In most organizations, the high proportion of waste provides an almost infinite source of possibilities for improvement. Thus, ignorance or no-problem is necessarily a bad thing – rather, it should be thought of as a gap between what is and what should be and as an opportunity for learning and improvement.
The Problem of the Patient in the Corridor
Who of us has not heard about the problem of overcrowding in hospitals? Recently, a large Israeli healthcare-centre asked the ILE team to help them find solutions for this acute problem, which has a terrible impact on the quality of care, the dignity of patients and the safety of both the staff and the patients.
Not one of the members of the ILE team is a physician, nor have any of us worked in the health system, and we certainly don’t have a ready-made prescription in our pockets. So when we don’t even have a solution to the problem, where do we get the hutzpah to offer managerial guidance?
Instead of taking a solution off the proverbial shelf, the ILE team encourages organizational transformation based on internal strengths. To this end, we enlist and train change leaders from the field. Their first step has been to examine and understand the existing situation by mapping regular activities in the departments and diagnosing organizational work processes.
Subsequently, they will identify the obstacles that prevent the flow of patients (including, for example, problematic communication between professional units and unwieldy procedures for writing discharge letters). Providing additional funds, by the way, is not a creative solution and usually isn’t even necessary, although it is often the first idea that is brought up. The proportion of waste in the vast majority of organizations is so high, that it provides an almost infinite source of possibilities for improvement.
Problems as Opportunities to Sell Ready-Made Solutions
After several days of observations in the internal medicine wards, we realized that the teams are dealing with a series of problems whose roots are deep in areas where they have no influence, such as the impossibility of hospitalizing complex patients in the community, budgetary difficulties, and a shortage of personnel. “If we can’t cut down the number of patients in the department,” these loyal workers say, “we will settle for providing quality service to the patients we have.” But they soon discover that the existing overload does not allow them to do so. Huge problems are strangling their motivation to deal with capacity-building as a systematic solution to daily problems.
It is so easy to be tempted to offer temporary solutions, I think to myself. I make my income off of other peoples’ problems. In the first meeting with the hospital executive directors, someone tossed out to one of the senior managers the same line that I have heard so many times before: “We need solutions, not more questions!” Indeed, when an organization that is not used to learning and coping independently is forced to respond to pressure and lack of resources, as the hospitals in Israel are, it turns to “Managerial Experts” to solve their problems for them – until the next crisis. That was the moment to demonstrate the difference between problem solver and coach. The essence of my job as a Lean facilitator is to build independent capacities within the members of the organizations, so that they will be able to solve their own problems and implement organizational processes within the framework of their own work.
Traditional (mass production oriented) organizations, which view problems as a threat to the existing order, exert pressure to find facile solutions, at the price of perpetuation of the culture of lazy thinking and the degeneration of the parts of the brain that deal with problem-solving. It’s not coincidental (and certainly not without cost) that the consulting industry is offering ready-made solutions, which are useful in the short run but perpetuate the lazy culture, which is the biggest opponent an organization can face.
Problems as an Opportunity to Change Organizational Culture
From failed change processes, I learn that each time that it seems to me that I have a ready-made solution in my hands, I have fallen into the trap of “The Man Who Did Not Know How to Ask.” A lean manager or facilitator has to learn to pause, even if it frustrates those who are not used to being in an uncertain space. The truth is, we don’t have the answers — the workers in the field have the answers, and that is why the ILE team guides the medical teams towards designing the process of organizational learning.
If we define a problem as the gap between what is and what should be, or between performances to plan (P2P), then the method of problem-solving transforms a problem into a learning opportunity and a chance for improvement. For that reason, we have attempted to design a problem-solving organizational culture together with the medical, logistical and managerial teams. That is: We encourage them to bring up problems instead of hiding them; to set aside time from work to raise problems and seek solutions; to strive to understand the roots of the problem and not to merely cast blame; and finally – to articulate clear measures (%P2P) in order to determine the quality of constant improvement (Kaizen).
A Culture in Which Problems Are Solved at Their Roots
Encouraging an open discussion, according to the principles of critical thinking, enables us to build trusting relationships with the teams. Our role is then to show them the way to create a space for growth that will empower all of the members in the organization to deal with problems independently and to learn from them.
Instead of instant problem solving, the purpose of a Lean Transformation is to create an active, entrepreneurial culture, including, for example, the ability to solve problems at their roots through trial and error according to the principles of Dr. Deming (PDCA); as a communication mean the A3 methodology provides a framework for defining a problem, identifying its root sources and empirically examining possible solutions. The A3 methodology does not merely aid in understanding the problem and its solution; rather, in addition, it aids in understanding and documenting the process and way to solve the problem, as part of the organizational knowledge (which I will write about in my next column). In this way, we enable the organization’s stakeholders not only to reach sustainable solutions, but also to create the capacity to cope independently in the future.
Boaz Tamir, ILE.