Posted by: Knightbird | September 24, 2011

Sustaining Improvement

I had a conversation with the Alaska Native Medical Center’s relatively new Hospital Administrator this week. For the first time in 8 years, I heard that there are in fact problems with performance at the hospital. This was refreshing. As I have said to my staff, until we can learn to admit the defects that occur, stop blaming co-workers for the defect and immediately work to correct the defect, we will not improve. It was acknowledged that communication was often lacking, there were silos in the organization and a lack of standard work. The first steps towards improvement are being taken.  Now we just need to see if this administrator lasts. In my 8 years at Chugachmiut, we have had 5 hospital administrators and are on our 3rd ANTHC CEO. There was one interesting comment from this administrator: he commented that sustainability was a potential problem, and with good reason. Few if any improvements have been sustained in the past 8 years.

So here is my take on sustainability: give your employees a dream they can believe in; teach them the tools of lean (along with teamwork, communication and honesty); and give them the responsibility and authority for continuously improving the value streams they work in. Then hold them accountable with a transparent performance reporting system that do not blame and shame.

My feelings about command and control management have been discussed previously. I have also contrasted this method with a six-sigma method in the past. Now, I am known as a six-sigma basher at the Alaska Native Tribal Health System. I have not come to this view without considerable thought and reflection. The tools of six-sigma are fine. But think about this. You create a hierarchy of employees and assign them projects. They are the bosses to whom everyone defers and reports to. They have supposedly extra knowledge that other employees without green or black belts do not have. The Belts are assigned the project and they are responsible for the results. Green Belts defer to Black Belts who in turn defer to Master Black Belts. If the project goes wrong, fingers can be pointed at the Belts as the reason.

Six-sigma projects also take months to complete. Some have to have executive approval. And the results are scrutinized and any improvements touted as proof of the wisdom of management selecting six-sigma and training the right people. This kind of workplace is not widely deployed without a substantial investment in Belts. Pressure is put on the projects to be successful as a sign of management wisdom and oversight. I know. I have been guilty of this.

In contrast, a sustainable workplace has every employee alert to defects and quick to address them in a standard way that they know and learn. They collaborate with others who are in the value stream. They are pursuing continuous improvement not for the sake of management, but for the sake of their customers, external and internal. They don’t need permission to improve, but are entrusted to make the improvements they can. Managers and executives are there to support the employee in the delivery of value and are quick to respond to requests for help, assistance and funding. Continuous improvement is their mantra and they are proud of the work they do and want to do it better.  They sustain the system because they are the system—they are recognized as being equally important as the resources they work with. What a system.

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