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  • Wait…don’t tell me

    This crossing sign visualizes the concept of pausing before moving forward together, just like the request to “wait…don’t tell me.” I experienced this pausing before moving forward when helping a 9-year old with her third grade reading homework. She was struggling and asked me to tell her the words she didn’t know. After doing that a few times, I realized that when I gave her the answer, she didn’t recognize the word the next time she saw it. So, I slowed down. When she didn’t know a word, we paused and she sounded it out – she began to recognize these words the next time they appeared....
  • Kitting reduces setup time

    A fundamental principle of lean is to reduce waste—all those things that suck up time and energy but don’t contribute value. For example, taking my camera on hikes was too much effort because of waste: searching for the memory card, the backpack, and the camera that were haphazardly located in three different rooms. Then I realized that these wastes could be eliminated by applying the quick setup technique of a kit. A kit is a collection of items needed to perform an activity. Many professions use kits for needed supplies and tools – the plumber’s toolbox, a chef’s knives, a doctor’s...
  • Low-hanging fruit

    While I was taking an early morning walk, a patch of ripe blackberries caught my eye – a tasty treat of low-hanging fruit. As I sampled the ripe berries, my thoughts went to a time at work where our team didn’t see the low-hanging fruit. Years ago, working as a research scientist on a team scaling up the manufacture of an HIV test, I dressed in my clean room “bunny suit” for a day of cutting-edge, geek science with my team. It was my first time performing a process step that challenged my manual dexterity. The process was labor intensive and time-consuming, so a team member also decided to...
  • Self-care

    Take a breath…pause for just a moment and take a deep breath. My family is in the final hours of preparing for a wedding, and the days have been long, intense, and emotional. Everyone is giving 100 percent. As we were jumping from one important activity to another, I remembered an experience I had last week of pausing to smell the roses. Travelling briskly between the office building and the hospital, I paused to smell a rose. I felt my mind slow, the pressure ease a little, and my self-awareness increase. I realized that I was pushing myself (and probably others) too hard — beyond what was...
  • Importance of continued measurement

    Have you ever held a kaizen workshop that resulted in significant improvement, only to find six months down the road that the process has reverted to the old ways and the improvement was no longer evident? Why does this happen? The main reason for this type of regression is lack of leader follow-up. With most kaizen events, we measure the improvement during the event and then at 30, 60, and 90 days afterward. If the improvement has been sustained during that period, we consider it a success and move on to something else. If we aren’t hearing anything negative, it must be okay, right? Wrong!...
  • Restoring joy to caregiving – reflections on National Nurses’ Week 2017

    Reflecting on the theme of National Nurses’ Week 2017 – “Nursing: the Balance of Mind, Body and Spirit” – I think about the importance of restoring joy to caregiving. When we use lean methodologies to take the waste and inefficiency out of work, we improve in the three dimensions of the Triple Aim: population health, patient experience, and cost. For the last few years, recognition has grown that a key dimension may be missing from that model:[1] a focus on staff engagement and the well-being of providers as a necessary element to achieving the Triple Aim. Fortunately, those of us who...
  • Perfect takes practice

    Feeling adventurous, I went ocean kayaking. Having paddled before, I thought I was capable. As the professional instructor demonstrated the correct way to hold the paddle, I learned that my grip and arm position were wrong. Adjusting, I was ready to learn to paddle. I struggled with the correct movements, especially a flip back of the left wrist which I kept doing as a forward twist. The instructor coached me a few times before saying, “You’ll get it when you’re on the water.” On the water, I got it for a little while, but then I drifted back to my old way. This pattern of catching myself...
  • Step in, step up

    Recently, a team was doing a 5S workshop. A 5S workshop (sort, set in order, shine, standardize, sustain) is an intensive week-long event that is a fundamental step to implementing lean process improvements. It involves letting go of treasure/junk that has accumulated as a safety net. Then, everything is put in place, cleaned, inspected, made predictable, andmaintained through auditing and 5-minute daily touch-ups. The process has been described as “bone crunching” or “gut wrenching” for the teams as they build consensus and make many, many tough decisions. It’s always a challenge. At the...
  • Detours

    The quick experiment failed. Now what? It’s time to find an alternate route forward—to find the detour, the Plan B (or Plan C or … Plan H). As I was walking to work, I discovered the sidewalk was closed for construction. I didn’t see a path forward. Crossing the street, I found a detour – the detour was the only way forward. The same applies for experiments: it’s not a straight path, there are detours. The unexpected is what needs our creativity, persistence, and fortitude. Finding or making detours is where the learning happens. It’s the forward part of “fail forward fast.” It’s the...
  • Fail fast

    During a weekend photography class, I had the opportunity to try a unique lens. We took pictures in the morning, critiqued at lunch, took pictures at sunset, self-reflected, and repeated. In the space of a weekend, we had four rounds of experiments using PDCA (plan–do–check–act). The short interval between doing and reflection enabled us to see the connection between what we had done and the impact on the photograph. We weren’t reckless – we established a goal and critiqued each photograph on its closeness to the goal, its technical accuracy, and artistic merit. If we had taken months to do...

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