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"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/
cc cc
Learning from Toyota
3
Toyota Your Company
X
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)
1
2
3
4
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.
Mike Rother – Toyota Kata
A PRACTICAL MODEL OF SCIENTIFIC THINKINGThe Four-Step Pattern of the Improvement Kata
ExperimentsToward the TC
Challenge
Threshold of Knowledge
CurrentCondition
NextTarget
Condition(date)
1
2
3
4
Mike Rother – Toyota Kata
9
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
A PRACTICAL MODEL OF SCIENTIFIC THINKINGThe Four-Step Pattern of the Improvement Kata
ExperimentsToward the TC
Challenge
Threshold of Knowledge
CurrentCondition
NextTarget
Condition(date)
1
2
3
4
Mike Rother – Toyota Kata
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
Mike Rother – Toyota Kata
A PRACTICAL MODEL OF SCIENTIFIC THINKINGThe Four-Step Pattern of the Improvement Kata
ExperimentsToward the TC
Challenge
Threshold of Knowledge
CurrentCondition
NextTarget
Condition(date)
1
2
3
4
Mike Rother – Toyota Kata
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
Mike Rother – Toyota Kata
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
forms
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
Cost
Staffing challenges
Operating loss
Storyboards are most effective when linked to
strategic priorities.
Strategic priorities must be focused &
formally expressed.
Improvement efforts cannot
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
Venue
Learner
Coach
Weekly Challenges Meeting
Competent/Proficient
2nd
Coach
Gemba Walk
Novice
(sometimes)
(None)
Move Toward
Competent +
Limits
People
Time
Expertise
Obstacles
Limits can spur
creativity.
Coaching Kata Proficiency AssessmentBy Yvonne Muir, Jennifer Ayers & Julie Simmons
© Mike Rother / Improvement Kata Handbook Appendix - Forms
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
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
Storyboards are most effective when linked to
strategic priorities.
Strategic priorities must be focused &
formally expressed.
Improvement efforts cannot
be separate from
management.
Limits can spur
creativity.
Intentional practice = Intentional learning
Good processes produce
important outcomes
Reframe “missteps” as
experimentation
The PROCESS Learning Spiral
Let the learning dictate the
forms
By 11/24, create a 1st draft / worst map of a revised
protocol that reflects what we have learned to
date.
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
Intentional practice = Intentional learning
• 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
Good processes produce important outcomes
Good processes produce important outcomes
Intentional practice = Intentional learning
Good processes produce
important outcomes
Reframe “missteps” as
experimentation
The PROCESS Learning Spiral
Let the learning dictate the
forms
PROCESSLearning Spiral
STRATEGYLearning Spiral
Intentional process = 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
As we practice the Improvement & Coaching Kata, our knowledge deepens and our self-efficacy grows.
TAKEAWAY: