LEAN Thinking – FRAMING, It's all About Framing

I like words. My belief is that words I use say a lot about me, in addition to what I am meaning to say.

One word I have been paying attention to for some time is “framing.” I first became aware of framing in the early 1990s while studying psychology; and then it was “reframing” that caught my attention. I was at a training and talking with other participants, one of whom was offering what I heard as a negative critique of the earlier talk. I had appreciated the talk and made a comment that took the idea being expressed and transformed it into one I felt was more positive. One of the others listening complimented me on a “good reframing” of the other person's point. I had not thought that was what I was doing and filed away what I took as a compliment to think about later. ¹

As my studies progressed in psychology, I learned more about reframing and used it in a more conscious manner. I learned that it is a very powerful method of working with and influencing others. A seemingly simple shift in the context of the item or issue being discussed can change the way it is being perceived. In the field of psychology I've used reframing to clarify the possible intent of a comment heard or action experienced by a client. In business I've used reframing to change or broaden the context of what is being discussed. An example of this would be to take an aspect of business performance that may look like a positive attribute in terms of how it helps a business unit perform within a service line, but when looked at in terms of the customer's needs, may turn into a negative that does not benefit the customer. Here the initial context may be “How does this make my job easier?” and the new context is “How does this benefit the customer?”

The “frame” that most of us utilize in our working lives is “What will do the best job in this case?” And that frame has benefited us. We do want to do the best job and asking that question, in the frame of “my job” and “this case” puts into focus the way we usually think. Lean thinking asks that we look at a new way of “framing” our questions. We put down a personal, team, or company frame and adopt a client frame. The new questions are “Will the client pay for this? Does this add value for the customer?”

And this means that a new frame needs to be used from top to bottom of our organization. To become more effective at what we do, we all need to reframe our conversation, or questions. We will still ask about the top and bottom line, and all the other questions. However, our first questions will be with the customer, about the customer, and from the customer's perspective. 

1From Wikipedia, the free encyclopedia: The term reframing designates a communication technique which has origins in family systems therapy. ... Another meaning or another sense is assigned by reframing a situation or context, thus sees a situation in another frame. A frame can refer to a belief, what limits our view of the world. ... Psychotherapists trained in the reframing by communication attempt to let scenes appear in another point of view (frame) so that someone feels relieved or is able to deal with the situation better.

A LEAN Approach in Healthcare – Lean Patient Centered

An Institute for Healthcare Improvement (IHI) Innovation Series white paper (2005), Going Lean in Healthcare, spells out how the principles of Lean management or Thinking can and do apply to healthcare. (http://www.ihi.org/knowledge/Pages/IHIWhitePapers/GoingLeaninHealthCare.aspx) The paper includes examples from Seattle’s Virginia Mason Medical Center and northeast Wisconsin's ThedaCare, Inc.

The paper provides a brief summary of what Lean thinking or management is and where it came from. It looks at the value stream mapping approach and emphasizes how important it is to maintain our focus on the patient – the patient who defines value in our system.

Given that this paper was released in 2005, why has healthcare not embraced Lean thinking more extensively?

The paper addresses one major impediment – skepticism in the form of “we are not making automobiles, this is healthcare.” While I also believe this is an important point, I see more to our reluctance than skepticism. I believe that it is also a complex combination of “lacks” - lack of consistent leadership, lack of time, lack of money, and lack of a compelling reason to change. As long as we think we are doing an adequate job of providing service as measured by our peers, we have little motivation to make a change. And change is hard.

Yet, if we will take a look at the potential benefits of Lean thinking – improved flow, reduced costs, decreased adverse event rates, improved patient satisfaction, etc. – it makes a move to Lean practices one of the most critical steps any healthcare organization can take.

One additional reason for not jumping into Lean may be the name; Lean. While we may want to be lean ourselves, for the organization we work in we seem to prefer Fat; fat in all ways, so we think we are safer or protected in some way. We want fat or extra supplies, and the same with people ready when we need them. All of this leads to excess in our systems and processes that do not add value, value in the only terms that matter, those of the patient. Lean thinking turns this around by looking at our systems or processes with the patient answering the question: Does this add value? So while the system and processes become leaner, it is not just to satisfy a financial goal; it is to satisfy a patient goal. It is very Patient Centered – a goal we can all support by whatever we call it. Lean Thinking, Lean Management, or Lean Patient Centered. 

Let me know if you want to learn more about how to get a certificate in Lean Thinking.  I can offer training in conjunction with an excellent trainer.  (Send me an email: dr.fritzmb@gmail.com) 

Copiers: 100,000 – Innovators: 1

In a transcript of a talk by Mark Pagel at Edge (http://edge.org/conversation/infinite-stupidity-edge-conversation-with-mark-pagel), Pagel discuses his views of evolutionary biology as it pertains to creativity. His thesis, as I understand it, is that throughout our history we have only required a few creative people to move us forward. What he sees as more important to our development has been the efforts based on social learning of the copiers or followers; those who recognize the innovations and move them on into society. He goes further and states that even the efforts of those we have identified as innovative “just got lucky.” (Pagel states: “... the generative mechanisms we have for coming up with new ideas are no better than random.”) He is very aware that his ideas are not likely to be well received.

But they got me thinking, and I believe Mark Pagel is right on target. He is saying that social learning, copying the very good spear of my neighbor rather than trying to invent my own spear, has had a more profound influence on moving us forward than that of the original innovator. This has meant that natural selection for good copying by a large number of us wins over a large number being good at innovation. Pagel sums this up as “... we may have had strong selection in our past to be followers, to be copiers, rather than innovators.”

He goes on to imply that as we have grown in numbers and in the size of our groupings, from bands of 25, tribes of 150, and on up to nation-states, we have needed proportionately fewer innovators. Innovation goes farther and faster with better copiers and followers.

Pagel then goes in to his ideas about how we innovate, or generate ideas. His conclusion is, “And I want to go further, and suggest that our mechanism for generating ideas maybe couldn't even be much better than random itself.” (I don't want to dwell on this aspect of his thesis; I will let you go to the link and read this for your self.)

So, what does this mean for me and you?

For my part, I'm feeling better about not having been nominated for a Nobel award. My goal has always been to see how ideas fit together; starting with an idea that I usually find is not entirely original, as I read more in a wider range of areas that add to my idea – comparing it to those of others, and so on and so on. These notions of Pagel make this effort more worthwhile that I had thought. In fact, it means my efforts are integral to our evolution. (If I eventually find a way to share them and move them out into the world; like in a Blog.)

Those of us looking around for the next Big Thing and trying to see how it fits into our life or business are doing the real heavy lifting for our society. Sure we need some people engaged in basic research, but if these ideas are not put into use or circulation by the rest of us, they never become innovations that make any difference.

So, when you spot someone trying really hard to come up with the next Big Thing, thank them for their small part in the larger scheme of things and tell them you will take it from there.