Reducing Waste for Shoppers

Big Boxes Aim to Speed Up Shopping (WSJ)

No, this isn’t about waste in packaging (I saw how the UK is pushing milk in plastic bags that you put into a reusable plastic jug at home, 75% less landfill space). Nor is it about wasteful stuff that we buy. Let’s put that all aside.

According to stats cited in the WSJ article, stores, such as Wal-Mart and Target, have found that customers want to spend 21 minutes in the store. If they have a list of 10 items and can’t find 7, they’ll quit and leave. It’s not that the items are out of stock – they can’t be found because the store is so large and hard to navigate!

So the stores are actually looking at things from a customer standpoint. The traditional grocery store is to spread out common items (milk and vegetables) to force you to walk the whole store – that’s waste for the customer, potentially. Target is trying a new approach:

Target Corp. and Wal-Mart have attempted to make shopping easier for new moms by clustering baby clothes, baby food, strollers, diapers and even maternity clothes in the same department. Target customers "have responded favorably and it has translated into positive financial results for Target," says spokeswoman Lena Michaud, who declined to cite specific sales figures.

This approach (better organization) can be win/win: the customers get what they came for, walk less, and the store gets increased revenue. Wal-Mart is also driving changes that you might call “cycle time reduction”:

Among the changes: better signs to help shoppers find merchandise, more convenient placement of hot-selling items and staffing changes to speed up checkout times.

How did the stores get here?

Focusing on convenience represents a turning point for discount retailers. For years, they kept building bigger and bigger boxes, figuring the combination of low prices and huge assortment trumped other considerations.

Sounds like classic “mass production” thinking – bigger must be better! But customers are strapped for time, it’s the only resource that’s in limited supply for everybody (as Womack and Jones wrote about in Lean Solutions).

Maybe the Tesco Lean story and some of the ‘Lean Solutions’ concepts are taking hold? Tesco is coming from the UK to the US soon, so it’s time to take notice!! Target and Wal-Mart beware!! Time to look at removing waste from the retail supply chain, as well.

Lean Thoughts on "Sicko"

I’ve been asked a few times by blog readers about the movie “Sicko” since I work in the healthcare world. It opens tomorrow in the U.S. I haven’t paid for a Michael Moore movie since “Roger and Me,” a movie that did have quite an impact (a brainwashing impact that leads to kneejerk “GM bad!” reactions, some would say) as a Detroit-area kid whose mom is from Flint and someone with personal and family history with the auto industry.

I’m going to write about what I expect to see and how I expect to react. We’ll see how the movie stacks up in reality. I have read plenty of reviews (over a dozen) and have watched Michael Moore interviews on Youtube. No, I didn’t download the movie online, but that was more due to lack of good broadband connections than lack of nerve, will, or technical skill. The trailer can be found here on Youtube. I'm trying to avoid kneejerk "Michael Moore bad!" reactions, as well here, trying to come into this with an open mind. I'd invite others to do the same.

One thing that was powerfully reinforced to me during the Global Lean Healthcare Summit that I just attended is that we have to separate our world’s healthcare problems into a few categories:

• Problems with access to care
• Problems with delivery of care

“Sicko” appears to focus solely on the first problem. The Hollywood Reporter review says:

“Sicko" posits an uncontroversial, if not incontrovertible, proposition: The health care system in the U.S. is sick.”

Yes, but sick in what way (or ways?). I think Dr. Moore has only diagnosed part of the problem (good news, he thinks he's curing you of TB, but he missed the pancreatic cancer that's also brewing inside you).

As the NY Times review said:

“I haven’t heard many speeches lately boasting about how well our health care system works.”

The first problem, the lack of access to care – and Moore focuses less on the uninsured than on those with insurance who get systemically screwed by the insurers and HMO’s. Moore than beats the audience over the head with his simplistic view that socialized, government-run systems are better (and practically Utopian).

From what I’ve read, “Sicko” largely ignores (or completely ignores) the problem of waiting times for people who DO, in theory, have coverage in socialized medicine countries like Canada and the U.K. You have coverage and can get routine or elective care, but the waiting times might still be outrageous. Is waiting two years for a hip replacement surgery any better for your quality of life (when you’re 85) than NOT being able to get the surgery. The definition of “coverage” seems to be a very loose one, at best. At the summit, I heard the story of an attendee’s elderly parent, “covered” under “universal care” who was not able to get a hip replacement. The parent had practically never been sick, paying in, but not dipping into the system. And they couldn’t get care when they finally needed it (and were desperate to improve the quality of their remaining life).

This ign.com review puts it well from a British perspective:

But Moore neglects to ask how long we need to wait for a hospital bed in many cases. Or if people ever get sick because the hospitals they're staying in aren't clean enough. This is where our NHS fails, but because it doesn't support Moore's case it's simply not mentioned.

