I used to be really annoyed with people who took a wait-and-see approach to change. They're not resistant, exactly, and they might be classified as "late adopters." But I could understand active resistance better than passive indifference.

Now, however, I have a little different take on things. Because I have realized that if you wait long enough, you may find that whatever was changed comes back around again!

Such as...

• Centralization vs decentralization of departments or functions
• Use of consultants vs hiring internal resources
• Outsourcing vs insourcing

This reminded me about the lines from the Disney movie, "The Lion King," where young Simba gets the explanation about how the antelopes eat the grass and the lions eat the antelopes, and then the lions die and their bodies turn to grass (OK, you knew it would be a PG version) which is then eaten by the antelopes. So everything comes back to a big circle of replaying the same scenarios.

For process changes, it's easy to see how this becomes just another bright idea to wait out, to someone who's been around a long time. Especially when you're in an organization that promises that every change is NOT just the flavor of the month, and then six months later it's disappeared. So how can I criticize someone for saying, "Well, go ahead with this Lean thing, I'll just wait and see what comes of it before getting enthusiastic about it." After all, they've probably been right about all the other wonderful new initiatives and changes that have come and gone before.

Maybe you are fortunate enough to work in a place which has solved this circular pattern, or maybe you are trying to break out of that. Would you care to share your experiences, to help us put some perspective on the issue?

While the iSixSigma.com site has been down, the rhetoric about "fixing healthcare" in the US has dramatically heated up. "We need to take the waste out of healthcare!" "We're paying too much for healthcare!" "Everyone should get all the healthcare they need regardless of cost!"

Without getting into the political debate, let's just touch on these points from a quality perspective.

There's a balance between cost, speed and quality that's quite a challenge in healthcare. For example, if I order $5000 worth of tests on day 1, and can tell you your diagnosis on day 2 and start treatment, what's that worth to you and your health (even if it turns out that 5 tests out of the 30 ordered didn't help with the diagnosis)? How about taking the cost-effective route: I'll order one test per day, evaluate the results, and then order the next test. It may take me 21 days to figure it out, while you are waiting all the while, but hey! it did cost less! So, in which example was there more waste???

Paying too much for healthcare... does that mean we are paying more than the value we receive, or just more than we desire to (or can afford to) pay? Most of us a) don't know how much our healthcare actually costs; b) can't judge the quality of the medical care we receive; and c) won't haggle over the cost of an IV solution when the care of a loved one is at stake. There's an emotional element of this debate that is not susceptible to logical reasoning. We see this in all the stories of people who have gotten poor care or ran out of money or their insurance wouldn't cover a certain procedure. If we try to "ration" care in the most logical way possible, we immediately run into the emotional (or moral, if you prefer) discussion about denying care to those who need it on a purely financial basis. The factual and emotional issues are entangled as we debate this topic.

Should everyone get the healthcare they need regardless of cost? It's my personal opinion that provision of basic services, including healthcare, should be a function of an organized society. But, it's not a "commodity" service like garbage collection, is it? Since we do have to look to our tax-paying citizens and employers to pay for "healthcare for all" - the question of course is, how much should each of us contribute to this worthy cause? And who decides how that money is to be used?

Having stirred the pot this morning, I will close by saying - it's a complex system!

• There are no "specifications" for inputs (patients who need care come in all conditions and with variation in their genetic, mental, physical, experiential, cultural, economic, and social backgrounds);
• Processes are highly complex with many stakeholders and overlapping responsibilities
• There is an expert-based culture of physician caregivers (now expanding slightly to other medical professionals);
• Outcomes may not meet the patients' goals through no-one's fault (you can mostly blame our biologically-based life processes, I guess) but which may in some cases be due to poor care or non-compliance on the part of the patient (for example, not taking medications in the way they were prescribed).

So I just caution you to think carefully about all the proposals that will be floated to "fix" the healthcare system, and don't jump to solutions too soon on this one.

