If you don't have time to watch the video, we have summarized the second half of that episode right here. You can also read the summary of the first half of that episode on our blog here.

From Project-Based to Frontline-Focused Continuous Improvement

Questions from the healthcare industry seemed to be prevalent in this episode of Ask Us Anything, one of them asked by Jim, who works in a hospital that practices Lean and continuous improvement exclusively in projects. Jim said he believes the goal of his organization is to get improvement to the frontline sometime in the future, and asked how his organization can move from a project focus to a frontline and individual focus.

Graban said that he has been coaching an organization outside of healthcare that has been doing what they call continuous improvement projects for 20 years.

“The problem is, these projects would drag on for months, if not years. They were hardly continuous. They were improvement,” Graban said.  As he explained, organizations that have developed a culture of continuous improvement all seem to balance big projects, strategic initiatives, frontline involvement in identifying and solving small improvements, as well as mid-level Six Sigma, Green Belt projects, rapid improvement events, Kaizen events, etc.

“I think it’s ‘all of the above,’ and you use the right mode of improvement for the right problem,” Graban said. “And I think the other point I would make is that whether it’s projects or small improvements, hopefully, it’s all still a PDCA or PDSA (Plan, Do, Study, Adjust) type process.”

“There needs to be a realization by an organization to really make movement in this area, and that realization is that 80% of the improvement potential of the organization is sitting at their frontlines doing bottom-up work. That 20% at the top can be found when you execute top-down work really well,” Jacobson said. When an organization comes to that realization, the next step is changing minds, and the best way to do that is to find common ground, he explained.

“I think that you can certainly change the mind of an organization, but it’s going to take some of the fundamental building blocks of changing the mind of an individual,” Jacobson said.

Graban related that point back to the organization he has been coaching, who put some effort into thinking about how they were going to communicate the shift in improvement strategy.

“They had executives involved, communicating the desire, the expectation, the belief in employees; that they could create a big difference though many, many small improvements,” Graban said. “Striking a balance, they didn’t want to beat themselves up for their old approach, but there was a recognition that things had gotten too bureaucratic and improvements that were small, weren’t really posing any sort of filter to be selected for a big project. So, executives and their process improvement team have been communicating with employees, they’ve been doing some pilots doing proof of concept to show that people will participate and that it will make a difference, and now we’re at a point to talk about some rollout strategies.”

In terms of rollout, Jacobson pointed out that in learning how to develop a culture of continuous improvement at various organizations over the years, KaiNexus has realized that organizations are typically doing one of five things, and they ultimately need to try to do all of them to develop that culture. The five things Jacobson listed were:

1. Bottom-up improvements
2. Top-down initiatives
3. Strategy
4. The teaching of Problem Solving Skills to leadership and those who are interested in learning them
5. Ensuring KPI’s and data is front and center so that everyone can see the level of progress

Jacobson added that an organization doesn’t have to start with all five, and he certainly hasn’t seen any organization doing them all perfectly at the start, but all five should be the goal.

Daily Huddle Across Large Spaces

It wasn’t a goal, but rather a mandate that led to the next question Graban and Jacobson answered in this episode of Ask Us Anything. The question came from Amanda who works at a hospital that is attempting to implement Lean throughout and has made a mandate that every unit in the hospital do daily huddles. She works in IT, in a unit of business system analysts with varied duties and offices across town from each other, and asked how her unit can accomplish the daily huddle task.

Jacobson was quick to offer the obvious answer, which of course is technology, like KaiNexus. He explained that there are five needs technology—whether it’s paper, SharePoint, Excel, or some other recording technology—must meet. Technology must help with collaboration, help with visibility, help measure the impact, become a knowledge repository, and help develop a standard.

“For collaboration and visibility, it is so obvious that you need a digital solution when you’re talking about distributed teams. And in fact, what we’re now realizing that becoming more connected has created this opportunity where people are able to do work in distributed teams much easier than they could even five or ten years ago,” Jacobson said. “We have numerous examples of customers that are doing daily huddles using KaiNexus.”

“I mean there’s a problem to be solved, not just distributed teams, but people working multiple shifts who don’t really cross paths. How can you huddle not just across separation of distance, but separation of time?” Graban added. “For years, I’ve seen people have their shift pass-down log, where it’s a physical binder and they’re writing things, but we can maybe replace that with technology that’s more effective in different ways.”

Graban also added that he had another concern about the question, which was the idea of a mandate to hold huddles.

“I’ve seen people get off track when they put the tool before the purpose,” Graban said.

A mandate like everyone must have a board, everybody must do a huddle, everybody must have metrics, or everybody must log into KaiNexus, isn’t helpful if people don’t understand the purpose and have a connection to what problem they are solving and how it will make their work-life better. Without that connection you might get compliance, you might get people going through the motions, but that is all, Graban said.

“When phrased as a solution, or a countermeasure to a problem that people care about, I think that’s what leads to success,” Graban added.

Compliance Issues and Project Scope

The final question answered in the webinar came from Yevette who wanted some tips to deal with a specific scenario. She asked that, while understanding that employee engagement, honesty, openness as well as management buy-in of the continuous improvement and Lean process are important, what should be done in a scenario where an ongoing continuous improvement project revealed non-compliance issues that management want to exclude from the scope of the project?

Graban’s first reaction was to hope that someone has another mechanism to solve the non-compliance problem, even if it’s outside the project work.

“If there are issues or scenarios where there’s non-compliance with the standard process, and that’s creating the risk of harm or other sorts of problems, you might say we can’t expand or can’t have scope-creep of this project, but there’d better be a process for getting that addressed some other way,” Graban said.

“When I see and I hear noncompliance, my initial thought is, ‘Why?’ Jacobson said. Is the standard they’re being asked to do not providing any value to the customer? Are people overworked? Do they not know what they should be doing?

“And then, I think there needs to be an emphasis, once the standard is set and agreed upon by everyone, there has to be really good messaging of why.”

Jacobson explained that often when there are issues of non-compliance one of two things are found to be the cause:

1. The thing needing to be complied with is no longer relevant to the work as it’s done now.
2. People don’t know what the standard is.

“A perfect example happened at KaiNexus two weeks ago. I mentioned we have a very particular way we do meeting invites, where the word ‘KaiNexus’ comes before the word ‘customer.’ When the prospective customer looks at their invitation calendar, often times the title gets truncated, so we try to make sure ‘KaiNexus’ is first. It often makes it more difficult for us if we’re looking at a view of the calendar, but there’s a very customer-centric thought process behind that. One of the newer people—they hadn’t just started, but started about a year back—said, ’I had no idea we had a standard.’”

Once Jacobson explained the "why" behind it, it was no longer an issue. KaiNexus also put it into the employee onboarding process to prevent the non-compliance from happening again.

As Graban summed up, “It’s not bad apples. It’s not people not wanting to do their job properly. But I’ve seen so many instances like [the KaiNexus email example], where people thought they were following the procedure and it turns out they really weren’t. That’s system issue, that’s a training, communication, supervision issue, and important things to address.”

Coming Up Next

The next installment of Ask Us Anything is scheduled for October 17, 2017. You can register for that webinar here. Until then, you can check out the back episodes, in full, here.