spiral learning with kata - michigan lean consortiummichiganlean.org/resources/documents/2016... ·...

"Spiral Learning" with Kata

By Amy Mervak

2016 Annual Healthcare SymposiumMichigan Lean Consortium

Kata Basics

Toyota Kata YouTube Channel

http://www-personal.umich.edu/~mrother/

Learning from Toyota

Toyota Your Company

The Toyota Kata Research Questions

What are the unseen managerial routines and thinking that lie behind Toyota’s success?

Scientific Pattern of Thinking and Behaving

How can others develop similar routines and thinking in their organizations?

A routine of intentional coordination between what we think will happen (theory), what actually happens (evidence), and adjusting based on what we learn from the difference.

What weexpect

to happen

Whatactually

happenedLearning

"Let's try it and see"

5By Mike Rother

Scientific Thinking

A PRACTICAL MODEL OF SCIENTIFIC THINKINGThe Four-Step Pattern of the Improvement Kata

ExperimentsToward the TC

Challenge

Threshold of Knowledge

CurrentCondition

NextTarget

Condition(date)

Mike Rother – Toyota Kata

THERE'S AN OVERALL, UNIVERSAL HABIT:THE META SKILL OF SCIENTIFIC THINKING

Practicing the Improvement Kata and Coaching Kata is not the solution to a problem. It's learning how to go about solving problems.

Scientific thinking is a content-neutral, universal skill for finding our way to challenging goals along uncharted paths.

We don't know what the problems and solutions of the future will be, so it's a good idea to practice this kind of meta skill.

Challenge

CurrentCondition

NextTarget

Condition(date)

The Improvement Kata in 10 Minuteshttps://www.youtube.com/watch?v=uqZOu1D639Q

All Obstacles, Waste, & Opportunities

Known Obstacles, Waste, & Opportunities

Knowledge Threshold

Direction we’re most likely to move

Possible directions

ChallengeTC

Challenge

CurrentCondition

NextTarget

Condition(date)

Key points about Knowledge Thresholds:

There’s Always a Knowledge Threshold

1. They're hard to see, until you practice seeing them.

2. We see farther by trying something. The Knowledge Threshold is the Learning Edge, where your next experiment should take place.

3. We don't know in advance what the result of a step/experiment will be.

The path is unpredictable

Challenge

CurrentCondition

NextTarget

Condition(date)

The Toyota Kata Research Questions

What are the unseen managerial routines and thinking that lie behind Toyota’s success?

Scientific Pattern of Thinking and Behaving

How can others develop similar routines and thinking in their organizations?

Deliberate Practice (with Coaching)

COACHING

FREQUENTPRACTICE

MASTERY

STARTERKATA

Corrective feedbackTo ensure the Learner practices the rightpatterns

Interest, motivation, enthusiasm (growing self efficacy)"I'm getting better at this"

Structured routinesfor beginners

To practicefundamentals

A little every day

Ingredients for Acquiring New Skills

Think of sports and music. With the following ingredients you can acquire new skills & habits

The Coaching Kata

Card is downloadable at:http://www-personal.umich.edu/~mrother/KATA_Files/5Q_Card.pdf

By Mike Rother 15

Itʼs practice designed specifically to improve performance over time.

Itʼs practice that involves continual evaluation of your weaknesses and targeting specific weaknesses, rather than repeatedly doing what you already know how to do.

Itʼs practice that requires a coach. Observation and specific feedback on your current performance is critical to understanding what to work on and acquiring new skill.

Itʼs practice where you donʼt move on to the next part of the routine youʼre trying to learn until you master the part youʼre currently working on.

WHAT IS “DELIBERATE PRACTICE”?

By Mike Rother

What the Improvement Kata and Coaching Kata Are About

By Mike Rother

Scientific Thinking Pattern

Deliberate Practice (with Coaching)

Kata in ActionOur Experience

As we practice the Improvement & Coaching Kata, our knowledge deepens and our self-efficacy* grows.