Is healthcare in its current form in the US perfect? NO! But first I think we have to go back to quality basics and agree on who are the customers, and what is value-added to those customers. I've seen many more "solutions" floated, than thoughtful consideration of just what it is we want to get to. I encourage everyone to join this debate from the quality improvement perspective, and to lend your expertise to the discussion!

p.s. It's good to be "back on the air" again! Kudos to those at iSixSigma.com who have been working to resolve the issues that interrupted service over the past several weeks.

I enjoy teaching, so if you asked me whether you could do too much training, my first response would be "no, of course not!"

But, on second thought, I would have to say, "well, maybe."

It's been my experience that knowledge alone is usually not enough to create an improvement. A lot of people enjoy being trained (a day away from the office, with lunch included) and also like knowing what could be done to create a better process. But, having a lot of knowledgeable people bumping around in your organization doesn't necessarily mean that there are any improvement activities going in. It's the doing - or execution, if you will - that separates the thinkers from the achievers. So the important question seems to be, when do you know enough to start improving things?

There is a train of thought that runs like this: "We don't need to train our whole organization in Lean or Six Sigma; that takes way to long to get any ROI (Return on Investment). Let's start by getting some project teams together and use them to drive improvements."

There's another train of thought that says, "Let's not go shooting off in a lot of different directions. We'll train our executives, then our other leaders, then our managers, then our front-line staff; we'll come up with a deployment plan, and then we'll be ready to do projects."

So is there a "right" way to approach a Lean Six Sigma deployment?

Now, before you all write back to me telling saying that the answer is "IT DEPENDS!" I will ask the question a different way: Have you, in your experiences, ever found that an organization did too much training? Or that an organization did too little training? What were the effects or consequences? And what advice would you give an organization new to Lean Six Sigma, on the balance between training and project focus? Thanks in advance for sharing your thoughts!

When I begin a new project, I include a Communication Plan as part of my team work. That is, we take the stakeholder list and think about who we need to be in communication with, as we move through the project phases. Some of you may do this based on an ARMI exercise (Approvers/ Resources/ Members/ Interested Parties) or Stakeholder Analysis exercise (List of key stakeholders and their estimated level of commitment to the project). We include activities like face-to-face conversations, presentations in department meetings, newsletter articles, postings on the web site, etc.

But even though we try to heed the mantra, "communicate 8 times, 8 ways" it seems like we always have a gap in our communication.

For example: Our team invites a key department leader to our project meeting; we discuss our project and get agreement as to next steps. We plan an elevator speech and ask the leader to discuss it at his/her next department meeting and get agreement to do that. We talk about possibly sending an email or posting information on the department's bulletin board for those who can't attend the meeting. All good so far!

Then, a week later - after the department meeting, and having seen for ourselves that the information is posted on the bulletin board, a few team members stroll through the department to gauge the level of buy-in. And - do they find that everyone is informed, interested, and enthusiastic about the project? Or, do they find that people are negative toward the new process that's coming their way?

Why, no! We find that most people remember vaguely hearing something about some new process, and others just give us blank stares. When the bulletin board is mentioned, we get the response "Oh, I know it's there but it never changes so I don't look at it."

So, what are our learnings from this type of situation? We only communicated once or twice, one or two ways - so obviously we would need to keep our communication plan active! But are there other ways that you have been successful communicating outside of your project team, as you make progress? Thanks in advance for sharing!

My organization requires that we write our annual performance goals into a web-based system that can be sent to our bosses for their review. As I was working on this last week, it struck me that in the past I would not have written those goals the way I do now.

For example, "improve service" would have been a typical goal for one of my previous positions. Today I'd be examining: What data will be used to measure the improvement? What is the target? What type(s) of service would be in scope? What customer segment would be studied? Who are the stakeholders for this service, and how many would have influence or control over aspects of the improvement?

In other words, I'd be a lot more specific - call it SMART if you want - and at the end of the year I could clearly tell whether or not I had met the goal. In the past, I'd say "well I worked really hard all year on this and I think people are more satisfied with the service, based on the 2 - 3 customers I spoke with."

Now, it's still possible to "game" the system by picking easy targets that would be hard to miss, or choosing focus areas without established metrics. But, I wonder how much more effective I would have been as a supervisor, manager, or director if I had known and used a process- and metrics-oriented approach to leadership.

