Mark Graban has edited a new book, ‘Practicing Lean‘. Mark’s description says –
‘If we keep practicing, we might get good at it eventually. We all have a starting point in our personal “Lean journeys.” Looking back at our first year of work in Lean or continuous improvement methodologies, we probably weren’t very good at it. What are our reflections and lessons learned? This book is a compilation of those stories.’
All of the proceeds of the book are being donated to the Louise H Batz Patient Safety Foundation. Details of the book are available at this link. Originally published on Leanpub, it is now available on Amazon as a Kindle version, or as a paperback.
I contributed a chapter on my experiences to the book. I also wrote a summary of the common ground I detected in the varied contributions, and which Mark has added to the book. I’m grateful to Mark for his agreement for me to include that section on leanhealthservices. If it sparks your interest, please consider buying the book: It’s for a good cause.
The Habits of an Improver
The combined experiences of the contributors to this book range over decades, industries, and continents. From people who have worked on Lean for many years, to people who have started their Lean journey more recently, the accounts include many variations. Some people worked in organisations with active support for Lean, while others were expected to deliver improvements with little support.
When reading the accounts as a whole, it is the similarities, rather than the differences, that jump out. Lucas and Nacer (2015) tried to identify the behaviours that are important to improvement work in health care. The present book provides an opportunity to look at themes recurring in many and varied accounts of Lean work in different settings.
Assertions on the nature of Lean are common – “Lean is about efficiency” or “Lean doesn’t touch on errors or variation,” for example. By contrast to these incorrect broad brush statements, this book’s contributors are remarkably consistent about the nature of Lean. Authors unite around a focus on value to the customer; reduction in waste; attention to flow, reducing errors and delivering quality. Unlike the statements on some book jackets and websites, the contributors see no conflict between efficiency, quality improvement and error reduction.
The accounts are also united in rejecting the common notion that Lean is a set of tools that can be picked through as required, with other aspects being ignored. To obtain and maintain significant improvement, the way organisations are managed, and the way organisations engage their staff, are also essential elements of the approach. Quite a few authors described their experiences in organisations that treated Lean as another blade on a Swiss Army knife, to be pulled out for a particular problem. Most contrast this with the greater improvements gained by organisations that took a whole system approach to Lean.
Several authors go on to argue that Lean techniques are of limited value if they are applied by rote. Examples of enthusiastic but unhelpful application of 5S are often discussed, and some examples are given in this book. Clarity on the purpose of methods is important, rather than seeing them as ‘must dos’ that have to be applied relentlessly in every situation, regardless of context.
People who see Lean as a collection of techniques might find it surprising that authors generally make only passing mention of particular methods within Lean. This relates at least in part to the widespread discussion of the engagement of people, and the attitudes that support it. The technique that seems to come up with the greatest frequency is one of the most basic: improvement cycles. In several chapters, the contributors emphasise the value of rapid cycles of change, measured appropriately and compared to the original predictions. One author notes the value of running experiments “for the sake of learning.”
Mark Graban gives examples, separated by a decade, of people in industry and in healthcare telling him that they are “expected to check our brain in at the door.” This is a terrible waste of human potential and expertise and, across the board, the Lean practitioners in this book reject it. Rather than seeing staff as people who don’t care, don’t try and do as little as possible to get through the working day, their experience is of people who want to do a good job, and often blossom as soon as they are given the chance to express opinions, look for solutions, and make changes to their work for the benefit of their customers.
Several authors used variations on the Toyota theme of “go and see, ask questions, show respect.” People working in industries or services are not unthinking automatons who just need to do what they are told. When harnessed, the experience and enthusiasm of staff can make an enormous difference to error identification, problem solving and the delivery of quality.
This isn’t to say that everyone will embrace Lean. The case studies make it clear that some people in organisations don’t enjoy the approach, or have a career that has developed in such a different system that they do not manage to make the leap to a new approach. This doesn’t make them bad people, and several chapters illustrate how the same person who is initially hostile to Lean may become a convert over time. For some people, this doesn’t happen, and they may decide to move to an organisation with the more traditional approach that they find more sympathetic to their views. Again, this decision needs to be treated with respect.
