At work, before you do anything else, go see your customer (internal or external), go see your team or staff – see how they are doing, go see and spend time where the work is done.

Guess who benefits the most when you do this? That’s right, you. By practicing “go and see” (genchi genbutsu) at “the place where value is added” (gemba), you learn empathy, you demonstrate trust and care, and you become informed, which helps your judgment as a leader.

Most, or some of us, who find home in an office or a cube and also on the factory floor or some other hands-on setting, are tempted to check email or voice mail when we first get to work. Fight the temptation – before checking your email or checking your voice mail, Go to the Gemba.

For you, this might mean:

1. If you’re doctor, go see your patients first.
2. If you’re a consultant, go see your clients first.
3. If you’re a manager in a factory, go see the people at the factory floor first.
4. If you’re an emergency room nurse, go see the folks in the emergency room first.
5. If you’re an executive, go see your staff or team members first.
6. If you’re like the rest of us and, just plain normal and nothing special, think about your customer – probably not the end customer, but most likely your downstream customer. Are you meeting their needs? Quit playing Farmville, Mafia Wars, or Frontierville – get up and talk to your internal, downstream customer – are you meeting their needs?
7. If you’re a customer service agent, go and see your co-workers and see what the customer’s are calling about. What’s the current pulse of the customer?
8. If you’re a marketer, go and see how your team is doing; how are your products and services doing? are they meeting the needs of your customers?

Here’s the point:

Before you get too comfortable in that ergonomic chair, dual monitor screens, spend time where the value is added. That usually means spending time where the work is truly done and with the people who are doing it. And, that usually doesn’t mean, in your cube or office.

I scheduled a meeting this week and a room for our meeting.  During the course of our conversation, we began to discuss process and other items related to the their work.  Gratefully, I had enough awareness to stop the conversation and we, as a team, walked out to the Gemba and continued our discussion there.

Where we ended-up was not comfortable or warm, but we were in their natural environment – where they do work everyday.  In this environment, they were able to show and share, not just talk about it.  Then, something really magical happened.

What proceeded was a very productive and energetic discussion that turned into a mini Kaizen.  I guarantee that it would not have turned out so well if we had continued our discussion in the meeting room.

Go to the Gemba.  In the Gemba, we begin to empathize with people – we not only see their pain, but we feel it – and that has tremendous power to change hearts and minds.

A spreadsheet or report doesn’t invoke emotion, but experiencing the facts can.  That is the power of being in the Gemba.

There is a Design Thinking opportunity to Emergency Room care.  In my previous post, I discussed the time involved in waiting to receive care -queueing properties of ER care.  What I didn’t discuss is the feeling and experience of the patient during care.  That’s the topic for this post today.

We know that ER Wait Time is a problem.  But, that perspective is based on quantifiable factors, such as time and number of patients waiting.  But, there are “soft” or qualitative factors that are quite important and need to be addressed when discussing human experience.

This is exactly what IDEO did in a recent Hospital redesign.  In their words,

One of IDEO’s designers, Kristian Simsarian, took on the redesign of a hospital emergency room. Kristian checked in as a patient, videotaping every experience — and one of the first things we noticed, watching the tape, was the sheer amount of time he spent lying on his back, waiting on the rolling cot, staring at the acoustic ceiling tiles.  The tiles became a symbol of the overall ambiance: a mix of boredom and anxiety from feeling lost, uninformed, and out of control.

We could have responded by saying, “Let’s make the ceiling tiles more colorful” or — as many hospitals do — “Let’s put televisions everywhere to distract people.”  Instead, we started a series of deliberate discussions about the findings, and those led us to talk about improving the overall approach to ER logistics, so patients were treated less like objects to be positioned and allocated, and more like people in stress and pain.

The Psychology of Queueing

We know that the Principles of the Psychology of Queueing (Wait Time Psychology) are the following:

1. Unoccupied time feels longer than occupied time.
2. Process-waits feel longer than in-process waits.
3. Anxiety makes waits seem longer.
4. Uncertain waits seem longer than known, finite waits.
5. Unfair waits are longer than equitable waits.
6. The more valuable the service, the longer the customer is willing to wait.
7. Solo waits feel longer than group waits.

