This lack of depth can be problematic to practitioners seeking practical solutions to their problems. Instead of knowledge that can be learned, practiced, and reproduced, they often get good stories (e.g. marketing) or worse, misleading information that can cost their future. It is a modern-day challenge that I don’t have a good answer for. But critical thinking — asking questions — always helps.

To illustrate my point, let’s look at an example. Harvard Business Review early this year had an article “Why Process is U.S. Health Care’s Biggest Problem.” The authors shared their experience in applying improvement methodologies, particularly the Toyota Production System (TPS), to the patient care process. Many people think of TPS as a method to improve manufacturing operations. Applying TPS to address the US health care problem sounds intriguing. What questions would you ask while reading the article?

Framing the problem
The authors introduced the problem of the care-delivery process in terms of “not standardized,” “lack of reproducibility,” and “every caregiver does it his or her own way.” This can give the reader the impression that standardization is the solution. Whenever I see “not” or “lack of” or similar words in a problem statement, I immediately treat them as implied solutions. What are the root causes of the observed variation? What kind of analysis has been done to understand them? Presenting solutions disguised as problems limits our ability to see the real problem.

More than semantics
The authors continued their introduction by offering the solution: “Stable systems that are reproducible” and “A process must first be stabilized and then standardized.” What is a “stable” system or process? How is stability measured in a patient care process? Is stability a problem in their system? What did they do first to stabilize the process? None of these was presented.

Many terms in business improvement methodologies carry specific or even profound meanings. They are not buzzwords to be used casually. As Walter Shewhart and Edwards Deming taught us, a stable process lacks special (or assignable) cause variation, which is different from common cause (or random) variation. This distinction is one of the most foundational concepts in business improvement because it directs us to very different courses of action. Without knowing how these terms are operationally defined in the patient care process and seeing the analysis on sources of variation, readers learn nothing if not confused.

Elements of a system
The authors claim that “There are two types of improvement systems needed to create a well-designed care process.” But little is discussed about why the two are needed and how they work together.

An improvement methodology, such as TPS, includes numerous elements (e.g. principles and tools). It is only effective if the elements are used together in a cohesive way. The result is not the sum of a few arbitrarily chosen parts; a missing element could lead to a complete failure of the methodology. In addition, the elements have to be used in a well thought-out sequence applicable to the particular situation. This is not different from strategy development. One cannot simply pull elements from various disconnected strategies and hope that they work together.

What were the strategic choices available to the leaders? How did they decide which methodologies or elements of the methodologies to implement, and which not? Under what conditions would a radical redesign be necessary? Were the decisions to standardize or radically redesign the process strategic, convenient, or ad hoc? How do other core TPS elements, such as value and flow, fit in the big picture? Answers to any of these questions would greatly improve a reader’s knowledge.

Managing change
What do we standardize, and what not? To what extent do we standardize? These are two important, practical questions leaders have to answer because of commonly known resistance to standardization. How did the leaders manage change? For example, did they evaluate how the existing culture or social structure in the organization might support or hinder the standardization effort? As described in The Toyota Way by Jeffery Liker, an enabling (as opposed to coercive) social structure is essential to TPS. It empowers employees, supports organizational learning, and provides rules and procedures as tools as opposed to controlling them. The statement “Every nurse and doctor does not get to do it his or her own way. Standards are established about how the work is performed, and those standards are followed by all until a better way is determined collectively by the team” indicates more control than empowerment. This and several other similar statements leave readers wondering if standardization would ever work for them.

The above are but a few sample questions we could ask to gain useful knowledge from others. What is your experience? What would you recommend?

For more than a decade, I have led, supported, and observed Lean Six Sigma deployments in many organizations in life sciences. As a result of varying degrees of success, some people praise the transformative power of Lean Six Sigma, whereas others view it as an outdated management fad. While these perspectives are understandable, it is not helpful to organizations searching for the right path to business improvement.

Lean Six Sigma, or more generally, Operational Excellence, is a management methodology or a set of principles and tools. By itself, it is not sufficient to achieve desired outcomes. It requires know-how. Failure to achieve intended goals often has more to do with how we use it.

“Using the right tools for the job” sounds obvious. But when it comes to sophisticated tools and complicated jobs, it’s not. That’s when we ask professionals, e.g. a doctor or lawyer, who will help diagnose the problem and evaluate options to enable us to make an educated decision.

Similarly, before we jump on the Lean Six Sigma bandwagon, ask these questions:

1. What is the reason to bring in the methodology?

Do we want to solve a problem we have today, or develop a new and sustained organizational capability or culture? Lean Six Sigma is very effective in delivering quick wins, e.g. reducing waste and resolving some quality issues. Building a quality culture, agility, and continuous improvement capability is an entirely different game. In my opinion, both objectives are valid but they require very different implementation methods.

2. What are the specific and measurable goals to justify the investment?

Depending on the goal, the financial investment and organizational commitment required vary greatly. The more we can specify and quantify the goals, the more we can plan for the right resources and set the right expectations. We often underestimate or are unaware of the investment required to create the desired organizational change. It is not surprising that when the results do not come quickly, many are disappointed and give up.

3. What is the organization’s experience in managing change?

If the goal includes developing a new capability or culture, it is imperative to assess the organization’s readiness for change. Operational Excellence requires a different mindset and behavior that many organizations do not have. If the organization lacks the experience or resources to manage change, there is a high probability that the change initiative will fail. In this case, it would be better to take a stepwise approach to allow the organization to develop change capability gradually as it improves the business.

There are obviously more questions to consider before and during the deployment. Answering these three questions from the start will help leaders clarify and communicate their vision, gain support, and prevent some common pitfalls in Lean Six Sigma implementation.

Typically, OpEx professionals stress how process design, management, and continuous improvement help reduce variation and waste and increase quality and productivity. Scientists often see the drawbacks — processes being rigid, overly prescriptive, and unnecessarily complex, creating bureaucracy and limiting people’s creativity.

Understanding Innovation Work

As W Edwards Deming said, “A bad system will beat a good person every time.” A poorly designed or implemented process certainly can stifle innovation. A better question is “How can we design and implement processes that enable creativity and innovation?” The emphasis here is “enable” not “control.” It is not an easy task, and I have been involved in making a few bad processes in my career.

From my experience, the first step to answering this “how” question is to understand deeply, first-hand, how the creative and innovative work is done. This cannot be accomplished by studying tasks and making flowcharts as we have done in manual work analysis for a century. Creative work does not follow a linear sequence of steps, visible and repeated as in a value stream. There is no value object that we can follow as it is being created. Instead, we have to get to know the people involved and learn how they work, individually and collectively, to generate results. Go Gemba, as we say in Lean. Only then can we start designing processes that enable them to innovate.

A Perspective from Apple

It is instructive to quote a few statements from Tim Cook in an interview with Bloomberg Businessweek 16 months after becoming CEO of Apple. When asked about the enormous pressure to continue to create breakthroughs, Cook responded:

“Creativity and innovation are something you can’t flowchart out. Some things you can, and we do, and we’re very disciplined in those areas. But creativity isn’t one of those.”

Maybe Apple’s secret of innovation includes its understanding of where processes are needed and where they are not.

The following also resonates strongly with me.

“Creativity is not a process, right? It’s people who care enough to keep thinking about something until they find the simplest way to do it. They keep thinking about something until they find the best way to do it. It’s caring enough to call the person who works over in this other area, because you think the two of you can do something fantastic that hasn’t been thought of before. It’s providing an environment where that feeds off each other and grows.”

How well do you understand what drives creativity and innovation in your organization?