Lean Hospitals Survey

In support of the book I am writing, I am conducting a survey of Hospital organizations and their views and experiences with Lean. The survey will be distributed through some more formal channels, but I also wanted to post it here for any Hospital readers of mine who stumble across it. Please only take the survey if you are a Hospital employee or representative.

Direct Link to Lean Hospitals Survey

If you would like to send the survey to others, you can use the "email post" feature at the bottom of the post (the icon of an envelope). Or you can send them:

1. To the survey link (right click and copy the link)
   
   
2. To the Lean Blog, www.leanblog.org, there is a link in the upper left Admin section
   
   
3. To my other website, www.leanhospitalsbook.com, where there is a survey link.

Thanks for your participation!

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Bad Systems in the News: Northwest

NWA blames pilot absences: Detroit Free Press

Updated: NWA calls back all its pilots as cancellations mount

In another example of media/management blaming, Northwest Airlines is blaming pilots for forcing the airline into canceling flights at the end of July.

Northwest Airlines blamed a spike in canceled flights Friday on pilot absenteeism and warned that it would probably cancel more flights over the weekend.

Blame, blame, blame. Of course management would blame pilots instead of their own mismanagement. It's much harder to look in the mirror than it is blaming others. How might you guess this is somewhat of a systemic problem? The fact that they had the same problem at the END of JUNE. Same bad pilots? Ha, more likely the same bad management.

The union points the finger (which one, I'm not sure) back at the management team that led the airline into bankruptcy (shame on them) and out of bankruptcy (bringing big retention bonuses).

"We continue to maintain that this is a staffing issue," said union spokesman Monty Montgomery. "We notified the airline months ago that there isn't adequate staffing to fly the summer schedule."

As The Consumerist points out, Northwest hasn't brought back enough pilots after the bankruptcy and schedules are heavy. They quoted business writer Joe Brancatelli:

Northwest is trying to operate with about 25 percent fewer pilots and co-pilots than it employed in 2000. The inevitable result: massive crew shortages at the end of June when Northwest's remaining pilots "timed out" and could no longer fly. (According to federal regulations, pilots cannot fly more than 100 hours a month.) Northwest canceled more than 1,200 flights during the last 10 days of June. The final 10 days of July and August won't be much better.

Northwest is playing the usual airline game of sticking it to the employees. The pay for pilots and flight attendants gets slashed, while corporate execs feed at the greed trough. Where is "respect for people" in the airline biz? Can you blame pilots for not volunteering to fly beyond their normal schedules when the airline isn't bringing back their colleagues? It's like the scene in the movie Office Space where the boss tells Peter that they're a bit short on people (after a layoff), so he's going to have to work Saturday AND Sunday.

That's why so much of leadership comes back to basic human psychology, as Deming was fond of pointing out. You often have to step back and ask, "How would you expect people to react?" Sort of like when we talk about the need for a "No Layoffs Due to Lean" pledge. When lean efficiency improvements lead directly to layoffs, why would you expect employees to remain enthusiastic for Lean? Would you expect pilots to rebel by calling in sick to Northwest? Why should they go out of their way to help the company when they're continually dumped on? It's a shame when companies get focused on fighting internally instead of fighting the competition.

On a somewhat related industry note, American Airlines was fined about $250k for safety violations at O'Hare. As the site The Consumerist said:

We don't know about you, but it makes us uneasy to hear that an airline is being irresponsible with the safety of its employees. How then, does it feel about the safety of its customers? If the employees aren't doing their jobs in a safe environment, what makes you think you're flying in one?

Well said!

What a messed up industry. If you look at the "old" carriers, it's probably a more across-the-board mess than the Detroit Three.

Updated: The updated link I posted at the top says that Northwest is trying to bring back the rest of their furloughed pilots, but:

"A significant percentage is choosing to not come back," Montgomery said, though he was unable to provide a specific number.

The way management treats them, can you blame them if they have other options?

Previous contracts considered anything above 80 hours of flight time overtime. Pilots are no longer paid overtime.

"We're having all our pilots fly overtime with no extra pay," Blaufuss said.

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Not Cutting Their Way to Greatness

CEO's cost cuts feared too steep

Radio Shack's best days are long behind them, apparently (that's not exactly breaking news). The most recent CEO, "turnaround" specialist Julian Day, has been there a year and the local paper (RS is HQ-ed in Fort Worth) is evaluating his performance. It's harsh. I don't envy the guy, it's a tough job, but he's going strictly by the "slash and burn" management book. Does that really require enough creativity and skill to merit the huge paycheck?

But one year into Julian Day's tenure as chief executive, skeptics on Wall Street and inside the company are wondering whether the turnaround veteran's drive to cut costs will hurt morale so much that it puts the Fort Worth-based electronics chain's biggest strength at risk.

Employees are stretched so thin at stores that service is suffering. Customers are walking out of stores because nobody is helping them and employees are so disgruntled about staffing and pay cuts that it sounds like they're not trying anymore. That's how stores should be run for customer satisfaction and growth? Probably not.

I've always joked that you can cut costs, no matter what it costs you! The same line pops up here:

Day "can maybe bring profit back to the company, but at what cost? And at whose cost?" the manager asked.

Even Wall Street doesn't like their cost-slashing strategy:

Visits to RadioShack stores helped convince Bank of America analyst David Strasser to slap a "sell" rating on RadioShack this month. In addition to having concerns about the continued deterioration of the cellphone business and the impact of advertising reductions, Strasser told clients that cuts in commissions and benefits "have hurt employee morale and decreased store employees' willingness to aggressively cross-sell products."

Maybe that's progressive Wall Street thinking -- actually going to the "gemba" (the stores) instead of just looking at how the financials "look good" on paper. You can only get so far by slashing costs -- advertising and people being the main things RS has slashed.

It's better to have a strategy for being effective. As Goldratt always said, you can only cut costs to zero, while revenue has no upper boundary.

Another analyst sums it up even better:

"Running the company for cash and margin rather than retailing success does not seem like a viable long-term strategy," wrote Carol Levenson, research director at Gimme Credit.

In other words, you can't cut your way to greatness. A "Lean Retailing" strategy would focus on effectiveness and customer satisfaction, while engaging and involving employees. An inventory strategy that keeps the right products on the shelves when needed and some semblance of strategy (RS's has been "high service," not "low cost.") They're not going to "out Best Buy" Best Buy or Circuit City. You've got to do more than just slash front-line expenses and create disgruntled employees!

Lean Success in Michigan

Hiring, new floor plan help spur manufacturer - MLive.com

Here's a story about a small Michigan manufacturer that is using Lean as part of their growth strategy, as opposed to those who use it strictly for cost cutting in a shrinking business.

They were barely a manufacturer in 2004:

"... the company was an "immature manufacturer," having outsourced the majority of its manufacturing while keeping research and development internal..."

Not only did they start manufacturing, but they came at it from a Lean perspective:

Instead of downsizing its staff, Mopec has increased employment and added assembly workers.

"We saw great potential for growth in our industry for our products and we weren't sure how to best manage those processes," VanDusen said. "But with the help of outside resources we laid out a plan for an efficient shop floor and since have invested more than $200,000 in equipment and even more in new employees."

There are more details in the story, but I like their results:

Through the lean training Mopec more efficiently aligned its machinery and plant floor, so some additional space didn't have to be developed.

Mopec has nearly doubled its work force to over 50 since 2004 while boosting revenues. Profits have remained strong, executives said, and the company has used added cash flow to make substantial internal investments.

Way to go, Mpoec! I hope they remain on the pathway of continuous improvement.

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Today's Dilbert and Product Development

I won't overanalyze this, but here's an example of (yet again) the pointy-haired boss not understanding the business or the products he's "managing."

Not a "gemba walker," that pointy-haired boss (click the image or visit www.dilbert.com for the larger cartoon).

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Bad Systems in the News: NBA

Last week, I saw a number of news stories that caught my eye, non-manufacturing stories about systems (or lack thereof) and blame. What do the Transportation Safety Administration, the National Basketball Association, Detroit Public Schools and Northwest Airlines have in common? Poor systems... read on.

National Basketball Association (NBA):
You might have read about the NBA ref, Tim Donaghy, who accused of betting on (or possibly even fixing the outcome of games). The USA Today had an interesting article about the oversight (or lack thereof) with NBA officials:

An ineffective system for training and evaluating game officials helped allow possible illegal betting to go undetected, according to two veteran NBA referees and another who recently retired.

It's interesting to me that this article doesn't just point the finger of blame at the "bad ref." If the charges against Donaghy are true, he must be held accountable, by his employer (well, he's already quit) and by the law. Looking for systemic causes or enablers isn't inconsistent with holding people accountable.

How many businesses have an "ineffective system for training and evaluating" employees? That's what the Training Within Industry program is supposed to help address right? Could that approach be applied to the NBA? Possibly.

The referees make it sound like the rules and guidelines for calling fouls are so open to interpretation that it's hard to teach and hard to hold refs accountable for not calling plays the right way. I reffed intramural basketball for two years in college and it's a very tough thing to learn and get good at. There's so much action, so fast (even in a typical college gym), that you can't possibly see everything or call everything consistently.

Can you use TWI rules to "break down" the job of a referee? There's a certain "art" to officiating, but that's true of so many other jobs. There are judgment calls, but it's also possible to have others validate or calibrate the judgment of each referee, to make sure they are calling games as consistently as possible.

I read in some other article (and now I can't find the reference) that the NBA *does* have "observers" who travel and rate the officials -- were "calls" correct, were "non calls" correct even (basing a "non call" on the reaction of a bench or coaches). Unfortunately, it sounded like the qualifications for being an observer were pretty weak -- no basketball refereeing experience was necessary.

No wonder that was called an "ineffective" system. Hiring observers with no experience makes about as much sense as a manufacturer hiring an engineer, fresh out of college, to supervisor workers in a department he or she knows nothing about (which probably still happens, it's not the Toyota Way approach to supervisor, where you'd tend to promote from the front line workers).

Next: Northwest Airlines

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LeanBlog Podcast #28 -- Norman Bodek

LeanBlog Podcast #28 features our friend and frequent guest, Norman Bodek, noted lean author, consultant, and President of PCS Press. This also celebrates the 1 year anniversary of the Podcast, which featured Norman as our first guest. As I've given him credit for previously, the Podcast really was Norman's idea when he said I should do "radio interviews" with him. Thankfully, this has turned into a series of interviews with others that I have enjoyed immensely. I hope you enjoy them as well.

If you enjoy this podcast, I hope you'll check out the rest of the series by visiting the LeanBlog podcast main page.



MP3 File (Right Click to Save-As)

Keywords and Main Points, Episode #28

• Summary of Norman's talk at the TWI Summit and the "pledge of continuous improvement."
• Gantt's book "Organizing Work" (via Google Books) -- the stakeholder groups that a business must serve (including community)
• Lifetime employment and the obligation for good management
• Can you have a workplace with no bosses? Example of a Skippy peanut butter plant
• Is the ultimate goal automation? Norman's thoughts on that
• Managers's resistance to change as a separate type of waste?
• Being on the floor all the time as a manager
• Norman talking about "conscious learning" (his next book)

If you have feedback on the podcast, or any questions for me or my guests, you can email me at leanpodcast@gmail.com or you can call and leave a voicemail by calling the "Lean Line" at (817) 776-LEAN (817-776-5326) or contact me via Skype id "mgraban". Please give your location and your first name. Any comments (email or voicemail) might be used in follow ups to the podcast. Click here for the main LeanBlog Podcast page with all previous episodes.

