T-Minus 101 Days Until the 6th Annual Lean Healthcare Transformation Summit – Acting Our Way Into a New Way of Acting?

Love this post from our ThedaCare friends! The “under the surface” is my favorite.

gembawalkabout

I had the good fortune of being asked to present at the Society For Health Systems Process Improvement Conference.  I could not stay for the entire conference, but I can see by the Twitter feed that there were lots of great comments and energy around the presentations.

cover slide

I like to start my presentations with a Tweet and short video.

Screen Shot 2015-02-22 at 8.49.42 AM

This was my 3rd year presenting, and I will likely come back because there is a lot more work to be done.  A little ingredient is missing, but it is absolutely vital – profound knowledge.  I was pleased to see that I was not the only one who mentioned the important contributions of Dr. W. Edwards Deming.  James Hereford, COO at Stanford Health Care was also a presenter.

hereford

I guess the primary point I tried to make at the conference is summarized in this slide.

Screen Shot 2015-02-22 at 8.32.09 AM

It took years and…

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Falling Up vs. Burning Platforms: Culture, Mindset, or Stimulus?

(Perspective 2 in a series of weekly perspectives on Structured Problem Solving)
Last week in Part 1 of this series on Structured Problem Solving, we introduced the Turning Adversity into Opportunity Mindset.  This week we will enlarge our knowledge of “Falling Up” and discuss its lesser cousin “burning platforms.” 

Do you remember the 3 Paths in Falling Up?  
There are two scenarios to illustrate this concept: 

Scenario #1:  Falling Up.  Think of yourself as an employee (or company) in today’s tough economic times and you’ve just been laid off (if a company, you’ve just declared bankruptcy). Conventional thinking leaves you with two outcomes:
1.       How can I survive this?  Reactive in nature.  Not very positive.
2.       Woe is me!  Worst case scenario and very negative. 
However, there is a third option!

3.       Use this adversity as a way to not only pick yourself up, but as an opportunity to get better than before.  You create your own future!  Real transformation happens here.
Remember, we often undermine our ability to tackle our challenges when we don’t use other options.  We become helpless.  We create self-fulfilling prophecies.  This is a sure fire route to failure and what positive psychologists call “learned helplessness.” 

Scenario #2:  Burning Platforms. 
This is similar to scenario #1, except the adverse event hasn’t occurred yet and you face a looming black cloud (for the Federal sector this is the Secretary of Defense’s Efficiency Cuts).  Again, conventional thinking leaves you with the same two outcomes:
1.       How can I survive this?  Reactive in nature.  Not very positive.
2.       Woe is me!  Worst case scenario and very negative. 
Again, there is a third option!

3.       Use this looming adversity as an opportunity for growth and get even better.  
However, the difference in this scenario is the “looming” condition.  This is where I disagree with many change advocates who enjoy using (or just talk about) burning platforms as catalysts for change.   When working with teams, there are differing levels of social engineering going on.  Using looming, negative events is a very reactive and poor way to get teams to gel for lasting success.  Yes, they may band together to get the problem solved, but once the looming event passes or a decision is made, most teams go back to business as usual. 

Is that real change?  Have you affected the culture?  In my book, NO.

But I digress, the key here is that we must create an organizational culture that considers problems (even looming ones) as an opportunity to improve, which leads to the key methodology in our Lean Six Sigma Practitioner Professional toolbox: Structured Problem Solving.  Perspective three in this series will look at Plan-Do-Check-Act (PDCA), Define-Measure-Analyze-Improve-Control (DMAIC), and Observe-Orient-Decide-Act (OODA).   I will leave you with a thought from Shawn Achor, the author of The Happiness Advantage:
“…..And above all remember that success is not about never falling down, or even simply about falling down and getting up over and over.  Success is more than about simple resilience, it is about using that downward momentum to propel ourselves in the opposite direction.  It is about capitalizing on setbacks and adversity to become even happier, even more motivated, and even more successful.  It is not falling down, it is falling up.”

About the Author: Ernie Shishido is a Master Black Belt with the US Air Force’s Business Transformation Office with 29+ years of uniformed military service.  Ernie can be found on LinkedIn @ http://www.linkedin.com/in/ernieshishido or by email at er.shishido@gmail.com / ernest.shishido@pentagon.af.mil (until 10 Dec 2010).  






