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Lean Psychology:
Leveraging Human Nature to Achievee e ag g u a atu e to c e e
Optimal Improvement
Company
LOGO
Learning Objectives
Participants will learn:
 How psychology affects the entire improvement
process, from strategy to execution.
 What you can do to ensure both short- and long-
term success.
H t t th b i d l h How to meet the basic needs people have
through the improvement process.
Specific tactics that leverage human nature to Specific tactics that leverage human nature to
achieve optimal business performance.
© 2011 Karen Martin & Associates 2
Your Instructor
 Early career as a scientist; migrated to
quality & operations design in the mid 80’squality & operations design in the mid-80 s.
 Launched Karen Martin & Associates in
1993.
 Introduced to Lean in 2000.
 Specialize in applying Lean in non-
f i imanufacturing environments.
 Co-author of The Kaizen Event Planner;
co-developer of Metrics-Based Processco developer of Metrics Based Process
Mapping: An Excel-Based Solution.
 Instructor in University of California, San
Karen Martin
Principal, Karen
Martin & Associates
© 2011 Karen Martin & Associates
Diego’s Lean Enterprise program.
3
Why Lean Psychology?
Long term interest in human behavior.
Avid practitioner of hansei (reflection) –
began to notice trends and patterns.
Success in changing my own paradigms
and approach.pp
Growing concern that Lean isn’t being
properly appliedproperly applied.
© 2011 Karen Martin & Associates
The Win-Win
A well-executed improvement approach not
only serves the customer and generates
significant return for the organization, it also
meets the psychological needs of
individuals, creating a highly motivated
workforce.
© 2011 Karen Martin & Associates 5
Two Pillars of The Toyota Way
Respect for
H it
Elimination of waste
th h tiHumanity through continuous
improvement
Plan
DoAct
Check
© 2011 Karen Martin & Associates
Sakichi Toyoda (1867-1930)
The Change Agent’s Many
“Non-Technical” Hats
© 2011 Karen Martin & Associates 7
The Change Agent’s Most Important Hat:
Psychologist
Psychologist
Ab h M lAbraham Maslow
What motivates people?
What do they fear?
© 2011 Karen Martin & Associates
Maslow’s Hierarchy of Needs
Typical Work Needs
 To belong
 To be needed
 To understand
 To see progress
 To learn
 To create
 To be adequately
compensated To create
 To contribute
 T b h d
co pe sated
 To work in a pleasant
environment To be heard
 To be recognized
environment
 To be safe
Ph i ll
 To be competent
 Physically
 Emotionally (treated well)
10
To Succeed
When needs aren’t met…
Apathy
Turnover / absenteeism
Obstacle creation (overt and/or covert)Obstacle creation (overt and/or covert)
Lawsuits
S b tSabotage
© 2011 Karen Martin & Associates 11
Components for Effective Change
EffectiveEffective
ChangeChange
VisionVision SkillsSkills IncentivesIncentives ResourcesResources Action PlanAction Plan
ConfusionConfusionSkillsSkills IncentivesIncentives ResourcesResources Action PlanAction Plan
AnxietyAnxiety
GradualGradual
VisionVision IncentivesIncentives ResourcesResources Action PlanAction Plan
GradualGradual
ChangeChange
FrustrationFrustration
VisionVision SkillsSkills ResourcesResources Action PlanAction Plan
VisionVision SkillsSkills IncentivesIncentives Action PlanAction Plan FrustrationFrustration
False StartsFalse StartsVisionVision SkillsSkills IncentivesIncentives ResourcesResources
s os o SkillsSkills IncentivesIncentives ct o act o a
© 2003, Enterprise Mgmt Ltd.
Resistance toResistance to
Changeg
© 2011 Karen Martin & Associates
Why people resist change
Poor understanding
Cynicism & skepticism (low trust / faith)
Low involvement
Change fatigue
Lack of consensusLack of consensus
Fear
© 2011 Karen Martin & Associates 14
Reducing Resistance – Improve
Understanding
Clear strategy – established by leadership
 Hoshin kanri
 Value stream maps
Customer Demand:
15patients perDay
(Takt Time1920seconds)
8 hours per day
Referring
Physician
% C&A = 65 %
Hospital
Schedule
Appointment
Cycle Time = 11 mins.
Lead Time = 12 mins.
% C&A = 98 %
6
Pre-register
Patient
Cycle Time = 30 mins.
Lead Time = 990 mins.
% C&A = 100 %
5 Lead Time = 12 mins.Lead Time = 990 mins.Lead Time = 24 days
1
23
4
CT=Cycle Time
LT=Lead Time
%C&A=% Complete & Accurate
E Pay Excel ADSSymposium Internet
Waiting Room
Management
System
Fax Order
Solutions
PACSMeditech Auto Fax 50%
Us Mail 25%
MD Mailbox 25%
Rework Loop
via Fax 25% of
the time
Check-in
Patient
(Admitting)
Cycle Time = 2 mins.
% C&A = 90 %
5
Send
Reports
(Imaging)
Cycle Time = 3 mins.
