Your employees are finally submitting improvement ideas. The next risk is that the flood dries up into an idea desert. Mark Graban and Dr. Greg Jacobson, hosted by Ron Pereira of Gemba Academy, talk about what to do next.
[DRAFT: key topics and cleaned-up transcript to come]
Presenters: Dr. Greg Jacobson, co-founder of KaiNexus, and Mark Graban. Host: Ron Pereira, Gemba Academy. Recorded July 2014.
This transcript has been edited for readability.
Ron Pereira: This is Ron Pereira with Gemba Academy, and welcome to another webinar. Today we're visiting with our friends from KaiNexus, Mark Graban and Dr. Greg Jacobson. Greg is co-founder and chief product officer of KaiNexus. He graduated from Washington University in St. Louis, attended Baylor College of Medicine, and completed a residency in emergency medicine at Vanderbilt University Medical Center. After reading Masaaki Imai's book Kaizen, Greg's implementation of Kaizen principles at Vanderbilt led to a software tool that ultimately led to the founding of KaiNexus. Mark is VP of Innovation and Improvement Services at KaiNexus, author of Lean Hospitals, co-author of Healthcare Kaizen, and founder of LeanBlog.org. I'll be back at the end for Q&A.
Mark Graban: Thanks, Ron. Great to be here. We're sitting side by side, so this will be interactive, and hopefully fun and thought-provoking. Please send us your questions through the chat box, because we'll have Q&A time at the end. Some people submitted questions in advance, and we've built those into what we'll cover.
Mark Graban: Today's theme is good news, bad news. Congratulations: you've started an idea program, a suggestion system, a Kaizen initiative, or a Lean program, and you have lots of employee ideas. Now what? It's a great problem to have. We asked for ideas, and now we have a ton of them. What do we do?
Mark Graban: In a lot of organizations, it really is a wave -- a flood of ideas. There's pent-up energy, and ideas come crashing forward. As a leader, that wave might look a little scary, like something that could crush you. I've seen organizations get a couple of ideas per person in the first week, 25 or 30 ideas in a hospital department. We don't want that wave to turn into a drought, an idea desert where the flow of ideas has dried up. That's one of the things we'll talk about today.
Mark Graban: Even before the wave, the starting point may be a desert. In manufacturing and healthcare, you might have 20 years of history where nobody has been asked for their ideas. But the ideas are there, like water just under the surface. If we figure out how to tap into that spring, the water comes flowing out. We've both found that the bottleneck in idea generation is never a lack of ideas in people's heads. They're just not being engaged.
Mark Graban: So we might start with a desert, then get a big wave of ideas. Better yet, since that wave looks scary, can we turn it into a calm, steadily flowing river, where ideas keep coming forward and flowing through an implementation process that makes people happy and excited and leads to more ideas?
Mark Graban: We use the word journey a lot in the Lean world, and we have to work at it. It won't happen overnight or in a month. You can't run a month-long Kaizen program and think you've created a culture that will magically sustain itself. It takes effort, discipline, and consistent leadership. If you engage people and ask them to identify problems and ideas, you will get a flood of ideas. That's a nice problem to have, and one we can deal with.
Greg Jacobson: If there's one thing you take away from this hour, we'd love to see everyone become a stream. We'll talk about how to handle that initial wave and how to prevent the desert.
Greg Jacobson: Over the last decade of working on continuous improvement, we've learned that organizations everyone would describe as having a culture of continuous improvement have three things in common. They're in no particular order, but it's probably not an accident that we list effective leadership first. Without leadership that supports, promotes, and talks about continuous improvement, the rest of the organization will never start. And note that we say effective, not that leaders need to spend 100 percent of their time on it. This isn't something that overwhelms a leader. It's a few minutes each day of beating the drum.
Greg Jacobson: Second, they use some kind of methodology. It's probably no surprise, since Mark wrote Lean Hospitals and our company is named after the word Kaizen, that we subscribe to many of those views. But if your organization is focused on A3s, PDSA, or Six Sigma, that's great. What matters isn't which methodology. What matters is that it's done in a systematic way and doesn't feel like the flavor of the month -- that you dig in and say, this is how we do things.