So here's my question to my readers! Have you used a Lean, Six Sigma, or other process-based approach your whole professional career, or did you learn it mid-career? It would be interesting to know what your reflections on the difference it might have made, had you been exposed to the concepts and methodology earlier in life - I invite you to share.

[Note: For those who may not have run into this acronym before, SMART refers to goals or metrics that are Specific, Measurable, Attainable, Relevant, Time-bound. There are a few variant versions but all reflect the same basic principles.]

Throughout my career I’ve had the pleasure of meeting colleagues from a very large variety of manufacturing cultures. Sometimes I talk to people that work in a "mass" environment with poor performance, and I hear about how good it must be to work in an efficient workplace, with relatively good performance. I always get the questions about how easy it is.

Let me tell you...it’s not easy, and by the way - it shouldn’t be.

You might ask me why....and here are some reasons.

The name of the game is continuous improvement. If your organization doesn’t get better, then you aren’t going anywhere. You maintain your improvements be continuously revising your metrics to reflect your improvements. Your plant may start at 50% production efficiency, then move to 75%, then to 90%, then to 95%, 97%, 99%, 99.5%, etc...how hard do you think it is to go from 99% to 99.5% production efficiency? It’s very difficult - probably more difficult than going from 50 to 75%. No doubt, you’re doing much better at 99% than you were at 50%...but then again, the 50% number doesn’t matter anymore, since your system has grown to be much more capable than that.

Now, imagine what it’s like to have this approach with all of the organizational metrics. The unique part about all of this is that this type of culture grooms people into constantly thinking of how to get better every day. That’s a powerful element.

Any people out there living through this type of culture? What are your challenges and how do you get through them?

Over the years, I’ve come in contact with several different companies that say that they are "lean". Yes, TPS (the Toyota Production System) is a great framework for production, with its teachings of one-piece flow, kanban, etc...but what about the actual implementation of the lean concepts at other companies besides Toyota?

I’ve seen desks with outlines of where the stapler and the computer monitor should go, yet with no sense of continuous improvement in the culture. I’ve also seen kanban implemented with min and max levels clearly marked, yet with no safety stock even left due to variation in production downtime. On the other hand, I have seen a really good "lean" production system operating every day as well, but that has been the exception.

What’s up here? It seems like that it is almost impossible to get to real ’lean’ operations unless you actually start up with a lean philosophy.

So here’s a burning question--

Overall, is "lean" a concept that is being actively implemented with success at "mass production", or is it something that is being attempted by doing all of the easy things first while putting off the hard stuff?

As always, your input is always appreciated!

I was asked a very interesting question last week, after I gave a lecture on 5S.

"Do you find that people who are very organized and who apply Lean or Six Sigma principles at work, also apply these same principles at home? Is this linked to a personality trait?"

Now I will confess right off that I am NOT always as organized at home as I am at work. Part of that has to do with the different amounts and types of stresses that are in the work vs home environment, and part of that is related to my particular personality trait or preference if you will. I am (believe it or not) an introvert by nature. Now, my favorite definition of the terms introvert and extrovert is not related to being happy in a crowd - but is related to how we recharge our batteries. Think of a Friday evening, when you have just gotten off work and are heading home. It's been a long, exhausting week with a lot of extra time spent on the job. Do you prefer to recharge by (a) going to a party or event with a lot of excitement and energy in the room, or (b) going home or to a quiet place with soft music, a good book or show, and limited interaction? I'm in the (b) category, so I call myself an "adapted introvert" - most of my work is done with and through people, so at work I'm a driver and always "on" for my audience. At home I'm a low-energy kinda gal.

So back to the question - my answer was that I know many people who are as driven at home as they are at work - color-coded containers, everything in its place, ready for a surprise meeting or out-of-town guests at a moment's notice. I also know people like myself who are very organized at work but more laid-back at home. Truthfully I don't know anyone who is unorganized at work, but very organized at home. (But maybe I should get out more!)

What do you think? Do you agree with my categories, and would you have answered the question differently?

That would be... Consultants.