% C&A = 90 %
6
5 mins.
0.0833 hrs.
2 mins.
0.0833 hrs.
1 mins.
0.75 hrs.
10 mins.
0.5 hrs.
15 mins.
0.0833 hrs.
3 mins.
4.13 hrs.
15 mins.
6.08 hrs.
5 mins.
16 hrs.
1 mins.
1.83 hrs.
1 mins.
2 hrs.
3 mins.
LT = 32.5 hrs.
CT = 56 mins.
CT/LT Ratio = 2.87%
Prep
Patient
(Tech)
Cycle Time = 10 mins.
% C&A = 100 %
2
Check-in
Patient
(Imaging)
Cycle Time = 1 mins.
% C&A = 98 %
3
Complete
Exam
(Tech)
Cycle Time = 15 mins.
% C&A = 90 %
2
Transmit
Images
(Tech)
Cycle Time = 3 mins.
% C&A = 100 %
2
Read/Dictate
Exam
(Radiologist)
Cycle Time = 15 mins.
% C&A = 95 %
2
Transcribe
Report
(MDI)
Cycle Time = 5 mins.
% C&A = 75 %
6
Review
Draft/Sign
(Radiologist)
Cycle Time = 1 mins.
% C&A = 95 %
2
Print
Reports
(Imaging)
Cycle Time = 1 mins.
% C&A = 99 %
2
30 mins. 5 mins. 248 mins. 365 mins. 960 mins. 110 mins. 120 mins.45 mins.5 mins.5 6 7 8 9 10 11 12 13 14
Rolled First Pass
i ld 29%
© 2011 Karen Martin & Associates 15
yield = 29%
Reducing Resistance – Improve
Understanding
Clear communication
 Why is improvement needed?
 Establish a sense of urgency
 Data sells!
 What’s our strategy?
 What do you expect from us?
 How will you support us?
You may need to coach your leadership team.
© 2011 Karen Martin & Associates 16
Pick your Crisis
Shrinking margins Regulatory pressure /
li iCustomer dissatisfaction
Shrinking market share
compliance issues
Rising litigation
Rising costs
Rising competition
Social, economic,
environmental, or
political pressures
Desire to absorb growth
without adding typical
political pressures
Downward
performance trendscommensurate staffing
Impending acquisition
performance trends
(in speed and/or
quality)
© 2011 Karen Martin & Associates
Staff burnout
q y)
Reducing Resistance – Why is
Improvement Needed?
Data sells!Data sells!
© 2011 Karen Martin & Associates 18
V l St M i Ch t
Reducing Resistance – Improve Understanding
Clearly Communicate via Charters
Value Stream Mapping Charter
Event Scope Leadership / Coordination Schedule
Value Stream Recruiting, Hiring, & Onboarding Process Executive Sponsor Sherrye Hutcherson Event Date(s)Oct 27, 28 & 29, 2009
Specific ConditionsExternal hires
Value Stream
Champion
N/A
Start/End
Times
Oct 27, 28 8:00 am - 4:30 pm
Oct 29 7:30 am - 2:00 pm
Customer Demand 100 per year
Facilitator Karen Martin Location9 West SeminarFacilitator Karen Martin Location9 West Seminar
Trigger Vacancy
First Step Hiring manager completes VPA
Team Lead N/A
Meals
Provided?
Lunch, morning & afternoon
snacksLast Step Employee completes NEI
Boundaries &
Limitations
N/A
Coordinator Andrew Peacock
Interim
Briefing(s)
Oct 27 & 28 3:30-4:30 pm
Oct 29 1-2 pm
Improvement
Timeframe
Future state will be fully implemented by 2/15/2009
Briefing
Attendees
Tim Burke, Sherrye H and other
Division ManagersTimeframe AttendeesDivision Managers
Event Drivers Mapping Team
1 Cumbersome process as perceived by the customer. Function Name Contact Information
2 Need to free capacity and operate more effectively. 1Staffing Paula Pittman
3 2FCS HR Patty Yager
4 3Talent Management Tad Leeper
5 4HRIS Chris Ritz
Measureable Objectives 5HR Compliance Carl Olsen
1 Reduce LT from req to offer acceptance from 45-55 days to 30 days. 6Comp & Benefits Nyla Cork
2 7Recruiting Sheila Love
3 8Diversity / Affirmative Action Joyce Cooper
4 9Hiring Manager, Call Ctr Deb Emerson
5 10Hiring Manager, Production Ops
Planned Deliverables On-Call Support
1 Current State VSM Function Name Contact Information
2 Future State VSM 1IT Gary Van Osdel
3 Implementation Plan 2Fort Calhoun - Security Herb Childs
4 3
5 4
Potential Obstacles Approvals
1 Executive Sponsor Value Stream Champion Facilitator
2
3 Signature: Signature: Signature:
4 Date: Date: Date: 19
Reducing Resistance – Improve
Understanding
Waste is at the root of most workplace frustration
d i t l d i t d t t l fli tand interpersonal and interdepartmental conflict.
Use this reality to sell the need for improvement.