Greg Jacobson: Third is some kind of enabling technology. As organizations get larger and have multiple sites, and try to spread this work across the whole organization, today's technology can make that a lot easier.
Greg Jacobson: It makes a lot of sense to apply the PDSA mindset to implementing continuous improvement itself. You don't want to have the idea on Monday and start that afternoon. You want to do some planning and get people on board. Then, once you start implementing your system, you need to be constantly reflective: we're doing this now, so let's study it. What can we tweak? What can we do better? Then adjust, and repeat the cycle over and over. You apply PDSA to the small things you're improving, but don't forget to apply it to the system of improvement too.
Greg Jacobson: What we see a lot, Mark, is people getting stuck in the P. They've been planning for months -- talking, meeting, coordinating, and planning some more. That's not a cycle. You can't learn until you do. Going back to the wave analogy, unless you're an expert surfer, you'll watch the waves and study them a bit, but eventually you have to say, "I'm taking this wave," and adjust from there.
Mark Graban: If you surf, you'll try a wave, fall off, hopefully not hurt yourself, learn from it, and do better. Sometimes people get hung up on not starting until they know it will go perfectly, and nobody can get started that way. There will be little mistakes.
Greg Jacobson: The longer you plan, the more weight gets put on it. It's like standing on the edge of a diving board, thinking about everything that could go wrong, until you turn around and walk off. You'll never attain perfection at the start. You get better over time, especially if you're studying what you're doing and adjusting. Do some planning, but start and move forward.
Mark Graban: In the beginning, before the big wave, it might start as an initiative: we want your ideas, we want you to identify problems and opportunities for improvement. If the initial enabling technology is a bulletin board and note cards, it might look like this real picture from a transplant institute I worked with. In the first two days, they generated 20-some ideas. Some were in the new ideas column, some were already being worked on, and for some there was good agreement that they were ready to do.
Mark Graban: One important thing, early on and on an ongoing basis, is to talk with people about their ideas and the problems they see. Don't let things sit on the board, which would just be a more visual suggestion box where things sit for weeks or months. We want visibility, because it puts some positive pressure on us to move things forward. Again, the bottleneck isn't a lack of ideas. When you ask people, they might shrug, or they'll say, "Wow, you're finally asking me. Here are five things I'd like to be involved in."
Mark Graban: Here's a chart from KaiNexus for one of our manufacturing customers' first 60 days. The blue line is submitted ideas, and it's pretty much linear. That's their initial wave. What's important is that the red line, ideas completed and implemented, doesn't lag too far behind. There's a slightly growing gap, which is probably an early point of learning and reflection. It's good they aren't letting ideas sit forever, but maybe they're a bit overwhelmed because submissions are rising faster than completions.
Greg Jacobson: Here's another customer where the wave was bigger. They opened the floodgates, and you get a really steep blue line. How do you get to the river? Don't get overwhelmed. The behaviors we're about to discuss create that nice, steady stream, which is what we're really looking for. We're not looking to do this for three months and stop. We're looking to do it forever.
Mark Graban: Sometimes there's an initial burst of pent-up ideas, and then you reach a steady state. Sometimes you see a continued linear progression, where it started as a steadily flowing river and they maintained it.
Greg Jacobson: But not handling the wave correctly -- and we've seen plenty of patterns of people handling it correctly -- ends up like this, where it flatlines. That's when it becomes a desert. So how do you go from the wave to the river without plateauing into the desert?
Mark Graban: When we start asking people for ideas, there's a question that almost always comes up in the first couple of days or the first week. Nobody asks whether the Kaizen approach is going to work. They ask some version of, "How do we know our leaders won't get bored with this?" They've been through programs of the month. They've seen leadership get excited about something and then let it fade after a couple of months. If they're going to jump into the pool, they want to make sure management won't drain it.
Mark Graban: To prevent the idea drought, which both leaders and employees should be concerned about once we've set the expectation that we want everyone's involvement, there are five things we'll cover. First, discussing ideas constructively and collaboratively with employees. Second, prioritizing ideas, and challenging whether that's even necessary. Third, assigning responsibility for improvement work. Fourth, creating time for improvement. Fifth, tracking improvement. We want ideas to keep flowing to implementation instead of hitting a dam.
