt Time = 32 minutes) 8 hours per day %C&A = 85% Cross Training Standard Work CT=Cycle Time LT=Lead Time %C&A=% Complete & Accurate Work Balance Co-locate Schedule appt Pre-register Patient Refer Patient (Physician) 3 6 Cycle T ime = 11 mins. Lead T ime = 45 mins. % C&A = 98 % % C&A = 85 % Standard Work Lead T ime = 5 days Risk Reduction (Joint Commision) Symposium E Pay Remove Redundant Check-in Excel Meditech Set-up Reduction Standard Work Prep Patient, Conduct Exam, T ransmit Images (T ech) Check-in Patient (Imaging) 5 mins. 3 4 60 mins. 0.0833 hrs. 5 2 Cycle T ime = 1 mins. % C&A = 98 % 120 mins. PACS Continuous Flow 6 420 mins. 5S 2 7 Standard Work Print Reports (Imaging) 2 mins. Cycle T ime = 1 mins. % C&A = 95 % 7 hrs. 15 mins. Rework Loop via Fax 10% of the time Batch Reductions Review /Sign (Radiologist) Cycle T ime = 15 mins. % C&A = 95 % 2 hrs. 28 mins. Fax Order Solutions Waiting Room Management System Visual Workplace 2 Us Mail 15% Voice Recognition Read/Dictate Exam (Radiologist) Cycle T ime = 28 mins. % C&A = 90 % 1 hrs. 1 mins. Internet Auto Fax 80% MD Mailbox 5% Value Stream Alignment Pull System (Supplies Kanban) Reduce Data Entry Requirements 1 2 Lead T ime = 45 mins. 2 Send Reports (Imaging) 8 30 mins. Cycle T ime = 1 mins. % C&A = 99 % 0.0333 hrs. 6 0.5 hrs. 1 mins. 9 Cycle T ime = 3 mins. % C&A = 90 % 1 mins. LT = 11.4 hrs. 3 mins. CT = 49 mins. CT /LT Ratio = 7.14% Value Stream Champion: Paul Scanner Created July 20, 2005 RFPY = 59% Rolled First Pass yield = 59%

Current State Value Stream Map Supplies Purchasing - Current State VSM Purchasing — Non-repetitive purchases less than $5,000 Inititate Req. 1 Originator 31 PT = 10 mins. C&A = 10% Supplies Hard Copy Form File File Maker Quicken Vendor Website Excel ERP Data Entry Review Budget 2 Review Req. Finance PT = 5 mins. C&A = 60% 0.25 days 4 hrs. PT = 5 mins. C&A = 95% 0.5 days 5 mins. 20 Reqs Review 4 Requisition 40 hrs. PT = 5 mins. C&A = 90% 8 hrs. PT = 5 mins. C&A = 100% 1 days 5 mins. 8 hrs. 7 10 Reqs 1 PT = 10 mins. C&A = 95% 4 hrs. PT = 15 mins. C&A = 98% 0.5 days 10 mins. Approve in ERP 24 hrs. PT = 5 mins. C&A = 90% 3 days 15 mins. Submit PO to Supplier 8 63 Reqs 9 10 External Supplier Corp Purchasing Manager 1 Admin Asst Financial Mgr 1 1 days 5 mins. Enter Requisition Review 6 Requisition IS Manager 1 1 5 days 5 mins. Review 5 Requisition Sys Engineer Supervisor 2 6 2 hrs. 3 Corp Purchasing 6 56 hrs. PT = 15 mins. C&A = 98% 7 days 5 mins. 80 hrs. PT = 20 mins. 10 days 15 mins. LT = 28.4 days PT = 65 mins. AR = 0.477% RFPY = 4.2% Customer Demand: 615 requisitions per y ear PT = Process Time LT = Lead Time C&A = % Complete & Accurate AR = Activ ity Ratio (PT/LT x 100) RFPY = Rolled First Pass Y ield