If you look at the “just in time” principle of Lean and the Toyota Production System, you might say that products (or healthcare) should ideally be delivered at the “right place, right quantity, and right time.” It seems that the socialized medicine systems don’t always meet the “just in time” criteria either. “Free” access isn’t free to everybody – it must be paid for. And since no country has infinite funds (with maybe the exception of the U.A.E.), rationing or delays must inevitably occur. Don’t count me in with those who think a profit motive or free-market is inherently evil. However, as Moore shows in “Sicko,” insurance bureaucrats who deny claims to covered individuals as a way to pad corporate profits might be the closest thing to evil we might find in the film. Here we have a case of patients WITH coverage being DENIED care. Our system isn’t perfect, but neither is socialized medicine. We’re human, therefore we design imperfect systems, regardless of how well intended we might be.

From the Hollywood Reporter:

The tales unravel about how a successful medical claim is called a "medical loss" by the insurance industry and how denying claims can lead to promotions in that industry.

The “value” provided to the customer is a “loss” to the managed care provider. Is insurance about the only industry where this is true? Apple does not make money by denying iPhones to customers who want them. Insurance companies, however, pit themselves against us – we “win” (get care), they “lose” (lose profits).

So let’s say we’ve “solved” the access problem with socialized medicine… well except for the waiting. We would still have massive patient safety issues and unnecessary (or at least expedited) patient mortality. As many have come to say, “hospitals are a dangerous place.” Giving more people more access to more care will increase their exposure to errors, potential harm, and expedited death. Again, access to imperfect care is probably better than NO access to care in most cases.

I’m not here to solve the problem of the insurance system. Plenty of others are debating and discussing that. Giving universal coverage to all almost seems like an unfixable problem. But, we CAN fix medical mistakes (and I’d recommend a more informative and less political documentary, such as “Good News… How Hospitals Heal Themselves.”

Every country around the world (at least the 20 countries represented at the summit) has care delivery issues – errors, medical mistakes, and a lack of standard treatment protocols (or failure to follow them) is hurting and killing patients:

• ED’s are overwhelmed, slowing treatment and care (sometimes tragically so)
• Radiation therapy machines malfunction, giving a lethal dose to a patient
• Wrong drugs are given, causing death
• Wrong site surgeries occur due to lack of error proofing and lack of “time outs” to confirm the right procedure is starting
• Lab specimens or results are mixed up, giving mistaken diagnoses which delay treatment (or cause harm)
• Hospital acquired infections are spread at rates much higher than hospitals with “best practices” in prevention

I could go on. My point is to look out for this: we should feel a moral imperative to increase BOTH the access to care AND the quality of the care that’s delivered. It continues to amaze me that the numbers of uninsured Americans (almost 50 million) gets thrown around much more regularly than the numbers of Americans killed (100,000) or injured by hospitals and our poor processes/systems.

As Moore was quoted in the Time review:

“"We are the richest country in the world. We spend more on health care than any other country. Yet we have the worst health care in the Western world. Come on. We can do better than this."”

Yes, we can do better. But I’d argue it’s easier to focus on the estimated 30% of healthcare spending that goes to waste instead of the roughly 30% that goes to administrative overhead. I agree we can do better – but let’s focus on continuous process improvement and kaizen instead of just tinkering with the payment system.

“Sicko” seems to be less of an indictment of healthcare delivery system and more of an indictment of the American system of insurance. Regardless of your thoughts on a single-payer system (I’m currently against it), I’d hope we could all agree on a moral mission to dramatically improve the quality of care delivery. Lives are at stake in both cases.

Updated: Here's a piece from today's WSJ about problems in Canadian and UK health systems, how they're considering market reforms. The grass is always greener...

Updated: Southwest Airlines Would Say Delphi Management is Failing

Updated: Delphi workers in NY rejected the contract proposal.

Updated: It looks like the contract has been accepted by the UAW...

I got caught up on the WSJ during my long trip home from the UK and saw many aspects of Lean and connections. First, looking toward the GM world (I’m temped to quit even writing about their struggles):

WSJ article link | Detroit Free Press article

Wall Street is, of course, pushing for wage cuts for workers. These are the same analysts that sometimes get outsourced to India, so maybe they'll learn eventually.

"We think GM can make a compelling case to UAW members that material wage and/or benefit cuts are needed," Mr. Barry wrote.

I guess with all of Delphi’s accumulated Shingo Prizes for “Lean excellence,” the ONLY remaining waste was those pesky high wages.

The tentative deal appears to give Delphi many of the concessions it sought, including wage cuts, the closure of all but four of its U.S. plants and a big reduction in the number of union workers it will employ in the future. CRT Capital Holdings LLC, an investment company based in Stamford, Conn., estimated Delphi's UAW head count by 2011 will fall to 1,600 from about 18,300.

That’s just sad, all around.

According to the agreement, Delphi will cut its wages for current workers to $14.50 to $16.23 an hour from the current $27 an hour. New hires will be paid $14 an hour.

Delphi will offer lump-sum payments, relocation allowances, buyouts and early-retirement packages to soften the blow for workers. In addition, GM agreed to take control of some Delphi plants and open the door for certain Delphi employees to "flow back" to the auto maker, which spun Delphi off in 1999 and once employed a sizable chunk of Delphi workers.

“Softening the blow?” We’d like to cut your pay by half, but be lucky you still have a job at all!! How you could have true Lean and a lean culture in that kind of environment is beyond me. Let’s quit giving Shingo Prizes and awards to Delphi, eh? Their business is crumbling, let’s not hold them up as an example for others to follow.

