In some “Kaizen Kickoff” coaching that I've been doing recently, I've been spending time with managers and other leaders as they interact with nurses and other staff members with the goal of finding problems, opportunities for improvement, and ideas.
One question that would normally get asked of busy staff members (who would almost always moving or in front of a computer) was:
“Are you busy?”
The managers were trying to be respectful (if the nurse was on their way to a patient room for something, we don't want to interfere with the work being done), but the question was getting in the way of the Kaizen process.
Even if the nurse or staff member was NOT right in the middle of something, in a typical healthcare environment, staff want to look busy. If they aren't busy, there's the risk that they might be sent home early or that management might consider layoffs.
In every single case, “Are you busy?” was followed with a quick response, “Yes.”
I commented to the managers that nobody was going to volunteer information about not being busy. We needed a better, more engaging (and less frightening question).
This question was, “Can you take a few minutes to talk with us about ideas for improvement?”
We got far more “yes” responses to that question — and a few “Not right now, but in a bit” responses.
In a traditional culture (this is true in manufacturing or healthcare), managers place a very high value on everybody being busy all the time. It's easy to see somebody who is not working at any given moment.
But, Lean thinkers realize that if everybody is busy all the time, then we have lots of delays and poor patient flow. If everybody in a unit is busy all the time, nobody can respond immediately to a call light.
If the emergency department is always 100% busy all the time, they can't respond quickly to a trauma or a patient with chest pain.
We don't expect the fire department to be 100% busy all of the time, do we?
In a Lean culture (which this organization is moving toward with Kaizen and other Lean principles and management methods), managers are more concerned about poor patient flow and the work not flowing well… instead of just being worried about everybody being (or looking) busy.
This is part of the culture change required with Lean and Kaizen. It's not easy, but it's important.
Are there other questions that you find are helpful or get in the way??
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Great post, Mark. During a client engagement a while back , we witnessed firsthand the fear many workers have if they’re caught being “not busy.”
During work with the client’s key suppliers who were field-based workers–and I mean that quite literally–we discovered a problem with supervisors not being aware of work flow problems. While driving from job site to job site, supervisors wouldn’t stop when everyone looked busy because they didn’t appear to need help. But we soon discovered that the field workers were so afraid of being sent home or being deemed “lazy,” that they’d do whatever it took to look busy.
When we told them we wanted them to stop all movement when they had a problem that needed supervisor intervention or supplies ran out–to literally sit down–they looked at us as if we had three eyes. (Note: this was a very remote area with very poor cell phone or walkie talkie coverage.)
Eventually the field workers grew comfortable with physically representing the truth and improvement accelerated around work flow because the problem became more transparent. It’s tough to fix a problem if you don’t know it exists.
Being “busy” has all kinds of implications for improvement. And none of them are good. :-)
Great article!
This takes me back to early eighties when every machine operators had a daily expected “bag rate” for production. The above average operators would be done an hour or two before end of shift.
They would head toward the bathroom (silent break room) for remainder of shift. Many were written up or warned about this practice. In turn the operators just slowed to the pace of everyone else from that point forward.
But they looked busy!
A true leader or a lean soldier could have certainly seen the lunacy of punishing the best and brightest. If you can’t coach and motivate this group you should hand in your stripes!