Future State Value Stream Map Supplies Purchasing - Future State VSM Purchasing — Non-repetitive purchases less than $5,000 Lack of awareness Lack of confidence Change fatigue Additional IT access Enter Req. in ERP Integrate Form File with File Maker 1 Originator 31 PT=30 mins. C&A = 85% Supplies Requisition Checklist Vendor Websites File Maker Cross Training Approval Additional IT access 2 4 hrs. 6 hrs. 0.75 days 5 mins. Place Order 3 4 5 External Supplier 6 PT=20 mins. 80 hrs. PT=20 mins. C&A = 98% 1 days 5 mins. Dedicated Buyers Corp Purchasing 8 hrs. PT=5 mins. C&A = 90% PT=5 mins. C&A = 95% 0.5 days Approve in ERP Dept. Manager 1 Supervisor 2 Use budget in place of Quicken Auto Notify Standard Work for review Review Req. ERP 10 days 20 mins. LT = 12.3 days PT = 30 mins. AR = 0.508% Customer Demand: 615 requistions per year PT = Process Time LT = Lead Time C&A = % Complete & Accurate AR = Activity Ratio (PT/LT x 100) RFPY = Rolled First Pass Yield RFPY = 71%

Most inspection (reviews, approvals, audits, etc.) is grounded in lack of trust or fear.    Low faith in process reliability Low confidence in people performing the work Fear of losing control  High “need to know”  Risk aversion  Fear re: outcome © 2010 Karen Martin & Associates 31

Current State Value Stream Map Supplies Purchasing - Current State VSM Purchasing — Non-repetitive purchases less than $5,000 Inititate Req. 1 Originator 31 PT = 10 mins. C&A = 10% Supplies Hard Copy Form File File Maker Quicken Vendor Website Excel ERP Data Entry Review Budget 2 Review Req. Finance PT = 5 mins. C&A = 60% 0.25 days 4 hrs. PT = 5 mins. C&A = 95% 0.5 days 5 mins. 20 Reqs Review 4 Requisition Review 5 Requisition Sys Engineer Supervisor 2 6 2 hrs. 3 IS Manager 1 1 40 hrs. PT = 5 mins. C&A = 90% 5 days 5 mins. 8 hrs. PT = 5 mins. C&A = 100% 1 days 5 mins. 8 hrs. 7 10 Reqs 1 PT = 10 mins. C&A = 95% 4 hrs. PT = 15 mins. C&A = 98% 0.5 days 10 mins. Approve in ERP 24 hrs. PT = 5 mins. C&A = 90% 3 days 15 mins. Submit PO to Supplier 8 63 Reqs 9 10 External Supplier Corp Purchasing Manager 1 Admin Asst Financial Mgr 1 1 days 5 mins. Enter Requisition Review 6 Requisition Corp Purchasing 6 56 hrs. PT = 15 mins. C&A = 98% 7 days 5 mins. 80 hrs. PT = 20 mins. 10 days 15 mins. LT = 28.4 days PT = 65 mins. AR = 0.477% RFPY = 4.2% Customer Demand: 615 requisitions per y ear 5 “Inspections” PT = Process Time LT = Lead Time C&A = % Complete & Accurate AR = Activ ity Ratio (PT/LT x 100) RFPY = Rolled First Pass Y ield

Excessive Approvals & Authorizations Is the approval redundant? (same skill set and perspective as another approver) Is the approval a “rubber stamp”? Does the approver have the technical skills and experience to understand what they are signing? Does the approver have the authorization to approve or deny? Is the approver accessible? Is the approver on the routing list merely to stay informed? © 2010 Karen Martin & Associates 33

Lean Approvals Move authorizations to the lowest level possible    Closest to the work Create standard work re: decision making and train lower level approvers accordingly Audit periodically until trust is assured Remove approvals that serve merely as notification devices  Design notification to occur “off-line” Process design goal: maximum of two signatures for any decision © 2010 Karen Martin & Associates 34

Future State Value Stream Map Supplies Purchasing - Future State VSM Purchasing — Non-repetitive purchases less than $5,000 Additional IT access Enter Req. in ERP Integrate Form File with File Maker 1 Originator 31 PT=30 mins. C&A = 85% Supplies Requisition Checklist Vendor Websites File Maker Cross Training Approval Additional IT access 2 6 hrs. 2 Place Order 3 0.75 days 5 mins. 4 5 External Supplier 6 PT=20 mins. 80 hrs. PT=20 mins. C&A = 98% 1 days 5 mins. Dedicated Buyers Corp Purchasing 8 hrs. PT=5 mins. C&A = 90% PT=5 mins. C&A = 95% 0.5 days Approve in ERP Dept. Manager 1 Supervisor 4 hrs. Use budget in place of Quicken Auto Notify Standard Work for review Review Req. ERP 10 days 20 mins. LT = 12.3 days PT = 30 mins. AR = 0.508% 1 “Inspection” Customer Demand: 615 requistions per year PT = Process Time LT = Lead Time C&A = % Complete & Accurate AR = Activity Ratio (PT/LT x 100) RFPY = Rolled First Pass Yield RFPY = 71%