The story above violates almost all of the principles of wait time psychology.  But, nevermind that: what speaks even more loudly is the experience the human has while waiting – they are staring at the ceiling.

In the Gemba – and only in the Gemba – do we get a sense of empathy that must spur us to action on behalf of the customer.  Raw data doesn’t produce empathy; only human stories and experiences in the Gemba can produce a change of heart.

Recently, Tim  Brown, the CEO at IDEO came to a realization that Design Thinking can coexist with Six Sigma and Lean.  For a while, his stance was really of black-and-white thinking: it’s either Design Thinking or Lean Thinking.  This position is akin to a student who believes that if he doesn’t earn an “A” in a class, he believes he failed.  Clearly, not healthy.

The irony in all of this is that while Tim Brown was calling Six Sigma and Lean “toxic”, IDEO, his firm, had been using many of the tools and methods from Toyota – the inventor of Lean Thinking.

An Orphaned Mother

Toyota is the mother whose ungrateful children have abandoned.  In IDEO’s case, in particular, while Tim Brown was attacking Six Sigma and Lean, his firm had been using it’s tools all along.  For example, IDEO’s patented Human-Centered Cards showcases several methods to help designers arrive at innovative design.  One card shows the 5 why’s.  Who invented the 5 why’s?  You got it, Taiichi Ohno, from Toyota.

Other tools on the Human-Centered Cards shared by Lean and Six Sigma practitioners as well as Design Thinkers are:

• Error Analysis (Failure Mode Effects Analysis – again, from Toyota)
• Flow Analysis (Process Mapping or Value Stream Map – again, from Toyota)
• Affinity Diagramming
• Activity Analysis (Value-Stream Mapping – again, from Toyota)
• A Day in the Life (Genchi Genbutsu – again, from Toyota)
• Empathy Tools (Gemba – again, from Toyota)

In All Fairness

I’m thankful that one of my early mentors was a trained ethnographer, with a PhD in Anthropology from the same graduate school I attended.  From him, I learned that humans are incredibly complex but simple at the same time and, to understand the human condition and be able to do something positive about it, we actually need all the help we can muster – from all disciplines.  His words and mentoring still ring true to this day.

To be fair, I greatly admire IDEO.  They have done some amazing work for companies and are defining how we understand innovation.  Their work has influenced me greatly.  Indeed, I often engage in amateur ethnographic expeditions, thanks to my early training in anthropology.^{1 2 3 4 5 6 7 8 9 10 11 12 13 14}

A Reformed Dichotomous Thinker, An Undercover Lean Thinker

Tim Brown is a reformed dichotomous thinker.  For him, it’s no longer black-or-white; lean thinking or design thinking; six sigma or design thinking.  In his words,

I have to admit that for a long time I was highly skeptical of design thinking’s ability to operate in a Six Sigma environment and I was once quoted in the Economist as saying that it was toxic to innovation.

I don’t think that anymore.  Having spent more time studying companies like Toyota I have realized that high quality (the goal of Six Sigma) is a great platform for new ideas (the goal of design thinking).  Similarly, as Chuck Jones implies, Six Sigma can help new ideas get better faster.  Having been involved in several first mover products at IDEO I can attest to the fact that very rarely is that first iteration the best possible product in terms of quality or functionality.

Perhaps we should think of design thinking and Six Sigma being part of a cycle, each feeding the other to create new and improved products, services and experiences. Of course the biggest challenge will be to build business cultures that are agile enough to incorporate both.

This is good, refreshing, and healthy.  After all, we need all the help we can muster if we are to better understand and more positively contribute to the human condition.

My hats off to Tim Brown and IDEO.

Dichotomous Thinking No More; Design Thinking and Lean Thinking – Yes.

The two pillars in Lean Thinking are Continuous Improvement and Respect for People.  What is not well understood is that most of what we know as The Toyota Production System comes from these two pillars.  The Lean sub-culture tends to over-emphasize the “tools” of Kaizen, but miss the point altogether, since the tools stem or originate from one of the pillars above.  The relationship between the 2 Pillars and Waste is subtle, but important.