Combined with respect for staff, most authors counselled humility. People who discover Lean often become very enthusiastic indeed. In the urge to help improve systems, it is easy to slip from respect for staff in to a more directive approach. This is discussed further in relation to coaching, but also comes up in the context of lifelong learning. Despite decades of experience in some cases, contributors are generally reluctant to describe themselves as experts. This seems to be because they know what they don’t know. Many chapters describe learning Lean as a lifelong process. There are always things to learn, and people to learn from.
Taught courses are important, but mentoring, on the job training and practical experience are all discussed by various authors. Conferences, site visits, podcasts, books and videos all feature in the accounts of different authors. The overall impression is of a widespread acceptance that you never “know” all of Lean, and that you can always learn something new. This book is an example of that process.
Go To The Gemba
Theory is a wonderful thing. Scientist use theoretical frameworks, as long as they are useful for a particular problem – but another group of scientists, or sometimes even the same scientists, actively try to disprove the theory. In management, where this second group may not exist, it is easy to treat theory as fact.
Theories on what happens in a factory or service, what problems occur, why they occur and what approach might improve the problem, are common. In Lean, the chapter authors assert, you need to go to see what is happening, rather than to assume that you already know. Learning to see is not easy, but you can learn the skill, particularly if you combine it with respect for people.
Management consultancy models, where an expert comes from outside, looks at your processes, and tells you what to do, are common. In some cases, it even works to help with a particular problem. The challenges from this model are that changes may not be implemented; when they are implemented, and have an impact, they may not be maintained, and that it may do little to prepare your workforce for the next problem they encounter, other than to teach them that they need an expert to come to sort it for them.
In the descriptions in this book, by contrast, contributors do not paint themselves as heroes who fix a problem. In some cases, they understandably started out with this approach in their enthusiasm to spread Lean methods, but without exception, they moved to an approach where they seek to help people develop their own problem analysis and problem solving skills, using Lean methods. This relates back to the themes of direct observation – the people who do the work generally know what is happening – and respect for people. The experience of many of the authors is that if you support people in developing the skills in on the job coaching, then they can continue to make changes over time, and in turn can become coaches in their own right, who demonstrate a way of working to their own colleagues.
Workplace culture is a theme in several contributions. Organisations develop ways of doing things, and people often have a collective view of what has been tried, and what has worked, in the past. If respect for people is lacking, and workers are not expected to notice problems or contribute ideas, then it can be very difficult to persuade people that anything is going to change. The things that managers pay attention to are usually the things staff prioritise.
A learning culture, where people identify problems, and tackle them without fear of being blamed, is an important asset. If you don’t know where the problems, are, it is very difficult to tackle them. In a workplace where people are asked for ideas rarely and where most management attention is associated with problems, and probably criticism, beginning to move the culture to a willingness to talk about problems, discuss solutions and try things out can be challenging.
Several authors discussed this, including identifying quick wins and starting small with staff ideas, rather than tackling a huge issue straight away. Other people report working on major issues from the start, but usually where they can obtain good management commitment to change, and to the use of the relevant methods.
The book contributors come from diverse backgrounds, and work in many different settings. What unites them is stronger than what divides them. A commitment to core ideas on Lean, respect for people, understanding that no matter what you know, there is always more to learn, and that people achieve more when you support them to learn, are common themes in these accounts.
The authors report working in organisations with different degrees of receptivity for Lean ideas, and the accounts indicate that some organisations find it easier than others to adopt Lean. The cross-setting applicability of the ideas are clear. While detailed approaches vary by setting and organisational context, the importance of career long learning in lean comes across. By sharing experiences, we can see ways of getting better at Lean, together.
Lucas B, Nacer H. (2015) The Habits of an Improver. London, The Health Foundation.