Good listening does not come naturally to me.

In the past, I have often found the “solution” prior to fully understand the problem, occasionally “fixing” the wrong problems….clearly an ineffective, waste-filled process.  My physician recently shared with me a study on doctor/patient communications: the results: a doctor will interrupt their patient 17 seconds after asking them a question. In self-reflection, I am reminded of good A3 thinking, done the Toyota Way.  In the simplest terms, the sheet is divided into two halves, the left side or current condition for problem definition, effects etc, the right or target condition side is for counter-measures, milestones and their status. Toyota’s philosophy, holds clarity of problem definition as equal in importance to counter-measures to the problem. , after-all, fixing the wrong problem is not our objective, this would diminish both the process and the people involved and waste a lot of valuable resource.  Identifying the real problems than applying the scientific method for problem solving is our true objective.

My experience, both professional and personal, has informed me over and over again, that humans like to be listened to and dislike being ignored.  Perhaps when we think we are listening, we are giving unintentional feedback to “our customer” that we are not.

The 7 Habits of Highly Effective People
Steven Covey
Habit 5 — Seek First to Understand, Then to be Understood

Principles of Empathic Communication
1. Character and Communication
* Communication is the most important skill in life
* If you want to interact effectively with me, to influence me, you first need to understand me.
* You have to build the skills of empathic listening on a base of character that inspires openness and trust.

2. Empathic Listening

* Most people listen with the intent to reply.
* When another person speaks, we are usually ‘listening’ at one of four levels:
a- ignoring
b- pretending
c- selective listening
d- attentive listening

Very few of us ever practice the highest form of listening — empathic listening.

* Only 10 percent of our communication is represented by the words we say, another 30 percent by our sounds, and 60 percent by body language.
Dr. Covey suggests we “Diagnose Before we Prescribe” …….let’s make sure we are solving the correct problems…….otherwise our efforts are waste.

Other resources:

Casaa Resources

Some words on “active listening”

If you are really listening intently, you should feel tired after your speaker has finished. Effective listening is an active rather than a passive activity.
When you find yourself drifting away during a listening session, change your body position and concentrate on using one of the above skills. Once one of the skills is being used, the other active skills will come into place as well.
Your body position defines whether you will have the chance of being a good listener or a good deflector. Good listeners are like poor boxers: they lead with their faces.
Meaning cannot just be transmitted as a tangible substance by the speaker. It must also be stimulated or aroused in the receiver. The receiver must therefore be an active participant for the cycle of communication to be complete.

The Par Group
Following are some keys to listening well

1. Give 100% Attention: Prove you care by suspending all other activities.
2. Respond: Responses can be both verbal and nonverbal (nods, expressing interest) but must prove you received the message, and more importantly, prove it had an impact on you. Speak at approximately the same energy level as the other person…then they’ll know they really got through and don’t have to keep repeating.
3. Prove understanding: To say “I understand” is not enough. People need some sort of evidence or proof of understanding. Prove your understanding by occasionally restating the gist of their idea or by asking a question which proves you know the main idea. The important point is not to repeat what they’ve said to prove you were listening, but to prove you understand. The difference in these two intentions transmits remarkably different messages when you are communicating.
4. Prove respect: Prove you take other views seriously. It seldom helps to tell people, “I appreciate your position” or “I know how you feel.” You have to prove it by being willing to communicate with others at their level of understanding and attitude. We do this naturally by adjusting our tone of vice, rate of speech and choice of words to show that we are trying to imagine being where they are at the moment.

Purpose

When interacting, people often are not listening attentively to one another. They may be distracted, thinking about other things, or thinking about what they are going to say next, (the latter case is particularly true in conflict situations or disagreements).

Active listening is a structured way of listening and responding to others. It focuses attention on the speaker. Suspending one’s own frame of reference and suspending judgment are important in order to fully attend to the speaker.

Tactics

It is important to observe the other person’s behavior and body language. Having heard, the listener may then paraphrase the speaker’s words. It is important to note that the listener is not necessarily agreeing with the speaker—simply stating what was said. In emotionally charged communications, the listener may listen for feelings. Thus, rather than merely repeating what the speaker has said, the active listener might describe the underlying emotion (“you seem to feel angry” or “you seem to feel frustrated, is that because…?”).

Individuals in conflict often contradict one another. This has the effect of denying the validity of the other person’s position. Either party may react defensively, and they may lash out or withdraw. On the other hand, if one finds that the other party understands, an atmosphere of cooperation can be created. This increases the possibility of collaborating and resolving the conflict.