TAKEAWAY:

* The perception of one's ability to reach a goal

The PROCESSLearning Spiral

The STRATEGYLearning Spiral

Intentional practice = Intentional learning

Good processes produce important

outcomes

Storyboards are most effective when linked to

strategic priorities.

Strategic prioritiesmust be focused & formally expressed.

Improvement efforts cannot

be separate from

management.Reframe

“missteps” as experimentation

Spiral Learning

Let the learning dictate the

Limits can spur

creativity.

We take care of people who are dying, and their families.

Physical

Emotional

Spiritual

Negative media coverage

Unclear Territory

Regulatory requirements

CompetitionAuditor scrutiny

Staffing challenges

Operating loss

Strategic priorities must be focused &

formally expressed.

be separate from

management.

The STRATEGY Learning Spiral

Limits can spur

creativity.

Our Improvement History

• Success with Projects using the IHI’s Model for Improvement

• Variability in sustainment of gains

Continual Projects does not equal Continual Improvement!

Improvement efforts cannot be separate from management.

Down is

better

75% of my To-Do List items will be

addressed by the end of the work day.

60 min/day are devoted to projects (tasks that can be delayed by day-to-

day work/fire-fighting).

Early Storyboards

Storyboards don’t relate to the organization’s priorities.

Organization’s priorities are not sufficiently expressed.

Too many priorities (# in the 40s) and not well-defined.

40 priorities = No priorities

Storyboards are most effective when linked to strategic priorities.

2 Challenges

Strategic priorities must be focused & formally

expressed.

Priorities

Weekly Leadership Meetings

Storyboards

Advance Group

Alignment

As we practice the Improvement & Coaching Kata, our knowledge deepens and our self-efficacy grows.

Spreading Scientific Thinking – Our “Learning Edge”

Periodic improvement Daily improvement

QI staff leading

Eliminate waste(what CAN we improve?)

Group learners & coaches

Move From To

Middle leadership leading

Strategic objective(what MUST we improve?)

Individual coach/learner relationships

Learner

Weekly Challenges Meeting

Competent/Proficient

Gemba Walk

Novice

(sometimes)

(None)

Move Toward

Competent +

Limits

People

Expertise

Obstacles

Limits can spur

creativity.

Coaching Kata Proficiency AssessmentBy Yvonne Muir, Jennifer Ayers & Julie Simmons

Stage Level Characteristics Autonomy

3Expert • Intuitive grasp of coaching based on deep, practiced understanding

•Direct, yet supportive

•Coaching conversations are natural; learner doesn't notice being coached

•Sought after for coaching advice

2nd Coach

needed

occasionally

2Proficient •Clear perception of learnerʼs gaps or weaknesses

•Uses coaching to guide: adapts to the situation, asks meaningful questions

•Ability to assess learners preferred learning style (auditory, visual, kinesthetic)

•2nd Coach capability

2nd Coach

needed

periodically

Competent •Capable of sensing learners uncertainty level and knowledge threshold

•Consistently coaches learner with a repeatable pattern

•Coaching embedded in normal daily work

1Advanced Beginner

•Narrow "development perception"; recognizes need for 2nd coach

•Becoming comfortable providing feedback to learner

•Beginning to observe and listen more (vs. talk and advise)

•Asks some probing questions to gain insight

Must have a

proficient 2nd

Coach at each

coaching cycle

Novice •Rigidity in asking questions / uses closed ended questions

•Lack of discipline to follow a pattern and recognize its importance

•Focuses on results (command and control)

•Not able to hear and identify when learner has hit a Threshold of Knowledge

Peer Coaching

• 2nd Coach is a must

• Experienced how it felt to be the Learner at the same time

• Novices progressed to Advanced Beginners fairly quickly

• Gave me 2nd Coach practice

1-to-1 Coaching Cycles within Weekly Meeting

Describe gaps. Recommend

actions. in TC form.

Describe gaps. Recommend

actions.in TC form.