Now back to Southwest Airlines. This WSJ article strikes quite a contrast.

Southwest is struggling to keep profit margins up as they grow – they’re chasing market share with unprofitable growth, but the CEO says the growth is necessary for the employees’ job security (growth is good for that, see Toyota). Their cost advantages compared to other competitors are shrinking. How are the other airlines doing it? Mostly by taking from the Delphi playbook, having slashed wages (well, except for retention bonuses to those precious executives).

What does Wall Street want them to do? It’s an easy guess:

Lehman's Mr. Chase says the problem lies elsewhere. "The real problem is labor costs," he says. "We don't see ancillary revenue as a sufficient fix for the problem."

But Southwest’s leaders (and yes, I think they truly ARE leaders) see it realistically:

Southwest, which prides itself on being employee-friendly, is one of the only airlines that has not sought wage or benefit concessions from its workers. The airline characterizes its work force as ultraproductive and pleasant to passengers. If management seeks pay cuts, it risks alienating employees who Mr. Kelly calls the airline's "greatest weapon."

Mitch Hall, an in-flight crew-scheduling supervisor who started at Southwest 15 years ago as a mail worker, says he was confident after 9/11 that Southwest wouldn't cut pay or lay off workers. "There wasn't a doubt in my mind," he says, adding that the company has always treated him well so he's going to "do them right." Mr. Kelly says he'd consider pay cuts a "management failure."

I’ve blogged before about Southwest’s continuous improvement programs, employee driven, that sound very “Lean”. But CEO Kelly is honest:

He said he expects managers to find new ways to cut costs. "Communicate with your people...talk about waste continuously...control spending," he wrote.

Mr. Kelly says that "little bittie incremental improvements aren't going to solve" the airline's problem. "We can't do it overnight."

I'd be much more positive about Southwest's chances -- sure they can't do it overnight, but they seem to have the long-term in mind better than Delphi management has. It's better to work with your employees to reduce waste rather than ganging up on them and slashing their pay.

Maybe Southwest can earn a Shingo Prize this year. Wait, that might just be a predictor of their decline, so maybe they should avoid that!!

Lean Love Advice: Part 4 of 4

By Mike Lopez

I've written about the four rules of Lean before. I have been thinking about how they apply to marriage. To refresh those of you who have not read the Harvard Business Review article by Steve Spear and H. Kent Bowen, I will restate the rules here and share how I see them apply to relationships. This is the fourth in a four part series to apply each of the four rules.

Other posts in the Series:

1. Lean Love Advice: Part 1
2. Lean Love Advice: Part 2
3. Lean Love Advice: Part 3
4. Lean Love Advice: Part 4 - This Post

Welcome now to Lean Love Advice: Part 4

Rule 4: Any improvement must be made in accordance with the scientific method, under the guidance of a teacher, at the lowest possible level in the organization.

The basic advice of Rule 4 is that improvement to the relationship is achieved through a partnership between the members. In a marriage or partnership, the couple is the lowest possible level in the organization. This pretty much says that appeals to parents or friends to help intervene are not going to be as effective as working with your partner directly. How true. The rule also talks about the scientific method. What is the scientific method? According to Wikipedia, the scientific method is explained in the following scheme:

1. Define the question
2. Gather information and resources
3. Form hypothesis
4. Perform experiment and collect data
5. Analyze data
6. Interpret data and draw conclusions that serve as a starting point for new hypotheses
7. Publish results

An important point to make about the scientific method is that it is a predictive process. In love, it means that we become amateur behavioral psychologists. Perhaps I find out that my wife likes roses. I make a hypothesis that buying her roses will result in positive reinforcement from her. I test this hypothesis by buying roses. What was the reaction? She got hives and tossed them in the trash. Interpreting this data, I realize that she is allergic to roses. I revise my hypothesis to say that she likes to LOOK at roses. If I buy her a rosebush and plant it near the end of the property, she will be able to see many roses without getting hives. I do this and analyze the data. I receive praise for the solution and she very much enjoys her new rosebush. Then, the most important part is to make sure everyone knows that you planted a rosebush for your wife. You got to publish those results.

The main point of the scientific method is to make sense out of your actions and develop behaviors that lead to more love. I think it is safe to say that couples that fall out of love have not observed and reflected on the consequences of their actions. This is something that is required by the scientific method.

Thanks for reading this series about Lean Love Advice. I hope that it has helped paint a new light on Lean and shows that it is not just applicable to making cars and cutting metal. The rules and principles of Lean can apply to all aspects of life if you let them. Lean is not a panacea, but it is an effective framework with which to solve problems of all types.

With that final statement, I open up an experiment to you. With only the rules and tools of Lean as our guide, let us all attempt to answer Lean Love Advice.

Submit your questions to Dear Lean Love at .

All inquiries will be treated as anonymous unless otherwise specified. Replies will be placed on this blog or another blog depending on the quantity of questions. Do you think Lean can guide your relationship? I'm interested to find out.

Lean Love Advice: Part 3 of 4

By Mike Lopez

I've written about the four rules of Lean before. I have been thinking about how they apply to marriage. To refresh those of you who have not read the Harvard Business Review article by Steve Spear and H. Kent Bowen, I will restate the rules here and share how I see them apply to relationships. This is the third in a four part series to apply each of the four rules.