In the book Leader Effectiveness Training, Thomas Gordon states “Active listening is certainly not complex. Listeners need only restate, in their own language, their impression of the expression of the sender. … Still, learning to do Active Listening well is a rather difficult task…”[1]

Active listening is used in a wide variety of situations, including tutoring,[2] medical workers talking to patients,[3] HIV counseling,[4] helping suicidal persons,[5] management,[6] counseling and journalistic settings. In groups it may aid in reaching consensus. It may also be used in casual conversation to build understanding, though this can be interpreted as condescending.

The benefits of active listening include getting people to open up, avoiding misunderstandings, resolving conflict and building trust. In a medical context, benefits may include increased patient satisfaction,[3] improving cross-cultural communication,[7] improved outcomes,[3] or decreased litigation[8].

Active listening can be measured by the Active Listening Observation Scale.[9]

Barriers to Active Listening

All elements of communication, including listening, may be affected by a barrier(s) that can impede the flow of conversation between individuals. Some of these barriers include distractions, trigger words, vocabulary, and limited attention span to name a few[10].

http://www.neshingoprize.org/

Industry Week Webinar link

Creating Level Pull workbook link

What two operational issues are the primary focus of your healthcare clients?

Well, as in any industry, hospitals face a wide range of issues and challenges. For Lean folks who are familiar with the SQDC framework, it maps well to a hospital’s concerns — Safety (patients and caregivers), Quality (of care and of service), Delivery (avoiding delays and ensuring the right care is delivered), and Cost. Most everyone has been aware of the increasing costs of healthcare – the general public is recently becoming more aware of the patient safety and quality risks they face in a hospital. And these are all problems that can be address with Lean.

One interesting (and I think positive) development is the trend for Medicare/Medicaid (now followed by private insurers) to NOT pay for preventable medical errors. Traditionally, healthcare has been a “piecework” pay structure — if you did work, you got paid for it. So even if a patient got a bedsore (due to lax care) or suffered from some other preventable medical error, the hospital could submit for reimbursement to cover the care that shouldn’t have been needed – if care had been provided right the first time. I think this is a step in the right direction – creating more of a financial incentive for quality… although it’s somewhat sad that quality requires incentives. The incentives are right, in theory, but we also need to provide hospitals with a METHOD for actually improving quality, something more than demanding that people “be more careful”.

Do you find cultural issues relating to continuous improvement and change in general in healthcare?

It’s been very interesting. On the one hand, the types of waste, the mindset, the management issues were all eerily familiar as I moved from manufacturing into healthcare. You have hospital cultures that tend to think batching is the most efficient way of doing work. Hospitals tend to fall in love with automation and information technology as a single bullet solution as much as factories — with similar disappointments and results. The most important cultural factor is basic relations between employees and management. My heart sank the first time I heard a skilled hospital professional complain “Nobody ever asks me what I think… I’ve been turned into a robot” (and that had NOTHING to do with automation). Non-Lean hospital managers have to unlearn some of the same bad habits that factory managers struggle with — you have to get out to the Gemba, you have to ask why instead of blaming people, and you have to get everybody involved in kaizen, instead of relying on top-down decision making and control. Now, the one HUGE advantage that hospitals have is the orientation around serving patients. Even if people have gotten a bit crusty over time, most people went into healthcare to take care of people. There’s a huge intrinsic motivation that you can tap into that I never saw in a place that made widgets. If you can orient people around Lean being incredibly good for patients AND the employees, you can go far with Lean in a hospital.

Why are so few healthcare providers implementing continuous improvement/lean?

To some extent, there’s the “we’re different” factor. Something that’s viewed as just a factory toolkit will get resistance from hospitals. But when Lean is understood as a philosophy and a management system — it makes sense. There are enough great examples out there now – ThedaCare, Virginia Mason, Avera McKennan — hospitals that are transforming their management system and the entire organization …. these aren’t hospitals that are just dabbling with Lean tools. I think the “Lean doesn’t apply to us” argument doesn’t hold water anymore. The things that interfere with Lean adoption in hospitals are the same dynamics that we face in manufacturing organizations — a lack of willingness to change from executive level, supervisors and managers not wanting to give up control of the workplace, people being measured on their own department’s budget and results instead of overall system effectiveness…. hospitals are, at a detailed level, just another workplace – people doing work, fighting systems that often don’t serve their needs, and people who manage those people — many of the challenges across hospitals and factories are just human nature.

