Positive Lean in Health care

8/12/2019 Positive Lean in Health care

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ROSS FACULTY

Bill Lovejoy

WORKSHOP

Positive Lean in Health Care

Bill Lovejoy

Positive Lean in Health Care


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Who am I?

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Conclusions: Challenges to lean practice

High in-group excitement, less so outside the team

Regression to past levels of performance

Project fatigue

If nothing changes, cynicism can grow

Background:

Years of project work at

UM and other hospitals

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Two MAP projects 2013:

Merge lean and POS in VA and UM hospital projects

Outcome:

Enthusiastic embrace of Lean-POS at the VA Hospital

Less so at UM

Differences:

No clear tactics, sort of a grab bag without structure

Prior buy-in by VA hospital lead was able to overcome this

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Personal Interactions

Jane DuttonProfessor of Management and Organizations

John Billi, M.D.Professor of Internal Medicine, UM Medical School Vice President for Medical Affairs

David Shaked

CEO Almond Insight, change management consultancyAuthor of Strength Based Lean 6 Sigma

Other Key References

Kim Cameron, Gretchen Spreitzer

UM Ross School of Business Center for Positive Organizational Scholarship

David CooperriderWeatherhead School of Management

John ShookFormer director UM Japan Technology Management Program

The Head of consulting firms Lean Transformations Group and TWI Network, Inc.

First, some acknowledgements

This presentation is a mash-up

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Why would a left-brain guy like me

be attracted to the Positive perspective?

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Who would you rather spend time with?

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Positive approach What is it?

Philosophical underpinnings

Tactics

What can lean and POS learn from each other?

Why especially in health care settings?

Examples from health care

Testimony from audience

Summary

Lean approach What is it?


Tactics

Lovejoy

9Lean Positive Learn Healthcare Interactive


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Lean: What is it

A set of beliefs and practices that

evolved after WW2 to help Japan recover economically,

facilitating the production of high variety at minimal costby reducing waste and employing flexible systems.

Lean Positive Learn Healthcare Interactive Lovejoy10


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History: Let a thousand flowers bloom

Taichi Ohno 19501960s in Japan, later in the US

Toyota Production System, Just-in-time

W. Edwards Demming 1950s in Japan, later in the USStatistical Process Control, Total Quality Management

Motorola 6 sigma 1980s

Process capabilities

Then combine them into a bouquet

Lean 6-sigma or just Lean



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Philosophy of lean

Lean Positive Learn Healthcare Interactive

Problems are opportunities (no problem is problem)Parameters become decision variables

Use existing resources within the organization

Workers as experts

Continuous improvement

Eliminate all waste

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Tactics of Lean



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Define (what problem do you want to solve?)

Control (disseminate, make is SOP)

Improve (test your recommendation, validate it)

Analyze (gather data, evaluation possible improvements)

Measure (what is your current state of performance?)

repeat



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The Language of Lean

Kaizen

Pull Production System

Visual management

Kanban

Bottleneck logic

Value Stream Mapping

Level production

Takt time

Genba Gembutzu

Current and Future States

5 Whys = 1 How To

Poka Yoke

Jidoka Standardized work

Muda

A3

5S

Genba Genbutsu



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An emphasis on the visual



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Tactics





Summary


Philosophical underpinningsTactics

Lovejoy

19Lean Positive Learn Healthcare Interactive


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What is Positive business research and practice?

A focus on dynamics that are typically described by words such as

excellence, thriving, flourishing, abundance, resilience, or

virtuousness

The study of phenomena associated with what individuals and

organizations aspire to be when they are at their very best.


Cameron, Dutton and Quinn. POS: Foundations of a New Discipline, 2003

Cameron & Spreitzer, 2011

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Problem!

Lets solve it!

Figure out its root cause

Eliminate it

Change SOP

Fantastic!

What did they do?

Lets figure that out

and learn from it



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Philosophy of Positive Approaches

People and organizations are already repositories of many good

things. Every person and every organization has times when theyare at their best, and those times are worthy of study and

reflection.

Organizations are dynamic and evolving, endogenously defining

themselves. The direction of that growth can be influenced

Positive meaning, climate and relationships nourish people,

generating the energy required to continue to improve, allowing for

an endogenous bootstrapping of improvements in organizations.