Reducing Resistance & Building “Process Trust” Demonstrate how the current state process impacts the customer Point out that non-value-adding work is typically not stimulating Facilitate candid conversations Pose “what if” scenarios Develop clear and concise standard work and provide excellent training and cross-training around it Time-limited audits Improvement pilots © 2010 Karen Martin & Associates 36

Pay Close Attention to Body Language Body language and demeanor tell the whole story      Crossed arms No eye contact Sudden change in level of engagement Set jaw Incongruity between words and actions © 2010 Karen Martin & Associates

Techniques for Using Body Language Cues Draw them out. If safe, ask them directly.  Establish and get agreement re: “Cards on the table” rule upfront Allow them to express their feelings. Make it safe – protect them from ridicule. Listen carefully – ask others to listen carefully too. Ask the team to comment. © 2010 Karen Martin & Associates 40

Eliminating Non-Value-Adding Work Try to anticipate upfront. Create a game plan for “redeployment.” Assure the person they won’t lose a paycheck. Help them find more fulfilling, value-adding work (doing wasteful work is usually boring and frustrating.) Keep tabs on his/her emotions. Be honest. Play to their “currency.” Invite / allow them to emote. © 2010 Karen Martin & Associates 43

Dealing with Outrageous Behavior Your job is to have the team’s back. Have zero tolerance for disrespect. Engage leadership if need be. Have side bars outside the room. Allow the person to emote. If they won’t settle down, they must leave the team. © 2010 Karen Martin & Associates 45

Helping a Team Get Unstuck or Back on Track Return to the goals and objectives for the improvement activity. Flip chart “parking lot” ideas. Use the “ticking clock” technique. Take a break. Go outside. Talk about something unrelated. Eat. Reach out to the executive sponsor. Turn to brainstorming. Prioritize ideas. © 2010 Karen Martin & Associates 47

PACE Prioritization Matrix Easy 5 4 13 23 8 22 17 3 10 21 1 16 15 20 19 14 6 7 11 2 18 12 Difficult Ease of Implementation 9 High Anticipated Benefit Low

Dealing with Resistance Assess whether it’s valid or “emotional resistance.”  Ask “why?” “Would you be willing to try it for 30 days”? They: “We’ve already tried that.”  You: “Don’t throw the baby out with the bath water.” © 2010 Karen Martin & Associates 50

Use visuals and data to demonstrate the degree of dysfunction in the process

Dealing with Risk Aversion or Lack of Innovation Get alignment re: risk tolerance across the leadership team. Facilitate candid conversations. Pose “what if” scenarios. Create safety nets. Audit as needed. Engage the executive sponsor. Show them examples, perhaps outside of their industry, or even non-work related.  Develop a library of photos © 2010 Karen Martin & Associates 53

Psychology in Use Issue Team is designing someone out of a job Resolution Quick intervention with leadership and affected parties Professional level workers feel a task is “beneath” them “Difficult person” no one wants to work with Organization is filled with doubt and skepticism Demonstrate the TRUE impact and benefits Involve them – they become the greatest advocates Leadership is reluctant to give up tactical control Help them see how their role shifts for the positive © 2010 Karen Martin & Associates Hold REAL Kaizen Events 55

Techniques…  Use a charter with clear goals and objectives (that you’ve obtained consensus on upfront).  Gain consensus on the easy things first.  Makes saying no more difficult  If more than 20% of the affected parties disagree with the planned direction, don’t do it! (yet)  Keep working it – understand the issues – get to root cause  Revisit improvement objectives.  Use data.  Ask the resistors if they’d be willing to try it for 30 days.  Create a contingency plan in case failure occurs.  Explain WHY!!!! © 2010 Karen Martin & Associates 56

Learning Objectives Participants will learn how to:       Establish the environment for honest and, yes, sometimes emotional discussions. Read body language and behavior to assess buyin. Address both overt and covert resistance. Gain consensus every step of the way. Spark innovation in risk-adverse environments. Help leadership create a worker-initiated improvement environment. © 2010 Karen Martin & Associates 58

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