For example, let’s take the Andon Cord, a tool in the Toyota Production System.

An Andon is a cord that hangs on both sides of a production line. It is to be ‘pulled’ when a problem happens on the line and, when pulled, production stops on the line, loud irritating Japanese music blasts through the speakers, bringing attention to everybody that there is a problem.  The team gathers together, conducts root cause analysis (5-why’s), implements countermeasures (solutions on the spot), then the production line start again and the Japanese music stops.

Now, suppose your organization breeds fear in its people and that questioning the status quo or speaking-up when there is a problem is viewed as bad. In this type of environment, implementing the ‘tool’ of an Andon Cord will not work.  Why?  An Andon Cord is just a tool, but it represents an organizational tenet of “if there’s a problem, please speak your mind and be not afraid.”  If that tenet doesn’t exist, then it makes sense that nobody will pull the Andon Cord.

Changing Worldview, Changing Behaviors

Lean Thinking is more about changing worldview and behaviors:

when you change a person’s worldview, a change in their behavior will follow, then they begin to improve their world

In this specific example, an Andon Cord did not work because the fundamental worldview of the company is that they do not want to know if there are problems, or that they do not value the employees’ opinions or input — THAT is a bigger problem than the cumulative effect of all defects in the company (more precisely, that is the root cause of waste as well as issues in organizational effectiveness).

For this example, here is what is at play:

1. Speak-up if you see a problem
2. Don’t pass problems up or down the value chain
3. Improve the way you work, the service, and the product
4. There is an end-customer, but the person upstream and downstream from you is also your customer

If an organization doesn’t subscribe to these basic principles, then no matter how many Andon Cords are available at your company — nobody will pull them.

Underutilized People

Switching gears now.  A related tenet to the Respect for People Pillar, is the idea of Underutilized People.  While not officially one of the 7 Wastes in Lean, Underutilized People clearly sits in the Respect for People Pillar.

Barry Schwartz, in an inspiring TED talk on Practical Wisdom, explains the impact on the organization and customers when the company structure and values creates underutilized people:

In this talk, Schwartz tells us about a hospital janitor, showing the responsibilities associated with the job in their job description.  Of all the Janitor job descriptions, not a single one involves interacting with other people.  When Schwartz interviewed hospital janitors about the challenges of their jobs, all the problems they listed dealt with other people.

For example, good janitors knew not to vacuum the floor when guests were napping, or not to mop the floor when a patient was walking the hallways and restoring his strength.  Being a hospital janitor involves interactions that require kindness, care and empathic thought that’s not in the job description.

To test Barry Schwartz’s findings, I went to Monster.com (NYSE: MWW) and search for “Hospital Janitor”.  The job description is one I found for an Elderly Care Facility:

Cleans and maintains entry lobby, including cleaning of windows, doors, mopping floors, vacuuming carpets, etc., at least daily, and more if necessary to maintain excellent entrance appeal.

Cleans laundry room, community room, conference room, and management offices on a daily basis.

Vacuums hallways on a daily basis.

Cleans community bathrooms on a daily basis, more if necessary to maintain in a sanitary manner.

Cleans stairways and elevators on a regularly scheduled basis.

Does cleaning of units, including stoves, refrigerators, bathrooms, floors, windows, etc.

Reports all maintenance repairs needed to Maintenance Supervisor.

Sweeps and cleans parking lot on daily basis.

Waters flower box on a daily basis (seasonal).

Picks up trash from grounds.

Uses hose to clean front entry walks.

Changes all light bulbs in hallways and common areas.

Does minor work orders for residents and/or management as assigned by Maintenance Supervisor.

Reliable…Must be able to work a flexible work schedule

Not one of the requirements deals with elderly patients, listening to them tell war stories, smiling at them, or any other small nice-ities that can make the day for an elderly person.  This job description reflects the values of the company.

A Long-Winded, Jagged Post

Yes, a lot of inter-related ideas in this post.  Here’s the point:

Worldview and Values matter – those dictate the behaviors of everybody in the company.  When “tools” don’t work, that is because the values don’t support the “tools”.  Focus on Worldview and Behavior — then the rest will follow.