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Bad Systems in the News: Detroit Public Schools

I've fallen behind in my blogging the past few days, but I'll be back on track. I saw a number of news stories that did catch my eye, non-manufacturing stories about systems (or lack thereof) and blame. What do the Transportation Safety Administration, the National Basketball Association, Detroit Public Schools and Northwest Airlines have in common? Poor systems... read on.

Detroit Public Schools:
Lets start with Detroit, since the situation is spelled out pretty clearly by the new superintendent. Since I grew up outside of Detroit, I still scan the papers online sometimes and ran into this article in the Detroit Free Press, which starts with:

Detroit Public Schools Superintendent Connie Calloway said Friday in a candid conversation with the Free Press that she inherited a system in which there are no administrative procedures in place for seemingly basic functions and rules are not respected.

We often take for granted, in manufacturing, that a business has processes. These processes often are full of waste (are "not Lean") but there is a process. It seems, while a generalization, that people in industries outside of manufacturing really aren't taught to be "process thinkers" (yet alone "value stream thinkers").

Calloway is really having to shake up the school district, so rumors spread when a new leader comes in:

The new superintendent, who started on July 1, said that contrary to rumor, she is not a “my way or the highway” type of leader, but one who expects stakeholders to follow standards and procedures.

I think the same could be said for a "Lean leader." Lean leadership isn't a dictatorship, but you do have to set expectations that people follow "standardized work." Again, the school isn't trying to "be Lean," I'm just looking for parallels here. A "Lean leader" would go a step further than just following standards -- they would also expect people to make suggestions for improving said standard.

An editorial in the paper spells out more, including Calloway quoted as saying:

The system, she says, seems "unaccustomed to process" of any kind.

She also uses the word "apalling." As a leader, you have to be careful in telling people how bad things are. It might all be true, but people might not necessarily trust an outsider. People often have pride in how they've done things, even if it's all wrong. Think of the challenge of an Alan Mulally coming into Ford, trying to talk about how bad things are and how Toyota is doing so much better. He runs the risk of being tuned out or demonized by those with an interest in maintaining the status quo. This happened in the DPS before:

Think of Deborah McGriff, hired in the early 1990s to shepherd the school system through the early days of reform. She was blunt, too, about how awful she found things to be here, and she refused to back away from tough assessments or unpopular prescriptions.

She lasted less than two years, though, because those who don't want to hear the truth were allowed to cast her as the enemy. Nearly 20 years later, no one can credibly argue that things are better than they were when she left.

I saw similar attempts when I was at GM and we had a new plant manager with a NUMMI background come in to fix things. I wrote about it here in this post about Mulally. The union tried to make him the enemy, that he was criticizing the workers, when that wasn't the case, at all. Spin and politics can get in the way of change in any environment, unfortunately. Hence, the challenge of leadership!

An example of the broken processes:

A few examples: Calloway notes that Detroiters have argued for years over the way the school system doles out contracts. Rather than focus on the accusations, she has asked the district's procurement office to outline its standard operating procedures, so she can check to see that the proper safeguards are in place. She said she'll do the same with every department.

Again, this reminds me of "Lean leadership" -- not pointing the fingers of blame but, instead, focusing on defining processes. Without a process defined, how can you tell if people are following the process or not?

I really wish Calloway a lot of luck with her journey. Maybe Mulally and other Lean leaders in Detroit can help out. First off, by setting a good example, but secondly, getting involved and helping bring "Management 101" practices (yet alone Lean) to the school district.

Coming Next: Bad Systems in the News: the NBA

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Reader Question: Role of a Company President?

Since we've been talking about leadership and Lean, it's coincidence that I got this email from a reader. I'll let the blog readers answer this

Posted with permission:

I am [name withheld], 25yrs old, working for a small manufacturing firm of over 70 employees in (Saitama Ken) Japan.

I have been working for eight months in the current company, staring from the scratch with educating the employees through, Learning by doing - Muda, Mura, Muri, 5S, PDCA, Autonomous maintenance, drawing the Current state map, via lectures and group activities lead by a Kaizen leader (Shop floor worker-only ).

I have had my share of employee resistance and management resistance. But the most persistent of all is that from the president who is 41 years old and refuses of go to (Gemba) shop floor.

As a company, we take 30 minutes (Kaizen Time) everyday for Kaizen activities and during the Kaizen time, the president does come to the shop floor. Subject to being present in the company during the Kaizen time. But, he does not agree on going to the shop floor on regular basis – during the actual working hours. He thinks that it is not his job to go to Gemba (shop floor) and observe. But the top managers and Floor managers job and he takes decisions based on the data in files and information from the top managers and floor managers, who in the past did not observe the gemba them selves. But have now started going to gemba regularly for the last one week, due to my repeated reminder.

I would like to request for your thoughts, if possible of the blog readers and contributors about, what is the role of the President in a firm, which wants to or is implementing Lean ?

What do you think? Click comments to answer...

I think this is an interesting example that shows "not all Japanese companies are Lean." Also maybe think about how a 25 year old can influence senior leadership. That's quite a challenge my reader has.

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New Sponsor: LeanSupermarket.com

I'd like to welcome a new sponsor, the Lean Supermarket (www.leansupermarket.com). It's a startup online store that offers a wide range of supplies for your Lean implementation efforts, run by an active lean practitioner.

The owner of the site, Brent Jorgenson, sends out an informative email newsletter with Lean tips. If you'd like to subscribe, email him at brentjorgenson@leansupermarket.com and tell him the Lean Blog sent you.

Let's Try a "5 Whys" Survey

Following up on the LEI survey that was released and discussed here, I've been talking with a few folks offline about what the "root causes" really are for Lean struggles. Instead of pointing at "who?" what would we find if we asked "Why?" And then asked "Why?" again. Let's utilize one of the Toyota Production System problem solving methodologies, the "5 Whys?"

So, an online survey is cheap and easy to set up. Let's give this a try. It's an experiment, in the spirit of PDCA. I'm not sure if this problem really lends itself to 5 Whys, because as blog reader Ralf pointed out, this is a complex business and organizational problem. It might not lend itself to an online survey, since I'm used to doing this in person and interactive.

Click Here to Take Survey

Those who take the survey and leave an email address (which will not be sold or distributed), we are going to do a few Lean giveways, including a donated copy of "Workplace Management", given by our friends at Gemba Research. I'll publish the results here and will email them out to those who leave an email address.

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"No fault, just an accident"

Explosions rock downtown Dallas | Latest News | WFAA.com

Working from home with this news on in the background, the massive gas cylinder explosions at a business near downtown Dallas, about 30 miles from my home.

What jumped out at me was the TV reporter probing "whose fault was this?" and the fire inspector/spokesman said:

"There's no fault, it's just an accident. We need to find out why this happened."

It's a horrible looking scene. A few burn victims, let's hope for their survival and recovery.

The spokesman was talking about some equipment failures/flaws that led to the chain reaction of explosions. It will be interesting to see if there is true root cause investigation (the Feds are headed in, for what that's worth) or if it eventually comes out that it was "somebody's fault."

It might be the fault of one person, but would you suppose this is more likely caused by something systemic and preventable? The video certainly was scary, the tanks flying through the air onto roads and over the freeway.

With Lean problem solving, we need to ask "why?" and not first look for "who?". Are fire investigators, by training, good root cause problem solvers? On the news, I'm hearing a lot of "why?" Why did this happen? Why are sites like this so close to downtown and major freeways? Many root causes are contributing to what could have been a much more lethal situation.

What About The Other Car Makers?

by Dan Markovitz

This blog has commented (here and here) on the WSJ's rush to predict the folly of just-in-time manufacturing in the wake of the earthquake last week that crippled Japanese auto production. ("Blame it on kanban, the just-in-time philosophy of keeping as little inventory on hand as possible.")

What's striking about the WSJ's maligning of just-in-time is that the earthquake forced the temporary shutdown of nearly 70% of Japan's auto production -- not just Toyota's. Honda, Nissan, Mitsubishi, Mazda, Suzuki, and Fuji Heavy Industries (Subaru) also had to stop or slow production last week.

So why attack just-in-time? Why not attack mass production, since it clearly didn't keep the other car companies running? Or the danger of single-source supply for critical parts? Or having factories in Japan, a notoriously earthquake-prone country, for that matter?

Fortunately, Toyota's president, Katsuaki Watanabe, doesn't pay too much attention to the shrill cries of the WSJ. He announced that

the company will examine its risk management and risk control and look for ways to become less dependent on single suppliers. He stressed the auto maker won't change its kanban, or just-in-time, strategy of keeping as little inventory as possible on hand, which reduces warehouse costs and ensures quality.

The solution to these once a decade disasters? Kaizen, of course.

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Survey Blames Blame for Lean Struggles

The LEI is out with their annual survey (pdf) about our ongoing struggles implementing Lean, with articles (reprinting the press release) and blog posts already written, The results aren't the views of the LEI, but are the views of the respondents to their survey.

The survey asks, in part, "What are the biggest obstacles to lean implementation at your facility?"

I appreciate the work the LEI does, but maybe they should change their survey to a "5 Whys" format to get to the "root cause" of these problems. The format of the current survey seems to ask "Who is the biggest obstacle...?", which reeks of finger pointing, a practice that isn't supposed to be part of the Toyota Way. Instead of asking "who?" we are supposed to ask "why?" Update: Take our trial "5 Whys?" survey on this topic.

Before the blaming begins, last year's #1 reason was "backsliding," which seems more an illustration or example of the Lean struggles than a cause itself. Anyway, it fell to #6 on the list this year. My nitpicking aside, if we're "backsliding to old ways of working" (as the LEI puts it) less, that's a good thing. Hooray, Lean world. Rather than just pointing at backsliding, a more appropriate question, for those who are still backsliding, would be "why are you backsliding?"

In this year's survey, the top obstacles are (in a "check all that apply" format):

1. Middle management resistance (36.1%)
2. Lack of implementation know-how (31.0%)
3. Employee resistance (27.7%)
4. Supervisor resistance (23.0%)
5. Lack of crisis (17.7%)

And the list goes on through the 10 choices on the survey.

Viewed from the positive perspective, *only* 36% percentage of us face resistance from middle managers, which might not be that bad. 64% of us are able to get our middle managers on board, maybe those are the ones with a crisis to use as a motivation for Lean.

While the LEI press release headline says "New Survey: Middle Managers Are Biggest Obstacle to Lean Enterprise," that's an unfortunate analysis. I would have titled it "Ineffective Leaders Blame Other Employees for Lean Enterprise Struggles." Blame, blame, blame, maybe they could add "our ungrateful customers" and "our lousy suppliers" as survey choices next year?

Sorry to be blunt, but when we find ourselves saying (and trust me, I've caught myself saying it before) "this Lean effort would be going great only if so-and-so would get on board," that's a cop-out and an excuse. It's blaming others and I don't think it's productive. It's OK to identify lack of buy-in as a problem, but then get to work on it! It's our job, as leaders, to get people on board. There are many ways of doing this and many books written on the topic already. It's not an altogether bad thing to recognize your managers are not on board with Lean, the question is what do you do about it?

#7 in the list hits on what I think is the real key: "Failure to overcome opposition." That starts smelling like more of a root cause to me. And that was only about 4% of the responses. There's some leaders who are looking in the mirror (or maybe the respondents were pointing the finger of blame upward).

I followed up with Chet Marchwinski of the LEI and he told me they do not know the population distribution of who responded (the range from CEO to front-line employee), but it's interesting to see "Lack of top management support" isn't in the Top 10. Actually, Chet pointed out that it wasn't a choice and there were no open-ended responses allowed in their survey format. Based on some feedback from myself (and others), they are considering adding that as a category/choice for next year.