Other posts in the Series:

1. Lean Love Advice: Part 1
2. Lean Love Advice: Part 2
3. Lean Love Advice: Part 3 - This Post
4. Lean Love Advice: Part 4

Welcome now to Lean Love Advice: Part 3

Rule 3: The pathway for every product and service must be simple and direct.

What is the product in a relationship? Of course, this is up to the customers of the relationship, but my initial sense is that one of the primary products must be love. I mean, if love is not flowing, that is probably a problem in the relationship. Rule 3 tells us to create simple and direct pathways for product to flow. How do we maximize the flow of love while shunning the wastes? Let's review the wastes. I've learned eight in my training. How do these wastes manifest themselves in relationships and lead to the breakdown of love flow?

1. Overproduction - Can you love too much? Yes. It is called being "needy" or "clingy?" Everyone needs a break. Even the biggest extrovert needs to be alone sometime. A relationship that produces too much love in the form of constant and unending attention or closeness is overproducing.
2. Overprocessing - When I think of overprocessing, I think of a system with too many rules and regulations to get any work done. When you have to sign a paper eight times before a product can move out the door, that is overprocessing. In the love arena, overprocessing is making excuses to not express love. In more psychological terms, overprocessing is creating conditions to withhold love as a punishment. You didn't do the laundry, so he won't talk to you all night. You dropped a bowl of tomato soup on the rug? Move into the dog house, mister. Couple overprocess all the time. Removing overprocessing is another way to increase positive reinforcement. Rather than look for way to withhold love, a better approach is to find ways to express it.
3. Motion - Before I married my wife, we lived in two different cities. Having to move back and forth between cities was a nuisance to the relationship. When two people are far apart, it impedes flow.
4. Transportation - This is the waste of moving the product from supplier to customer. To maximize flow, the movement of love from person to person needs to be minimized. This waste manifests itself in bad communication. When people can directly communicate love, the movement is excruciatingly slow or non-existent from one person to another. It reminds me of the shy teenager that is unable to confess his undying devotion to the girl next door. All you have to do is make some type of unambiguous move and the communication is sent. Without it, no flow, dude.
5. Injury - When feelings are hurt, that is an injury and it impedes the flow of love.
6. Waiting - If I made my wife wait two days after our anniversary to give her a card or gift, that would be a big problem. Love needs to be delivered when it is expected by the customer. Note to customer: You must submit a purchase order in order to receive love (see Lean Love Advice: Rule 2).
7. Defects - If you give your vegetarian husband a steak dinner to show about much you care, that is a defect. The love doesn't flow. The thought may count, but the full effect of all that effort to show love is impeded.
8. Inventory - Having an inventory of love is like having an inventory of money. It really doesn't do you any good in the bank. Spending money is where you derive all benefit from having it. Some die hard savers, like myself, might say that they value the peace of mind. Still, the peace of mind is based on the knowledge that you have it when you need to SPEND it. Love is not like that. If we spend 10,000 units of love, we don't have any less. There really is no reason to keep inventory. When you feel it, you should immediately spend it.

These eight wastes all impede flow. By removing them from your love behaviors, flow can be increased. Other Lean tools can also be used to increase love flow. For example, let's look at level loading. By level loading the expression of love, we keep it moving at a regular pace. How do we level load love? Routines and standard work are a good start. This may not be a popular suggestion, but you can make a schedule to express love at defined intervals. We also want to change up the love we express. You need to vary the expressions between dates, flowers, gifts, phone calls, letters, talks, walks, and other activities. That is level loading. How about work cells? To me, this is establishing your routines in ways that maximize the expression of love. In order to do this, you need to obtain value from the customer's perspective. Once obtained, you can then structure your dates, letters, and other expressions in ways that create maximum love value in the least effort. No sense in having to write 50 letters to get the output of one really good one. I would much rather write 50 really good ones. Try other tools. Lean is a diamond in rough of love.

Next: Rule 4 - Continuous Improvement

Lean Love Advice: Part 2 of 4

By Mike Lopez

I've written about the four rules of Lean before. I have been thinking about how they apply to marriage. To refresh those of you who have not read the Harvard Business Review article by Steve Spear and H. Kent Bowen, I will restate the rules here and share how I see them apply to relationships. This is the second in a four part series to apply each of the four rules.

Other posts in the Series:

1. Lean Love Advice: Part 1
2. Lean Love Advice: Part 2 - This Post
3. Lean Love Advice: Part 3
4. Lean Love Advice: Part 4

Welcome now to Lean Love Advice: Part 2

Rule 2: Every customer-supplier connection must be direct, and there must be an unambiguous yes-or-no way to send request and receive responses.

To me, this is the most important rule of all. Communication has to be the biggest problem in a relationship. Isn't it the premise of several marriage books that communication is the cause of most major marital problems? I believe it. Rule 2 tells me that relationships have a better chance of success when both parties create unambiguous communication paths. Rule 2 applies to Rule 1 in a very important way. If I have taken the lead on finances, there must be a way for me to ask for help when needed. Rule 2 gives us the insight to create an effective communication plan. If I need help, I need to specifically request for help preferably using SMART requests:

• Specific
• Measurable
• Acceptable
• Realistic
• Time-bound

What is a good SMART request? "Honey, after you throw that raw meat into the trash, would you take the bag of trash out and throw it into the garbage can right away? I don't want it to smell up the house." This is specific (throw trash out), measurable (it is done or not), acceptable (she is not asking me to eat the raw meat), realistic (taking trash out is easy), and time-bound (right after I throw away the raw meat.) A malformed request would be, "The trash needs to go out."