Greg Jacobson: The concept underneath all of this is building trust. How do you build trust with frontline employees so they know the leader won't drain the pool, has their back, and that this will become something you do continuously? A lack of trust is one of the key reasons people won't let an idea come out of their head and through their mouth. They'll hold on to it until they know it's safe.
Mark Graban: Discussing ideas starts with asking for them, and asking in the right way. We want to engage and even inspire people. We want to talk about why improvement is important, what challenges we're trying to solve, and what goals we're trying to reach.
Greg Jacobson: That's where coaching comes in. We're not looking for really expensive, high-tech solutions. We're looking for small, low-cost things people can control in their own area. Coaching them in that direction leads to success for the ideas they bring forward.
Mark Graban: We covered this more in the 25 leadership behaviors webinar in the Gemba Academy library: asking not for big, huge ideas, but for smaller improvements that matter, especially at first. We also can't just demand improvement or set a quota. If we go in heavy-handed and say, "Our organization is broken, and you all need to do two improvements this month," people will focus on the quota. They might pick small, insignificant things just to say, "I did my two. Get off my back."
Greg Jacobson: Or they'll hold something back: "I have three ideas, but I've got a quota next quarter, so I'll save one."
Mark Graban: You can get a lot of improvement without targets and quotas. And to engage people, we can't ask only for cost reduction. We're not asking for big, million-dollar ideas, and we're asking for more than lots of small cost savings. We need to talk about all the things that matter to people.
Mark Graban: One question that came in advance: what's the best way to motivate people to submit a Kaizen idea, and how do you handle "what's in it for me"?
Greg Jacobson: The approach I've found most successful is simply asking people what frustrates them at work and what's important to them. Intrinsically, people want to do their jobs better. I'm an ER doctor. If you ask a tech, a nurse, or a doctor whether they want to provide the best possible patient care, the answer is absolutely. That's why they went into this line of work. And people hate inefficiency. I tell people that if you're frustrated at work, there's probably an underlying opportunity for improvement. Stop for a second, and instead of letting that frustration be negative -- and negativity spreads -- jot it down, even if you don't have the solution. Turn that negative energy into something positive. People love talking about themselves and making things easier for themselves. So just ask: we want to make your work easier. Tell us.
Mark Graban: You can tell Masaaki Imai's book is on the shelf above Greg's shoulder. Starting with what matters to you -- what's in it for me -- needs to align with what's in it for customers and the organization. That requires underlying trust. People need to be confident they can bring ideas forward without it leading to them or others losing their jobs as a direct result. We want shared alignment. Things that motivate people and make the workplace less frustrating might also lead to cost reduction.
Greg Jacobson: It's not a "might." We've seen it over and over. We know the patterns and the outcomes.
Mark Graban: We've found it's very important to talk not just about ideas, but about problems and ideas, or opportunities and ideas. The card Joe Swartz and I wrote about in our book has a spot for the problem and a spot for the idea. It's not a suggestion box slip that just says, "What's your suggestion?" KaiNexus has similar prompts: a title for the opportunity for improvement, a description of the opportunity, and a box for a proposed solution, which is optional. We want people to bring problems forward even if they don't know how to solve them, because then we'll discuss them as a team.
Greg Jacobson: That's where the systematic methodology comes in. We're not implementing a suggestion box. A suggestion box is very accept-reject. When you're building a culture of continuous improvement, the initial opportunity, idea, or problem is just the beginning. When you move to a committee that votes ideas up or down, you create something that won't be sustained. In those suggestion systems, the implementation rate is very low. They get a flood of ideas and implement a couple out of a thousand, and that kills things. Successful organizations implement 80, 90, or 95 percent of their opportunities for improvement.
Greg Jacobson: That collaborative process is about discussing and proposing countermeasures: maybe we can't do this, but what about that? Often you bring up a problem, I say, "That's a real problem, and I don't know the solution," and when we bring it to the team, someone else has the answer. That creates behavior that sustains.
Mark Graban: That might be a manager coaching an employee one-on-one or a team meeting reviewing ideas in their system. This work is very rarely a solo activity. Even when the workload is distributed, there's still collaboration. And we see very positive cycles. The more discussion we have -- "Thank you for your idea, we're working on it" -- the more ideas are generated. That's not just a loop of more talking. More discussion leads to more implementation, more people get involved, and implementing ideas leads to more ideas. We build momentum and energy. There's nothing magical here. We've seen this cycle time and time again.