I hate to point fingers of blame myself, but I'm more willing to hold accountable the upper management levels who are responsible for strategy and overall company direction.

We could do a "5 Whys" analysis, which might look something like:

1. Why are we backsliding? Because we're lacking employee buy in
   
   
2. Why do we have that? Because the supervisors aren't bought in and aren't holding the employees accountable
   
   
3. Why is that? Because the managers aren't explaining to the supervisors why Lean is critical to the company's success
   
   
4. Why is that? Because upper management expects their employees to implement Lean because they said so and without any other leadership, support, or organization alignment
   
   
5. Why is that? Because upper management is too busy blaming others (Wall St., China, suppliers, labor costs) to take the time to be leaders?

Any other thoughts? I'm actually going to pilot a "5 Whys" format of this same survey question to see if we can get to root causes and action and away from blame.

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Comments of the Week

If you're reading via RSS, that's great, I support free full-text RSS feeds for my readers (over 800 now via RSS, compared to about 500 who visit the website).

One thing you're probably missing out on, unless you do visit the website once in a while, are some of the informative and insightful comments left by the readers. Here are some of the best... come take a look and participate yourself, even. I like the Blog to be a two-way discussion, so come chime in.

• My post about the WSJ bashing "just in time" after the Japan earthquake brought many good comments including:
• Joe asked (in part): "What is the alternative, accept higher costs and worse quality just to buffer yourself from a 6.8 earthquake?"
• Matthew May left a very long comment giving some first hand insight into Toyota's past reactions to situations like this
• I included text of the letter I sent to the WSJ editors
  
  
• My post about the Art Smalley webcast got a helpful response giving the link to the archived presentation (thanks, Brad at Industry Week)
  
  
• My post asking if the NHS sending a large group to Japan to visit Lean factories was a "boondoggle" and if they should have just found lean factories in the UK (including Toyota) got many responses, including a comment from Jon Miller constructively defending the practice.
  
  
• My post on Starbucks, market pricing, and cost stirred (pun intended) some debate between myself and Ron Pereira and also got an explanation from Jon Miller again, publisher of the Ohno book Ron and I were discussing.

Thanks to my all of excellent commenters and for the value you add to the Lean Blog!

p.s. for the RSS readers... technical note, I'm trying to figure out how to incorporate a "Comments Count" tag at the bottom of each post in the RSS feed. It's a technical issue with Feedburner. I also have a separate RSS feed for the Comments, check it out in the upper left corner of the page or click here.

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The JIT Sky Didn't Fall

Forbes.com - Partial Production to Start Tuesday

Reuters Article - Toyota to Resume Full Production Wednesday

What do the Chicken Littles at the WSJ have to say now? After the earthquake in Japan last week, the WSJ ran a predictable story about how JIT "backfired" on Toyota. They are back up and running. Their plan is to make up lost production over the course of the year through OT. I'm sure that's still cheaper (and better for quality) than having held large inventory stocks to protect them from a rare catastrophic event.

Toyota Motor Corp. said it will operate at all of its domestic factories on Wednesday after it had resumed partial production at some of its car assembly factories on Tuesday.

My New (Additional) Blog on MBT.com

The magazine "Manufacturing Business Technology" (from Reed Publications) is launching their new website today. I'd invite you check them out at www.mbtmag.com.

For their new site, MBT asked me to contribute content on Lean Manufacturing, which I'm happy to do on my new blog for MBT. Other than a few introductory posts, content will be re-published from this blog, so if you're a regular reader, there's no need to track me on both blogs. The MBT blog will only be published Mon, Wed, and Fri and will focus strictly on manufacturing content. I would, however, invite you to check out their website and their other content from MBT and their network of publications.

I'm not really a Star Trek fan at all, but I guess the title of the blog is OK, "Get Lean and Prosper." It's a better title than "Get Lean for Lean's Sake" or "Get Lean to Win Awards." At least we're focused on prospering and long-term business success, since that's really what Lean is about. Lean is not about implementing tools for the sake of implementing tools (like 5S, kanban, etc.) Since Lean is a continuous journey and our goal is perfection, we can't really ever reach that perfection or a state of "Being Lean" or getting to that end state of Lean. But, the editors like the title, so there it is. What do I know about titles, anyway? Look how creative I was with the title of this Lean Blog, ha ha.

Anyway, I hope it will be good additional exposure for Lean and for this community. There are links to help drive people to this blog for additional content and comments.

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Changing the Culture at Ford

At Ford, the 'Outsider' Is Optimistic - WSJ.com

There's an interview with Ford CEO Alan Mulally today, we've featured him before on the blog (click the "Ford" link at the bottom of the post for more on the company).

The article focuses on leadership and, although not mentioning Lean or TPS (a first for a Mulally article?), you can see leadership and Lean culture traits that he is trying to instill in the executives and the company.

He first says:

"I listened to everybody. You use facts and data, and must demand and have high expectations for absolute clarity around the business environment. You talk to all the stakeholders, starting with the customers. You also look at the macro economics, the economy. You talk to customers, dealers, Ford employees, UAW, your suppliers, your investors, everybody."

This reminds me of quotes from Toyota's Gary Convis, you listen to folks, you look at "facts and data" (reminding me of the quote, from Ohno I think, that "data are nice, but facts are better"). Data can be fudged, facts are things you can see with your own eyes. I remember the NUMMI-trained plant manager who came into my GM factory. He spent months walking around and talking to people. Some of us were hungry for action, "Just tell us what to do!" But he took a very measured approach to understanding the problem and building trust, which seems to be Mulally's approach, as well.

Mulally also talks about the concept of making problems visible. He's talked before about how Ford had a culture of making things look good, of hiding the problems. As the Toyota saying goes, "No problem is a problem," or as David Mann (author of Creating A Lean Culture) puts it, you have to "embrace your problems." Again, Mulally tells a story:

"One of the first meetings we had, I asked how it's going, and most of it was all green and a little yellow. I said, "Hey, we lost like $12 billion, it can't all be green."

The next week, [Ford Executive Vice President] Mark Fields was launching the Edge [Ford's new small sport-utility vehicle] up at Oakville [Ontario]. He had a technical issue, so he chose not to deliver the car because we wanted to start off with the highest quality. In the weekly review, he presents the chart with all the launches. It has all the greens, yellows and this one big red box. The place goes silent.

I started to clap. I said, "Mark, that is great visibility and I am glad you understand that. Is there any help you need? Other resources you could get from technical or product development?"

So, within a couple weeks it went from red to yellow to green and we had a great launch. It's not a warm and fuzzy thing, it's relentless focus on your area. The expectation is we will portray it exactly as it is, and that's OK. What will not be OK is not dealing with it. "

I love that, "What will not be OK is not dealing with it." Baby steps toward changing the culture at Ford. I wish them luck. Maybe they should be bumped up a few places in the Best Lean Companies poll?

Does anyone else, short of the executive suite, see signs of similar culture change throughout the company? Click comments to tell us.

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Coffee Topics for Your Sunday Coffee

Starbucks Gossip: Is another price increase in the works at Starbucks?

One of the random blogs in my blog reader is Starbucks Gossip. I'm a regular customer (grande drip, no room) and I like getting some insights into how the stores work (and what employees complain about). The post I've linked to has much hand wringing about a potential price increase and the discussion focused on "is that fair?" and "well, did our costs go up?"

From the cost side, someone posted this:

According to Starbucks standardized procedures, the total amount of labor required (including prep and COGS) for a Grande Syrup Coffee Frappuccino is 1.5 minutes labor and $0.41COGS. A minute and a half of labor. That's about $0.20. Plus COGS. Wow. A whopping 61 cents.

Venti Raspberry Mocha Frappuccino: $4.60
Actual Cost: $0.61

Where's that other $3.99 going?

Somebody else came back with:

what about the labor of making said mixes, someone has to do that, then put said mix into the sure shot, label it, etc. Get your prices staright. [sic]

There are a lot of costs -- materials (COGS), direct labor (to make the drink), indirect labor (prep, other work), store overhead, corporate overhead.... but is any of that relevant to the price they can charge? A lot of that $3.99 is probably going to pay for employee health care that Starbucks funds.

Starbucks pays more for health care than for raw materials, but that's a different topic for a Lean Healthcare post.

I posted:

Prices companies charge are basic economics -- they charge what the market will bear. Why does Starbucks charge $4 for a venti drink? Because customers are paying it.

It has nothing to do with what your costs are. It has nothing to do with "what's fair."

If prices are too high, customers will go away. That's how business works.

Whenever you ask, "why does company X charge $$ for product Y?", the answer in your head should be "because they can."

We should all be so fortunate as to choose a business with low materials costs, where the customer is willing to pay a price that gives us a good strong margin! This ties back to the Toyota equation, Profit = Price - Cost. Starbucks probably isn't taking their costs and adding on a profit margin (Price = Cost + Profit). That would be outdated thinking.

I'm sure Starbucks is generally charging what the market will bear. Starbucks prices seem pretty consistent nationwide (at actual Starbucks locations). I'm sure they could charge more in some cities, but probably want customers to know what the price will be regardless of where they are? Does Starbucks have a consistent pricing policy, I wonder?

Remember this WSJ article (and my blog post) from a few years back about Starbucks and their efficiency efforts?

SME Lean Yearbook 2007

Link to Purchase on SME.org

I was very honored to be asked to write an essay/case study on lean healthcare for the Society of Manufacturing Engineers new "Lean Yearbook" publication and that book is out now. It's a large magazine format that is going free to all SME members with the regular Manufacturing Engineering magazine, but is can also be purchased separately for about $25.

The website is short on details, so here are some examples of the content, with many Lean Blog authors and friends represented!

• Jim Womack, the "State of Lean 2007"
• Jeff Liker and David Meier, "Chinese Companies Need Lean Management" (a topic David discussed on this Podcast)
• Jamie Flinchbaugh and Andy Carlino, "Farther, Faster and more Sustainable"
• Gary Connor, "Roadmap to Lean for the Smaller Shop"
• Laurie Harbour-Felax, "Arrogance, Cultural Barriers Limit Detroit Three"
• Jean Cunningham, "Integrating Lean and Information System Technologies"
• Mary Poppendieck, "Bringing Lean to Software Development"
• H. Thomas Johnson, "Manage a Living System, Not a Ledger"
• Bryan Lund, "Training Within Industry"
  

I wrote a case study of an initial Lean implementation with a hospital in Kankakee IL, Riverside Medical Center.

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Not Respecting the Front Line Workers

Road Commission under fire - mlive.com:

One of the two pillars of the Toyota Production System is "respect for people." It's a shame that we have to work on something so basic and fundamental, as this, but respect is often lacking -- from manager to employee or in the other direction. The news story I've linked to is from a county road commission in Michigan, the article says, in part:

"...the Road Commission's middle management had little respect for their employees who do the front-line work. County Commissioner Mark Ouiment, R-Scio Township, said employees and retirees are being 'treated badly'' by management."

The article didn't elaborate on how that played out on a day-to-day basis, but it's sad to see even the allegations, but it's not uncommon, is it?

Have you tried working on the "Respect for People" side of Lean in your workplace? If so, how have you tried to influence behavior or set expectations for what Respect means? Click comments to share your thoughts.

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Computers, Backups, and Risk

So we talked earlier about risk and manufacturing. What about risk and PC's? If you "single source" your data on a single PC or single hard drive, you're setting yourself up for failure. Hard Drive (or PC) failures are much more common than major disruptions to Toyota's supply chain!