“Think about the last time you left work feeling
© 2011 Karen Martin & Associates
y g
frustrated? What was the real reason?”
20
Psychology 101
People resist change unless you address
“WIIFM.”
If change isn’t viewed as a personal
improvement for the worker it’s unlikely to
© 2011 Karen Martin & Associates
be embraced and sustained.
21
Reducing Resistance – Improve
Understanding
The entire workforce must eventually be exposed to
L i i l d t l d d t d h thiLean principles and tools, and understand why this
approach is different.
M d iMy advice:
 Provide as much upfront training and exposure as
possiblepossible.
 Include a simulation – let them experience a
transformation.
 Provide leadership overviews that include discussions
about their roles and responsibilities, and key success
factors Help them gain alignment
© 2011 Karen Martin & Associates
factors. Help them gain alignment.
22
“Going to the gemba” heightens
awareness and creates understandingg
Why people resist change
Poor understanding
Cynicism & skepticism (low trust / faith)
Low involvement
Change fatigue
Lack of consensusLack of consensus
Fear
© 2011 Karen Martin & Associates 24
Cynicism & Skepticism Goes with
the Terroritory
“How many improvement approaches
have been attempted here over the past
10-20 years?”
“Is the work environment fundamentally
more pleasant than it was 10-20 yearsp y
ago?”
 Lower stress
 More teamwork and comraderie
 Greater fulfillment
© 2011 Karen Martin & Associates
 Greater fulfillment
25
Tactics for Dealing with Cynicism
& Skepticism
Don’t expect people to check it at the door.
Draw it out – invite them to admit it.
Ask them to “get in the car one more time and
come along for a ride.”
Acknowledge that the “proof’s in the pudding.”
Make sure all changes are improvements and
not merely changes.
f ’ ’ If it doesn’t improve the worker’s ability to be
successful, it’s merely change.
© 2011 Karen Martin & Associates 26
Why people resist change
Poor understanding
Cynicism & skepticism (low trust / faith)
Low involvement
Change fatigue
Lack of consensusLack of consensus
Fear
© 2011 Karen Martin & Associates 27
Reducing Resistance – Invite / Require
Involvement from All Stakeholders
The workers know best!
All i t t b hi hl f ti lAll improvement must be highly cross-functional.
Cross-functional problem-solving builds a sense of
b l i id th t it t b tibelonging, provides the opportunity to be creative,
and generates a feeling of accomplishment.
© 2011 Karen Martin & Associates 28
Maslow’s Hierarchy of Needs
Aided by cross-functional
improvement activities
Improvement Roles
Who? Accountability ToolWho? Accountability Tool
Senior What has to Value Stream
rategic
Leadership happen Mapping
Middle
Management
Str
Frontline
Workers
How it will
happen
Just-do-its
Kaizen Events
P j t
Management
actical
Projects
Ta
© 2011 Karen Martin & Associates
Improvement Roles and
Responsibilities
Leadership – set strategy (what needs to
happen)
Frontline workers – determine tactics (how(
it will happen)
Improvement professionals – CoachImprovement professionals Coach,
Teacher, Facilitator.
Not Toyota like: “Getting your employeesNot Toyota-like: Getting your employees
to buy into the change that you want to
implement to improve the operation ”
© 2011 Karen Martin & Associates
implement to improve the operation.
31
Why people resist change
Poor understanding
Cynicism & skepticism (low trust/faith)
Low involvement
Change fatigue
Lack of consensusLack of consensus
Fear
© 2011 Karen Martin & Associates 32
Change Fatigue
© 2011 Karen Martin & Associates 33
It’s a marathon, not a sprint
Help leadership develop realistic expectations
regarding results and the resources needed to getregarding results and the resources needed to get
there.
 “How long has this been a problem? It may not get How long has this been a problem? It may not get
solved overnight.”
Allow “absorption time”; schedule regular hanseip g
sessions.
Pacing is key - avoid “organizational implosion” by
attempting too much too fast.
Check in with the customer (workforce) frequently
© 2011 Karen Martin & Associates
and adjust accordingly.
34
Why people resist change
Poor understanding
Cynicism & skepticism (low trust/faith)
Low involvement
Change fatigue
Lack of consensusLack of consensus
Fear
© 2011 Karen Martin & Associates 35
Consensus-Building Tactics
Alignment around strategy.
Improvement is well-defined and well-
communicated.
Cross-functional teams.
Upfront and periodic input from teamUpfront and periodic input from team
member’s peer groups.
R i d t ti t id th tReview and testing outside the team.
Interim briefings between teams and
© 2011 Karen Martin & Associates
leadership.
36
Interim Briefings
Periodic updates
 Discoveries
 Direction team is taking – process check
Minimize the surprises; get buy-in as the
team moves along; reduces rework by theg; y
team
Venue for challenging policiesVenue for challenging policies
© 2011 Karen Martin & Associates
Why people resist change
Poor understanding
Cynicism & skepticism (low trust/faith)
Low involvement
Change fatigue
Lack of consensusLack of consensus
Fear
© 2011 Karen Martin & Associates 38
Types of Fear & Countermeasures
Fear Countermeasure
Job loss • “No one will lose a paycheck due to
improvement ”improvement.