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Delving Deeper: Levels of Culture

(Perspective 2 in a series of weekly perspectives on Building a Culture based on CPI principles)

Last week in Part 1 of this series on Building a Culture based on CPI principles, we introduced the concept of Your Culture is Your Brand.  This week we will define “culture” and critically analyze the significance of addressing cultures in the context of “levels.”

Culture is everything.   Good culture= Zappos success.  Bad culture= Enron failure.  Good culture neglected= Toyota quality problems.  Do I have your attention now?

Defining Culture.  To practice what I preach, I attempt to start every kaizen event or enterprise-level project by defining the major term for the week in order to baseline foundational assumptions.  Predictably, a gap exists amongst team members. To define culture (and delve deeper), the guideline I use comes from my Sensei (John Allen of TSD) who had me study Edgar Schein:

“[Culture is] … a pattern of shared basic assumptions (values, beliefs, norms) that was learned by a group as it solved its problems of external adaptation and internal integration, that has worked well enough to be considered valid and, therefore, to be taught to new members as the correct way to perceive, think, and feel in relation to those problems.”

As you look at the words in bold, the definition seems straightforward enough, but the rub comes in during the analysis. Most people talk about culture in broad terms, knowing that it is important, good for success, a great goal to strive for, and requires a decade to develop. That is ok, but those are superficial interpretations.   To truly undertake a culture change effort, one needs to analyze and differentiate the level in which the culture manifests itself, as it is crucial to creating and executing a successful change effort.  I cannot stress this enough.

I’m a visual (and auditory) person, so let’s show the chart again to point out the different levels of culture:

1st Level – Artifacts.  Sees, Feels, Hears.  I am sure you’ve seen places where signs hang that say “Quality is Job#1” and “Think Safety 1st,” or you hear a certain type of music playing in the hallways, you see everyone wearing a certain style/type of clothing, or notice how everyone communicates to each other.  Can you make a good assumption about the real culture at this company?  It is like judging a book by its cover.  You can, but is it wise?  Would it be fair or smart to think a company was not innovative because their office layouts and their dress were stodgy?  That is what is meant by hard to decipher.

2nd Level – Espoused Beliefs and Values. This is straightforward and must not be misunderstood.  To be an espoused value or belief, it cannot solely be trumpeted by the CEO, but evolve by:

1.       Actual joint action on the belief/value by the group (not just the CEO)

2.       The proposed value/belief action must create real success in solving problems.

3.       Finally, it achieves social validation.  I.E. If you don’t comply, you become part of the “out” group (excommunicated).

Essentially, these are your company’s strategies, goals, and philosophies acted out.  However, there still can be some large areas of behavior still unexplained.

3rd Level – Underlying Assumptions.  This is where actions stemming from company beliefs and values are taken for granted.  These assumptions are non-confrontable and non-debatable!

Now, you can see why analyzing culture and developing change actions by understanding levels is so powerful.  Understanding culture at this level helps us understand what the true culture is and what we are up against.  Understanding at this level is priceless, but we seldom delve this deep.

So, for an organization to learn something new in this realm (the deepest level of culture), requires us to resurrect, reexamine, and possibly change some of the more stable portions of our cognitive structure – How we think.   And that is the subject of Part 3 of this series:  Current way of thinking vs. a Continuous Process Improvement mindset.

P.S. Let me know and I will gladly work with you to share Edgar Schein’s book, Organizational Culture and Leadership.  Once you read it, it will change your thinking about culture.

About the Author: Ernie Shishido is a Master Black Belt with the US Air Force’s Business Transformation Office with 29+ years of uniformed military service.  Ernie can be found on LinkedIn @ http://www.linkedin.com/in/ernieshishido or by email at er.shishido@gmail.com / ernest.shishido@pentagon.af.mil (until 10 Dec 2010).

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Delving Deeper: Levels of Culture

(Perspective 2 in a series of weekly perspectives on Building a Culture based on CPI principles)
Last week in Part 1 of this series on Building a Culture based on CPI principles, we introduced the concept of Your Culture is Your Brand.  This week we will define “culture” and critically analyze the significance of addressing cultures in the context of “levels.”   

