Build the Problem-Solving Muscle of the Organization
Education is the most powerful weapon which you can use to change the world.
—Nelson Mandela
Training for professional skill and leadership development is by far the most important element in engaging employees while they experience change during an organization’s transformation journey. In today’s business environment, organizations across industries have realized the importance of training employees in creative and innovative approaches to problem solving as important skills for success. Some of the organizations are not just solving problems creatively, but also defining, measuring, and analyzing problems innovatively. To give an example, a hospital measured lead time for their emergency department admission process in “5D’s”: door (arrive in ED) to doctor to decision to done to depart (admit to unit).
Hospital Heal trained their staff in creative and innovative approach to problem solving using the Simplexity Thinking System, whose developer, Min Basadur, says, “Developing people in creative problem solving makes people better at finding problems. That may sound odd until you consider that innovation requires new solutions—and new solutions require anticipating problems, changes, trends and opportunities.” “Every act of creation is first an act of destruction,” said Pablo Picasso.
Creating a plan with a five-year time horizon provides a big-picture view to the organization in terms of who would be trained, what they would be trained in, and how much budget would be required. The plan allows leaders to do workforce planning for scheduling and backfilling key positions, and getting their commitment on resource availability for training and development. The number of people and their frequency of training over the five-year period, however, depends upon what objective the organization wants to achieve in the end. Table 20.1 shows an example of a training plan for engaging employees in the transformational journey undertaken at Hospital Heal.
In Table 20.1, Year 0 represents the year dedicated to establishing foundational elements for the excellence journey, part of which included site visits to other best-practice hospitals, as well as grooming the core team and the value stream coaches (Figures 20.1 and 20.2).
Figure 20.1 Core team and value stream coaches trained at Hospital Heal.
Figure 20.2 Core team and value stream coaches leading a session at Hospital Heal.
A word of caution for organizations who define success by only measuring “number of employees trained” in a particular period: in my experience, the number of employees trained, by itself, is a very weak metric because it fails to inform the impact on organizational performance. Therefore, it is best to support the training metric with other measures such as “% staff trained who led at least one project,” “number of ideas generated/implemented,” “amount of time/dollars saved,” or “percent increase in time spent in value-added activities,” etc., each of which can be measured at an individual or team level.
As mentioned in Chapter 6, the central core team at Hospital Heal was comprised of individuals that had expertise in the knowledge areas listed in the Business Excellence Model (Figure 6.3). The value stream coaches, on the other hand, were full-time dedicated resources from frontline operations that were seconded for a period of thirty months to undergo training with the core team for an initial period of six months and then facilitate change in the operational areas of clinical, mental health, and corporate, for the remaining period of twenty-four months. The intent was that upon completion of their tenure, the individuals would assume leadership roles in the organization and new value stream coaches would replace them.
The rigorous in-house training provided to the core team and value stream coaches included self-study, in-class sessions, practical simulations, and hands-on real applications. (Note that ISO 18404:2015 has now come up with uniform standards to certify both organizations and individuals in either Six Sigma, Lean, or both.)
Among many definitions of Lean, the one below resonates with me the most.
Lean: A mindset of continuous improvement. It’s a system that empowers people at all levels to remove waste and maximize what is of value to the customer. In the healthcare setting, the customer is the patient.
Don Drury, former VP of Merrill Lynch, defines quality and business quality as:
Quality: The realization of value entitlement
Business Quality: A state in which the customer and provider realize the mutual gratifying exchange of value
Learning through Visuals: Figures 20.3 through 20.26 and Tables 20.2 through 20.12 are select examples, worth sharing, of education content from Lean Thinking that I developed over the years, collected from conferences I attended, or stole shamelessly from other best-practice organizations that I visited (remember, do not reinvent the wheel).
Figure 20.3 Alternate approaches to problem solving.
Figure 20.4 Six Sigma approach to problem solving.
Figure 20.5 Six Sigma differentiates “vital few” from “trivial many” variables.
Figure 20.6 The five principles of Lean.
Figure 20.7 The strength of Lean Six Sigma combined.
Figure 20.8 Seeing things differently.
Figure 20.9 Classifying activities using the Lean lens.
Figure 20.10 Kano model for understanding the voice of the customer.
Figure 20.11 Steps for creating a problem statement.
Figure 20.12 Creating a value stream map using the PPIM approach.
Figure 20.13 Example of a demand map of patient flow through the ED at a hospital.
Figure 20.14 Example of a length-of-stay (LOS) map of patients in their journey.
Figure 20.15 Illustration of a standard operating process.
Figure 20.16 Example of a 5 WHY analysis to understand the root cause.
Figure 20.17 Example of a fish bone analysis to understand cause and effect.
Figure 20.18 Creating an environment that has a place for everything and everything in its place.
Figure 20.19 Example of an unbalanced line and its pitfalls.
Figure 20.20 Cell design to promote single piece flow.
Figure 20.21 Cross train to build capacity and improve workflow.
Figure 20.22 Application of visual management.
Figure 20.23 Kanban and supermarket tools support the pull system.
Figure 20.24 Visually managed buffer beds in healthcare support the pull system. (From Baker, M., I. Taylor, and A. Mitchell. How to improve patient care while saving everyone’s time and hospitals’ resources. Making Hospitals Work. Lean Enterprise Academy Limited, May 2009, p.168.)
Figure 20.25 PDSA scientific thinking: continuous-improvement cycle.
Figure 20.26 Summing up Lean Six Sigma tools in an A3 thinking template.
Table 20.2 Six Sigma’s Breakthrough Equation: Output (Y) Is a Function of Input Variables (X’s)
Table 20.3 Six Sigma Roadmap to Process Improvement
Table 20.4 Impact of Lean Application in Healthcare
Table 20.5 Eight Types of Waste Explained Using the Acronym “DOWNTIME”
Table 20.6 Project Charter Template
Table 20.7 Example of Creating a Problem Statement for Readmission of Patients
Table 20.8 Identifying Stakeholders Using SIPOC
Table 20.9 Creative Use of SIPOC Tool for Understanding the Big Picture
Table 20.10 Data Collection Methods
Table 20.11 Collaboration Request Template Used as a Service Level Agreement (SLA)
Table 20.12 Activities in a Rapid Improvement Event (REI)
Sensei Gyaan: Switch to in-the-moment training and coaching as compared to full-day classroom training sessions. For in-class training, it is recommended to have a maximum mix of 40% theory and balance as a practical application of the learning. Offer training only to individuals who have a real problem to solve. Do not entertain employees who want to attend training to get certified in Lean Six Sigma, or who claim to learn something new by attending. Set clear expectations with those who receive the training that, as a part of their graduation, they will be required to see one, do one, and teach one.