• “Your job may change but your
paycheck is assured.”
• Job loss only due: to 1) poor
f 2) k t d tperformance, 2) market downturns.
Incompetence • Training, training, training
• Confidence leads to competence
Loss of control (leadership) • Adequate workforce skill development.
• Help them see how freed time will
enable them to be more effective
leadersleaders.
Improvement won’t be adequately
resourced (workforce)
• Leadership commitment
Chaos sustainability permanence • Pilots; experiments
39
Chaos, sustainability, permanence,
failure
• Pilots; experiments
• Monitoring
• Continuous improvement
A Spirit of
ExperimentationExperimentation
Reduces Resistance
t Ch d tto Change due to
“Fear of Permanence”
Plan
PDCA reduces risk of
failure
Do
Check
Act
© 2011 Karen Martin & Associates
Cultural Transformation Process
Results
Actions The Results Pyramid
Partners in Leadership
Beliefs
p
Experiences
© 2011 Karen Martin & Associates
Experiences
Creating New Experiences
Scientific method (PDCA)
Leadership setting clear strategy via hoshin
kanri and value stream maps.
Leadership staying out of the weeds – frontline
workforce designs and implements tactical
solutionssolutions.
Cross-functional collaboration.
D di t d ti f ki i tDedicated time for making improvements.
Rapid, consensus-driven improvement.
R l t ti iti ff ti t i i
© 2011 Karen Martin & Associates
Relevant, time-sensitive, effective training.
42
If you expect resistance,
ill t i tyou will get resistance
© 2011 Karen Martin & Associates 43
Miscellaneous Thoughts
and Observationsand Observations
© 2011 Karen Martin & Associates 44
Psychology 101
We seek pleasure and avoid pain.
© 2011 Karen Martin & Associates
Observation #1
If it’s too hard to do, we will
delay or avoid doing it
 Builds up work-in-process
 Prolongs lead times
Aim for work simplification –p
make it easy to be
successful, difficult to fail.,
© 2011 Karen Martin & Associates 46
Observation #2
The more you create ay
“safe haven” for
people to tell thep p
truth and share their
feelings, the fasterg
the improvement, the
greater the results,g
and the deeper the
organizational healing.
© 2011 Karen Martin & Associates
g g
Observation #3
When processes
are monitored, we
perform differentlyperform differently
Post metrics!
 Especially leading
indicators
© 2011 Karen Martin & Associates 48
Observation #4
Most inspection (reviews, approvals, audits,
t ) i d d i l k f t t fetc.) is grounded in lack of trust or fear.
 Low faith in process reliability
 Low confidence in people performing the work
 Fear of losing control
 High “need to know”
 Risk aversion
 Fear re: outcome
© 2011 Karen Martin & Associates 49
Observation #5
People want to perform well
Most people will do
h t it t k twhatever it takes to
get their jobs done,
hi hwhich may cause
them to:
 Ignore policies and
procedures
I l i Ignore regulations
 Cut corners
© 2011 Karen Martin & Associates 50
The right process will produce the right results.
Observation #6
Poorly designed processes are typically
behind interpersonal and interdepartmental
tension – not personalities.
Poorly designed processes are behind poor
© 2011 Karen Martin & Associates
process performance.
Observation #7 – Words Matter
Words greatly impact “group think” and
i di id l h lindividual psychology.
 Help staff transform their thinking and speech
f “N b ” t “Y if ”from “No, because…” to “Yes, if…”
 Sensitize people about the word “can’t”:
/ “ ” Disempowers / creates “victim thinking”
 Closes off possibilities
 Stifles innovation and creativity Stifles innovation and creativity
 They (and possibly you) will need to break
habits
© 2011 Karen Martin & Associates
habits.
In Summary
If used properly, Lean principles and tools
are 100% grounded in leveraging human
nature to achieve:
 high functioning organizations
 that perform optimally, and
 that everyone wants to work for
 and do business with.
© 2011 Karen Martin & Associates 53
What can you do to become a
better psychologist?
Reflect
Be fully present
 Listen deeply – use every sense
 Observe
ExperimentExperiment
Be an active learner
Read Read
 Take classes
I l d h l i k di i
© 2011 Karen Martin & Associates
 Include psychology in work discussions
54
Learning Objectives
Participants will learn:
 How psychology affects the entire improvement
process, from strategy to execution.
 What you can do to ensure both short- and long-
term success.
H t t th b i d l h How to meet the basic needs people have
through the improvement process.
Specific tactics that leverage human nature to Specific tactics that leverage human nature to
achieve optimal business performance.