Culture is everything.   Good culture= Zappos success.  Bad culture= Enron failure.  Good culture neglected= Toyota quality problems.  Do I have your attention now?
Defining Culture.  To practice what I preach, I attempt to start every kaizen event or enterprise-level project by defining the major term for the week in order to baseline foundational assumptions.  Predictably, a gap exists amongst team members. To define culture (and delve deeper), the guideline I use comes from my Sensei (John Allen of TSD) who had me study Edgar Schein:
“[Culture is] … a pattern of shared basic assumptions (values, beliefs, norms) that was learned by a group as it solved its problems of external adaptation and internal integration, that has worked well enough to be considered valid and, therefore, to be taught to new members as the correct way to perceive, think, and feel in relation to those problems.”

As you look at the words in bold, the definition seems straightforward enough, but the rub comes in during the analysis.  Most people talk about culture in broad terms, knowing that it is important, good for success, a great goal to strive for, and requires a decade to develop.   That is ok, but those are superficial interpretations.   To truly undertake a culture change effort, one needs to analyze and differentiate the level in which the culture manifests itself, as it is crucial to creating and executing a successful change effort.  I cannot stress this enough. 

I’m a visual (and auditory) person, so let’s show the chart again to point out the different levels of culture:
1st Level – Artifacts.  Sees, Feels, Hears.  I am sure you’ve seen places where signs hang that say “Quality is Job#1” and “Think Safety 1st,” or you hear a certain type of music playing in the hallways, you see everyone wearing a certain style/type of clothing, or notice how everyone communicates to each other.  Can you make a good assumption about the real culture at this company?  It is like judging a book by its cover.  You can, but is it wise?  Would it be fair or smart to think a company was not innovative because their office layouts and their dress were stodgy?  That is what is meant by hard to decipher. 

2nd Level – Espoused Beliefs and Values.  This is straightforward and must not be misunderstood.  To be an espoused value or belief, it cannot solely be trumpeted by the CEO, but evolve by:
1.     Actual joint action on the belief/value by the group (not just the CEO)
2.     The proposed value/belief action must create real success in solving problems.
3.     Finally, it achieves social validation.  I.E. If you don’t comply, you become part of the “out” group (excommunicated).
Essentially, these are your company’s strategies, goals, and philosophies acted out.  However, there still can be some large areas of behavior still unexplained.  

3rd Level – Underlying Assumptions.  This is where actions stemming from company beliefs and values are taken for granted.  These assumptions are non-confrontable and non-debatable! 

Now, you can see why analyzing culture and developing change actions by understanding levels is so powerful.  Understanding culture at this level helps us understand what the true culture is and what we are up against.  Understanding at this level is priceless, but we seldom delve this deep. 

So, for an organization to learn something new in this realm (the deepest level of culture), requires us to resurrect, reexamine, and possibly change some of the more stable portions of our cognitive structure – How we think.   And that is the subject of Part 3 of this series:  Current way of thinking vs. a Continuous Process Improvement mindset.
P.S. Let me know and I will gladly work with you to share Edgar Schein’s book, Organizational Culture and Leadership.  Once you read it, it will change your thinking about culture. 

About the Author: Ernie Shishido is a Master Black Belt with the US Air Force’s Business Transformation Office with 29+ years of uniformed military service.  Ernie can be found on LinkedIn @ http://www.linkedin.com/in/ernieshishido or by email at er.shishido@gmail.com / ernest.shishido@pentagon.af.mil (until 10 Dec 2010).  

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Connecting is at the Heart of Developing People: Relationships

(Perspective 2 in a series of weekly perspectives on Lean Six Sigma Mentoring/Coaching principles)
Last week in part 1 of this series on Lean Six Sigma Mentoring/Coaching principles, we introduced the concept of Explosive Growth and how you generate it: Through Leaders Developing Leaders. This week we expound on the ingredients that produce the glue and the environment to successfully mentor and coach: People + Connection = Relationships.
The wording in the title is very intentional: Connecting at the Heart.
People.  Regardless if you are manufacturing cars, fixing planes, providing service at a hotel, seeing a patient, doing transactions at a bank, investigating a crime, or running a back office, People are the Company. No matter what we do, we do not lead machines, paperwork, or any other inanimate object:  We lead, mentor, and coach human beings that have Hearts. If you see any company mantra, vision, or mission statement that reads “People are our competitive advantage,” “People are our greatest assets,” or something to that effect: RUN.   I could provide you loads of data, but all you need to know is that when those companies hit a hard patch, their layoff actions speak louder than words:  “People are our greatest liabilities.”