Greg Jacobson: Notice we put "bad ideas" in quotes. The worst way to handle one is to ignore it and never respond. That's the last time that person will engage in improvement. The next worst, which is still in the red category of things not to do, is to just say, "No, we're not doing that."
Greg Jacobson: You start moving toward sustained behavior by explaining: we can't do that because of X, Y, and Z. In the emergency department, there might be a big redesign or a new wing being built, and someone has an idea that relates to the old system when there's a huge change coming next week. That's a good example of explaining why you can't do it now. But what really leads to more improvement is going back to the person who identified the problem, taking it to the team, and asking: even if we can't address the whole problem, is there something we can do in the interim that moves us in the right direction?
Mark Graban: The key point from this section is to communicate, communicate, communicate in different ways: face to face, one-on-one, in team meetings, and electronically, especially when people work different shifts, like the ER night shift in Greg's world. We need to engage everybody and discuss ideas as broadly as necessary to get them implemented.
Mark Graban: The second topic is prioritization, and I want to challenge it. People always say, "We have this flood of ideas, so we must prioritize and decide what to implement first." I want to step back. Prioritization is a countermeasure. What's the underlying problem? Usually it's, "Too many ideas came in, and we can't implement them all this week." So we prioritize what's most impactful, the biggest cost saver, the easiest, or what ties to this year's goals. The problem is that when we label things low priority, we discourage and disengage people. They'll say, "You asked for ideas, you don't like mine, so forget it."
Mark Graban: So I challenge the general practice of prioritization, or even whether we need a PICK chart. I've never used one. It's a very common practice, and the thinking behind it is good: quadrants of high or low effort and high or low impact. What will we definitely implement? What's a challenge because it's high impact but high effort? What do we kill because it's high effort and low impact? The problem with the PICK chart is the underlying assumption that there are bottlenecks in the improvement process. Another problem is assuming a high-effort idea can't be changed. A high-effort idea doesn't have to be pigeonholed, cast aside, or killed. Instead, we can work toward alternatives that take less effort.
Mark Graban: That's the collaborative discussion process. Instead of saying, "That's too complicated, end of story," we talk and see if we can find something easier that still has high impact, or something with a little less effort and a little less impact, which is better than doing nothing. If we distribute the improvement workload more broadly and find smaller, simpler things to implement, we don't have to spend as much time prioritizing. If a team would spend an hour a week prioritizing, I'd rather they spend that hour on actual improvement.
Greg Jacobson: The problem is when the priority label becomes a pigeonhole and that's the end, rather than something that keeps moving.
Greg Jacobson: Something we see a lot in organizations moving into this mindset is the assumption that opportunities for improvement come into the system and the manager implements them all. There's the bottleneck. And not only is it a bottleneck, it's not collaborative, it's not communicative, and it doesn't empower the very people you want to empower. Instead, the manager should reach out to frontline staff, and the best person to reach out to is often the person who submitted the opportunity for improvement.
Greg Jacobson: It can't always work that way, and I've seen it become a double-edged sword, where you throw it back in the lap of the person who submitted it and they don't have the authority, understanding, or tools to implement it. But in many, many cases, you'll be amazed at how much you can involve the person who submitted it. Instead of one big arrow from the manager, think of lots of small arrows. That's a great example of why you want to coach people to look for small, low-cost, low-risk ideas. Those are things frontline workers can be empowered to do. Distribute the work.
Greg Jacobson: When you assign improvement work, think about who's the best person to investigate it. Do we need data? Should we bring in a quality person because it's higher risk? How will we test and evaluate countermeasures? Based on the complexity of the problem and the goal, you can see who needs to be involved. It might be a team of three, each bringing something different. Some people love pointing out problems, and others have trouble generating ideas but come up with great ones once they see a problem.
Mark Graban: There are often a lot of handoffs, and this becomes a much more collaborative process within a team or between employee and manager. We're not just dumping things on staff. We have to work together with them.
Greg Jacobson: That's where technology helps, because you can see patterns. You can see that when Mark collaborates on opportunities, he does it very well, and you can form teams easily.