© 2011 Karen Martin & Associates 55
Lean Resources
The Toyota Way, Jeffrey Liker
Lean Thinking, Jim Womack
Lean Hospitals, Mark Grabanp ,
The Kaizen Event Planner, Karen Martin &
Mike OsterlingMike Osterling
© 2011 Karen Martin & Associates 56
Recommended Resource
© 2011 Karen Martin & Associates 57
For Further Questions
7770 Regents Road #635
San Diego, CA 92122
858 677 6799858.677.6799
ksm@ksmartin.com
Free monthl ne sletterFree monthly newsletter:
www.ksmartin.com/subscribe
Learn / Connect :
58

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Lean Psychology: Leveraging Human Nature to Achieve Optimal Improvement

  • 1. Lean Psychology: Leveraging Human Nature to Achievee e ag g u a atu e to c e e Optimal Improvement Company LOGO
  • 2. Learning Objectives Participants will learn:  How psychology affects the entire improvement process, from strategy to execution.  What you can do to ensure both short- and long- term success. H t t th b i d l h How to meet the basic needs people have through the improvement process. Specific tactics that leverage human nature to Specific tactics that leverage human nature to achieve optimal business performance. © 2011 Karen Martin & Associates 2
  • 3. Your Instructor  Early career as a scientist; migrated to quality & operations design in the mid 80’squality & operations design in the mid-80 s.  Launched Karen Martin & Associates in 1993.  Introduced to Lean in 2000.  Specialize in applying Lean in non- f i imanufacturing environments.  Co-author of The Kaizen Event Planner; co-developer of Metrics-Based Processco developer of Metrics Based Process Mapping: An Excel-Based Solution.  Instructor in University of California, San Karen Martin Principal, Karen Martin & Associates © 2011 Karen Martin & Associates Diego’s Lean Enterprise program. 3
  • 4. Why Lean Psychology? Long term interest in human behavior. Avid practitioner of hansei (reflection) – began to notice trends and patterns. Success in changing my own paradigms and approach.pp Growing concern that Lean isn’t being properly appliedproperly applied. © 2011 Karen Martin & Associates
  • 5. The Win-Win A well-executed improvement approach not only serves the customer and generates significant return for the organization, it also meets the psychological needs of individuals, creating a highly motivated workforce. © 2011 Karen Martin & Associates 5
  • 6. Two Pillars of The Toyota Way Respect for H it Elimination of waste th h tiHumanity through continuous improvement Plan DoAct Check © 2011 Karen Martin & Associates Sakichi Toyoda (1867-1930)
  • 7. The Change Agent’s Many “Non-Technical” Hats © 2011 Karen Martin & Associates 7
  • 8. The Change Agent’s Most Important Hat: Psychologist Psychologist Ab h M lAbraham Maslow What motivates people? What do they fear? © 2011 Karen Martin & Associates
  • 10. Typical Work Needs  To belong  To be needed  To understand  To see progress  To learn  To create  To be adequately compensated To create  To contribute  T b h d co pe sated  To work in a pleasant environment To be heard  To be recognized environment  To be safe Ph i ll  To be competent  Physically  Emotionally (treated well) 10 To Succeed
  • 11. When needs aren’t met… Apathy Turnover / absenteeism Obstacle creation (overt and/or covert)Obstacle creation (overt and/or covert) Lawsuits S b tSabotage © 2011 Karen Martin & Associates 11
  • 12. Components for Effective Change EffectiveEffective ChangeChange VisionVision SkillsSkills IncentivesIncentives ResourcesResources Action PlanAction Plan ConfusionConfusionSkillsSkills IncentivesIncentives ResourcesResources Action PlanAction Plan AnxietyAnxiety GradualGradual VisionVision IncentivesIncentives ResourcesResources Action PlanAction Plan GradualGradual ChangeChange FrustrationFrustration VisionVision SkillsSkills ResourcesResources Action PlanAction Plan VisionVision SkillsSkills IncentivesIncentives Action PlanAction Plan FrustrationFrustration False StartsFalse StartsVisionVision SkillsSkills IncentivesIncentives ResourcesResources s os o SkillsSkills IncentivesIncentives ct o act o a © 2003, Enterprise Mgmt Ltd.
