Model for Improvement as Inquiry Guide

It’s hard to become a good observer and coach.

In The Work of Management: A Daily Path to Sustainable Improvement (2017, LEI, Cambridge, MA, https://www.lean.org/Bookstore/ProductDetails.cfm?SelectedProductId=410 ), Jim Lancaster describes the multiple challenges he faced and the adjustments he made over almost two decades to observe and coach his people. Importantly, Jim had the advantage of a world-class coach guiding his practice as he and his team built a Daily Management system.

What options do supervisors and managers have if they don’t have a world-class coach by their side?  How can they see and coach in ways that help people in their organization do a better job?

I faced these two questions last week. 

The scene:  A clinic is improving access to appointments and care coordination, part of an initiative in a larger organization. 

How should we design a series of hour-long visits by a senior manager to the clinic?  The aim of the visits:  the senior manager should understand the current situation at the clinic and identify system barriers that constrain the clinic’s performance in order to loosen those constraints.

The organization does not have a formal Daily Management system that could make it easy to assess and enhance work unit performance and management capacity.  The senior manager has not formally practiced work unit observation, inquiry and coaching.

Let’s start with the first visit, which aligns with the fundamental Lean advice to “Go see.”  We’re challenged to prevent a “dog and pony” performance that hides more than it shows.

I have a prediction:  The Model for Improvement provides a robust framework for inquiry that should yield insight into the clinic’s management capacity. 

To understand the current situation, here are questions the manager can try to answer during the first visit:

1.      Aims What is the aim of the clinic?

2.      Measures  How do people measure performance, relative to the aim?  What is the current performance?

3.      Changes   How do people develop changes to bring their performance closer to the aim?  What is an example of a recent change?

4.      Plan-Do-Study-Act  How do people use the Plan-Do-Study-Act cycle to test their changes, to learn by doing?  What is an example of a recent Plan-Do-Study-Act cycle?

We’ll find out how the first visit goes, part of our own PDSA learning.