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Creating a Continuous 
Improvement Culture 
Webinar
August 13, 2013
Welcome!
• Argentina
• Australia
• Bermuda
• Brazil
• Canada
• Finland
• France
• Great Britain (UK)
• India
• Latvia
• Netherlands
• New Zealand
• Spain
• United States
• Uruguay
www.ksmartin.com/subscribe
 Coach / Facilitator / Consultant / Trainer: 
Lead Lean transformations & develop people 
across all industries.
 Teacher: University of California, San Diego
 Author & Speaker:
Karen Martin, President
The Karen Martin Group, Inc.
www.ksmartin.com
3
October 2013 Shingo Prize 
winner!
© 2013 The Karen Martin Group, Inc. 4
Upcoming Webinars
• How Outstanding is Your Organization?:  An Assessment
– Tuesday, September 17, 2013 – 11:00 am‐12:15 pm
– https://www2.gotomeeting.com/register/923117162
• Value Stream Mapping: Visualizing Work Flow and 
Aligning People for Organizational Transformation
– Tuesday, October 8, 2013 – 11:00 am‐12:15 pm PT
– https://www2.gotomeeting.com/register/151856458
• Improvement Facilitation & Coaching: An Open Forum
– Tuesday, October 29, 2013 – 11:00 am‐12:15 pm PT
– https://www2.gotomeeting.com/register/999232762
© 2013 The Karen Martin Group, Inc. 5
After the webinar…
• All recordings are available on:
– www.vimeo.com/karenmartingroup
– www.youtube.com/karenmartingroup
– www.slideshare.net/karenmartingroup
– www.ksmartin.com/webinars
• The materials are available on
– www.slideshare.net/karenmartingroup
© 2013 The Karen Martin Group, Inc. 6
Key Topics
• The 4 conditions you need to create to 
build a continuous improvement culture.
• What continuous improvement looks and 
feels like.
• How to sell leadership on the management 
and leadership behaviors and skill 
development needs that lead to continuous 
improvement.
© 2013 The Karen Martin Group, Inc. 7
Kaizen
Kai = Change Zen = Good
Continuous Improvement: 
A Way of Life
© 2013 The Karen Martin Group, Inc. 8
Improvement needs 
to be part of        
doing the work.
© 2013 The Karen Martin Group, Inc. 9
Continuous Improvement Classics
1982 1982 1986
Recent “Daily Kaizen” Books
© 2013 The Karen Martin Group, Inc. 11
The Toyota Way 2001
• Respect for People
– Respect – We respect others, make every effort to understand each other, take 
responsibility, and build mutual trust.
– Teamwork – We stimulate professional growth, share the opportunities of 
development, and maximize individual and team performance.
• Continuous Improvement
– Challenge – We form a long‐term vision meeting challenges with courage and 
creativity to realize our dream. 
– Kaizen – We improve our business operations continuously, always driving for 
innovation and evolution.
– Genchi Genbutsu – We believe in going to the source to find the facts to make correct 
decisions, build consensus, and achieve goals at our best speed.
© 2013 The Karen Martin Group, Inc. 12
Continuous 
Improvement: 
The Relentless 
Pursuit of Perfection
© 2013 The Karen Martin Group, Inc. 1313
New Ideas Generated, Tested, Refined, and 
Implemented by Everyone, Everyday, Everywhere
© 2013 The Karen Martin Group, Inc. 14
True Continuous Improvement
CHECK
CHECK
CHECK
ACT
ACT
ACT
© 2013 The Karen Martin Group, Inc. 15
What does 
Continuous Improvement 
look and feel like?
© 2013 The Karen Martin Group, Inc. 16
Meet Menlo Innovations
© 2013 The Karen Martin Group, Inc. 17
One million ideas a year.
© 2013 The Karen Martin Group, Inc. 18
What’s it take to 
create a true 
C.I. culture?
© 2013 The Karen Martin Group, Inc. 19
Creating a C.I. Culture: 
Requirements
• Will
• Skill
• Authority
• Guidance
© 2013 The Karen Martin Group, Inc. 20
© 2013 The Karen Martin Group, Inc. 21
You have to 
want it.
© 2013 The Karen Martin Group, Inc. 22
You have to develop 
an intrinsic belief that 
good enough never is.
We need to pass the improvement baton 
from the elite few 
to the common many
23
Respect for People: Develop & Engage
The people who do the work are the experts.