Connection.  Going back to the virtuous circle diagram, see how the inner circle now overlaps with the middle.  For those who have “think 4 hours ahead of your student/team mindset,” you can see how powerful a Venn diagram can be to illustrate points:

 

 

In a nutshell:  Leaders engaging people create connections and relationships.  We cannot begin to discuss mentoring and coaching principles, even more importantly, successful coaching and mentoring until we can fully grasp that that you must get at the heart of people (people are the company) and the only way you can do this is with engagement and trust to build an enduring relationship.
Relationship.  No relationships = No Mentoring and Coaching.
As a CPI Leader, you cannot even begin to have the mentoring and coaching discussion until you understand that you must have a relationship with your people:

 

 

Successful mentoring and coaching begin with a great relationship with the people you work with.   In the next perspective, we will discuss and define what successful mentoring/coaching is and a way to measure it.
About the Author: Ernie Shishido is a Master Black Belt with the US Air Force’s Business Transformation Office with 29+ years of uniformed military service.  Ernie can be found on LinkedIn @ http://www.linkedin.com/in/ernieshishido or by email at er.shishido@gmail.com / ernest.shishido@pentagon.af.mil (until 10 Dec 2010).

 

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Problems are Just Mile Markers and Turning Adversity into Opportunity Mindsets

(First in a series of weekly perspectives on Structured Problem Solving)
As Lean Six Sigma Practitioner Professionals, these ARE the mindsets we need to live by and a core practitioner skill we need to have honed and some may call it our weapon: Structured Problem Solving.  Mindsets we also, need to ingrain into the culture of the organization we live in or support.   
You may be wondering why there are two titles.  For me, each of them were epiphanies, and although they are essentially the same, they truly are different “states” along a continuum of a CPI Structured Problem Solving mindset.     
“Problems are Just Mile Markers” is the mindset of incremental and continuous process improvement.  As you tackle each problem, additional challenges arise because you never stop growing and learning about your processes.  Although it can feel stressful and confusing, it is also very powerful as continual engagement of people (both between the employees themselves and also your engagement with teams) create such awesome effects.  
The only thing constant in life is change.  Good change framed in a virtuous cycle of process improvement (Plan-Do-Check-Act or Define-Measure-Analyze-Improve-Check or Observe-Orient-Decide-Act) looks at problems as opportunities, so problems become mile markers. Each one we pass, means we’ve gotten better.  I cannot stress enough:  A journey of a 365 days/steps starts with a single step.  
“Turning Adversity into Opportunity,” on the other hand, assumes we already understand that problems are indeed opportunities; however the mindset here takes it a giant leap forward.  The mindset is about Failing Forward or Falling Up.  What does that mean?  It will take a little bit more time (and space!) to fully illustrate Falling up and it will be the topic of Part II of this series, but as a primer think about this phrase:  Lasting success is more than about simple resilience, it is about using that downward momentum to propel ourselves in the opposite direction — you can create a third opportunity when adversity happens.  
Here is a visual depiction:
About the Author: Ernie Shishido is a Master Black Belt with the US Air Force’s Business Transformation Office with 29+ years of uniformed military service.  Ernie can be found on LinkedIn @ http://www.linkedin.com/in/ernieshishido or by email at er.shishido@gmail.com / ernest.shishido@pentagon.af.mil (until 10 Dec 2010). 
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Your Culture is Your Brand