Small wins can lead to significant changes



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Tactics of Posit ive Approaches



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Develop Positive Meaning

1. Define people and units in terms of their strengths

2. Strengthen the connection between peoples work and

their belief that they are having a positive impact on

others

3. Diffuse positive meaning through spreading of

authentic stories where employees, management and

project teams made a positive difference for others

Tactics: POS group at UM



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Stimulate Positive Emotions

1. Actively focus on what is working and enabling desired

outcomes

2. Strive for the momentary experience of more positive than

negative emotions

3. Show gratitude

4. Recognize the link between the physical environment and

individual flourishing




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Build Positive Connections

1. Respectfully engage others; show esteem, respect and

care for another person

2. Engage in task enabling (help others)

3. Build trust

4. Engage in play




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Philosophy of Appreciative Inquiry

1. Human system grow in the direction they persistently ask

questions about. The very first questions we ask are

fateful, they determine the direction of the inquiry, and

who you will interact with.

2. Reality is co-created by people all the time

3. Every living system has many untapped, rich and

inspiring accounts of the positive. Linking the energy ofthis core to a change agenda and changes never thought

possible are suddenly and democratically mobilized.

D. Cooperrider and D. Whitney. A Positive Revolution in Change: Appreciative

Inquiry Case Western Reserve University working paper, undated.



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Tactics: Appreciative Inquiry

Determine topic of inquiry: This needs to be generative,

excites people

Discover: Organizational inquiry (interviews, anthropology)

or sometimes objective identification of high performers

Dream: Building on what is going well, what would a

wonderful future look like?Design: Generate concrete propositions about what should

happen in that future.

Destiny: Act on the propositions



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Example: Sexual Harassment consulting

Consultant concerned that years of workshops etc. have not

decreased the incidents or perceptions of sexualharassment in the organization.

What would an AI approach look like?


D. Cooperrider and D. Whitney. A Positive Revolution in Change:

Appreciative Inquiry Case Western Reserve University working paper,

undated.

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Determine topic of inquiry:This needs to be generative, excites people.

Not generative:

reduce sexual harassment or reduce lawsuits


D. Cooperrider and D. Whitney. A Positive Revolution inChange: Appreciative Inquiry Case Western Reserve

University working paper, undated.

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Determine topic of inquiry:This needs to be generative, excites people.

Not generative:

reduce sexual harassment or reduce lawsuits

More generative:

Develop a new-century organization a model of high

quality cross-gender relationships in the workplace




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Company-wide interviews by employees: study and share their stories

about what it means to create and sustain high-quality cross-gender

relationships in the workplace.

Using the stories as a basis, create propositions about what a future

would look like.


For example, Every task force or committee, whenever possible,

should have co-chairs of different genders.

This organization was eventually singled out as one of the bestplaces for women to work



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Tactics





Summary





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Work with existing resources


Similarities between Lean and Positive

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Respect for employees, workers as experts, the potential lies within them



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Envision and strive for a better future state



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Redefine problems as opportunities



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Disseminate best practices



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Emphasize learning and progress (personal and organizational)



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Emphasize learning and progress (personal and organizational)

Small wins beget big changes



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Lean Posit ive methods

Organizations are static, until we

intervene, move from currentstate to future state and stay

there until next intervention

Organizations are evolving all the

time, change is happening, soidentify and focus on positive

change

Get to the root cause. Why do

problems happen?

When and where do problems

NOT happen?


Differences between Lean and Positive

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Organizations are static, until we

intervene, move from currentstate to future state and stay

there until next intervention

Organizations are evolving all the

time, change is happening, soidentify and focus on positive

change

Get to the root cause. Why do

problems happen?

When and where do problems

NOT happen?

Knowledge and practice focus Meaning focus, and emotional

and relational climate



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Structured knowledge Tacit knowledge

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Quantitative data Narrative data

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Variability is evil Without variability in practice,

there would be no positive

deviance

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Variability is evil Without variability in practice,

there would be no positive

deviance

Questions framed in problems to

be solved

Questions framed by what is

going really well?

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Image credit: Pickycovers.com

What can Lean and POS learn from each other?

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Attention to relational aspects of human interaction


Lean can learn from Positive approaches

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Attention to the qualitative aspects of human thriving



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No problem is problem but also No celebration is problem



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No problem is problem but also No celebration is problem

Attention to an energizing and generative corporate mythology



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A systematic approach to personal and organizational

development


Positive can learn from Lean approaches

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development

A common language



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development

A common language

A more balanced address of unacceptable behaviors

(problem is problem)



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Tactics



Examples from health careTestimony from audience

Summary





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Critical national importance

Most challenging from a physics perspective

High relevance of values and ethics, no single bottom line


Why is this important inhealth care settings?