24
© 2013 The Karen Martin Group, Inc. 25
Foster an environment of curiosity
“Why?”
“Why not?”
“What if?”
© 2013 The Karen Martin Group, Inc. 26
= Development
© 2013 The Karen Martin Group, Inc. 27
Requisite Knowledge & Skills
• Value‐adding vs. non‐value‐adding
• Three conditions to eliminate:
– Mura ‐ unevenness
– Muri ‐ overburden
– Muda ‐ waste
• Eight types of waste
• PDSA/PDCA (Plan‐Do‐Study‐Adjust or Check‐Act)
– Including root cause analysis
• Process metrics
– Process time
– Lead time
– % Complete & accurate
• Process mapping & process documentation 
© 2013 The Karen Martin Group, Inc. 28
Detailed Steps
  1.  Define and break down the problem.
  2.  Grasp the current condition.
  3.  Set a target condition.
  4.  Conduct root cause & gap analysis.
  5.  Identify potential countermeasures.
  6.  Develop & test countermeasure(s)
  7.  Refine and finalize countermeasure(s).
  8.  Implement countermeasure(s).
Study
Evaluate 
Results
  9.  Measure process performance.
10. Refine, standardize, & stabilize the process.
11. Monitor process performance.
12.  Reflect & share learning.
Adjust
Do
Clarifying the PDSA Cycle
Plan
Develop 
Hypothesis
Conduct 
Experiment
Refine 
Standardize 
Stabilize
Phase
Continuous 
Improvement
New 
Problem
50‐80% 
of the 
total 
time
© 2013 The Karen Martin Group, Inc. 29
Root Cause Analysis: 4 Key Tools
CauseCause--andand--Effect DiagramEffect Diagram
Machine Measurement Environment
People Material / Info Method
Budgets
Submitted Late
Lack of experience
Time availability
No sense of import
No stnd spread sheet
Email vs. FedEx
No standard work
Input rec’d late
Forecast in other system
Manual vs. PC
System avail.
No milestones
$ vs. units
Weather delays
Dispersed sales force
Changing schedule
Machine Measurement Environment
People Material / Info Method
Budgets
Submitted Late
Lack of experience
Time availability
No sense of import
No stnd spread sheet
Email vs. FedEx
No standard work
Input rec’d late
Forecast in other system
Manual vs. PC
System avail.
No milestones
$ vs. units
Weather delays
Dispersed sales force
Changing schedule
5 Why’s
Why?   
Why?    
Why? 
Why?    
Why?
Paret o Chart
Credit Applicat ion Delays
2 9 0 9
6 2 7
5 6 1
2 4 2 1 8 0
2 4 9 3
4 1 %
7 7 %
8 6 %
1 0 0 %
9 7 %
9 4 %
0
500
1000
1500
2000
2500
3000
3500
N o Si gna t ur e I ns uf f i c i e nt
B a nk I nf o
N o pr i or
a ddr e s s
C ur r e nt
C us t ome r
N o C r e di t
H i s t or y
O t he r
Reason f or Delay
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Check Sheets Quantify Occurrences
|Equipment failure
|||||||||||||Changing customer
requirements w/ no
adjustment to expected
delivery
||||||||||Order entry error
|||Staffing/absenteeism
|||||Quality issue requiring
rework
|||||||Material shortage
TallyReason
|Equipment failure
|||||||||||||Changing customer
requirements w/ no
adjustment to expected
delivery
||||||||||Order entry error
|||Staffing/absenteeism
|||||Quality issue requiring
rework
|||||||Material shortage
TallyReason
© 2013 The Karen Martin Group, Inc. 30
Empowerment
Work: Degrees of Granularity
Value 
Stream
Process Process Process
Step StepStep
31
Micro 
Perspective
• Identify the  
tactical “how”
• Heavy frontline 
involvement
• Metrics‐Based  
Process Mapping
Macro       
Perspective
• Define strategic 
direction (“what”) 
• Heavy leadership 
involvement
• Value Stream 
Mapping
You may need 
to draw them 
out.
© 2013 The Karen Martin Group, Inc. 33
Boundaries
Learning & development
© 2013 The Karen Martin Group, Inc. 34
Give every team member
“Freedom with Boundaries”
© 2013 The Karen Martin Group, Inc. 35
Loosening the Reins
36
C.I. Essentials:
Supervisors & Managers must become proficient 
Process Managers & Improvement Coaches
© 2013 The Karen Martin Group, Inc. 3737
How are you performing?