It took me a few times, but I've been burned by PC's before. I had a hard drive (a 20 MEGA-byte drive in a Dell 386 PC) die on me my junior year of college (between semesters, at least) and I had a home PC crash, losing some digital pictures (back in 2004 or so, before I had taken too many).

My home laptop died on me last night. Just shut off during use and won't boot or power up again. I'm sure the data is still there, but I have backups thankfully and I thought I'd share a reminder and some easy, painless PC backup methods. I use the first AND second methods I'm outlining below, so I'm not crying over lost data. My Compaq PC still has three weeks left on its extended warranty, thankfully (another illustration of risk and cost there, that extended warranty -- waste of money or good protection?).

Folder Share

Folder Share is a free product, a company acquired by Microsoft. This is a very automated approach to backups if you have 2 PC's in your home. My layman's explanation of how it works:

1. Install the software on 2 PC's
2. Select folders
3. The software automatically and continuously syncs the shared folders across your PC's, creating a live backup.
   

The odds of BOTH pc's simultaneously are very slim. If your house burns down (knock on wood), this strategy might fail though. There might be other features of Folder Share I don't know about or use, but the price is right and it works for my simple needs.

External Hard Drive

I also use an external portable hard drive to backup my work PC, as well as files from the home PCs (additional redundancy). I've had good success with the Westerrn Digital Passport series of drives. I also recommend the Allway Sync backup software, available in free or inexpensive "professional" editions. There's even a version you can install right on the External drive, you plug in your PC and it automatically syncs.

This approach is inexpensive (under $100) and easy, although you still have to be disciplined enough to plug the drive in and do the backups (schedule it in your calendar). The external hard drive might carry the same "what if your house burns down?" risk.

Online Backup

If you're really paranoid about the house burning down, or if you have really valuable data, you might consider an online backup service. I haven't used one and there are too many to mention. The idea here is that you install software that automatically and continuously backs up files on a remote server. The vendors promise data security, but that might not be comfortable for some, losing sight of your data. You have to select a stable, trusted vendor who won't abuse your data or go out of business.

Does anyone have experience or recommendations? No spam posts please! You can mention company names, but only if you have used them.

So, as my dad commented on the post about Toyota and risk, we always have to evaluate economics and expected value/benefits in situations like this or the Japan earthquake.

• What are the odds a PC will crash? HIGH
  
• What are the odds your house will burn down or otherwise be destroyed? LOW
• What are the odds your PC crashes AND the online backup vendor might go out of business on you? WHO KNOWS?
  

You have to do what makes sense for you, your available funds, tolerance for risk, and the value of your business or personal data.

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Updated: Step 1 Earthquake, Step 2 JIT Bashing

A Key Strategy of Japan's Car Makers Backfires - WSJ.com

Be sure to read the comments for an excellent story from Matthew May about the 1997 Toyota situation and parallels to today. Also check out his blog post on the topic.

I predicted it on Wednesday, that the Japan earthquake, which led to production shutdowns at Toyota, Nissan, and others, would be quickly followed by an article that blames that risky Just-In-Time strategy. Well, it only took two days for the WSJ. Either that's "Just-In-Time" writing, or they keep articles like that ready to go in the warehouse! The WSJ article says:

"For want of a piston ring costing $1.50, nearly 70% of Japan's auto production has been temporarily paralyzed this week.

Blame it on kanban, the just-in-time philosophy of keeping as little inventory on hand as possible. The strategy keeps inventory costs down and ensures quality. It generally works because Japan's auto makers have long prided themselves on the almost familial relationships they have with a handful of suppliers of custom parts that deliver several times a week or even daily.

The strategy also has a downside, as became evident after the 6.8-magnitude earthquake that hit central Japan on Monday..."

I'll come back later and add some of my thoughts, but wanted to share the articles for you to read and comment on...

There is also a free article with similar themes here.

The Journal wrings its hands about JIT and risk about once a year. Others pick up on this tired theme, which I blogged about here in response to an article in The Manufacturer.

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Upcoming Podcast: Bob Emiliani

I'm announcing another LeanBlog Podcast, with Bob Emiliani, President of The Center for Lean Business Management, LLC and co-author of the book Better Thinking, Better Results, the Wiremold Lean story.

Wiremold is a well-known Lean success story, but the 2nd edition of the book tells the more recent path that Wiremold has been on, as highlighted recently on the Evolving Excellence blog. It seems like a sad story, but one we can learn from.

If you have questions for Bob, email me at leanpodcast@gmail.com or leave a voicemail question by calling 817-776-LEAN or by using Skype ID "mgraban".

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The First Lean Dentist

I recorded my Podcast interview with Dr. Sami Bahri, "The First Lean Dentist," last night. What a treat it has been to talk with Dr. Bahri. I can't wait to get this edited and released so you all can hear the discussion. Dr. Bahri is pretty humble, but I am so incredibly impressed with his Lean understanding -- the tools, the employee involvement, the management system, the drive for continuous improvement.

One example of what jumped out at me was his discussion of leadership and PDCA. I'm paraphrasing, but Dr. Bahri said he tells his employees "Don't trust me" when he has an idea. He doesn't want them implementing or changing something because he says so. He wants them experimenting to see if the idea works or not. Sometimes the ideas don't work, and that's OK. He is setting a great example of PDCA (Plan, Do, Check, Act) for his employees, so they will give their own suggestions and follow that same model.

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Updated: Quake forces Toyota to halt production

Yahoo! News

Updated: No real updates in the news, maybe we'll learn more in the morning... but a few more thoughts of mine added below.

Toyota (as well as other Japanese automakers, including Nissan) is having to shut down a dozen factories in Japan due to the earthquake:

"Tom Libby, J.D. Power and Associates' senior director of industry analysis, said customers shouldn't notice the shutdown because Toyota likely has sufficient inventory to cover a few days of lost production."

How long before we see another article that asks "Is Just-In-Time Too Risky??"

Updated: It is a supplier, Riken Corp., whose factory and warehouse were damaged. Yes, Toyota has suppliers with warehouses, that might surprise you if you're new to Lean. It's this new experiment in San Antonio where Toyota is tying themselves directly to the suppliers. In other cases, the suppliers would typically have some finished goods inventory to ship from, that famous "just in time" delivery.

Even, with Toyota schedules being pretty level (the "heijunka" concept"), the suppliers might still have to keep some inventory (it might just be hours or shifts worth) if they have setup time issues that prevent them from perfectly matching Toyota's build schedule. Plus, there is some buffer inventory in place. Nobody is perfect, lines go down from time to time, so you keep a little buffer.

Toyota, Japan's No. 1 automaker, will stop production lines at a dozen factories centered in central Aichi prefecture Thursday afternoon and all day Friday, said Toyota spokesman Paul Nolasco.

Toyota will re-evaluate soon if they will be able to start up again on Monday.

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IW Webcast with Art Smalley

IndustryWeek : Prerequisites for Lean Success: Learning From Toyota

This webcast is today, Wednesday July 18 at 2 PM EDT. I can't log in live, I hope it's archived. Can somebody volunteer to take some notes and post a summary for the blog?

You can read more about Art Smalley at his website, www.artoflean.com, lots of great stuff there.

Does a UK Hospital "Have Boondoggle?"

Fury Over 84 000 pound NHS Trip To Japan (from The Northern Echo)

With apologies to the Got Boondoggle? lean blog, this story is about a group of NHS hospital executives and physicians taking a study trip to Toyota in Japan. Maybe they got the idea from our country's Virgina Mason Medical Center and their trips.

The trip is being criticized ("criticised" I guess) by some who feel that's not a good use of funds that could go to direct patient care (although the spending was defending as coming from specific training funds, not patient care -- but still, I can see the point that the money COULD have been allocated to the patient care bucket, even if it had NOT been).

Families of patients denied drugs on the NHS, as well as two GPs, have criticised the trip to study Toyota's "lean management" techniques at a time when cash-strapped health authorities are trying to cut costs.

But the North-East Strategic Health Authority stood by the decision last night, insisting that the lessons learnt would save money and make the NHS more efficient.

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Last month's visit cost £84,000 to fly a 14-strong team to Japan. Officials said the cash came from "central training funds".

I can certainly understand the NHS position that learning about Lean and the Toyota Production System *is* a good investment. But, do they really have to go to Japan to learn this? Does anybody have to go that far? Some critics suggested they could have visited local UK Nissan or Toyota factories, or other NHS hospitals that are using Lean already.

"...the decision to send a team to Japan was taken because there were no similar examples locally or nationally."

At the First Global Lean Healthcare Summit alone, you had three examples of Lean success -- NHS Bolton Hospital, Unipart, and Tesco.

I can understand people CHOOSING to go to Japan, but to say you HAD to doesn't ring true to me.

Another critic said:

Dr Andrew Saunderson, who recently retired as a GP after working in Spennymoor, County Durham, for 34 years, said: "It strikes me there must be easier ways of getting this information - the internet for example.

"I have to be convinced that a trip to Japan will tell you how they do things. It may not be transferable to our culture, and the technique of making cars is an entirely different process from caring for people."

Now that critic's not even convinced that Lean isn't "just a Japanese thing" or "just a manufacturing thing." Common misunderstandings that we have to educate people about.

Who do you go visit when you're learning about Lean? Click "comments" to tell us. How far have you been able to travel to see a "Lean" factory? Would you find value in going to Japan, given language barriers? I've never been to Japan, myself. Would you recommend that Lean students try to visit Toyota Georgetown (TMMK) instead? Was the trip described in this article a "boondoggle?"

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P&G and Target Pricing

P&G's Global Target: Shelves of Tiny Stores - WSJ.com:

Interesting article in the WSJ about how Proctor & Gamble has had to adapt its approach in countries like Mexico, with different types of customers and different retail models:

"In marketing goods to low-income shoppers, P&G tries to keep in mind their budget constraints and even the coins they carry. Because they are often paid a daily wage, Mexican customers generally carry five- and 10-peso coins. 'If you want to sell to low-income consumers, you have to know what's in their pockets,' Mr. Riestra says. 'It doesn't make sense to have something cost 11 or 12 pesos.'

Now the article doesn't mention "Lean," but it takes us to the Lean notion of Profit = Price - Cost, where the Price is set by the market and your job, as producer, is to get your Costs low enough to be able to hit your Profit targets. Traditional business thinking (which pretty well ignores rules of economics) takes your production cost and what might be called your "entitlement profit" (such as "I need 10% profit on this") and determines the Price as Cost + Profit.

Toyota has taken the approach of saying "Here is what the market will give us for this car, so we have to engineer our costs accordingly." They call this Target Costing and Value Engineering. I think that's the approach P&G is using, even if they get the terminology a bit wrong:

To ensure satisfactory profit margins, P&G uses what it calls 'reverse engineering.' Rather than create an item, and then assign a price to it -- as in most developed markets -- the company first considers what consumers can afford. From there, it adjusts the features and manufacturing processes to meet various pricing targets. To hold down the cost of its Ace Natural detergent, used to hand-wash clothes, P&G reduced the amount of enzymes in the product. The result: a product that costs a peso less than regular Ace and is gentler on skin. P&G says that reverse engineering helps to keep the company's after-tax margins 'comparable' to those in wealthier, developed countries."

P&G also realizes quality is important, that you can't "trick consumers" by cheapening the product in a way where the product doesn't work anymore. That's good long-term thinking.

Updated: Matthew May also has a good take from this same article

Updated: Evolving Excellence also had a different angle on this same article

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Four Lean Hospital Stories from the UK

By Andrew Castle:

Mark's note: Today's guest blogger is a friend of the blog and a consultant who does Lean work for the UK's National Health Service.