(First in a series of weekly perspectives on Building a Culture based on CPI principles)
Where have you heard about this before?  Does Tony Hsieh, CEO of the billion dollar company Zappos that was recently acquired by Amazon.com, sound familiar? When I heard Tony Hsieh utter the phrase “Your Culture is Your Brand” in his audiobook, “Delivering Happiness: A Path to Profits, Passion, and Purpose,” all other thoughts ceased.  This was so deep and I knew right away that the interpretation was so clear-cut and unambiguous in nature, but the awareness (self and organizational) and execution are so distorted that people believe they know what culture is and believe they are working on culture when indeed, they may not.  
Why is this important?  If you create a strong culture at all levels (more on that in the picture below), you build lasting success in your organization.   Some people talk about fixing it, some just think it is so tough they give it some effort, and there are those that let it go because “culture” it is too soft.  Successful people and organizations work on culture and then work on it some more and never take it for granted.  
Why is this important for you as a Lean Six Sigma Practitioner Professionals?  Because building a culture of Continuous Process Improvement (CPI) creates a powerful environment for success to breed.  Two distinct and critical concepts here: 1) Building a culture and 2) Creating a CPI Environment.  You need to understand the first to create the second.  
Understanding what culture is and analyzing at what level it manifests itself, is the subject of Part II of this series.  But as a teaser, here is a visual to get you thinking:
About the Author: Ernie Shishido is a Master Black Belt with the US Air Force’s Business Transformation Office with 29+ years of uniformed military service.  Ernie can be found on LinkedIn @ http://www.linkedin.com/in/ernieshishido or by email at er.shishido@gmail.com / ernest.shishido@pentagon.af.mil (until 10 Dec 2010). 
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Creating Explosive Growth for Your Organization: Leaders Developing Leaders!

(First in a series of weekly perspectives on Lean Six Sigma Mentoring/Coaching principles)

First things first, this is about you: The Lean Six Sigma Practitioner Professional. You are a leader of a powerful methodology that can create huge success and growth for your organization. That is the first point that you must keenly grasp when you take on this role. Too often, we think of ourselves as internal or external consultants, and that is ok to keep you going daily, but ultimately you are leader that develops other leaders. Leaders who develop leaders create explosive growth! Explosive growth is measured by the extensive impact that a multitude of leaders can accomplish versus a single “CEO Type” of leader. Imagine the impact of a shared vision created and executed by multiple leaders versus just the vision of one person.

Visually, it is a virtuous circle:

Before you get upset with me for downplaying the role of an internal/external consultant, let me explain. If you consider yourself as mainly a consultant, you are focused on creating successful outcomes, or worse yet, achievement. At best, these practitioners are creating followers, not leaders. It is all about your mindset: Developing the people you serve first, creates the short and long term successful outcomes. This is the essence of Servant Leadership.

If you’ve stuck with me this far, then the question becomes: How, as Lean Six Sigma Practitioner Professionals, do we develop leaders? It is all about successful Mentoring and Coaching. And that is the subject of Perspective 2 and beyond of this series.

About the Author: Ernie Shishido is a Master Black Belt with the US Air Force’s Business Transformation Office with 29+ years of uniformed military service. Ernie can be found on LinkedIn @ http://www.linkedin.com/in/ernieshishido or by email at er.shishido@gmail.com / ernest.shishido@pentagon.af.mil (until 10 Dec 2010).

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Culture of Accountability

Was reading a great book called “How Did That Happen,” a book about creating a culture of accountability. Serendipitously, it will help tremendously with a project I am working. In a nutshell, everyone wants to create a great culture but the question is “what type of culture?” In this case, a culture of accountability is right:

2 Types of Accountability: Positive and Negative.
Look at as a personal attribute.
Positive) Taking accountability for yourself
Externalize the need for change, self-motivating, resourceful.

Negative) Holding other people accountable.

Time to create a culture of Accountability. A team, department, division, or companywide culture in which people take accountability to think and act in the manner necessary to achieve desired organizational results.
You establish the necessary foundation on which an organization can build an accountable workforce, from top to bottom. Two critical phases:

1. Clearly define expectations and results expected.
2. Form, communicate, align, inspect (measure) expectations through systems, policies, and process that help with needed culture shift.
a. Form: mutually understood and agreed-upon expectations can get people 100 percent committed to getting the job done. Clearly defining the result.
b. Communicate: Why (Make it compelling) – What (the expectations)– When . Get away from “Marching Orders, Ensure multiple mediums, Ensure you make it clear on how it gets done,
c. Align: Getting everyone to buy-in, not just comply. Get divisions, organizations, and the people to all align their expectations. (maybe get ANG, AFRC?) Getting full commitment. Is the expectation clear, achievable, needed , and linked?
d. Measure: Assess the condition, execute, support and reinforce progress, and continuously review. Reward when they make it well!

What do you think?

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