Lean Presentations

Garr Reynolds talking about effective presentations in  TED Tokyo talk

Da Vinci was credited for saying that simplicity is the ultimate sophistication. It seems that our modern life is plagued with complexity and unnecessary clutter in all aspects of life, one of which is the art and science of presentations design and delivery.

Presentation waste:
Many of the seasoned experts in the art of presentation design like Garr Reynolds, Nancy Duarte, even the late Steve Jobs, all emphasize the concept of simplicity in the content, visual design and delivery of effective presentations.
What does this have to do with lean? Lean is about utilizing the minimum to achieve the maximum, and this is what an effective presentation should do, not only on the visual design part, but also the content, and the way it's delivered. In their books, presentation experts talk about simplicity, restraint, and the signal vs. noise ratio, and editing ruthlessly to remove the unnecessary, where a presenter should use the minimum ideas, visual elements, and even time to deliver the main message without bombarding the audience with too many info and crowded slides that would cloud their perception and attention. When you see some of the great TED talks, you may notice the minimalism in presentation slides and delivery (sometimes even without slides) that the speakers apply.
Garr Reynolds refers to such principles as presentation zen, and he draws a lot of examples from the Japanese culture where he lives and works. Is it a coincidence that such principles share similar cultural roots with Lean?
The same thing applies to presentations of complex data in a simplified manner, much like what Hans Roslings has been doing in his presentations.

Presentations and respect:
As we know that one of the pillars of lean thinking is respect for people, and that also applies very clearly to the principles of effective presentation. "It's not about you, it's all about them", this is what Garr Reynolds and others say when designing their presentations (design is the overall planning process of a presentation, not only the visual part). It's about the audience, their perception, their interests, and their time listening to you. It's not about how good you look on stage or how fascinating the facts you are presenting. In order to do that, an effective speaker must study his audience before even putting in the content of his speech.

I read once that editing is the skill of the 21st century, where everything has become inflated and full of waste. This is in the heart of good presentations, and in the heart of lean.

On the Mend

A gem for any lean healthcare enthusiast or beginner.
In this book, Co-author Dr. John Toussiant explains the lean transformation journey of Thedacare Health System in the US over seven years, the early beginnings, ups and downs, pains and triumphs, managing change, techniques and lessons learned, in an anecdotal and story like fashion.
This book shows how could any healthcare system transform from the traditional management style to a lean management thinking, and what needs to be done to achieve that.
For me, this is the best book I've ever read so far about healthcare lean transformation, and it's a must read for any executive thinking (or not thinking for that matter) about running a health system in a lean way.
There are so many detailed examples of how to build the culture, set standard work for training and actual work, the results of applying lean on both clinical and business sides.
At the end, a nice chapter about how to start and what would Thedacare do differently to start a lean transformation journey, provided to all of us on a silver plate.
Some of the many lessons you could learn are:
1- The critical role of executive leadership in building a lean culture and system. Sounds like a cliche but for a very good reason as explained thoroughly in the book.
2- In Lean management, the focus is always about the patient, not the organization. The organization will definitely benefit along the way.
3- Traditional medical teaching and upbringing of clinicians and the challenges that create for change.
4- The importance of data and info in making the case for change and guiding the improvement work.
5- Aligning everyone in the organization to the true north through Hoshin Kanri..
6- Empowering everyone at all levels to be a problem solver.
7- The need for standard work for managers to lead and manage in a lean way.

If you are looking for one book that shows you how a traditional healthcare system moved into Lean thinking, this is the one!

Accreditation and Lean

It's true that accreditation of a healthcare organization does NOT necessary mean that such organization provide high quality and safety to its patients. There are many differences between compliance and improvement, in terms of goals, motives, scope, targets,and impact on the staff and culture. As a matter of fact, depending on the way compliance is marketed and implemented within an organization, it can be hinder the efforts for continuous improvement.
In this part of the world, compliance is usually mistaken for quality management, and the focus of many organization is just to implement the standards and pass the surveys, that's it. This is evident by the increasing number of healthcare organizations receiving international accreditation compared to the low level of care and safety provided. Sad but true!

Joint Commission International (JCI) , a group which follows the US-based-The Join Commission-had added a new standard for hospitals in 2014 which asks quality professionals to analyze the impact of improvements prioritized by the leadership on efficiency and therefore cost. I remember that a Lean project was the first thing that jumps to my mind when trying to comply to such standard.

It's really interesting to see accreditation bodies starting to look at efficient use of resources in healthcare, and the efforts made to improve that. This could be driven by the long standing and continuous rise in healthcare cost and expenditure not only in US but worldwide, to the point that it has become an international standard. I believe the success of lean healthcare organizations in US and other countries, and the fact that you can provide safe and high quality care while lowering cost through reduction of waste is a reality today proven by facts and figures. Advanced healthcare systems have realized today that a sustainable safe and quality care can't be accomplished without proper and efficient use of resources, with people as the main one.

Is it possible that accreditation bodies will demand healthcare organizations to adopt Lean in the near future ?

Red Beads

Watching the Master playing the Red Bead Game live!

During the recent IHI Middle East Forum in Doha, Dr. Don Berwick, Co-founder,President Emeritus and Senior Fellow of the Institute of Healthcare Improvement, demonstrated to us the famous Red Bead Game, used by Dr.W. Edward Deming in his famous seminars in the late 90's to teach how management should support workers to identify system problems and errors (the red beads), respect their knowledge and skills, and work as a team to improve, rather than blaming them using old management theories and biases.
The moment when Dr. Berwick was on the stage playing the game with a group of attendees was almost magical, delivered in a humorous yet classy way, bringing moments we didn't have the chance to live back from the days of the father of total quality management, Dr. Deming.
According to Dr. Berwick , the originsl games was lengthier, but he demonstrated a shorter version to give us a taste of it. Another interesting confession made by Dr. Berwick is that when first attended the famous 4-day seminar by Dr. Deming as physician back in 1986, he flew back home on the second day frustrated and convinced by the teachings of Dr. Deming, he thought it didn't make sense to him at the beginning. Then at a moment of reflection and uncertainty, he decided to fly back and continue the rest of the seminar, of which he is very proud of.
Some of the main lessons from the Red Bead Experience are:
1- There will be always variation and errors in every process.We must understand variation in data to draw the right conclusions.
2- Staff or workers can only achieve what the system allows them to. There is no point of rewarding or punishing them based on randomness of a system.
3- To fix a problem or improve quality, look at the system instead of the staff. The management has the authority to change it.

Below is a clip of the original Red Bead Experiment run by Dr. Deming. Enjoy!