The following link takes you to an article on the BBC website. Essentially the government set a target that patients with suspected breast cancer (and others but the focus of the study was Breast Cancer) should be seen by a specialist within two weeks.

The result was naturally that urgent referrals increased. However the percentage of cancers detected decreased suggesting that more people were being referred as urgent but that they were inappropriate. In the meantime in the group of patients that did not qualify as “urgent” the percentage of cancers increased.

This is a classic interruption to flow. They carved out one group and prioritised them over another which in and of itself increases the longest wait. In addition, because it is so difficult to tell whether a suspected case really qualifies as urgent or not, unsurprisingly it goes wrong and non-cancers are referred and cancers are not. The lesson is that all need to be seen in a timely fashion and that as far as possible they need to be seen in the chronological order that they presented at the GP’s First In First Out.

The following three links are all related to NHS Scotland.

NHS Lothian's lean vision up for UK award

In the above article, NHS Lothian has been nominated for a Human Resource Excellence Award in the “Best Change Management Programme” Category in recognition of its improvement program which involves front line staff in generating ideas and implementing improvements to the service provided to patients.

Waiting times drop thanks to 'Toyota treatment'

Again a more focused story on NHS Lothian that demonstrates that by implementing the ideas generated by staff the organisation has managed to increase productivity to such an extent that they have reduced a waiting list for CT from a maximum of 21 weeks to 4 weeks, and seen an additional 20 patients per week. Had they not made these changes the additional cost of seeing these patients would have been in excess of £1m. ($2m). These accomplishments are again attributed to the involvement of the front line staff in the improvement process.

Clinic slashes cancer tests waiting time

The final article is on the implementation of a one stop clinic in Lothian. Essentially patients with suspected breast cancer can attend a clinic and receive a physical exam, mammogram, ultrasound, and biopsy and receive the result all in one day.

The benefits of this are self evident. Rather than a wait to receive test results or a wait between specific tests, all can be taken care of at the same time and there is no wait to find out if it is serious.

This change in working practice has come about by again involving front line staff involved in the provision of the service and after a week long examination of the current and desired future state, data has been collected and changes in the working practice were implemented.

Andrew Castle is a consultant with Applied Angle Consulting

Guesting on the Better Process Podcast

PodcasterNews - Industry Report Mark Graban Guest Podcaster

I don't do the commentary thing on my LeanBlog Podcast. But, I was invited by Ken Rayment to "take over" his podcast for a day. In the Podcast, I talk about the need to apply Lean methods to hospitals and healthcare, and why that should matter to manufacturers. It's about a 7-minute Podcast. Thanks to Ken for giving me a chance to share a little bit on this topic with his audience!

If you have comments or questions about the Podcast, leave them here by clicking "Comments."

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Webcast with Norman Bodek

IGLC Keynote Address:

"In this Keynote Address Mr. Bodek will be discussing the fundamentals behind the Kaizen philosophy of continuous improvement. He will speak to how the Construction Industry can get rid of the 'Punch-list Syndrome.'"

Knowing Norman, this talk will be of value to people in any industry, not just construction. The conference website is a bit confusing, it might be $50 for the online webcast, streaming or "on-demand." The webcast is Wednesday morning, July 18, 2007.

I'm going to release my next LeanBlog Podcast with Norman, probably next weekend. It will celebrate the one year anniversay of my Podcast, which really started because of Norman's idea to do an audio interview, so he was the first Podcast. I'm appreciative to him for the idea that turned into the Podcast series.

Who are the Best Lean Companies?

Here's a new feature that Amazon.com is offering, an interactive polling/ranking system. I created the list, without giving too much thought to the sequence, just to get the ball rolling. You can vote and either add new companies (scroll to the bottom of the list) (or vote to bump those on the list up or down (click the up or down arrows). I thought it might be fun to experiment with this, so check it out (if you're on RSS, you'll have to visit the Lean Blog website or click here to visit the survey on amazon). Be sure to click on "Comments" to see what others say or to chime in on why you voted the way you did.

Updated: 10/2008: Amazon has shut down the "unspun" list/voting service. Too bad. We had a good list going.

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I got a blurb on the Marketplace website

APM Marketplace (Business/Economy radio)

As you've read here, I'm trying to help get the word out that we should be not just focusing on access to care, but also focusing on quality of care -- preventable medical mistakes. I think it's much more realistic to solve the medical mistakes problem, with Lean, than it is to solve the access problem.

I submitted a blurb to the "rants" section of the Marketplace website and they printed it (without name, but I'm sure you'll believe it's me).

The webpage changes every day, so here's the text of it:

[Michael] Moore cites statistics that say 18,000 Americans a year die because they lack access to good healthcare. That's a tragedy. The bigger killer that's being ignored by Moore and the media are the patients who are killed when they do have access. The Institute of Medicine estimates that 98,000 Americans per year die because of preventable medical errors — wrong drugs given, hospital acquired infections, errors in surgery, etc. This problem does not go away even with universal coverage. Canada has a per-capital error rate that's as bad (if not slightly worse) than the U.S. The UK has major medical error problems as well. So, it's not the payment system that's the factor there. These are problems that hospitals are struggling with worldwide.

I'm also going to try submitting a 400 word essay on the topic to try to help get more exposure for the issue and the role Lean can play.

"Root Cause" in the News

In my morning reading yesterday, I was pleasantly surprised to see the phrase "root cause" in two stories I've written about here:

• Preventable Medical Errors (free, Modesto Bee)
• Deadly Products from China ($$, WSJ)

I have a post I've written, but haven't published, about how China recently executed the corrupt head of their pharmaceutical approval board for taking bribes to approve untested drugs that proved to be deadly. While his actions were despicable, I asked if killing that man really solved the "root cause" of what seems to be systemic corruption and unregulated greed that's leading to a slew of negligently harmful or deadly products made in China (toothpaste, pet food, tires, shrimp, monkfish, baby toys, cell phone batteries, etc.).

On that item first, the WSJ had a column that talked about that systemic culture of corruption in China and their willingness to ignore quality in the name of profits. Take this latest case of a Beijing vendor who was putting chemically treated cardboard into dumplings sold on the street. It's not just the stuff they are exporting. Chinese are doing this to fellow Chinese. How can this be? I don't buy the excuses of "They're a developing nation, of course they're going to behave this way." I'm sure the Chinese who are cutting corners KNOW they are doing wrong. I don't think it can be explained away as ignorance or the "growing pains" of capitalism.

The article says:

The chaos of communist rule over the past decades -- from famines to purges to neighbors informing on one another -- has also likely contributed to the blurring of moral distinctions. "The Cultural Revolution created an enormous dent in morality. Society [was] in confusion for a long time. Couple that with the madness of trying to get rich -- you put these things together and you end up getting contaminated toothpaste and pet food," says Peter Humphrey, longtime China hand and founder of risk-management consultancy ChinaWhys.

William McCahill, a 25-year Foreign Service veteran who is now managing partner of JL McGregor and Company, a China-focused research and advisory group, explains: "There is no sense of social solidarity that would tell you: I put this stuff in and maybe children are going to die."

I've always joked that if you ask "why?" six times (one more than the famous "5 Whys"), you end up blaming society, and that isn't very helpful. But it seems to be the "root cause" pointed to in China.

The article describes "widespread unethical practices." Will the execution of the one bureaucrat scare others in shaping up? What happened to intrinsic ethics? What would Deming have said about this attempt at quality and ethics through fear?

Now let's turn to the medical errors article. You can click on the link to read it, it's a free article. Long story short of the scenario:

"...her surgeon was talking with her husband about something unusual that had happened during the surgery a few days earlier.

Her husband, Gary Baumgartner, couldn't believe what he was hearing. The surgeon said he had operated on his wife while using a different patient's angiogram films."

Now, the typical reaction might be to blame the surgeon, the techs who handled the films -- punish, blame, and maybe fire.

What jumped out at me was that the reporter actually brought up the question of root cause and prevention. Brilliant! We rarely see that in news stories:

After serious mistakes, hospitals are supposed to do a "root cause" analysis, focusing on conditions and events in the hospital unit that day. Was there poor staffing in the cath lab? Had the employee worked a long shift? Was there a quick call for the films?

Any solution that simply asks employees to try harder is a recipe for more mistakes, Haraden said. The hospital should work on addressing the environmental factors that led to the error.

"Anytime you have a handoff there is a risk," she said. "One way to make the system more reliable is reduce the number of steps."

I hope the hospital is actually putting some root cause prevention measures in place. But what about sharing information with other hospitals? Why isn't information shared so that NO OTHER hospital makes the same mistake?

The good news is that the "root causes" of the hospital error are going to be a lot easier to fix than the root causes of China's quality crisis.

Upcoming Podcast: "The First Lean Dentist"

I'm very excited to announce that I will be recording a LeanBlog Podcast interview with Dr. Sami Bahri, the "First Lean Dentist," on Tuesday July 17. If you have any questions for Dr. Bahri, you can email me at leanpodcast@gmail.com or you can send me a voicemail question by calling 817-776-LEAN (or contacting me via skype ID "mgraban").

Here's a quick Google link to articles about Dr. Bahri.

Dr. Bahri presented at the Shingo Prize conference and has been featured in articles by the Lean Enterprise Institute, American Society for Quality, and the Society for Manufacturing Engineers, among others.

Dean Bliss also wrote a guest blog piece about seeing Dr. Bahri speak.

Here is a recent article from his local Jacksonville newspaper.

Press "1" If You're Hurting in English...

Parkland Hospital Deploys Galvanon's MediKiosk(TM) in the ER to Decrease Patient Wait Times

It's been discussed here before, how hospitals are just as susceptible as manufacturers are to the "Siren Song" of technology. This time, it appears Parkland Hospital (here in Dallas) is presenting with such symptoms...

You might know Parkland as the historic hospital JFK was taken to after being shot in Dealey Plaza. It's still open as the large county hospital for Dallas County. I presume they have long waits for ER treatment, as is common in hospitals. Many hospitals are taking the "Lean" approach to reducing waiting times in the ER. Strategies I've heard recently about include:

• Changing the "triage" process so patients are seen immediately by an MD -- providing more accurate assessment than an RN could with the added benefit of reducing the need for a patient to repeat the same story to multiple people.
  
  
• Separating the ER into two separate "value streams" or "patient pathways" -- patients who will be treated and sent home versus those patients who are likely to be admitted. A hospital in Australia implemented such a process and started seeing patients in each stream in a "FIFO" (first-in-first-out) process that cleared up delays immediately.

The Lean hospitals are fundamentally rethinking the process, not just automating parts of the process. Parkland went the technology route:

Parkland Health & Hospital System, based in Dallas, recently launched self-service check-in kiosks in the emergency room to speed the delivery of care and streamline registration processes. The technology, called MediKiosk, is provided by Galvanon, a subsidiary of NCR Corporation (NYSE:NCR).

So, basically, you have the "option" of pushing buttons on a glorified ATM machine? This is considered an advancement in healthcare? I'd think not, it certainly doesn't seem very "Lean" at first glance. This article claims Parkland is the first to implement this system. Do we want to see others? Here is the MediKiosk website with their PDF brochure (with pictures)

Three self-service check-in stations in the Parkland emergency room triage area offer patients the option of interacting in either English or Spanish. Instead of waiting in line to explain their symptoms, patients can identify themselves at one of the kiosks by entering their name, along with an additional identifier, such as a birth date. Patients then use the kiosk’s touch screen to identify their symptoms by pointing to areas on a body diagram where they feel pain and answering brief questions about the nature of their visit.

What amazes me is that this "innovation" is referred to as "more comfortable" and "less stressful" for patients.