This may seem excessively formal, but I love this type of request because it makes it so easy to please my wife. I know exactly what she wants and can give it to her exactly how she wants it.

Next: Rule 3 - Flow

Lean Love Advice: Part 1 of 4

By Mike Lopez

I've written about the four rules of Lean before. Earlier tonight, I was thinking about how they apply to marriage. To refresh those of you who have not read the Harvard Business Review article by Steve Spear and H. Kent Bowen, I will restate the rules here and share how I see them apply to relationships. This is the first in a four part series to apply each of the four rules.

Other posts in the Series:

1. Lean Love Advice: Part 1 - This Post
2. Lean Love Advice: Part 2
3. Lean Love Advice: Part 3
4. Lean Love Advice: Part 4

Welcome now to Lean Love Advice: Part 1

Rule 1: All work shall be highly specified as to content, sequence, timing, and outcome.

Rule 1 illustrates the importance of roles in a relationship. As men and women, we need to know how to behave in specific situations. Couples that establish specific roles within marriage are better able to deal with the challenges. In some cultures, men take the role of handling the family's external matters. They arrange for the children to marry. They typically bring in the food for the household. Women take care of the internal matters. They prepare the meals and raise the children. They direct the household. Together, the man and woman run a family that operates smoothly inside and outside the front door.

Men and women in our culture have evolved a different model through cultural enlightenment. The stereotypical gender roles have been changed to produce a model that shares internal and external duties between the male and female. This is an excellent and flexible model that allows for men and women to serve the family in the most effective ways. The only flaw is that men and women become confused with their family roles and responsibilities. With the added complexity of our flexible system, we have lost the ease of standard work.

Thankfully, getting back on track is easy. We don't need the traditional gender roles to move forward from where we are. We just need to work with our partner to establish standard work in the relationship. I don't think this means that only one person works or one person does the dishes. To me, establishing standard work means that one person takes the lead on every internal and external household issue. One person takes the lead so that if help is needed from both parties, the leader is responsible for obtaining the help. In our house, I take the lead on teaching the kids how to read. I take the lead on keeping the cars serviced. My wife takes the lead on making doctors appointments. She takes the lead on buying birthday presents. That doesn't mean I don't make a doctors appointment. Two days ago, I made a dentist appointment for us. As lead, she was the one who reminded me to make the appointment.

As followers of Rule 1, a couple will establish which person in the relationship will take the lead on each internal and external matter of the household. This is the most important step.

Additionally, couples need to establish standard operating procedures for how they will perform day to day activities. This includes activities like spending money, saving money, gift buying during birthdays and holidays. Every man knows that he is expected to perform a certain way on the wedding anniversary. That expectation is not confined to one day of the year though. Standard work should be defined for all expected behaviors. If the standard is that nothing is done, that is fine. As long as both parties agree to it up front, it is standard work.

Next: Rule 2 - Communication

Hello from the UK

Hello from the Global Lean Healthcare Summit in Warwickshire, England. It is amazing how truly global this movement is, as tonight I met or saw name badges of people from the US, Canada, UK, Italy, Denmark, South Africa, Germany, Netherlands, Brazil, Australia, and Turkey. That's very encouraging and shows how universal Lean is. People in Denmark are afraid of layoffs too. The NHS in the UK has similar problems as US hospitals.

My taxi driver coming back inadvertantly told a great gemba story. He mentioned he was an engineer with a masters but now ran this cab company with many employees. I asked why he was driving a cab and he said, "how would I know what was going on with my drivers and customers if I didn't also drive?"

What a perfect lean story for a lean setting!!!

Cheers,
Mark

Limited Blog Posts through June 27

Dear blog readers -- I'm going to be on the road through Wednesday June 27, not sure about internet access or time to post. As I mentioned, I'll be attending the Global Lean Healthcare Summit in the UK. I know of at least one Lean Blog reader who I'll be able to meet up with.

I'll have reports from the conference at some point.

Video -- Lean in the UK National Health Service

The positive ER post of the day.... here's a nice video of a news story from the UK. The physician being interviewed does a good job of explaining Lean. "Accident and Emergency" is the UK term for "Emergency Room"

• Reducing wasted/unnecessary steps
  
• Better for the staff (more time on patient care)
• Better for the patient (more timely care that's safer)

The negative ER post of the day is found here.

A Fatally Broken ER

Woman dies in ER lobby as 911 refuses to help

Click here for a more positive ER story posted on the same day... a UK hospital that used Lean to reduce ER waiting time dramatically... read this and think about the impact that Lean could have...

A very sad story from Los Angeles. I'm still haunted by the 911 tape I heard on the TV news last week. Why would someone have to call 911 from an ER? Because the ER is overwhelmed and backed up and, somehow, they weren't properly prioritizing a dying woman.