I was fortunate to have the opportunity to speak about lean for clinical laboratories at the recent Leadership Exchange conference, hosted by the American Society for Clinical Pathology. In discussions during the conference, I was asked many questions about the use of consultants to get started with lean. In many cases, stories started with "Our lab has been leaned out," with the consequences of positions being eliminated, front-line workers being unhappy with the standard work that someone else had decided for them, and being asked to clock each and every step of their process for days on end.

So my question is, what is passing for lean these days? No wonder I hear people saying, "Lean doesn't work!"

Now, I know that there are many fine, upstanding lean practitioners out there, who use strategic planning and the A3 approach to lean deployment. Maybe I don't hear about them because they're doing a fine, value-added job. But I do hear many stories about lean gone wrong.

Have you had an experience where someone was claiming to be a lean expert, but it didn't resemble lean philosophy as you know it?

Once upon a midnight dreary, while I pondered weak and weary,
O’er Breyfogle, George, and other volumes of forgotten lore,
While I nodded, nearly napping, suddenly there came a tapping,
As of someone gently rapping, rapping at my office door.
‘’Tis some Green Belt,’ soft I muttered, ‘working late on his R4 –
Only this, and nothing more.”

Ah, distinctly I remember it was in the bleak December,
And binders of Six Sigma projects lay like ghosts upon the floor.
Eagerly I wished the morrow; - vainly I had sought to borrow
From “Lean Thinking” ease of sorrow – sorrow for the lost Lean lore,
For the rare and radiant flowing caused by using pure Lean lore,
Flow of process evermore.

Back to my Cox Comics turning, all my soul within me burning,
Soon again I heard a louder tapping, harsher than it was before.
‘Surely someone’s working late, trying to finish their last tollgate,
I don’t want to make them wait – I must this mystery explore -
Let my heart be still a moment and this mystery explore; -
‘Twill take a moment – nothing more!’

So I flung the doorway wide, and, without a glance aside,
In there stepped a stately figure I could not in truth ignore.
Not the least of hand-shakes made he; not a minute stopped or stayed he;
Bold and mute and unafraid he came within my office door –
Looked like young Shigeo Shingo coming in my office door –
Looked, and sat, and nothing more.

Then this silent form amazed me by the way his silence dazed me,
By the look of grave intelligence and utter thoughtfulness he wore,
‘Thou thy head be shorn and shaven, thou’ I said, ‘art sure no raven.
Ghastly grim and ancient maven wandering from the shop room floor –
Tell me what thy lordly name is, teacher, I do thee implore!’
Quoth the Sensei, ‘Nevermore.’

‘What?’ asked I, merely guessing what the Sensei was expressing
As his fiery eyes burned through my scattered R4s on the floor;
Was he looking for my A3s, did he doubt my CTQ trees,
Did he think my 5-Whys weak and my lead times so very poor?
‘What!’ I shrieked, ‘You think my methods and my computations poor?’
Quoth the Sensei ‘Nevermore.’

‘Trickster!’ said I, ‘Thing of evil! – Causing waste by this upheaval!
It’s not Pull that brought you calling! By the Flow we both adore –
Tell this soul with deadlines harried if, within locations varied,
Through deserts hauled or rivers ferried, I can find the lost Lean lore –
Perhaps a book that you have written, penned to share the pure Lean lore?’
Quoth the Sensei, ‘Nevermore.’

‘Be that word our sign of parting, foul-mouthed fiend!’ I shrieked upstarting –
‘Get thee back into the workplace and your own shop’s gemba floor!
Leave no A3 as a token of the word that thou hast has spoken!
Leave me with my mind all broken! – quit the chair that’s near my door!
Take thy Wastes and 5S forms and take thyself right out my door!
Quoth the Sensei, ‘Nevermore.’

And the Sensei, not submitting, still is sitting, still is sitting
Near the photo of Jim Womack framed above my office door;
And his eyes have all the seeming of a demon’s that is dreaming,
And the lamp-light o’er him streaming throws his shadow on the floor;
And my soul from out that shadow that lies floating on the floor
Shall be lifted – nevermore!

(With apologies to Edgar Allan Poe, whose poem "The Raven" was written in 1845.)