LeanGeek.Blog: My favorite Lean tool isn’t on the first page of a Google search, and why that is a problem.

When you read about Lean tools, you often hear about 5S+Safety, Kanban, Value Stream Mapping, PCDA, or Visual Controls. These are all wonderful tools for the correct application; however, oftentimes, I see them misused, used out of context, or with no purpose. In many cases, they are used because it is an easy way to get started with Lean. I hear the phrase, “I read about 5S in a Lean book or saw it on a factory tour, so if we do this, we will be Lean.” I’ve been guilty of this practice getting started in my Lean knowledge journey, and I’m sure many other Lean practitioners have as well. Using a random Lean tool with no context or purpose is the equivalent of hiring a contractor to fix a leak in your roof, but they have a new finishing nailer, so they install new wood floors in your living room. The new wood floors are great, look nice, and are an improvement over the carpet but it hasn't solved the problem. 

What I believe we all should all be asking first is, “What problem are we trying to solve AND is this really a problem?” The first part of this question, “What problem are we trying to solve” is not the focus of my post today, but I believe this should be tied to the organization’s strategy and translated down to each department’s goals. I’ll have a future blog post on that. The second part, “Is this really a problem?” is the question I want to address and leads me to my favorite Lean tool, Process Behavior Charts (PBCs). If you do a google search of lean tools, you will not find PBCs on the first page results. This is a problem. While some may argue over technicalities that this is one of the seven basic tools of quality and not a Lean tool, I believe as Lean practitioners this should be one of the most used tools in your Lean tool belt to ensure you are solving problems that are real issues (signals) and not perceived issues (noise). 

There are many lengthy definitions of Process Behavior Charts, but in the simplest form, they are run charts that plot data over time with a set upper and lower limits. In addition to the charts, there is a list of rules to indicate if the data is just inherent variation “noise” or a clear signal that there is something we need to investigate, a change in the system, or a potential problem to solve. I first learned about Process Behavior Charts in Don Wheeler’s book, Understanding Variation - the Key to Managing Chaos and subsequently Mark Graban’s book, Measures of Success: React Less, Lead Better, Improve More. I was introduced to both of these gentlemen through their presentations at the Society for Health Systems conference (shameless plug), which is an organization where I volunteer my time. The point of this post is not to teach how to graph and interpret Process Behavior Charts. If you want to learn that, I highly recommend both of the books above. Mark Graban also has a great cheat sheet and google sheet on Creating a Process Behavior Chart.

Process Behavior Charts help us point to real problems in a system (signals) and not perceived issues (noise). They teach us how to react or, more importantly NOT to react to data. As Lean practitioners, we should be focused on the important problems that affect the company performance or the customer experience instead of “improving” vanity metrics or kaizen events with no purpose. For example, in a hospital, instead of blindly 5S’ing a supply room, maybe focus on a strategic goal such as reducing central line-associated bloodstream infections (CLABSI) and track it by unit using Process Behaviour Charts. When we identify that there is a signal on a unit and THEN conduct root cause problem solving and implement Lean tools such as standard work and kamishibai cards to ensure and teach the standard. By focusing on what is vital to the organization and the customer, you will have better buy-in from your staff. From a front-line clinician perspective, why would I be engaged in Lean if I was assigned to a Kazein event to clean up supply rooms when I knew that patients were being harmed due to infections and my time was being spent on a trivial project. If we can use tools, like Process Behavior Charts, to point us to the real problems to solve in your Lean initiative, you will be on your way to truly building a culture of continuous improvement with engaged employees.       

Challenge Questions:

1. What problem are you trying to solve? How is the Lean tool you are using addressing this problem?
2. Is this actually a problem? How do you know it’s a problem?  Have you measured the problem with a Process Behavior Chart? 
3. Is there a more crucial problem to solve? Are we utilizing human potential solving problems that are critical to the organization? How can we redeploy this talent to solving problems that are in alignment with the organization’s strategic goals?