You have written a book, “Lean Hospital” could you tell us about it……….

Certainly…. It’s called Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction (you can get more information at leanhospitalsbook.com) … after having a successful blog for three years, I was referred to Productivity Press, who asked me to write an overview book about Lean in hospitals. I was able to draw on my own experience as well as my colleagues and other clients of the firm I work for, ValuMetrix Services, as well as other hospitals that cooperated and shared their stories. The book is written as more of “why lean?” and “what is lean?” book more so than a detailed implementation guide. My book shares many examples of hospitals and departments who have made great improvements with Lean methods – laboratories, pharmacies, operating rooms, emergency departments, and more. I also try to define Lean in a way that hospitals can relate to, using their own examples and terminology, but without trying to change the essence of what we know Lean and the Toyota Production System to be. I do cover some of the Lean tools, such as kanban, standardized work, error proofing, and 5S, but I try to frame those tools in the philosophy and the management system of Lean. I wanted this to be the type of book you could hand to a hospital CEO or manager who knew little or nothing about Lean – the type of book that could motivate them to take action in their own hospital. I mean books are fine… I obviously like books… but we won’t gain much as a society if we have learning without action. There’s a huge opportunity to improve the quality of patient care — without spending tons of money… with Lean we truly can have better quality at a lower cost… we all deserve as much.

Taking place October 15 & 16, 2008 at the University of Mass. beautiful Boston campus. “A Community of Lean” , a great opportunity to listen to, and share your continuous improvement ideas with others clearly interested in the process.

Click on the Shingo Prize icon above for details.

Toyota’s alternative to “Command and Control”

What is the most challenging aspect of implementing lean in North America?

“It’s easier to act your way to new thinking than to think your way to new action”

Culture is embedded in the work.

“Managing to Learn” published by LEI
Mentoring the Toyota Way
Due to be available this summer (2008)

#1

Toyota culture……the learning experience at Nummi.

How was Toyota’s culture/management system initially accepted at Nummi (first joint Toyota/GM venture) in the early 1980’s?

Building trust
Mutual Respect
Front line managers, Supervisors, Lead-people
The Gemba challenge – “go see”

The second half of this podcast will be available May 25, 2008

Why should we join a network of companies with common interests? What’s in it for me and my company?

Let’s suppose your company is interesting in pursuing “lean” or the Toyota Production and Management System. Maybe you are working with an “external consultant” or have used your own internal resources. External consultants often bring a broad understand of concepts and practices learned through working in multiple situations and multiple companies and cultures, but alas…..I am one of “them”, so I bring little objectivity to that subject. Internal consultants can be successful as well.

Anyway……. you are on the road to creating a Lean/Continuous Improvement organization. Congratulations, that is great stuff…..but unless your company is in a position to win a Shingo Prize, perhaps you could learn something helpful for your Lean journey if you continue to listen.

Late in 2004 I founded a network of 4 client companies, all manufacturers. I was pushed to do so by my clients who always wanted to visit other companies who were also on the Lean journey to “go see” and compare their progress with the host company and learn. My initial plan was to meet at a host company (one of the four) each quarter or four times per year. After the first meeting the group decided they would like to get together more frequently. We now have 10 members and meet six to eight times per year.

The Lean Thinking Network’s objective is to leverage the collective knowledge, experience and motivation of the network to significantly improve the competitiveness and profitability of all member companies.

Some of the benefits network members have mentioned over the years:

1. Opportunity to see how others are implementing Lean
2. Opportunity to see other industries approach to Lean
3. Opportunity to see and listen to different cultures with the same objectives in mind
4. Opportunity to ask questions of peers
5. Opportunity to discuss problems with peers
6. Opportunity share forms, cards, tickets, photos, processes and concepts with peers
7. Opportunity to get support from peers when you cannot find the answer to a problem
8. Opportunity to exchange culture, visit peers and invite them to visit your facility
9. Opportunity to leverage special events such as presenters, tours etc.

We are located in the South Eastern portion of Pennsylvania (Lancaster-Reading-York-Harrisburg-Philadelphia). If you are not, maybe your local Chamber of Commerce has networks or your local MEP. Networks with competing companies typically have diminished value (little to no sharing). If possible, avoid this situation. In addition, don’t allow passive members. Active membership is necessary including hosting meetings.

Ok……why not? Get some help, support and opportunity. Join the community of Lean. You will be better for it.

