The Improvement Kata pattern (Mike Rother)

A couple of days after my birthday last year, at short notice, I got up early to catch a flight from Manchester to Detroit, Michigan, to learn about this new fangled thing called Toyota Kata* to support my new job. ‘What a gimmicky name‘ I thought, trying not to roll my eyes. Nevertheless, in beautiful Ann Arbor, over the next four days I learned much by way of asking improvement questions, routines for improvement learners, improvement coaches and coaches of coaches. First with sticklebricks at the University of Michigan, then at Zingerman’s Mail Order and finally with the very kind people at Mercy Health in Muskegon. It was a great trip and my colleague Ann and I were lucky enough to also have some time with Mike Rother, the brains behind Toyota Kata. You can read more about that Toyota Kata scouting trip here.

So, one year on. Here are some things I am reflecting on now from my Kata practice anniversary.

1. I was wrong about the gimmick. Completely. Kata is a full-on meta habit and practice. Deceptively simple; much more difficult to practice and sustain. If you want to be a Kata learner and coach, you really do need to commit, for the long term and like sports or music, train every day. Nothing gimmicky about it, if you practice properly.

2. It is hard, really hard, after almost a quarter of a century of improvement practice to pick up another perceived ‘way’ of improving and NOT be able to just run with it straight away, i.e. just learn it from a book and understand what to do, how to do it and be amazing immediately with it. Knowledge is not understanding; to be a Kata learner you really do have to be comfortable with vulnerability and saying ‘I don’t know’, no matter how much experience you have.

3. Being a Kata coach is frustrating at times. Why do my learners keep picking obstacles to work on that have nothing to do with their target condition? Why is it so hard to get daily data on a graph? Why can’t a Kata storyboard be updated before the coaching cycle? Why am I not getting this across as a Kata coach, why can’t I just tell them? Oops, I did. Sorry, didn’t mean to do that. Aggghhh.

4. Kata storyboards and A3s: maybe different; maybe not. I thought it would matter a lot a year ago, now I’m not so sure. Both ways of thinking, both have similar provenance. Perhaps a Kata storyboard could be viewed as an enhancement on the Western way of using an A3. Building more a rigorous approach to the dynamic scientific thinking incorporated in A3 thinking, rather than the static paperwork used for governance that many A3s have become in the Western A3 ‘plans on a page’ approaches. I’m actually beginning to find Kata storyboards easier than A3s.

5. As I have reflected before, I think this is an enhancement on the mainstream use of PDSA within health and care, whether used in the IHI-QI dominating model for improvement or lean thinking (or other improvement brands). The addition in particular of a Kata coach, (who is ideally your line manager) ‘tethered’ to you so you as a learner know you are not on your own, can easily ask for help, and are supported through Socratic questioning daily, is an excellent improvement and the way uncertainty is tackled is a definitive enhancement imho.

6. I am just learning much more now about the 2nd coach role and questions. So far, wow, how good is that Kata as a line manager! Really helping you to develop a coaching style and approach in a structured way. Love asking people about the type of experiments, the obstacles the Kata coach feels like they facing and reflecting on how to support that process. Much better that those vague rhetorical statements indicating that ‘leaders need to develop a coaching style‘ and then little clarity on how to practically do just that in a day to day setting.

7. The Coaching Kata questions are so helpful. Not just for a coach. But also for a learner. Gone is that dread in the pit of the stomach, when you know an ‘important’ person is coming and wonder what might they ask. Now there is a structure to the questions. Leadership standard work. Less scary all round. Berwick reported on the negative impact of fear on healthcare culture. Well for me, Kata is one way, a very practical way, to start to tackle that, one fear inducing obstacle at a time.

8. A year ago, all I was really worrying about was scale up and deployment and training people in Kata. Now all I can think of is ‘why was I so bothered about that?‘ In hindsight, I kind of missed the point. Kata isn’t a new improvement tool, contrary to my initial belief. It’s not a new variant of process mapping or Ishikawa diagrams or driver diagrams. It is a way of thinking and a way of behaving that can become an engrained habit, for all staff, especially leaders at every level. To do that, takes ummph, determination and daily persistence to practice. Training won’t cut it, and will take too long. Daily on the job, rugged determination to make it better by a learner and their boss and their boss’s boss is what it takes to really be a Kata practitioner. Each individual has to therefore decide for themselves – do I want to change my leadership habits and put the effort in? Deployment planning, perhaps not worth the time: ‘Kata the Kata’ instead. What are the obstacles to spreading Kata practice?

Finally, I reflect that in health and care we now spend much on training for improvement, in tools and leadership development. Off the job, in a batched classroom or virtual classroom, with many simulations, games, group work and post-its and maybe even essays. Lots of great evidence for this. But what if, to modify our improvement culture, this extensive training is necessary but insufficient without a way of making improvement real everyday.

Wouldn’t it be cool if we really acted out Batalden and Davidoff’s words of ‘everyone has two jobs‘ to do their job and improve their job… everyday… what would that really take? What might the obstacles be? Mindsets that training is ‘theory’ in a (virtual) classroom with some practice, rather than lots and lots and lots of practice?; improvement community professional protectionism wanting to keep improvement as something for experts?; job role perceptions and demarcation – not my job?; patient as well as staff practice concerns?; educational provider views and concerns re: the impact on training and quality of education?; and insufficiently prioritised time to practice Kata? All obstacles to work through.

Though, perhaps these obstacles somewhat conceal and hide other obstacles, perhaps like ‘I already know it all, I already do this, I’m an improvement expert‘ and ‘I’m not doing that, I don’t need to’ and ‘I can’t be a learner, I’m way too important for that, but I’ll be a coach that sounds more important and worthy of my status‘ or even ‘I’m not saying I don’t know, in front of others, that would be too embarrassing and they might think I’m an imposter’. Perhaps these are the bigger obstacles to daily Kata practice and improvement. On reflection, I feel like these ones are really important to reflect on as leaders and improvement role models. What cultural impact might Kata have in health and care when/if leaders manage to overcome those obstacles? What gesture might that send? What response from staff and teams might there be?

For me, to make improvement part of all our jobs everyday we need to make improvement a daily practice, with daily PDSA, democratising and increasing involvement, accessibility and inclusion in improvement, no matter our role and hierarchical position.. especially leaders, role modelling. Improvement for everyone, everyday so that it really can be part of everyone’s job.

For me, after one year of Kata practice and learning, I really do feel that far from being a gimmick, Kata could really be the glue and meta habit in health and care for continuous quality improvement. Kata practice could make daily improvement for our patients and service users a cultural reality.

* I have referred to ‘Toyota Kata’ just as ‘Kata’ throughout to simplify the text.