Mark Graban: Managers are often scared: "What if my people aren't capable?" Come on, give them a chance. If they're not capable, it's your job to help develop them. They can usually do more than you thought. Use the PDSA mindset, and recognize different capabilities within your team. Some people you can just ask to go work on something. Others will need more coaching and have more questions. They might be a little scared, too.
Greg Jacobson: That's where a process excellence team, a quality department, or an external consultant can help give people confidence by teaching good problem-solving techniques.
Mark Graban: So the key point from this section is don't let the manager be the bottleneck, and don't just shift that to one key staff member who becomes the bottleneck instead.
Mark Graban: Back to bottlenecks and creating time. We hear it a lot: managers, staff, or both don't have time for improvement. We need to shift that statement from an excuse to a problem. Is it an excuse -- "We don't have time, forget it, sorry we brought it up"? Or is it a problem, maybe one of the first we figure out how to solve? "Team, we don't have time for improvement. What are your ideas?" Maybe we shorten a staff meeting that's just sharing information that could be distributed on paper, and use that time for improvement instead.
Greg Jacobson: The image I have is being too busy fighting fires to create time to prevent the fires.
Mark Graban: A lot of times people get rewarded for firefighting, and we could instead reward people for improvement work. Intentionally creating time is key. At the transplant institute I worked with, the chair of the department, a world-renowned transplant surgeon, was very interested in the improvement work and in creating that culture. He said publicly to all his managers and staff that nobody would be criticized for taking 20 minutes away from regular work to work on improvement. He made the point that there's such a backlog of patients that they could choose to work 18 hours a day, but at some point they choose to go home. In the same way, they can choose to take time for improvement. Otherwise, they don't have a fighting chance of being able to care for more patients.
Greg Jacobson: It's great that he was showing leadership.
Mark Graban: I take healthcare people to the Toyota plant in San Antonio. One healthcare student asked, "How do you make time for Kaizen? People look really busy building trucks." They said that if there's downtime, they work on improvement. I'll throw a rock at hospitals here: a hospital would probably send people home early to save money instead of investing in improvement.
Greg Jacobson: In the middle of a night shift, things sometimes slow down. That's a perfect opportunity, if you have an engaged and empowered workforce, to work on fixing problems.
Mark Graban: And the hourly employee tour guide at Toyota said that if they have an idea and their leader thinks it's worth working on, the leader approves overtime for them. They're making that investment and choosing to develop people and make improvements happen. They're not playing the victim. The key point is that it's often easier to create a little time for a lot of people than a big block of time for one person.
Mark Graban: A question came in advance about balancing doing the work and improving the work. The transplant surgeon's work wasn't always time-sensitive in the way an emergency department is.
Greg Jacobson: It is in the ED, but in a different way. We can choose to make time there too. You look for the time that's naturally there when patients aren't immediately waiting. If you look for that opportunity, you'll find it in any system, and you can work to make it happen.
Greg Jacobson: The last topic is tracking. When you understand what your metrics look like, you can address problems. One thing we always hear is, "We have a hard time following up on ideas." One of the most important principles is responding to all of them, and hopefully implementing as many as you can. If you never implement anything, or only address half of them, that behavior won't be sustained.
Greg Jacobson: One question we got before the webinar was how to make sure a project champion prioritizes implementing and completing a project. That's where tracking comes in, and it's one of the main reasons we built KaiNexus: to make things visible and transparent, so it's easy to see who's working on what, and by when. Another person said they'd run a suggestion program for six months successfully, but struggled to get the designated champions to complete their projects. Focusing on small, low-cost, low-risk ideas -- a mantra you'll hear from me a lot -- helps make sure things get completed. And that's where leadership comes in. If a leader says, "Mark, you said we'd do this by last Friday. What can we do to help? We think this is important," it refocuses things.
Mark Graban: We want to track results by categorizing and quantifying them: safety, quality, satisfaction, engagement, cost and revenue, and time savings. We have to show progress. We can't just collect ideas; we have to show people we're implementing them. That drives more improvement, and we need to sustain it over time. More improvement more quickly leads to more impact for the organization, and making progress leads to more ideas because of those positive cycles.