Gray – Highest industry quality scores
Purple – Median industry quality scores
Blue – Our quality scores
© 2013 The Karen Martin Group, Inc. 38
Daily Kaizen vs. 
Breakthrough Kaizen 
(Kaikaku)
© 2013 The Karen Martin Group, Inc. 39
1. Increase sales 5%.
3. Achieve 10% profit.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec IT Mktg Ops HR Bob Fin PE Pario
COM 
Direct 
CDs / 
AMs
PD 
Rec
PD 
Mgmt
BMD SWS
2
3,500 units sold by 12/31/2013 through all channels 
(approx. $700K)
X X X X X X X X X X X X Bob Dana 2 3 3 3 2 3 3 1 1 3 3 1 3
11 Develop & deliver training to top 50 Dealers X X X X X X Bob Rex/Tim  3 3 3
21 Revised course materials by 6/30/2013 X X X Bob Josh R? 2 3 3 2 2
5
Education: 1 school district spec'd/underperforming 
COM distributor (25) by 12/31 valued at min $35K each
X X X X X X X X X X X X Howard Michael  S 1 3 2 3 3
8
10 new dealers on board (net) ($500K per dealer this 
year)
X X X X X X X X X X X X Howard Mike B 2 3
9
5 new distributors bringing $200K annual rev (& 5 
terminated)
X X X X X X X X X X X X Howard Howard 1 1 1 2 3
17 10 projects spec'd  by 12/31; $300K rev by 12/31 X X X X X X X X X X Howard Dana 1 3 3 3
29 20 by year‐end X X X X X X X X X X X X Howard Mark H 2 3 3 3
32 TBD X X X Howard Howard
33 TBD X X X X X X X X X Howard Howard
10
Useful reporting and metrics are established and in 
place 
X X Jim Randall 3 1 1 1 1 1 1
30 TBD X X X X X Jim Josh 3
31 TBD X X X X X X Jim Josh 1 1 1 3 1 1 1 1 1 1 1 1 1 1
25 TBD Jim  Shannon  3 3 1 1 1 1 1
26 System 7.0's in place X X X Jim  Randall 3 2 1 2 1
15
100% accurate payroll; 100% management satisfaction 
at April mgmt. meeting
X X X Josh Phyllis 1 3
20
Internet task list is simplified and streamlined for 
PDs then plan is rolled out to PDs 
X X X X Michael M Michael M 2 3 2 3
22
Design Calculator is updated successfully and rolled 
out
X X X Neall Matt D 3 1 1 3 2 2 3
24 Competitive Analysis complete and distributed for use X X X Neall Dana 2 3 3 3 3 3 3
1 Design changed to solve delam issue  long‐term X X X X X Susan David R 3 2 3
12
30 parts sourced in U.S.; completed plan for managing 
China‐sourced parts
X X X X X X Susan Shannon 3 3 2 2
13
Warehouse laid out; kanban revised; Syspro 
implemented
X X X Susan Shannon 3
14 Lay out complete; equipment installed X X X Susan David R 3 3
X = Planned
2013 Priorities
2013 Goals & Objectives
4. Improve morale (metric TBD).
2. Achieve 50% gross margin. Created: 01‐14‐13
Revised: 
Level of Effort/Involvement Required
Priority Goal or Measurable Objective Exec Owner
Plan review dates:
Tactical 
Owner
● =  Actual
< Company Name >
Contentremoved for confidentiality 
Tie Improvement to 
Annual Strategy Deployment Plans
Tie Improvement to Future State          
Value Stream Maps
Referring
Physician
% C&A = 85 %
Send
Reports
(Imaging)
Cycle Time = 3 mins.
% C&A = 90 %
6
Hospital
Schedule appt
Pre-register
Cycle Time = 11 mins.
Lead Time = 45 mins.
% C&A = 98 %
6
CT=Cycle Time
LT=Lead Time
%C&A=% Complete & Accurate
0.0833 hrs.
1 mins.
0.583 hrs.
10 mins.
0.333 hrs.
10 mins.
0.0833 hrs.
2 mins.
2 hrs.
15 mins.
7 hrs.
1 mins.
0.0333 hrs.
1 mins.
0.5 hrs.
3 mins.