Bring Kata to Existing Work Patterns

Conduct environmental scan; review key metrics

Set Annual Compliance

Plan priorities

Design Audit approach

(incl. outcome measures)

Conduct audit

Address gaps or choose

not to

Experiment - Bring Kata to compliance

Conduct environmental scan; review key metrics

Set Annual Compliance

Plan priorities

+Process Analysis

The STRATEGY Learning Spiral

Strategic priorities must be focused &

formally expressed.

be separate from

management.

Limits can spur

creativity.

Good processes produce

important outcomes

Reframe “missteps” as

experimentation

The PROCESS Learning Spiral

By 11/24, create a 1st draft / worst map of a revised

protocol that reflects what we have learned to

That it will be rough ANDinformative

AND be a step toward 11/30

due date.

Map completed!

“That this is doable ”

That a visual map is helpful

That this needs to be formalized.That we need

broad agreement on it.

Reframe “missteps”as experimentation

• Change idea

Assumption: Email alone ensures understanding & execution

Assumption: Email is a part of ensuring understanding & execution

Our Pattern

• Staff meeting discussion

• Delay

• Expectation Email

• Guideline

• (Frustration)

• Evaluation

Our Latest Approach

• Change idea

• Expectation Email

• Guideline

• Adjust / Follow up

• Immediate evaluation

Telling the Story

Early BoardUsed standard forms and layout

Current BoardUses the forms needed to tell the story

Let the learning

dictate the forms

Challenge:

Target Condition Actual Condition Now PDCA Cycles Record

Obstacles Parking Lot

Process Analysis

Process Analysis Steps - Adapted

Toyota Kata - p. 274

Assess customer demand and determine line pace

First impressions of the processBlock diagramIs there 1x1 flow?Are each operator's work steps the

same from cycle to cycle?Is line output consistent?

Is machine capacity sufficient?

Is the process stable?

What is the necessary # of operators if the process were stable?

Hospice Care of Southwest Michigan

How often is the process done? At the org level? Staff level?How long does it take?Is it stable? How variable is it? By day? By staff? By type of client?

Review existing regulatory guidanceMedicare CoPs * L-TagsRecommendations from NHPCO re: Best PracticeState LicensureOthers as applicable

First impressions of the processBlock DiagramHow consistent are the steps?Describe staff roles (e.g. RN, SW, Supervisor, etc)

Observe directly when possible.Interview staff to understand thought processes (what CAN'T be observed).Describe key process points using data (e.g. EMR data)Are there equipment restraints?(e.g. EMR limitations, IT system limitations)

Is staffing sufficient? Clinicians, Office Staff, etc.Look at benchmarks for caseload, visits, visit time, etc.Physician time

Virtual Storyboard

Q1 What is the Target Condition?

Virtual Storyboard

Q2What is the Actual Condition?

Outcome Data

Notated Graph

Process Map

Virtual Storyboard

Reflection on Last Step

Virtual Storyboard

Q3What Obstacles do you think are preventing you from reaching the target condition?

Which One are you addressing now?

Virtual Storyboard

Q4What is your Next Step? What do you Expect?

Q5When can we go and see what we have learned from taking that step?

Virtual Storyboard

Target Condition ReflectionQuestions

What went well?

What didn’t go well?

What was enjoyable?

What factors made the work possible?

What factors inhibited the work?

Are there any loose ends?

Virtual Storyboard

Accessibility and Flexibility

Virtual Storyboard

Good processes produce important outcomes

Good processes produce

important outcomes

experimentation

The PROCESS Learning Spiral

PROCESSLearning Spiral

STRATEGYLearning Spiral

Intentional process = Intentional learning

Good processes produce important

outcomes

Strategic prioritiesmust be focused & formally expressed.

be separate from

management.

experimentation

As we practice the Improvement & Coaching Kata, our knowledge deepens and our self-efficacy grows.

TAKEAWAY:

spiral learning with kata - michigan lean consortiummichiganlean.org/resources/documents/2016... ·...

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