Greg Jacobson: This is the manufacturing organization's first 60 days we showed earlier. Here's what happened next: the wave actually grew. That's because they were adding more and more people to the system. It wasn't that each person spent a greater percentage of their time on improvement; more people were joining. And after that, they sustained the flow of improvement work. That's very attainable for any organization with some behavior and discipline around it.
Greg Jacobson: Not every organization does this. Here's another customer, and this is where tracking and visibility matter. We know that right where things trailed off, there was a leadership change. The new leader didn't practice the same leadership behaviors and didn't believe in continuous improvement, and everything trailed off.
Mark Graban: You can see the lost potential. If that line had continued, you can extrapolate that they would have implemented 150 more opportunities for improvement. Based on their data of about $620 saved per improvement, that's roughly $100,000, and that's just scratching the surface. They're not getting the quality improvement, and employee engagement is probably going down. We want to avoid that.
Greg Jacobson: When things can be tracked, you can jump on problems early and do your PDSA cycle on your improvement program much better. Here's another organization's first 60 days -- the wave. What happened after? They added more people, and you can see an inflection point at day 60, and another at the end when even more people were added. You can see the acceleration.
Mark Graban: You can also look more granularly. Some departments really take off and some flatline. As leaders, the response isn't to go yell or remind them of a target or quota. It's to work with them to figure out what we need to do to make that level of improvement happen again. How do we make ideas flow like a river? That's the key question and the key challenge.
Ron Pereira: Great job, guys. We've got tons of questions. The first one came in on Twitter, from Carrie: "What's the best way to respond to a physician who questions whether improvement is even necessary?"
Mark Graban: I'm the engineer, not the doctor, so while Greg finishes his sip of water: doctors are people, too. I hear a lot of organizations ask how to engage physicians. How do you engage anybody? There are some different dynamics, but we ask people what problems they want to solve. We see a lot of residents using the system now.
Greg Jacobson: I honestly haven't encountered that. When physicians are asked, "What frustrates you about your day? Have you ever ordered a lab and it didn't come back? Have you ever waited on a patient? Has something ever gone wrong with a patient?" I think a physician would have a hard time saying, "No, everything has worked perfectly my entire career." Underlying that question, I think, is a reaction to the implication: why are you saying I need to improve? So reframe it, rather than making it accusatory.
Greg Jacobson: And physicians love data. If a physician or an organization is at the 99th percentile on everything, maybe move to another area. But you won't find a place that's always at the 99th percentile. Politically, doctors in many environments have more ability to say no, but usually that's because they're not being engaged. And they're very competitive. Show them data on something they can help improve, like time from pneumonia diagnosis to antibiotics, and they'll do it. If there's no data, ask what metric is important to them. Make them the center of the conversation, rather than saying, "You need to improve because you're doing things badly."
Mark Graban: At first in Kaizen -- and not just with doctors -- it's easier for people to point fingers: here's what I need you to fix. Once they're engaged in the process, they more often than not come around to looking at their own work and practices. That's a healthy progression.
Ron Pereira: Next, from Jack: is there any evidence that a technology enabler is better than other methods for spreading improvement?
Greg Jacobson: We have a lot of customer stories and data. One healthcare customer in particular compared before and after. When they did Kaizen with manual, analog methods versus after they started using software, they implemented a higher percentage of ideas and implemented them faster, which drives more improvement. Beyond more and faster improvements, there's spreading an idea beyond the 20 or 100 people in one workplace to other sites, remembering what was worked on three years ago, and having a real-time view of when something changes in a department. We've heard the same story over and over: "We tried to do this with Excel. We could never get the momentum or the visibility."
Mark Graban: We try to practice what we preach. The software addresses real problems, as opposed to thinking software is a silver bullet that does everything. It's one piece of the triangle.
Ron Pereira: Debbie asks for advice for teams that tend to skip over the planning phase of PDCA or PDSA.
Mark Graban: The simple advice is don't do that. But step back and ask people to reflect. What happens when we jump right to "do," or jump to a solution? Are we less effective? Do things drag out because we don't have good consensus? Apply PDSA thinking. If someone suggests we're struggling because we jump to solutions, figure out how to build a process to do less of that, and then measure: are more ideas getting implemented? Are they more successful? Are they having a bigger impact?