A woman who lay bleeding on the emergency room floor of a troubled inner-city hospital died after 911 dispatchers refused to contact paramedics or an ambulance to take her to another facility, newly released tapes of the emergency calls reveal.

Edith Isabel Rodriguez, 43, died of a perforated bowel on May 9 at Martin Luther King Jr.-Harbor Hospital. Her death was ruled accidental by the Los Angeles County coroner’s office.

Relatives said Rodriguez was bleeding from the mouth and writhing in pain for 45 minutes while she was at a hospital waiting area. Experts have said she could have survived had she been treated early enough.

Is this a single event at this hospital?

The incident was the latest high-profile lapse at King-Harbor, formerly known as King/Drew. The Los Angeles County Board of Supervisors is investigating claims of recent patient care breakdowns, including Rodriguez’s case.

Federal inspectors last week said emergency room patients were in “immediate jeopardy” of harm or death, and King-Harbor was given 23 days to shape up or risk losing federal funding.

There are certainly systemic factors. I won't pretend to know what they are, I wasn't there. There's a basic imbalance between "supply" and "demand" in many hospitals, we have to be able to fix this.

Rather than blaming an individual RN for the problem, the Chief Medical Officer, at least for now, is taking the fall:

Dr. Roger Peeks, the chief medical officer at the hospital, was placed on “ordered absence” Monday, the Times reported.

This is a point I bring up often when talking about problem solving -- do we "feel better" that the CMO was blamed? Would that fix any of the systemic problems if he were fired? What if he were thrown in jail?

We have to ask why -- why was this allowed to happen? What can we do to prevent it next time? We have to do more than just blaming people.

This article outlines other blaming:

The triage nurse involved has resigned, and the emergency room supervisor has
been reassigned. Additional disciplinary actions could come this week.

More blaming in this article:

At the same time, he said, the preliminary investigation suggests that the fault primarily rests with the nurse who resigned. "I think it's a tragic, tragic incident, but it's not a systemic one."

See, there we go, we have an easy scapegoat, the person who resigned. I'm sure the triage nurse feels horrible about what happened.

"Scores of people" have been fired, according to this article:

Scores of people have been fired, including the head nurse who was involved in that latest incident. The hospital remains under federal investigation.

The board of supervisors is calling for more training, but it has been a challenge. Supervisor Yaroslavsky: "How do you train a person to care?"

But what are some possible causes and root causes other than a "bad employee" or "many bad employees?"

• Bad triage processes -- why is this? Would other triage nurses handled the situation differently?
  
• Lack of triage training -- why? (possibly unrelated to the ER, but lack of skills was a problem in general there).
  
• ER Staffing shortages / lack of funding -- why?
  
• ER overcrowded -- why? Lack of insurance leads people to use the ER for primary care, overburdening employees.... this lead
  
• Lack of caring / silo-ed employees, a janitor mopped up the woman's vomit, but didn't stop to help, that "wasn't his job" I'm sure. Why is this? Why isn't there an "andon cord" where ANYBODY can "stop the line" and get immediate priority when they see a crisis?
  

I'm just brainstorming here. I doubt there's any single "root cause." It's just mind boggling how stuff like this happens. We need systemic fixes. Hold people (especially leaders) accountable, sure, but don't just blame and find scapegoats.

New VP Job on the Lean Board

Vice President, Lean Process Improvement -- $300 million+ Industrial Manufacturer -- Philadelphia, PA Metro Area


Click on the link above for a new job posting (the Lean Board does not require registration to read and it's free to join if you want to post messages).

Here's the general link for the Jobs board.

Are You Really Asking?

Here's one I came up with yesterday... having a discussion with supervisors about asking questions as leaders.

There's different tones of voice and different intents, when asking questions. The worst form would be, "Why the hell aren't you following the standard work??? How many times do I have to emphasize that??"

A better approach might be, "It appears that the standard work isn't being followed. Why is this the case? Has something changed? Is there a problem we need to fix?" (as a legitimate question that you want the answer to).

This is a "wife approved" example. If your wife asks, "Why did you leave your socks in the middle of the floor?" that really isn't a question that she's expecting an answer to. It's more of a polite way of saying, "I wish you wouldn't leave your socks on the floor, please pick them up."

Keep that in mind when asking questions of your employees. Are they really questions? Are you prepared to listen and engage in the response?

Because you never know, there MIGHT be a good reason that the standard work isn't being followed. You have to discover what that is and practice kaizen (or coach the employee on the importance of following the standard). That's different than saying "follow the standard work because I'm the boss and because I said so."

There's no good excuse why I left my socks in the middle of the floor!

Updated: Be sure to check out John Hunter's "Curious Cat" post on this topic

"Detroit is looking for a foreign villain"

'Face of Toyota' Steps Up At a Delicate Time - WSJ.com:

I'm surprised that Jim Press, about to be elected to Toyota's board, would be so blunt:

"Mr. Press -- who has said his job is to be 'the face of Toyota' and explain the company's policies and practices to ensure it is treated fairly -- said the currency market is out of Toyota's control. He pointed out that the company 'worked hard to make a profit' when the yen reached its historic high in the mid-1990s, which made Japanese exports more expensive. He also said that Detroit is looking for a foreign villain."