  • 13. Resistance toResistance to Changeg © 2011 Karen Martin & Associates
  • 14. Why people resist change Poor understanding Cynicism & skepticism (low trust / faith) Low involvement Change fatigue Lack of consensusLack of consensus Fear © 2011 Karen Martin & Associates 14
  • 15. Reducing Resistance – Improve Understanding Clear strategy – established by leadership  Hoshin kanri  Value stream maps Customer Demand: 15patients perDay (Takt Time1920seconds) 8 hours per day Referring Physician % C&A = 65 % Hospital Schedule Appointment Cycle Time = 11 mins. Lead Time = 12 mins. % C&A = 98 % 6 Pre-register Patient Cycle Time = 30 mins. Lead Time = 990 mins. % C&A = 100 % 5 Lead Time = 12 mins.Lead Time = 990 mins.Lead Time = 24 days 1 23 4 CT=Cycle Time LT=Lead Time %C&A=% Complete & Accurate E Pay Excel ADSSymposium Internet Waiting Room Management System Fax Order Solutions PACSMeditech Auto Fax 50% Us Mail 25% MD Mailbox 25% Rework Loop via Fax 25% of the time Check-in Patient (Admitting) Cycle Time = 2 mins. % C&A = 90 % 5 Send Reports (Imaging) Cycle Time = 3 mins. % C&A = 90 % 6 5 mins. 0.0833 hrs. 2 mins. 0.0833 hrs. 1 mins. 0.75 hrs. 10 mins. 0.5 hrs. 15 mins. 0.0833 hrs. 3 mins. 4.13 hrs. 15 mins. 6.08 hrs. 5 mins. 16 hrs. 1 mins. 1.83 hrs. 1 mins. 2 hrs. 3 mins. LT = 32.5 hrs. CT = 56 mins. CT/LT Ratio = 2.87% Prep Patient (Tech) Cycle Time = 10 mins. % C&A = 100 % 2 Check-in Patient (Imaging) Cycle Time = 1 mins. % C&A = 98 % 3 Complete Exam (Tech) Cycle Time = 15 mins. % C&A = 90 % 2 Transmit Images (Tech) Cycle Time = 3 mins. % C&A = 100 % 2 Read/Dictate Exam (Radiologist) Cycle Time = 15 mins. % C&A = 95 % 2 Transcribe Report (MDI) Cycle Time = 5 mins. % C&A = 75 % 6 Review Draft/Sign (Radiologist) Cycle Time = 1 mins. % C&A = 95 % 2 Print Reports (Imaging) Cycle Time = 1 mins. % C&A = 99 % 2 30 mins. 5 mins. 248 mins. 365 mins. 960 mins. 110 mins. 120 mins.45 mins.5 mins.5 6 7 8 9 10 11 12 13 14 Rolled First Pass i ld 29% © 2011 Karen Martin & Associates 15 yield = 29%
  • 16. Reducing Resistance – Improve Understanding Clear communication  Why is improvement needed?  Establish a sense of urgency  Data sells!  What’s our strategy?  What do you expect from us?  How will you support us? You may need to coach your leadership team. © 2011 Karen Martin & Associates 16
  • 17. Pick your Crisis Shrinking margins Regulatory pressure / li iCustomer dissatisfaction Shrinking market share compliance issues Rising litigation Rising costs Rising competition Social, economic, environmental, or political pressures Desire to absorb growth without adding typical political pressures Downward performance trendscommensurate staffing Impending acquisition performance trends (in speed and/or quality) © 2011 Karen Martin & Associates Staff burnout q y)
  • 18. Reducing Resistance – Why is Improvement Needed? Data sells!Data sells! © 2011 Karen Martin & Associates 18
  • 19. V l St M i Ch t Reducing Resistance – Improve Understanding Clearly Communicate via Charters Value Stream Mapping Charter Event Scope Leadership / Coordination Schedule Value Stream Recruiting, Hiring, & Onboarding Process Executive Sponsor Sherrye Hutcherson Event Date(s)Oct 27, 28 & 29, 2009 Specific ConditionsExternal hires Value Stream Champion N/A Start/End Times Oct 27, 28 8:00 am - 4:30 pm Oct 29 7:30 am - 2:00 pm Customer Demand 100 per year Facilitator Karen Martin Location9 West SeminarFacilitator Karen Martin Location9 West Seminar Trigger Vacancy First Step Hiring manager completes VPA Team Lead N/A Meals Provided? Lunch, morning & afternoon snacksLast Step Employee completes NEI Boundaries & Limitations N/A Coordinator Andrew Peacock Interim Briefing(s) Oct 27 & 28 3:30-4:30 pm Oct 29 1-2 pm Improvement Timeframe Future state will be fully implemented by 2/15/2009 Briefing Attendees Tim Burke, Sherrye H and other Division ManagersTimeframe AttendeesDivision Managers Event Drivers Mapping Team 1 Cumbersome process as perceived by the customer. Function Name Contact Information 2 Need to free capacity and operate more effectively. 1Staffing Paula Pittman 3 2FCS HR Patty Yager 4 3Talent Management Tad Leeper 5 4HRIS Chris Ritz Measureable Objectives 5HR Compliance Carl Olsen 1 Reduce LT from req to offer acceptance from 45-55 days to 30 days. 6Comp & Benefits Nyla Cork 2 7Recruiting Sheila Love 3 8Diversity / Affirmative Action Joyce Cooper 4 9Hiring Manager, Call Ctr Deb Emerson 5 10Hiring Manager, Production Ops Planned Deliverables On-Call Support 1 Current State VSM Function Name Contact Information 2 Future State VSM 1IT Gary Van Osdel 3 Implementation Plan 2Fort Calhoun - Security Herb Childs 4 3 5 4 Potential Obstacles Approvals 1 Executive Sponsor Value Stream Champion Facilitator 2 3 Signature: Signature: Signature: 4 Date: Date: Date: 19
  • 20. Reducing Resistance – Improve Understanding Waste is at the root of most workplace frustration d i t l d i t d t t l fli tand interpersonal and interdepartmental conflict. Use this reality to sell the need for improvement. “Think about the last time you left work feeling © 2011 Karen Martin & Associates y g frustrated? What was the real reason?” 20