Greg Jacobson: We see the opposite more often: too much planning, where you have to say, "Guys, we have to start doing something."
Mark Graban: I've seen hospitals with a unit-based council that gets together for an hour every month and basically just talks about problems. When they turn that time into improvement time in more of a Kaizen model, they unleash all sorts of improvement instead of talking about the same issues every month.
Greg Jacobson: Maybe the question is about knee-jerk solutions without any thought. But if you're really doing the Study and Adjust parts of the cycle, you'll catch it when people jump to the wrong conclusion.
Mark Graban: The study phase isn't just confirming whether we got the results we wanted. It's also reflecting on the process. Reflection might be, "Why did we talk about that so long before testing something?" or the opposite, "We tried something, it didn't work, and we should have spent more time discussing it." Some of that becomes self-adjusting, and as people mature with Kaizen, they strike the balance. If there's an obvious low-cost, low-risk, easily reversed solution, be biased toward testing it and seeing what happens. If it's more complex or risky or involves more people, do more planning. How much time should you spend planning? It depends.
Ron Pereira: Mark asks about having employees focus on problems their own team can solve and ideas for their own work area, rather than how someone else could do their job better.
Mark Graban: That's a really important factor. When you first ask for ideas, set expectations: we want to start with small things we can implement, because we're building our capabilities. When ideas come in that are blaming or finger-pointing, try to reframe them: what can we do about that problem? Or transfer it to the other department, and also come up with ideas we can implement ourselves.
Greg Jacobson: That's probably most important early on. If you immediately develop a finger-pointing culture, it will be negative. In an organization that has been doing this longer, it becomes easier to say, "What about this over here? We want to work on it with you," without pointing fingers.
Mark Graban: Over time, someone will identify a big, important, systemic problem, and through the Kaizen process it might become a Kaizen event, a project, or a strategic initiative. The role of leaders is to help triage what's local and simple and what's broader, and apply the right level of improvement methodology to the right type of problem.
Ron Pereira: These are all great questions, but I think I have the best one. Katie wants to know where she can get a T-shirt like Greg's.
Greg Jacobson: This was a one-off gift from Mark. Contact us, and we'll work on it.
Ron Pereira: From Matt: how do you get senior leadership to adjust their leadership style to engage frontline staff in submitting improvement ideas?
Mark Graban: This is a broader Lean question: how much can we do without senior leaders being fully invested in a culture of continuous improvement? We don't want that to be an excuse not to try. I've seen a gung-ho director build that culture locally, and you can do that. The risk is when a VP or C-level person comes in and says something that runs counter to the Kaizen approach. Say locally we're building a culture of pointing out problems, even things you did wrong -- like me putting the wrong LinkedIn link on the slide, which I admit. If our CEO, Allan, walked in and blamed me and yelled at me -- and I know he wouldn't -- that would undo a lot of the good local work. So I talk a lot with senior leaders and try to convince them. Some of it is borne out through experience. They see good things happening in departments and decide they want to do more than bless and endorse improvement, and get directly involved in coaching and modeling the right behaviors.
Greg Jacobson: I'll take a different angle. We've done a webinar, which is in the Gemba Academy library, on 25 leadership behaviors that promote this. But my angle is data. Show senior leaders what you've accomplished in one department -- cost savings, safety, satisfaction, time savings -- and ask them to imagine it across the whole organization. Do you need a study to determine whether parachutes work? Appeal to them: we just had 100 people aligned to make the organization better instead of one or two. Imagine 1,000 people, or all 5,000, working in harmony toward the goals you've set. You've set the ship's trajectory. Bring everyone on board. And the impact doesn't take five or 10 years. In almost every organization where we roll this out, there's real, tangible impact in the first 30 days. You can walk around and someone will say, "That was my idea. We save 10 minutes a day on this, and we saved $1,000 here."
Mark Graban: There are often unspoken mental models about Lean and continuous improvement. A senior leader says, "I've heard Lean and Kaizen are good, and I want that here." The unspoken model is often, "If we could just fix how frontline employees and managers do things every day, that would solve all our problems." But hospital CEOs like John Toussaint and Gary Kaplan say it starts with their own behaviors as senior leaders. This isn't about fixing the staff, and it isn't about blaming the senior leaders. It's about the whole organization getting in this together and figuring out how we all improve. It's not as simple as, "Come teach this to my staff so they quit being doofuses." Those mental models are hard to get through because they're unspoken. Asking questions -- why do you think we don't have a culture of continuous improvement? -- and running small tests of change can help open their eyes.