The Detroit Three (and some U.S. politicians, including the UAW) are focusing on the external excuses rather than the internal problems. It's not that external problems don't exist, but you hear FAR more talk about them than you do the need to quickly bring the right products to market, etc.

Fairly quickly Mr. Press will have to address complaints raised by American car companies and the United Auto Workers that Japanese auto makers are taking advantage of a weak yen to goose sales and profits in the U.S. Politicians from manufacturing states have protested that the weak yen allows Japanese auto makers to add features without increasing prices substantially. The Big Three auto makers, all of which have undergone restructurings that have cost thousands of jobs and run up huge financial losses, can't match that.

Updated: Evolving Excellence also has a take on this.

Toyota Slowing Down U.S. Plant Expansion?

Report: Toyota May Slow US Plant Builds: Financial News - Yahoo! Finance

WSJ article: REDUCED SPEED Toyota's New U.S. Plan: Stop Building Factories

Toyota is concerned about overexpansion and overcapacity in the U.S., apparently.

In Japan, most of Toyota's factories are clustered in a single place, Toyota City. In the U.S., over the past decade, Toyota has spread factories from Fremont, Calif., to Georgetown, Ky.

That clustering would certainly lead to supply chain efficiencies (and risks). For each new spread out site in the U.S., suppliers often have to build new locations (to be close to the new Toyota plant for just-in-time delivery). Of course, it wouldn't be "lean" if we talked about each supplier having a huge central factory that could easily feed ALL Toyota plants, would it? Lean gives us tools for not having to rely on "economies of scale" to be profitable. As commentators have pointed out before, part of Toyota's strategy of sharing the factory wealth is probably more politically-driven than supply-chain-driven.

"Toyota has just announced the new Mississippi plant, where production is set to start in 2010," Imai told The Associated Press. "As for North American plants after that, nothing has been decided."

The assembly plant on the outskirts of Tupelo, Miss., will be Toyota's eighth North American vehicle-assembly plant and the fourth new one in the past five years.

I think a more interesting topic to discuss -- why aren't the North American Toyota plants as flexible as in Japan?

In Japan, some of Toyota's plants are capable of building more than a half-dozen different vehicles. In North America, several of them build just one or two models, making them somewhat inflexible to adjust to sudden swings in demand.

Having less flexible demand worsens any overcapacity problem, as it's harder to shift production around (or forces the building of a new plant for a new product instead of using an existing flexible line). Can anyone shed more light on this?

"Decoding the DNA" Summary

Decoding the DNA of the Toyota Production System — HBS Working Knowledge

Here is a summary of the famous Spear/Bowen article on Toyota's "DNA." If you've never read it, definitely check it out. Also, the full article is well worth the $6 it costs to order and download it.

Psychology & Lean

By Mike Lopez

Extraversion or introversion. How do those personality traits figure into a Lean implementation? I have seen very event driven implementations of Lean. There are Kaizen blitzes, Value Stream Mappings, 6S events, and others. I think it is safe to say that extraverts have an easier time with all the typical Lean activities that require extensive interpersonal interaction. As an event goes on, the extravert can maintain a constant energy level and becomes more animated as the group gets more involved.

A refresher on introversion and extraversion can be found at Wikipedia:

Most people believe that an extravert is a person who is friendly and outgoing. While that may be true, that is not the true meaning of extraversion. Basically, an extravert is a person who is energized by being around other people. This is the opposite of an introvert who is energized by being alone.

I've heard many reasons why Lean won't work. Although we are familiar with how to overcome many of these objections, the apprehension may have nothing to do with facts and everything to do with implementation. People have a funny way of creating seemingly logical arguments to validate feelings. If you are trying to implement Lean in an environment full of people that cherish their independence and "alone time," consider modifying your implementation to appeal to the introvert lifestyle.

As a subject matter expert on being an introvert, I offer the following pointers for appealing to people like me:

1. Reduce the number of events and create tools that can be performed individually or in small private groups.
2. Focus on rules and principles. The underlying theory of Lean will captivate an introvert. Much more appealing is a discussion about the Four Rules or a discussion about the Five Principles (Value, Value Stream, Flow, Pull, Perfection). The 8 Wastes are cool, but they are only corollaries to the underlying philosophy.
3. Spread out events so that some people can recharge between sessions. I led a Kaizen that met one day a week for a couple hours for many weeks. Not typical, but it really helped everyone in the room stay focused for the short time we met. Nobody ever snapped from fatigue and we got a lot of stuff done.
4. Make your introverts into your Lean research staff. People like me enjoy the opportunity to apply rules and principles in new ways. As we sit in our office, we will research best practices and use them in combination with Lean principles to craft new ways of being Lean.
   

An organization that uses some of these tips will really help guys and gals like me warm up to Lean and see how it can positively affect the company.

Updated: China's Manufacturing Reputation

As More Toys Are Recalled, Trail Ends in China - New York Times

Pet food, toothpaste, childrens' toys.... (oh and let's not forget the recent slave labor stories).

Update: WSJ article with interviews from released slaves

When does China's reputation shift from "cheap labor" to "cheap crap?" Is it already there?

