Red is Not a Badge of Dishonor

Since we introduced Lean Daily Management (LDM) a little over a year ago, it has proven to be a very effective tool for generating focused problem solving and continual improvement led by the people doing the work. Lean daily management has been a great way to get people in action redesigning systems to work better. It’s also provided our senior leaders with the opportunity to visit our units and departments and learn about the many ways teams are working to improve patient care and to implement standard work. Through our daily rounding, we’ve also had the opportunity to get to know many of our frontline leaders and team members throughout the hospital who are studying problems and testing changes, allowing us to have open conversations with one another about how we can continue to move toward our vision. I remain truly excited about where LDM is taking us as we work toward continual improvement in our care.

Last week on LDM rounds, I had the chance to talk with Kate Devan, RN, BSN, CAPA, PACU Clinical Partner at Sherwood Surgical Center. Kate is a wonderful leader and she presented the LDM board for starting cases on-time at 7:30 a.m. under our aim of Least Waste. The LDM chart showed the metric in red for the previous day as they had two of the three cases starting on time, instead of all three. It was clear that seeing the red on the chart dismayed Kate and her team as they had been working hard toward achieving the goal of all cases being on-time, and they really care about what they do.

Pictured left to right: Holly Clevenger, RN, Clinical Partner,
Sherwood Surgical Center, Kate Devan and Laura Ghasseminia, RN.

“Sherwood has been working very hard to provide a safe and caring environment to our patients,” explains Kate.  “I felt extremely proud of our team in Sherwood for accomplishing two out of three cases on time, but also felt a sense of frustration that we were still not meeting our goals. I felt that maybe by setting our goal so high we were setting ourselves up for a goal that was not obtainable. It did not celebrate that we were successful in achieving over 60% on time starts, but rather showcased that we had 30% late starts and we were in the red.”

It became very clear that Kate was truly proud of what her team had accomplished already but that having to report that they still were in the “red” was a source of frustration for all of their efforts.

This caused me to reflect on the fact that many of our people see “red” as “bad,” and that I as a leader had done a poor job of explaining the nature of Lean Daily Management. It’s about finding process flaws and then testing changes to the process. If we don’t find the defects - and show the performance as “red” - we won’t know what to try to change. It seems that many of our people believe that LDM is about “catching people doing a bad job” and since we were children when red pens were used to find our mistakes…red is the color of negative judgment.

I am so excited about the great work that the Sherwood team is doing and it bothered me that they felt that the red on the LDM board was a badge of dishonor when nothing could be further from the truth. They have always done an excellent job but since LDM they have made dramatic improvements.

This opened up a candid conversation that provided us all with the opportunity to learn from our different perspectives. I pointed out to Kate and her team that in fact, identifying a defect in their process was actually great news and not something to be ashamed of!

After this conversation, Kate says, “It was reassuring to hear Dr. Chessare say the things that he did.  It felt as though he was in strong support of our efforts and our progress towards reaching our goals.”

When the engineers at Toyota find a defect, they actually celebrate this as an achievement because they know it’s an opportunity to make their product even better and generate problem solving.  Toyota has mastered the concept of daily improvement and at Toyota they know that if everything is green, nothing is being improved. Leaders in organizations that continually improve understand how to find the next opportunity, which requires people to think critically and not start from the presumption that everything is fine. As we discussed last week, we should start from the presumption that everything is NOT fine.

We must also move from the mindset of punishment to the mindset of curiosity. Red is not a badge of dishonor, but we are trained to think that it is. We are trained to believe that if you didn’t get it perfectly right the first time, you’ve failed. Not true!

I was grateful to have had this conversation with Kate and her team because it was a learning experience for me about what our teams are getting out of these conversations at the LDM board during the daily presentation. If everything is good and all of the charts are green, then we should be worried that we’re not asking the right questions or studying the right processes. We must celebrate green and say thank you when green came as the result of a new change. And, if we’re going to assign bad performance to anyone it should be when we learn of a defect in our processes and fail to test changes to fix it.

The Sherwood PACU team certainly has a lot to be proud of in their care of our patients and in their actions to make the care even better.

Experts in improvement have a wonderful phrase – “Every defect, a treasure.”

When you identify the defect, it gives you the opportunity to get better. If you have defects that you don’t know about, you cannot fix them. So, we should always be looking for the defects so we can test changes to improve.

Red is not a badge of dishonor. The only dishonor is to allow poor systems to remain as they are and to not be in action testing changes.