Ron Pereira: Let's do one more. Several people, including Jason and Cheryl, asked about rewards. Jason put it this way: "I gave an idea that saved the company $10,000. Shouldn't I get a piece of that savings?"
Mark Graban: It's such a double-edged sword. Joe Swartz and I write about this in our Healthcare Kaizen books, and I'd point people to Dan Pink's book Drive. Incentives work, but they create dysfunctions in a lot of different ways. "You should pay me a percentage of the savings" sounds fair, but it drives so many problems. The book Ideas Are Free by Robinson and Schroeder details this, beyond our own experience with suggestion boxes that were built on paying a percentage of savings. It gets dysfunctional in 10 different ways.
Mark Graban: It comes back to why there's a lack of alignment between what's in it for me and what's in it for the organization. If people feel that bringing ideas forward might get them fired, then a percentage is an insurance policy against that. But when there's trust and alignment, and the organization has broad-based profit sharing, it encourages teamwork and collaboration -- I'll sound like an idealist here. If we all implement ideas, at the end of the year we share the benefits, rather than "your idea saved this and mine saved that." I think incentives aren't necessary when you have good leadership. If you're going to have incentives, the more broad-based the better. Some say that's unfair because of free riders, but you can't fairly quantify team improvement -- "Greg spent 2.7 hours, so he gets this percentage of the percentage." It's too hard to administer.
Greg Jacobson: I'll add a different flavor. I didn't believe this until I read Daniel Pink's book Drive. If you want to get into the psychology, read it. He references studies and explains what the outcomes are and why. Then think about the behaviors that rewards create. Say you'll give an iPad for the best idea in May. Someone thinks, "There's already a really good idea in May, so I'll hold mine until June." Or, "I have 12 ideas today, but I'll wait." Then it gets adversarial: "This idea saved $10,000." "No, it saved $14,500." "What if you calculated it this way?" People start gaming the system.
Greg Jacobson: That said, no direct financial reward doesn't mean no recognition. Recognition is a key factor. Masaaki Imai talks about it in his book, and you'll see over and over that recognition is a key part of creating behaviors.
Mark Graban: One more dysfunction: if you give a percentage of cost savings, you send a strong message that all you care about is cost savings. In a manufacturing company, if I have an idea that reduces cycle time and improves on-time delivery, how do I translate that directly into a financial benefit? If we reduce length of stay in the emergency department, what's the cost figure? If I eliminate an injury that happened twice a year, there may be a financial number from insurance and health costs, but the gaming required to come up with a number is enormous. From my experience, I've seen percentage reward systems get incredibly dysfunctional, and I've seen people be incredibly successful with Kaizen without promising shared savings. That's what I'd challenge people to try. It can be done without targets, incentives, or rewards, but it requires lots and lots of recognition, which is cheap, if not free.
Ron Pereira: For anyone looking for it, the book is Drive: The Surprising Truth About What Motivates Us by Daniel Pink. I've read it and highly recommend it. I'll also plug one of the best books I've ever read, which Mark knows: Joy, Inc. by Richard Sheridan of Menlo Innovations, a software company in Ann Arbor, Michigan.
Mark Graban: I've visited Menlo and read the book, and there are very similar themes. There's another great book, It's Your Ship, about the Navy. There's a style of engaging leadership that isn't delegating or dumping things on people, but truly engaging and collaborating with them: setting a strong direction and letting everyone figure out how to reach the organization's goals. It's elements of strategy deployment, Kaizen, and Lean in different wrappers.
Greg Jacobson: And the take-home is that these are behaviors that can be learned. You don't have to be Michael Jordan. It's not that only 1 percent of leaders have this talent. These are behaviors that can be learned and repeated with discipline, and they produce predictable results, because they've worked in every industry and every size of company. Anyone can do this if they want to.
Ron Pereira: Great job, guys. I really enjoyed it. Thank you for coming on, and thanks to everyone who stayed on.
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