LT = 11.3 hrs.
CT = 43 mins.
CT/LT Ratio = 6.32%
Lead Time = 45 mins.Lead Time = 15 days
Prep
Patient
(Tech)
Cycle Time = 10 mins.
% C&A = 100 %
2
Check-in
Patient
(Imaging)
Cycle Time = 1 mins.
% C&A = 98 %
3
Complete
Exam
(Tech)
Cycle Time = 10 mins.
% C&A = 90 %
2
Transmit
Images
(Tech)
Cycle Time = 2 mins.
% C&A = 100 %
2
Read/Dictate
Exam
(Radiologist)
Cycle Time = 15 mins.
% C&A = 95 %
2
Review
Draft/Sign
(Radiologist)
Cycle Time = 1 mins.
% C&A = 95 %
2
Print
Reports
(Imaging)
Cycle Time = 1 mins.
% C&A = 99 %
2
20 mins. 5 mins. 120 mins. 420 mins. 2 mins. 30 mins.35 mins.
E Pay ExcelSymposium Internet
Waiting Room
Management
System
Fax Order
Solutions
PACS
5 mins.
Set-up
Reduction
Remove
Check in
and Reduce
System Access
Work
BalancingStandard
Work
Pull System
(Supplies
Kanban)
Visual
Workplace Voice
Recognition
Batch
Reductions
5S
Co-locate
Standard
WorkWork
Balance
Continuous
Flow
Value Stream
Alignment
Auto Fax 80%
Us Mail 15%
MD Mailbox 5%
Rolled First Pass
yield = 40%
Rework Loop
via Fax 10% of
the time
Customer Demand:
15 patients perDay
(Takt Time1920 seconds)
8 hours per day
1
2
3
4
5 6 7 8 9 10 11
Risk
Reduction
(Joint
Commision)
Meditech
Tie Improvement to A3s
41
© 2013 The Karen Martin Group, Inc. 42
Attaining Mastery
From The Outstanding Organization, p. 115
© 2013 The Karen Martin Group, Inc. 43
Skill Development Progression*
Unconscious 
Incompetence
Conscious 
Incompetence
Conscious 
Competence
* Commonly attributed to Noel Burch, 
Gordon Training International
Start Goal
Unconscious 
Competence
Consciousness
Competence
1 4
32
© 2013 The Karen Martin Group, Inc. 44
What you can do immediately no 
matter where you sit…
1. Make sure you know and are highly skilled in 
improvement basics.
2. Begin asking “why,” “why not?” and what if?” in 
every encounter/meeting.
3. Establish an improvement‐safe zone in your sphere 
of influence; quantify the number of ideas 
implemented.
4. Coach, coach, coach…and then coach some more.
5. Quantify results when possible and broadcast, 
broadcast, broadcast.
© 2013 The Karen Martin Group, Inc. 45
Upcoming Webinars
• How Outstanding is Your Organization?:  An Assessment
– Tuesday, September 17, 2013 – 11:00 am‐12:15 pm
– https://www2.gotomeeting.com/register/923117162
• Value Stream Mapping: Visualizing Work Flow and 
Aligning People for Organizational Transformation
– Tuesday, October 8, 2013 – 11:00 am‐12:15 pm PT
– https://www2.gotomeeting.com/register/151856458
• Improvement Facilitation & Coaching: An Open Forum
– Tuesday, October 29, 2013 – 11:00 am‐12:15 pm PT
– https://www2.gotomeeting.com/register/229489922
© 2013 The Karen Martin Group, Inc. 46
Karen Martin, President
7770 Regents Road #635
San Diego, CA 92122
858.677.6799
ksm@ksmartin.com
For Further Questions
Blog & newsletter:  www.ksmartin.com/subscribe
© 2013 The Karen Martin Group, Inc. 47
Your Questions
1. Are there unique challenges that exist with establishing 
CI cultures in union workforces?
2. Companies I worked for push Return on Investment as 
the metric for gauging CI activities and culture 
effectiveness. Is this the best metric, and are there 
others that we should be looking at?
3. How long does it take to change a 125‐year old culture? 
4. How do you recommend broadcasting successes and 
making them relevant?
5. Our division president wants to implement a long‐term 
vision, whereas corporate seeks quarterly results. How 
do I interact w/ president & direct reports to ensure 
buy‐in?
6. What are things that a middle manager can to do drive 
Lean culture?

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