I'll go out on a limb and say what we need are real patient flow improvements, using Lean methods, instead of throwing technology at one part the problem.

I'd be curious to get involved and ask "why" patients are waiting to be seen at the ER. Is triage really the bottleneck? Is a computer system cost effective compared to adding more people? Is it more humane? Is the ATM more effective?

Rather than throwing resources (ATMs or people) at it, can we streamline the process so triage can be done more effectives? Better yet, let's question if triage is really necessary... the goal isn't efficient triage, it's improved care, improved patient outcomes, and reduced waiting times. I'll be curious to see if there is a press release bragging about the actual results of this new technology...

LEI Web Seminar on Hospital VSM's

Value-Stream Improvement for the Office and Services

The Lean Enterprise Institute is giving a free webinar on August 2nd, featuring a hospital that presented at the First Global Lean Healthcare Summit, Hôtel-Dieu Grace Hospital, in Windsor, Ontario, Canada.

This webinar will explain how the Value-Stream Improvement model works by focusing on a case study of it in action at Hôtel-Dieu Grace Hospital, Windsor, Ontario, Canada. Key members of the implementation team, including front-line managers and a senior VP, will describe how Value-Stream Improvement uses mapping as a core improvement tool but incorporates implementation planning, regular review and reflection, and development of standard work – all adapted for non-manufacturing processes that often are difficult to see, measure, and standardize.

Click on the link at the top of this post for more information and to register.

Nominations for PodCast Awards

If you're a fan of the LeanBlog Podcast, or other Podcasts, please consider submitting nominations for the 3rd Annual Podcast awards.

Here are a few podcasts I am subscribed to:

Lean/Manufacturing

• Dwight Bowen's Competing Podcast
  
• Better Process Podcast
• Gary Connor's Lean Podcast

Business News

• APM Marketplace
• NPR Business Story of the Day
• Wall St. Journal Report

Fun Stuff

• GeekBrief TV
• Dennis Miller Radio
• Car Talk Call of the Week
• Best of Mike and Mike in the Morning
  

Which podcasts do you recommend?

Updated: An Interesting "Respect for People" Question

Lean Insider - Toyota Shifting Production to Lower Labor Costs? It Could Happen

The Lean Insider blog poses an interesting question.... is it keeping with the "respect for people" principle of the Toyota Production System if Toyota wants to move some production away from high-cost NUMMI (in high-cost California). Or, what if Toyota wanted to pull out completely, as rumored here on this other blog.

I'm still chewing on that one. What do you think? Feel free to comment here also. I'll post my thoughts later.

Update: Our friend Ron posted his thoughts at his Lean Six Sigma Academy blog.

Deming Seminar with Eric Christiansen

How to Create Unethical, Ineffective Organizations That Go Out of Business

Here's a posting for a Deming workshop co-led with former LeanBlog Podcast guest Eric Christiansen. In my podcast with Eric, we talked about how he, as CEO, has led his company as a "Deming Company," including the seemingly-radical idea of not paying commissions to salespeople.

I love the title of the workshop, wish I could attend.

WSJ Online is Free Today

The online WSJ is free today, sponsored by Dell. I don't know how much of the old archive is open, but if you haven't been able to read articles referenced here, you might want to check it out.

Click on the WSJ link below for my archive of posts that reference WSJ articles.

Saving Lives and Losing Them

After watching Michael Moore virtually melt down on CNN a few minutes ago, I had some thoughts...

As I wrote about before, there are two problems with healthcare:

1. Access to care
2. Quality of care once it's provided

The Lean work that I do is focused on quality of care, so I'm somewhat biased to focus on issue #2. Moore, in SiCKO, focused exclusively on issue #1, which I thought was a real wasted opportunity to focus on a bigger killer.

Michael Moore keeps screaming that 18,000 Americans without insurance die each year. That's awful, don't get me wrong. If you take the number as approximately 47,000,000 Americans who don't have insurance, that's a "death rate" of 0.000383.

The U.S. population, per Google, is approximately 301,000,000. That gives us 254,000,000 WITH insurance. If you believe the oft-cited Institute of Medicine numbers, 98,000 Americans die each year because of preventable medical mistakes. Also a tragedy. That's a rate of 0.000386.

Basically the same rates. I was stunned when I did the math in Excel. Is it fair to say that IF you were able to get coverage for those 47,000,000, that just as many (116,000) would die because of medical mistakes instead of today's total from 1) lack of insurance and 2) medical mistakes?

OK, that's not exactly right, because the 47,000,000 without insurance DO get treatment, usually through the Emergency Room. That's not the best treatment always, but we won't have two exclusive sample sets to compare.

But, I think my overall point is valid -- if we're going to get everybody coverage, we have an obligation to eliminate preventable medical mistakes the same way we've pretty much (knock on wood, I fly tomorrow) eliminated preventable airline disasters. Lean methods -- process focus, standardized work, root cause problem solving to name a few -- can help solve our quality crisis. Our goal needs to be ZERO preventable deaths, absolutely.

Instead of JUST focusing on the access crisis, let's also spent some time discussing the quality crisis. I, for one, am more confident in fixing the quality crisis. I'll put more faith in Lean methods than our politicians anyday. Has anyone heard a Presidential candidate talk about preventable medical errors??

-------------------------

Two somewhat unrelated points that I can't resist commenting on:

1) At the end of the interview, CNN's Wolf Blitzer asked Moore to continue taping a 2nd half of the interview that would air tomorrow. Ironically enough, Moore complained that he would probably be edited and parts of the interview would be left on the cutting room floor to make him look bad. I guess he's familiar with the method...

2) Moore made a huge assertion that doctors would rather see a Medicare patient because they know they'll get a check sent right out instead of fighting "an hour on the phone to get a $15 office visit paid" (with insurance). I've seen medical claims billers fight both private insurance AND the federal government, fighting to get rejected payments overturned. To say the government easily and efficiently ships checks out seems to be another example of fairy-tale land (along with "free" healthcare). As this article points out:

In a recent poll conducted by the Washington State Medical Association, 57% of physicians surveyed were either limiting Medicare patients or dropping all of their Medicare patients.

"Increasingly, physicians are being forced to choose between keeping their medical practices financially viable and treating all of the Medicare patients that need their services," the report said.

Medicare keeps slashing payments, which is, in a different way, limiting access to care. But, I don't recall Moore addressing that problem either.

Thanks to our Sponsors

I want to take a second to highlight our Lean Blog sponsors, particularly for those of you reading the free RSS feed. I appreciate their support of the site and the Lean community.

The 5S Store

The 5S Store (www.the5sstore.com) is a company and online store run by a Lean practitioner who had trouble finding all of his needed supplies in a single place. They are offering a 10% coupon code, good through July 20. Enter the code "July2007" at check out.

Kaizen Products

Kaizen Products (www.kaizenproducts.com) is the latest offering from the folks at Gemba Research, an online store for Lean training materials and supplies.

American LED-gible, Inc.

American LED-gible (www.ledgible.com) manufactures products for Lean environments, such as andon boards, counters, timers, and other electronic displays.

ThroughPut Solutions

Bill Hanover is sometimes contributor to the blog. He has a lean consulting firm that can be found at www.tpslean.com.

Another Lean Textile Example

Maintaining a fat-free factory floor

Here's a nice factory case study, once again in the textiles industry (just like this recent post). It's a company that is using Lean as a business strategy, to transform how they do business, to allow them to compete with Chinese imports.

From the article:

“As you lower lead times (the time between order and delivery) and do all those things, there's a couple of dynamics that happen,” said David Adair, the company's executive vice president. “You become more efficient. You create extra capacity and respond quicker. It's up to the company to find sales and generate new business based upon new capacities freed up.”

This sounds like a case of a company using Lean as a GROWTH strategy, not as a cost cutting approach. As management gets more business, that reduces the temptation to fall into the layoffs trap, which would kill enthusiasm for Lean.

It's a nice case study for a newspaper article, it touches on kaizen events (and sustaining kaizen), kanban, 5S, and smaller batch sizes. I love this example of how they didn't let their large truck be an excuse for maintaining large full-truck transfer batch sizes:

The company saved more money and time through other changes. In its pre-lean days, for example, the company would take three days to fill a 40-foot tractor trailer — leased from another business — from floor to ceiling with fabric to be transported to a Philadelphia company that would apply to them a special rubber backing. It would take several weeks in all by the time that company would be able to unload and sort the materials and the process was completed, because they had so much to do at once.

Now, in keeping with lean's emphasis on flow, Absecon Mills has bought a truck that it drives back and forth every day to Philadelphia as fabric is made, and developed a way to sort the fabric before it goes in the truck. That has reduced lead time for that part of the process to just a few days

It ends with a quote about the cultural challenges:

The hardest part, really, is changing the company's culture to reflect the lean process, Adair said. “Changing the culture of the company will take 10, 15, 20 years.”

It's not an easy quick fix, Lean. But, it's a long-term challenge worth taking on. Absecon Mills is proving that and, hopefully, will continue to do so!

The Lean Toolbox: Where is the thinking cap?

By Bryan Lund:

For the full article, click here for a PDF file

The Lean toolbox is brimming with attractive tools and if you are like most Americans, you can’t wait to get your hands on one of those shiny new gadgets and show it off to the neighbors. The problem with tools is that we get wrapped up in what they look like, not in the purpose of having the tool in the first place. Following is an example of where using a “lean tool” has gone bad. In this case, the 5 Why tool was put to work, and nothing happened, but was on display for the neighbors. Let’s take a look at why good intentions went awry.

First, a quick glimpse of the picture: a group is in the middle of a kaizen event and someone says there is a chronic problem with a machine. A facilitator of the group says, “Let’s use the 5 Why tool to solve this problem”, which the group proceeded to do. Following is the line of questioning and answers provided during the 5 Why session:

Problem: The parts carrier doesn’t slide on the belt.

Why do the carriers not move along the belt?

The belt is caked with grime.

Why is there grime on the belt?

We are using silicone instead of light oil. Silicone builds up on the belt and attracts grime.

Why are we using silicone?

We need extra lubricant and silicone works for that. We normally wouldn’t use silicone.

Why do we need extra lubricant?

There is a problem when the machine tries to screw the assemblies together.

Why is there a problem with screwing the parts together?

There is a problem with the threads, but we can’t figure that out.

At this point, the group felt as if they had hit a dead end and threw the problem over the wall to engineering to solve. Fast forward 40 days.

This approach concerned me for several reasons. First, the group had a nice, stylish, flashy form created on the computer and dated 40 days prior to when we observed it on the machine. There was no status on the problem, and further discussion with the operators in the area yielded no other information. Another thing, the group literally stopped questioning at the fifth why. Problem solving sometimes requires multiples streams of questioning and certainly should never be limited to asking “why” only five times. Finally, it wasn’t clear how a physical feature on the subassembly was causing grime to build up on the belt, thereby causing the carriers to stop on the belt. At first glance, it may be obvious that, “since the parts don’t go together easily, we use more lubricant, which is transferred to the conveyor belt, causing grime to build up. This is basic 5S stuff!” Sadly, when we blindly using Lean tools we inadvertently reduce the credibility of a continuous improvement program.

For the full article, click here for a PDF file

About the author: Bryan Lund is a Lean Coordinator in the Global Lean Office for Energizer Battery Manufacturing. www.energizer.com. Bryan is also involved with the reintroduction of the WWII production improvement program, Training Within Industry, or, TWI. Many elements of TWI, notably Job Instruction Training, are fundamental to maintaining stability and improvements within the Toyota Production System. Learn more about TWI at our local SME #204 website: Training Within Industry

Prevention and Odds, Protecting Children with Lean Thinking

Thursday: Newer pools minimize risk of drain accidents, officials say

You might have seen this heartbreaking story on the news, the 6 year-old girl who suffered gruesome injuries from a swimming pool drain.