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In our complex health care system no

value is created until hands touch patients

Nurses are on the front line

Helping people at their most vulnerable

moments

Life saving

Nurses provide 24/7 care, doctors and

specialists round and leave

Example: Nursing

Photo credit: everydaylife.goalpost.com

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Nurse labor costs are frequently thelargest hospital cost, and hospital

margins are not high (3% to 5%

operating margin) so labor costs are

closely monitored

Increases in patients/nurse

Need for more flexible nursing hours

= more disruptive schedules

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Emotionally draining

Physically exhausting

Unpredictable work schedules

Life and death situations

Moral and ethical challenges

Many nurses have left the professionPhoto credit: blog.soliant.com

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Photo credits:

bls.gov

everydaylife.globalpost.com

Yet every day millions of

people receive excellent

treatment through the healthcare system

So there is ample opportunity

to learn from what works



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Tactics





Summary



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I. Develop Posi tive Meaning


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1. Define people and units in terms of

their strengths

2. Strengthen the connection between

peoples work and their belief that they

are having a positive impact on others

3. Diffuse positive meaning through

spreading of authentic stories whereemployees, management and project

teams made a positive difference for

others.

II. Stimulate Positive Emotions

1. Actively focus on what is working and

enabling desired outcomes

2. Strive for the momentary experience

of more positive than negative emotions

3. Show gratitude

4. Recognize the link between the

physical environment and individual

flourishing

III. Build Positive Connections

1. Respectfully engage others; show

esteem, respect and care for another

person


3. Build trust

4. Engage in play

The student team identified the strengths of the

pharmacy unit as well as causes of current

problems.

Conducting such an appreciative inquiry into

what the unit was doing well enabled them to

see the student team as individuals who

recognized their value.

This helped the staff imagine new and attractive

possibilities for the future.

The student team believes that this effort paid

significant dividends in the level of cooperation

and engagement they received from thepharmacy.




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their strengths







others.






3. Show gratitude



flourishing




person


3. Build trust

4. Engage in play

When assembling surgical kits, nurses who met

the healthcare practitioners who would use the

kits worked faster and made fewer errors thannurses in a control group who had no beneficiary

contact.

When the patients photo was included in

their file, radiologists achieved 46 percent greater

diagnostic accuracy in scanning exams.

Hearing a patient talk for an hour about

experiences with treating a disease significantly

increased pharmaceutical employee engagement

scores on a survey two months later.

Ref: Outsource Inspiration by Adam Grant, in

How to be a Positive Leader: Small Actions Big Impact

by Jane Dutton and Gretchen Spreitzer.




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their strengths







others.






3. Show gratitude



flourishing




person


3. Build trust

4. Engage in play

The student team uncovered individuals personal

motivations for working in the VA system was the

opportunity to help the veterans who fought forthe country.

Approximately one-third of interviewees were

themselves veterans.

Talking about this helped strengthen theconnection between pharmacy employees

personal mission and positive impact on others.

The student team recommended that

management accentuate veteran assistance in

their mission.




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their strengths







others.






3. Show gratitude



flourishing




person


3. Build trust

4. Engage in play

The VA student team received feedback from their

hospital sponsors about the positive difference

they were making through their work.

The story of how the head of the pharmacy

division was emotionally impacted by the first

team presentation was repeated, and kept the

team motivated, throughout the project.




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their strengths







others.






3. Show gratitude



flourishing




person


3. Build trust

4. Engage in play

The pharmacy student team recommended daily

huddles in the pharmacy, not only to shareinformation but also to institutionalize expressions

of gratitude on a regular basis.

The team envisioned a daily huddle that would

start with each person sharing - one at a time-

what they are grateful for, or what they arecelebrating that week.

In addition, this tactic would provide some

motivation for staff to notice positive cues around

them.


I. Develop Positive meaning


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their strengths







others.






3. Show gratitude



flourishing

III. Build positive connections



person


3. Build trust

4. Engage in play

Before their first presentation, the student teamactively worked to put themselves in the shoes of

the front-line staff and empathized in a way the

staff could feel.

The result was, in their first presentation, members

of the staff were visibly moved, recognizing thatthis team gets it and understands their lives.

The staff could feel that the MAP team understood

them which increased their willingness to share

information and facilitate the projects progress.



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Tactics





Summary



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Still Evolving

What works and what does not?

What are best practices?

What specific tactics work when merging Leanand POS in health care settings?

How about you?

Share your experiences!

Positive Lean in Health care

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