Japan used to have that reputation until a man named Dr. Deming came along preaching quality and promising that he would turn the country's quality reputation around.

From this website:

He was invited to Japan at the end of World War II by Japanese industrial leaders and engineers. They asked Dr. Deming how long it would take to shift the perception of the world from the existing paradigm that Japan produced cheap, shoddy imitations to one of producing innovative quality products.

Dr. Deming told the group that if they would follow his directions, they could achieve the desired outcome in five years. Few of the leaders believed him. But they were ashamed to say so and would be embarrassed if they failed to follow his suggestions.
As Dr. Deming told it, "They surprised me and did it in four years."

Will China have its Deming? Will American companies that outsource to China have a new Deming?

I'm not saying all stuff made in China is crap. But I'm guess when you purchase/source products based on "price alone" (as Dr. Deming used to rail against), you end up with crap. Sourcers can't close their eyes and claim "see no evil." Companies have a responsibility to make sure they are sourcing from reputable vendors who follow guidelines of basic decency in what they "mistakenly" put in their products. "Mistakes" happen when people are trying too hard to hit unrealistic targets....

We need another Dr. Deming. I don't know who is willing to listen though.

Updated: NY Times article on dangerous toys from China

Updated: Free Lean Accounting Webcast

IndustryWeek : What YOU Need to Know About Lean Accounting (Hint: It's Not Just For Accountants)

Update: This is tomorrow, June 20.

Free 90-minute webcast, brought to you by Industry Week and SAP on Lean Accounting, featuring Brian Maskell and Jean Cunningham.

What Would You Ask the UAW?

For UAW Chief, a Bid To Forestall 'Waterloo' - WSJ.com

The UAW leader for the U.S., Ron Gettelfinger was featured in today's Wall Street Journal. He pretty much spoke the company line on the usual excuses for why the Detroit Three aren't as competitive as Toyota.

"In a defiant television interview to be aired this weekend, he blames currency imbalances and unfair foreign-trade practices for U.S. auto makers' competitive problems, and calls on the federal government to fix them."

It amazes me anytime an article comparing the "Detroit Three" and Toyota does NOT mention the Toyota Production System and the lean practices. You can argue that there ARE unfair trade practices (or unfairness that the Detroit Three have to pay for healthcare), but shouldn't the companies and UAW also focus on things they have control over, such as quality and efficiency improvements through lean? Or, as it was with Delphi, would lean success (at least gaged by Shingo Prizes) not be enough?

What would you ask Ron or the UAW, in the context of Lean, if you had the chance?

• What role does lean (or the lack of lean management) play in the gap between Detroit Three and Toyota? How does "factory lean" versus "lean enterprise" (including product development) impact Detroit Three competitiveness?
  

• Isn't the best way to prevent wage erosion to improve productivity and utilize workers' ideas and ingenuity? Is Detroit Three management moving away from the old, disrespectful "check your brain at the door" approach to managing production workers? Are UAW employees prepared to cooperate as "thinkers" if management would let them?
  
  
• Is the UAW no longer afraid of the word "lean?" Can the UAW work together with the company on lean methods, to help improve competitiveness? You can call it "global manufacturing" or "competitive manufacturing" instead of "lean manufacturing," if you have to.

Lest anybody misinterpret my point here, I have NEVER blamed UAW employees for the problems that GM and the others face. I worked with many good, well-intended UAW employees during my time at GM in the 1990's. It was bad management practices that got in the way of their success. I learned quickly that it wasn't "lazy union workers" that held the company back.

I just think it's fair to ask the UAW to publicly endorse lean methods as one way of solving at least part of that competitiveness gap. Sure, ask the government for help, but make sure that isn't the only strategy.

What are your thoughts on this, Detroit folks and auto industry folks?

BusinessWeek Debate Room Toyota, Take the Wheel

BusinessWeek Debate Room Toyota, Take the Wheel

Business Week poses this debate question:

The Japanese manufacturer deserves its new status as the No. 1 automaker, because it produces better vehicles than Detroit does. Pro or con?

Jeff Liker argues "pro." A guy from something called the "Level Field Institute" makes the usual excuses about yen valuations and labor costs.

What do you think?

Lean, No Wait ER's

U.S. hospitals try to pick up the ER pace - Yahoo! News:

You might have seen this sad case of a fatally broken ER on the news over the weekend and I have more comments on that later.

On a more positive light, "about a quarter" of U.S. emergency rooms are working on "no waiting" or "30 minutes or less" goals:

"Some hospitals are moving to eliminate waits altogether. The Adventist GlenOaks Hospital in Illinois promises no waits at all. As of last week, patients could skip the waiting room and go directly to a private room where treatment starts as registration is done bedside."

The article doesn't explicitly mention Lean, but the process change shown above could come through a Lean process. Lean never says "do stuff faster," whether it's a factory or a hospital. Lean thinking pushes you to take out waiting time by CHANGING the process.

As Deming said (I might be paraphrasing), the last thing we need is everybody trying their hardest as part of a bad system. We need to change the system, this is good for the patients, the employees, and the hospital.

That will be one of the major themes in my upcoming book, "Lean Hospitals." The book is underway, I'll post my progress as we go (and my writing actual vs .'takt time'), stay tuned.