These tragedies are somewhat common, when viewed from the perspective that one such tragedy is too many and that these events should be 100% preventable. They're somewhat "rare" if you look at the world from the standpoint of "what are the odds....?"

At least three other children have suffered similar injuries since 1990. And 33 others have died, most when they were trapped underwater by the drains in hot tubs or pools, according to federal reports.

From the reports, there are a few preventative measures that could help, let's look at them from a Lean perspective:

Since 1990, 170 people, mostly children, have been caught in drains and 27 of them have died. Legislation is pending that would require pools and hot tubs to have multiple drains to ease the suction.

Here's a good example of error proofing through re-design. One of the root causes of this type of injury is that the pool suction is so strong to begin with. But, it's not realistic to think we're going to retrofit all of the existing pools in the country.

Some pools have a safety vacuum cutoff which shuts down if someone is trapped. New drain covers which cost less than $50 can also help.

The cutoff is a nice error-proofing feature, but is that something that can retrofitted?

The idea of a $50 drain cover, one that's less likely to trap swimmers is a great idea -- inexpensive and easy to retrofit, I'd assume.

But what about "process" based solutions? There are allegations that the pool operator knew the cover was off or loose. You'd think it would be part of the operator's "standard work" to inspect these covers frequently and to shut the pool down completely if there was any delay needed in repairing or replacing the cover.

Now, I hope nobody is a smart-aleck and suggests that ultimate "error proofing" would be to ban swimming pools.

I heard one commentator on TV news downplaying the safety risks, she put the problem in terms something like "the odds are very slim.... 1 in 180 million....". That might be statistically true, but that doesn't mean that the chances of an injury like this are the result of pure chance.

I can cut my chances of this sort of injury to zero by not swimming. But, an approach that combines simple, inexpensive error-proofing with standard work and process improvements... now that's a Lean sounding approach that can save lives!!

If you're a parent who takes their kids to a city or community pool, you might want to do some proactive FMEA work rather than relying on "odds." We shouldn't gamble with safety.

Womack & Defining Lean

Recently, I saw Jim Womack give two talks at the Global Lean Healthcare Summit. One was a talk that could have applied, about Lean in a general sense, to a manufacturing audience as well as a healthcare crowd.

One point Jim kept bringing up was the need for simple definitions of Lean. Most of you are probably familiar with the five principles of Lean from the book Lean Thinking.

Not that it was a terribly complicated definition, but now Jim is talking about Lean as three principles. As he puts it, "If you like the definition, use it, otherwise you can come up with a different one."

• Purpose - start with a definition of your purpose, why are you in business?
  
• Process - define your processes and work toward perfection constantly, focus on your processes, not just on results
  
• People - Involve and develop your people.
  

It's reminiscent of a different Toyota "3P" model.

What models or frameworks do you use for giving people a brief overview into the Lean approach?

A Positive (Lean) Approach to Improving Healthcare

Better questions, wiser answers - The Washington Times

A "hat tip" to the curious cat for finding this excellent column by Clare Crawford-Mason, the producer of the outstanding documentary and DVD "Good News... Hospitals Heal Themselves."

I'm paraphrasing, but Clare asks why we aren't hearing more about the use of Toyota and Lean methods for improving hospitals? She supposes that there is less to be gained by politicians from pointing out solutions that are working instead of going on and on about problems that, of course, require government solutions.

Clare also gives credit, as usual, to Dr. Deming for his role in influencing Toyota and their production system and philosophy.

Is China's Chery Lean?

Chrysler Chery-picks (commentary) | MSNBC article

So Chrysler is going the route of importing inexpensive cars from China. The deal was signed, in China, on the 4th of July, which is a curious date for finalizing such an agreement.

Chrysler chairman Tom LaSorda announced that the two firms would be exporting cars built by Chery to Latin America and Western Europe within a year and to Europe and North America by 2010. "We will combine Chrysler's research and technology and global reach with Chery's lean manufacturing," he said.

Interesting. By "lean" does LaSorda (who knows what true "Lean manufacturing" is all about) mean "cheap" or "low labor cost?" I'd have to presume he means Lean as in the Toyota Production System.

Chery is only about a 10-year old company. According to the Wikipedia Page, about the company:

In its relentless pursuit of quality, Chery hired a Japanese engineer from Mitsubishi to head Chery's Lean/Six Sigma production systems, which were first applied to their cars in 2003.

A lean and six sigma double threat! Can Chery, who has been at this for three or four years, be better at Lean than Chrysler, who has probably been working on Lean, to some extent, for 20 years? Is it about being "lean" or is this deal all about cheap labor?

What do you think? I'm asking because I honestly don't know the answers here...

Toyota Thinking is Hard to Copy

Dollars and Sense: Company leaders must drive innovation

Here's a short and sweet commentary about the Toyota problem solving process, "Ohno Circles," and mention of a new friend of the Lean Blog, Matthew May.

It asks, in part:

In American culture, we usually seek the quickest solutions to problems without considering the problem in-depth.

In general, we are not a culture that places a premium on the value of thinking. How many of us would have the patience to stand in an Ohno circle and observe a process for even four hours?

There's one reason why Lean and TPS is so hard to copy, huh?

New Web Forum on Visual Management

Visual-Lean Institute Forums ~ View Forum

Dr. Gwendolyn Galsworth, a very popular guest on my Podcast, has a new web forum focused on visual management and "visuality."

It's a new forum and, as I know with my LeanBoard, it can be tough to build critical mass to keep the conversation going, but give her site a try.

Art Smalley Webcast July 18th

IndustryWeek -- Prerequisites for Lean Success: Learning From Toyota Event Registration

This should be an excellent webcast, featuring Art Smalley. I'll be registering for this, even if I can't watch it live that day.

People often want to rush into copying certain Toyota tools, such as kanban, without first understanding the Toyota leadership model or achieving "basic stability." Smalley will discuss how Toyota achieved stability through the 1950's and 1960's and what that means in a Lean context.

Click on the link above for more info or to register.

McKinsey Lean Consulting Job Posted

Over on the leanboard.org site, click here for the specific job posting or here for the general job board. This is a free service for all parties.

The first part of the description:

Deep Lean Specialist

As client demand in lean transformation has grown, so too has our demand for distinctive lean consultants. The primary role of a Deep Lean Specialist is to work as a client effacing consultant, a consultant to other client teams, and as a forward thinking knowledge builder in the best practices of lean transformation. Focusing on the big picture, Deep Lean Specialists use their knowledge to drive change in system and network redesign, as well as improvements to the overall execution of a system – thus the work will range from shop floor improvements to fundamental changes in work processes, and information and material flows.

Visit the board for the recruiter's contact information and to apply.

Matthew May's Elegant Solutions Blog

Elegant Solutions

I was recently introduced to Matthew May, the author of the book The Elegant Solution: Toyota's Formula for Mastering Innovation.

He is now actively blogging and is a great addition to the lean blogosphere.

Some recent posts worth checking out:

Response to WSJ's "The Drive-a-Toyota Act"

AMAZING HBR Interview with Toyota President Watanabe

The 3 Forms of Any Process

I was going back through my notes from the First Global Lean Healthcare Summit and thankful for the many wonderful thoughts and tidbits that I learned or re-learned.

One was a nice way of summarizing the different forms of a process:

1. What we THINK it is
2. What it REALLY is
3. What it SHOULD be

The gap between 2 and 3 is waste. Often, the gap between 1 and 2 can be just as great. That's why we have to "genchi gembutsu" -- go and see. We have to go to the "gemba," the actual place where the work is taking place to see what REALLY is happening.

At the summit, I heard a lot of talk about creating Value Stream Maps, both the current state and the future state. I heard many talking about getting big cross-functional groups together in a conference room to the create the map, starting with the current state. The current state map should represent #2, what REALLY is. But, the risk is that you document #1 instead of #2.

If you don't combine the Value Stream Map creation exercise with a healthy dose of "Ohno Circle" style process observation, you run the risk of documenting an inaccurate view of reality. Working toward perfection first requires an accurate and realistic view of the current situation. Be sure to NOT shortchange that process in your haste to create the map.

John Shook TWI Presentation

Presentation Link from TWI Summit

Thanks to Blog reader Jeff for sending this along. Jeff sends glowing reports about the first ever TWI Summit that he was able to attend recently.

The Shook presentation material is outstanding.

I had a chance to see John present at the Global Lean Healthcare Summit. Unfortunately, John had to present via video because the U.S. government was taking too long to process the update/renewal of his passport. But, John's talk on Toyota style leadership was outstanding. I'll share some of the highlights of that soon.

That's a whole different Lean story on the passport situation... lack of level loading (due to government deadlines and people procrastinating -- not saying that's what John did) and not having enough capacity to process that many passports so quickly.

Updated: Some Disgusting "Cost Cutting" Efforts

Hard-up hospital orders staff: Don't wash sheets - turn them over the Daily Mail

Updated: The hospital denies the claims (as has a commenter on this post)

This is NOT good problem solving or good patient care, if this is true, this story from the UK:

Cleaners at an NHS hospital with a poor record on superbugs have been told to turn over dirty sheets instead of using fresh ones between patients to save money.

Housekeeping staff at Good Hope Hospital in Sutton Coldfield, have been asked to re-use sheets and pillowcases wherever possible to cut a £500,000 laundry bill.

Posters in the hospital's linen cupboards and on doors into the A&E department remind workers that each item costs 0.275 pence to wash.

That's about 54 cents US. Here's an interesting question... if you were an employee given that order, would you follow it?

Efforts like this shouldn't be misconstrued as "lean," this sort of braindead "cost cutting." The article doesn't call it lean, but I want to be perfectly clear that lean isn't about cutting costs in a way that denies care or cleanliness to anyone. Lean is about reducing waste so that we can do MORE for patients and for employees.

More examples of the alleged NHS "cost cutting":

In January, staff at West Hertfordshire NHS Trust were amazed to receive a memo urging them to save £2.50 a day by prescribing cheaper medicines, reducing the number of sterile packs used, cutting hospital tests and asking patients to bring drugs in from home.

Epsom and St Helier Trust in South London has removed every third light bulb from corridors.

I'm sure this type of thing happens in hospitals in other countries too, I'm not just picking on the NHS. I'm picking on traditional "non-lean" management approaches.

For those who DID see Sicko...

What are your thoughts?

I wrote last week about my thoughts and hopes for the movie "SiCKO". I've actually seen the film now. I won't go into the details of how I managed to see it without any money flowing in Michael Moore's direction. I'm sure he can move to Cuba or France and have the government take care of him, if he's hurting for money.

I was really disappointed by the film. For one, I felt manipulated the whole time. Moore painted a simplistic (almost childlike) picture of America bad, Canada/Europe/Cuba good. If you take the worst examples of care here with the best examples of care "there," of course the U.S. system will look terrible. It would be like making a movie about Lean and showing how certain non-Toyota companies misuse Lean to close factories and hurt workers while some mass production plant in China is doing well. Would you conclude that Lean was horrible and mass production was great, if that's the picture that was painted?

I'll be the first to admit that there are problems with the U.S. system, it's by no means perfect. It was particularly frustrating to see, in the film, how the health insurance industry is set up for a "win/lose" relationship with their customers -- the more care they provide to you, the customer, the worse their profits are. It's horrible that HMO's employ doctors whose job it is to deny care to the insured, based on their medical expertise (what happened to the Hippocratic oath???). It's ridiculous that the woman in the car crash was dinged for not having her ambulance ride pre-approved (she was unconscious!!).