I will use examples of companies on “the Shingo prize path” which I will refer to as the “Shingo Way” (apologies to Dr. Jeff Liker and his wonderful book “The Toyota Way” and of hero and tool focused implementations which rarely achieve potential.

In a past podcast “the Stages of Lean and the Art of Kaizen” I spoke of five stages of Lean implementation.

1. Beginner (1 to 3 months) – implemented one Value Stream Map “future state” and are experiencing the “honeymoon effect”. Improvement is daily, and progress is fast. Some training has been given, but implementation is primarily carried out by a group of “heroes” and, therefore, is not sustainable. The program is “theirs”…..owned and operated by a select few.

? Beginner – the Shingo Way…..everyone has been trained in the Basics of Lean, 5S, work standardization, waste identification and problem solving. Management and Leadership are present throughout the training process, clearly and consistently showing support and explaining why. Improvement is perhaps not as rapid as the hero focused process, but we are building a sustainable culture of continuous improvement.

2. Stalling (3 to 9 months)– dealing with the post-honeymoon condition. Lean isn’t as much fun and is no longer new. It still makes sense, but it’s getting a little stale. You get what you measure. What are you measuring?

Stalling – the Shingo Way – the Scientific Method (Plan>Do>Check>Adjust) is used daily. Project and performance status are posted and everyone knows what the postings mean and how they can affect them. As long as we use the Scientific Method daily, stalling cannot occur. Progress is steady and culture continues to build.

3. Stalled (9 to 15 months)– Lean is part of how we do business, but aren’t we Lean now? “Why do we have to continuously improve? We are better than our competition.” What has been standardized? What are you measuring?

Stalled – the Shingo Way – we know we have a long, long way to go to achieve world-class competitiveness. We continue to train our people, develop work standardization and continuously improve operations. Each morning Leadership/Management/Supervision perform a focused “Gemba Walk”. The Scientific Method is now a way of work-life.

4. Re-emergence (12 to 24 months) – perhaps stimulated by some competitive failure, followed by deep soul searching, commitment and delivery of a carefully audited plan. Not making it to this step defines failure. All companies will stall sometime, some worse than others, it’s how they emerge that will make the difference. Courage, commitment and integrity are the keys.

Re-emergence – the Shingo Way – no need to re-emerge. We have worked diligently identifying and eliminating waste. Though we do experience failures, they are infrequent, root cause is quickly and effectively identified and counter-measures put in place to eliminate or reduce the impact of the problem should it occur again.

5. Sustainability – the entrance to the “promised land” is in sight. We constantly audit our standardization, measure and post key results. Continuous improvement is a natural component of our workday and an expectation of all employees. By the way, don’t expect to ever get to the “promised land” but never quit trying.

Sustainability – the Shingo Way – Our leadership enables and empowers all employees. We document measurable improvement continuously occurring in our business. We are part of the world economy, with respect to the community, environment, operational excellence and business performance.

a. Shingo Bronze Medallion recipients would most likely be characterized as having demonstrated strong application of Lean tools in the most critical areas of their challenging value stream.
b. Shingo Silver Medallion recipients must clearly have overlaid the tools with quality systems of management to ensure tool application is appropriate, value adding, consistent and continuously improving.
c. The Shingo Prize recipients will have a deeply embedded culture of Lean as evidenced by full deployment of Lean; Principles, systems and tools, across the entire value steam, from senior management down and across all of the critical support functions associated with the challenging entity.

Using the Shingo Prize criteria as improvement targets reduces confusion, clarifies objectives and provides profoundly useful feedback. Several times I have been told that a business is world-class, that they are just about as good as they can get and improvements will occur in spasms as reaction to operational pain or customer complaint. The Shingo Prize criteria provides a standardized model for defining excellence, a feedback system documenting your strengths and weaknesses and a real opportunity to achieve world-class status in the eyes of the world.

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Time Back Management’s client list includes American Express, W.L Gore Inc., Univ Calif S.F. Medical Center and the Lean Enterprize Institute (LEI).

Dan will be speaking at the Lean Transformation Summit in Orlando FL in March

Rachel Regen of the Lean Institute suggested I contact Dan and interview him for a podcast.

Listen to this brief podcast to hear Dan’s responses.

Welcome to Competing Podcasts Dan and Happy Holidays to you and our listeners.

1. When beginning with a new service company or the administrative branch of any company, many of us typically start with an administrative value steam mapping event. How do you get started with a new company?

2. Tell us about the “Worklean” process.

3. What value does “Worklean” bring to it’s users?

4. What are some effective measures for knowledge worker or knowledge systems performance?