  • 21. Psychology 101 People resist change unless you address “WIIFM.” If change isn’t viewed as a personal improvement for the worker it’s unlikely to © 2011 Karen Martin & Associates be embraced and sustained. 21
  • 22. Reducing Resistance – Improve Understanding The entire workforce must eventually be exposed to L i i l d t l d d t d h thiLean principles and tools, and understand why this approach is different. M d iMy advice:  Provide as much upfront training and exposure as possiblepossible.  Include a simulation – let them experience a transformation.  Provide leadership overviews that include discussions about their roles and responsibilities, and key success factors Help them gain alignment © 2011 Karen Martin & Associates factors. Help them gain alignment. 22
  • 23. “Going to the gemba” heightens awareness and creates understandingg
  • 24. Why people resist change Poor understanding Cynicism & skepticism (low trust / faith) Low involvement Change fatigue Lack of consensusLack of consensus Fear © 2011 Karen Martin & Associates 24
  • 25. Cynicism & Skepticism Goes with the Terroritory “How many improvement approaches have been attempted here over the past 10-20 years?” “Is the work environment fundamentally more pleasant than it was 10-20 yearsp y ago?”  Lower stress  More teamwork and comraderie  Greater fulfillment © 2011 Karen Martin & Associates  Greater fulfillment 25
  • 26. Tactics for Dealing with Cynicism & Skepticism Don’t expect people to check it at the door. Draw it out – invite them to admit it. Ask them to “get in the car one more time and come along for a ride.” Acknowledge that the “proof’s in the pudding.” Make sure all changes are improvements and not merely changes. f ’ ’ If it doesn’t improve the worker’s ability to be successful, it’s merely change. © 2011 Karen Martin & Associates 26
  • 27. Why people resist change Poor understanding Cynicism & skepticism (low trust / faith) Low involvement Change fatigue Lack of consensusLack of consensus Fear © 2011 Karen Martin & Associates 27
  • 28. Reducing Resistance – Invite / Require Involvement from All Stakeholders The workers know best! All i t t b hi hl f ti lAll improvement must be highly cross-functional. Cross-functional problem-solving builds a sense of b l i id th t it t b tibelonging, provides the opportunity to be creative, and generates a feeling of accomplishment. © 2011 Karen Martin & Associates 28
  • 29. Maslow’s Hierarchy of Needs Aided by cross-functional improvement activities
  • 30. Improvement Roles Who? Accountability ToolWho? Accountability Tool Senior What has to Value Stream rategic Leadership happen Mapping Middle Management Str Frontline Workers How it will happen Just-do-its Kaizen Events P j t Management actical Projects Ta © 2011 Karen Martin & Associates
  • 31. Improvement Roles and Responsibilities Leadership – set strategy (what needs to happen) Frontline workers – determine tactics (how( it will happen) Improvement professionals – CoachImprovement professionals Coach, Teacher, Facilitator. Not Toyota like: “Getting your employeesNot Toyota-like: Getting your employees to buy into the change that you want to implement to improve the operation ” © 2011 Karen Martin & Associates implement to improve the operation. 31
  • 32. Why people resist change Poor understanding Cynicism & skepticism (low trust/faith) Low involvement Change fatigue Lack of consensusLack of consensus Fear © 2011 Karen Martin & Associates 32
  • 33. Change Fatigue © 2011 Karen Martin & Associates 33
  • 34. It’s a marathon, not a sprint Help leadership develop realistic expectations regarding results and the resources needed to getregarding results and the resources needed to get there.  “How long has this been a problem? It may not get How long has this been a problem? It may not get solved overnight.” Allow “absorption time”; schedule regular hanseip g sessions. Pacing is key - avoid “organizational implosion” by attempting too much too fast. Check in with the customer (workforce) frequently © 2011 Karen Martin & Associates and adjust accordingly. 34
  • 35. Why people resist change Poor understanding Cynicism & skepticism (low trust/faith) Low involvement Change fatigue Lack of consensusLack of consensus Fear © 2011 Karen Martin & Associates 35
  • 36. Consensus-Building Tactics Alignment around strategy. Improvement is well-defined and well- communicated. Cross-functional teams. Upfront and periodic input from teamUpfront and periodic input from team member’s peer groups. R i d t ti t id th tReview and testing outside the team. Interim briefings between teams and © 2011 Karen Martin & Associates leadership. 36
  • 37. Interim Briefings Periodic updates  Discoveries  Direction team is taking – process check Minimize the surprises; get buy-in as the team moves along; reduces rework by theg; y team Venue for challenging policiesVenue for challenging policies © 2011 Karen Martin & Associates
  • 38. Why people resist change Poor understanding Cynicism & skepticism (low trust/faith) Low involvement Change fatigue Lack of consensusLack of consensus Fear © 2011 Karen Martin & Associates 38