It's sad, personally, that not everyone has good healthcare, but I didn't see realistic solutions in SiCKO. Just a bunch of "wouldn't it be nice if..." whining and dreaming.

Another disappointment is that the film didn't focus exclusively on healthcare. The movie was unfocused and rambled around on how other countries are better to their people in general -- free college, free healthcare, free childcare, free everything. Moore lives in a dream world where these things are all free. The movie is really more of a propaganda film for socialism than it is a documentary about healthcare. If the film had been advertised for what it was, I wouldn't have felt as disappointed in the content. I lost count of how many times Karl Marx was indirectly quoted (to each according to his needs, from each according to his means) or shown on screen. It wasn't particularly subtle propaganda.

Moore's main thesis of the film is about more than healthcare and more about society in general. Moore says we, the American people, are beaten down to live in fear -- we're saddled with college debt, we run the fear of losing healthcare, so therefore we're afraid to speak up and "make waves" with our employers (can't risk losing your job) or with "the man."

Reducing fear in our workplaces is a topic worth discussing, particularly as a disciple of Dr. Deming. But, I wasn't ready to buy into the grand conspiracy theories that Moore was hinting that, that our healthcare system in the U.S. is part of the grand scheme for the government and global corporations to hold us down.

If that's the type of thing you're interested in exploring, go see SiCKO. If you want real intelligent information about improving healthcare, check out these outstanding titles:

• Good News... How Hospitals Heal Themselves
• Remaking American Medicine

Moore missed a great opportunity to use his public soapbox to educate people about how hospitals are killing and hurting far too many patients, all around the world, through systemic mistakes that are very preventable - even in the UK, and in France, and (I'd suppose) Cuba. Those are problems we can fix, through Lean and through systems thinking.

Since I've given links to Moore, before, in the interest of "fair and balanced," here is a link to the anti-Moore site "Moore Watch."

I'd be curious to hear your thoughts on the film and what we can actually FIX with healthcare delivery around the world.

Updated: Here is a similar documentary called "Dead Meat" about the delays that Canadians face in waiting for their "free" healthcare. It's an interesting comparison to SiCKO.

Fatal Lack of Error Proofing

Safety rules not followed on ride that killed worker | Chicago Tribune

A safety precaution put in place for a thrill ride after a fatal accident three years ago wasn't being followed when a worker was killed on the same ride, an amusement park official acknowledged Saturday.

The ride's new operator, his view apparently blocked by a high back on the ride's seat, started the Mind Scrambler while Garin was kneeling on a seat bench, Spano said.

Tartaglia said the operator noticed Garin and shut the ride down within 20 seconds, but she had already been thrown to her death. Only one attendant was on duty when Garin died, he said, despite a safety measure put in place after a 7-year-old girl died in 2004.

Not a lot of details in the article, but it's a shame that the process (or lack thereof) allowed the ride to be started at a dangerous time. The employees were, I'm sure, told to "be careful" but the ride wasn't error proofed, and a young woman died, the 21 year old worker.

It seems like rides like this should have dual controls, dual switches that BOTH workers have to turn at the same time. This would help ensure that neither of them were in a dangerous zone. There should be some sort of "lock out" strategy or methodology, as would be very common in just about any U.S. factory today (at least if people are following the rules).

Resolved: Tis Better to be in the Gemba

There were a couple of articles in the WSJ this past week that, in an indirect way, talk about the value of being at the "gemba" as a manager (gemba is a Japanese word that means "the actual place" where work is happening). The gemba might be your factory floor (Toyota's Gary Convis famously moved his plant manager office into the middle of the gemba) or a hospital (the place where patients are being treated).

Common lean thinking is that leaders and managers have to get out to the gemba, they can't rely on management reports and having meetings in their executive suite. As Toyota folks like to say, problems aren't solved in the conference room, you have to go to the gemba and work with the people who are actually doing the work or dealing with the specific problem.

Why Running a Franchise Is Easier Than Ever (June 25)

Hat tip to my dad for sending this, showing a contrast with my "gemba-driven" cab company owner from the UK. If you remember, the cab company driver insisted on driving a cab (being in the "gemba" as we might say in the lean world, to make sure he understood employee and customer issues first hand.

The WSJ had an article that suggested some franchise business experts now say many franchises can pretty much run on auto pilot, with new technologies to track employees and sales. The appeal is that you don't have to be there, or at least hardly at all, that you can run the business off of reports. Uh oh. A gemba thinker might see the downside to that hands-off management:

Certainly such diversification and absenteeism has drawbacks. "The further away you are from being physically present, in a retail situation in particular, the more things can happen that are not good," Mr. Johnson says. He offers a small but telling example: sun reflecting off a misplaced display board may seem a tiny matter but would be of importance to a hands-on owner.

Those tiny matters can add up. Says Ms. Dugan at the University of Pittsburgh: "Any business, whether it's a franchise or not, takes a lot of work." She cautions that without careful management, working part time "won't provide the return you're looking for."

And the movement carries some risks for franchisers themselves. Experts caution that all the technological advances might paint a false sense of security...

A good manager, in any situation, shouldn't be tied to the gemba 100%, but you can't expect a business to run itself, you have to provide leadership and oversight.

Top Brass Try Life in the Trenches (June 25)

Here's an article that talks about companies that have programs to get the bosses out to the gemba:

By 11:30 a.m. one recent day, Carolyn Kibler had been on her feet for nearly six hours, shuttling among 16 dialysis patients at a DaVita Inc. clinic here. Her lower back ached from the unaccustomed strain.

Ms. Kibler is a vice president of the nation's No. 2 dialysis-treatment operator, earning a comfortable six-figure salary while overseeing 48 other clinics. For three days this spring, however, she helped treat seriously ill patients alongside technicians working up to 13-hour days for an average of $14.30 an hour. "The job is definitely more physically demanding than I had imagined," the 48-year-old executive admits.

That's precisely the point, according to DaVita Chief Executive Kent J. Thiry, who created the immersion program for his senior managers in 2002. "The experience changes their view of the world," he says. "They are better leaders as a result."

That sounds like a good thing, letting executives get a sense for how work is really done and what front line employees really deal with (good or bad). I don't know how many hospital CEO's go spend time with nurses, but I'd suspect it's low. And I mean significant time, such as shadowing them for a shift or at least a few hours. Going to "the gemba" isn't meant to be a superficial fly-by, you have to really observe and talk with people (listening more than talking).

Here's another great sounding example:

About 150 officials of Loews Hotels must spend a day every year in an entry-level job at one of its 18 U.S. and Canadian hotels. They share impressions with employees in their temporary departments and solicit ideas for making those jobs easier. One result: installation of handle bars on room-service carts so they are easier for waiters to push.

When out at the gemba, you don't want to come in as the outsider and start throwing ideas around. It's better to listen for ideas that the value-adding employees have themselves. As a gemba visitor, you can ask questions, but it's rude to come in as an know-it-all from the executive suite.

If you come into the gemba with the wrong attitude, it could backfire:

...such programs can increase cynicism among the rank and file, Mr. Lawler cautions. Executives' rare appearances in the trenches may suggest "these people really are out of touch," he says.

The CIO of the dialysis company made a curious comment, probably a bad choice of words on his part:

After the program, Mr. Cleaver accelerated plans to extend the training period for new analysts on the company's computer help desk, and lowered his expectations of productivity from such new hires. Before Reality 101, he notes, "I never really realized how incompetent entry-level people are when they start their jobs."

Now if he means that they need a better training program or better standardized work for new employees, that's OK. But if he got a bad impression and thought his employees were stupid or unskilled, that might be a bit of a condescending view of his employees. It makes you wonder if there is "respect for people" there or not?

Now, get out to the gemba!! You can share your reports of the value of gemba time here by clicking "comments."

A Kaizen Event Story

By Jean Cunningham:

Just a quick story of a kaizen event….this one was in a service company. They wanted to improve cash flow by getting receivable more quickly. By mapping the current process with a few of the sales people, the accounts receivable clerk, and two interested others, in one day we were able to see that we:

1. Did not have structure process for each activity
2. Did not have clear customer supplier relationship
3. Did not have a clear flow
4. But were willing to improve through experimentation.

We had a process that had 3 value adding steps and 30 in total. But since we looped through the process so many times, we really had about 200 steps!

So we created a clear structure of gathering all key information up front (I call that “Once and be done”) and then ensuring we made contact very early in the process with our key supplier relationship….the accounts payable clerk at the customer!

So the steps were radically reduced, but even better, the entire team now understands what work was being performed, and why the new process is better.

Time will tell if they see the cash flow improvement they expect, but they already know they want to keep using the Kaizen approach.

Recent Factory Examples in the News

Let's kick off July with some stories about Lean, stories that seem positive on the surface, at least. Be sure to read down to the final story, the textile maker, I think that's my favorite of the three.

Hamilton Sundstrand applies lean, quality techniques to supply chain

You might question the beginning of the story -- Hamilton Sundstran outsources work to a Phoenix supplier, Modern Industries (close to where I used to live), and then everyone realizes the supplier doesn't have the capacity. Oops. But send in lean to the rescue at least:

The [lean] team was on site at Modern and worked closely with the company’s employees for several months. “We laid out plans [manufacturing] cell by cell for the new site,” says Lapointe, “and Modern established its own team of lean experts. While we had our fits and struggles, the transition has gone very well. Both companies are better off because of the engagement.”

Lapointe recalls that the lean team approached Modern’s manufacturing process cell by cell and posted metrics measuring its performance. “Eventually everyone in the facility who isn’t involved the project wants to be included. They see the improvement. You get a competitive spirit that becomes contagious.”

Maybe not a perfect Lean story, but you hope the positive spirit really was contagious with the workforce and that it's not just management putting a positive spin on things.

More from aerospace:

Lean takes off at Cessna

Cessna operates using the Textron Production System, which is based on the
Toyota Production System and other principles, and focuses on reducing leadtime
and assets and improving flexibility and customer responsiveness by eliminating
waste. To do this, a supplier participates in value-stream mapping and
improvement workshops. These efforts help simplify processes and improve
productivity.

Now if they're just relying on kaizen events, you could argue that Cessna (or others) aren't really incorporating the lean culture and the ongoing spirit of continuous improvement. Do they sustain the gains after the events are over?

N.J. textile firm finds a system for success

The small company was really struggling:

With its industry threatened by imports from China and losing 340,000 jobs over five years, a South Jersey textile mill joined the panic, but only for a short time.

"I just decided that I'd better wake up and figure out a long-range strategy for running this business," said Randolph S. Taylor, chief executive officer of Absecon Mills Inc. He did, and it is working."

The company realized Lean isn't just about costs... it's about being faster than Chinese competitors:

He knew from the start that cutting costs had to be part of the strategy. But it turned out that there was something more important: completing an order faster than Chinese rivals.He knew from the start that cutting costs had to be part of the strategy. But it turned out that there was something more important: completing an order faster than Chinese rivals.

I like how the company appears to be involving all of its workers:

The brainstorming on how to improve is done by workers. "Instead of top-down management, our job is to support the workers who are making suggestions," Taylor said. The improvement has been dramatic. Absecon has cut the time between eceiving an order and delivering a product from 28 to 14 days. That beats the 10 to 12 weeks it takes to get an order from China by ship. "If Chinese goods are shipped by air freight, the price advantage shifts back to the American market," Taylor said. and even by air, Chinese mills can't match Absecon's new 14-day response time, he added.

Now *THAT* sounds like a great Lean success story. Let's get more of them!