  • 39. Types of Fear & Countermeasures Fear Countermeasure Job loss • “No one will lose a paycheck due to improvement ”improvement. • “Your job may change but your paycheck is assured.” • Job loss only due: to 1) poor f 2) k t d tperformance, 2) market downturns. Incompetence • Training, training, training • Confidence leads to competence Loss of control (leadership) • Adequate workforce skill development. • Help them see how freed time will enable them to be more effective leadersleaders. Improvement won’t be adequately resourced (workforce) • Leadership commitment Chaos sustainability permanence • Pilots; experiments 39 Chaos, sustainability, permanence, failure • Pilots; experiments • Monitoring • Continuous improvement
  • 40. A Spirit of ExperimentationExperimentation Reduces Resistance t Ch d tto Change due to “Fear of Permanence” Plan PDCA reduces risk of failure Do Check Act © 2011 Karen Martin & Associates
  • 41. Cultural Transformation Process Results Actions The Results Pyramid Partners in Leadership Beliefs p Experiences © 2011 Karen Martin & Associates Experiences
  • 42. Creating New Experiences Scientific method (PDCA) Leadership setting clear strategy via hoshin kanri and value stream maps. Leadership staying out of the weeds – frontline workforce designs and implements tactical solutionssolutions. Cross-functional collaboration. D di t d ti f ki i tDedicated time for making improvements. Rapid, consensus-driven improvement. R l t ti iti ff ti t i i © 2011 Karen Martin & Associates Relevant, time-sensitive, effective training. 42
  • 43. If you expect resistance, ill t i tyou will get resistance © 2011 Karen Martin & Associates 43
  • 44. Miscellaneous Thoughts and Observationsand Observations © 2011 Karen Martin & Associates 44
  • 45. Psychology 101 We seek pleasure and avoid pain. © 2011 Karen Martin & Associates
  • 46. Observation #1 If it’s too hard to do, we will delay or avoid doing it  Builds up work-in-process  Prolongs lead times Aim for work simplification –p make it easy to be successful, difficult to fail., © 2011 Karen Martin & Associates 46
  • 47. Observation #2 The more you create ay “safe haven” for people to tell thep p truth and share their feelings, the fasterg the improvement, the greater the results,g and the deeper the organizational healing. © 2011 Karen Martin & Associates g g
  • 48. Observation #3 When processes are monitored, we perform differentlyperform differently Post metrics!  Especially leading indicators © 2011 Karen Martin & Associates 48
  • 49. Observation #4 Most inspection (reviews, approvals, audits, t ) i d d i l k f t t fetc.) is grounded in lack of trust or fear.  Low faith in process reliability  Low confidence in people performing the work  Fear of losing control  High “need to know”  Risk aversion  Fear re: outcome © 2011 Karen Martin & Associates 49
  • 50. Observation #5 People want to perform well Most people will do h t it t k twhatever it takes to get their jobs done, hi hwhich may cause them to:  Ignore policies and procedures I l i Ignore regulations  Cut corners © 2011 Karen Martin & Associates 50 The right process will produce the right results.
  • 51. Observation #6 Poorly designed processes are typically behind interpersonal and interdepartmental tension – not personalities. Poorly designed processes are behind poor © 2011 Karen Martin & Associates process performance.
  • 52. Observation #7 – Words Matter Words greatly impact “group think” and i di id l h lindividual psychology.  Help staff transform their thinking and speech f “N b ” t “Y if ”from “No, because…” to “Yes, if…”  Sensitize people about the word “can’t”: / “ ” Disempowers / creates “victim thinking”  Closes off possibilities  Stifles innovation and creativity Stifles innovation and creativity  They (and possibly you) will need to break habits © 2011 Karen Martin & Associates habits.
  • 53. In Summary If used properly, Lean principles and tools are 100% grounded in leveraging human nature to achieve:  high functioning organizations  that perform optimally, and  that everyone wants to work for  and do business with. © 2011 Karen Martin & Associates 53
  • 54. What can you do to become a better psychologist? Reflect Be fully present  Listen deeply – use every sense  Observe ExperimentExperiment Be an active learner Read Read  Take classes I l d h l i k di i © 2011 Karen Martin & Associates  Include psychology in work discussions 54
  • 55. Learning Objectives Participants will learn:  How psychology affects the entire improvement process, from strategy to execution.  What you can do to ensure both short- and long- term success. H t t th b i d l h How to meet the basic needs people have through the improvement process. Specific tactics that leverage human nature to Specific tactics that leverage human nature to achieve optimal business performance. © 2011 Karen Martin & Associates 55
  • 56. Lean Resources The Toyota Way, Jeffrey Liker Lean Thinking, Jim Womack Lean Hospitals, Mark Grabanp , The Kaizen Event Planner, Karen Martin & Mike OsterlingMike Osterling © 2011 Karen Martin & Associates 56
  • 57. Recommended Resource © 2011 Karen Martin & Associates 57
  • 58. For Further Questions 7770 Regents Road #635 San Diego, CA 92122 858 677 6799858.677.6799 ksm@ksmartin.com Free monthl ne sletterFree monthly newsletter: www.ksmartin.com/subscribe Learn / Connect : 58