What People are Saying about the Lean Blog

A sampling of unsolicited quotes from readers:

"I read your blog on a periodic basis, and enjoy your insights."
- Management Engineer/Planning (Hospital System, Utah)

"I wanted to thank you for indirectly making a meeting with Dr. Gwendolyn Galsworth possible. I recently listened to your interview with Dr. Galsworth and became excited about the idea implementing these visual methods into our workplace. I also have to say I enjoy all of your interviews and look forward to future ones."

- VP of Manufacturing (New York)


"Just a comment on the podcasts, really great information and I find it very useful, I spend a lot of time traveling from home In the UK (Wales) to and from Europe in my current employment so lots of time to listen."
- Lean Champion (Europe)


"I particularly like the hands-on and real life scenarios. They help to sell the ideas to the folks on the production floor. I look forward to seeing any video clips or articles that companies in different states of improvement. The one post showing the Boeing 737 in production is very valuable and I've shown it to our entire production workforce. I'm an avid reader and enjoy all the links to other blogs for insightful reading and learning."
- Lean Leader (Manufacturing, New York)

"I just wanted to let you know how popular your blog has become at [health system]. I have been involved in some education of our senior leadership including our CEO. As part of the education they asked me for some reference materials on Lean and I sent them a link to your website. Over the last couple of weeks I have received several emails with questions generated from posts on your site. They have also discovered a lot of other blogs through your site and the amount of information on Lean flowing through the organization is growing everyday. Anyway, you have by far the best blog out there on Lean and I appreciate it more all the time."
- Lean Leader (Health System, Washington)

"Just a quick note to say thanks for your podcasts. I’ve been automatically downloading them into my ipod and while traveling from the hotel to my company’s facility in Shanghai just this morning, I toggled through the podcasts and found Womack’s two interviews about China !! How timely to be stuck in a heap of absolutely maddening traffic, heading to a facility that looked very similar to his remarks. I’m sure it takes a lot of time to put these interviews together. I, for one, appreciate it immensely."
- Manufacturing company, China

"I read your blog quite regularly. It, with a few others, acts as my make-shift sensei."
- Hospital reader

"I really enjoy your blog. I think its the best lean-related one out there. The variety of articles is interesting, and your perspective is thoughtful and open-minded. Compared to others, yours is less didactic and preachy, which I think makes it attractive to a wider audience. Keep up the good work."
- Blog reader (engineer)

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New Year's Lean Resolutions?

So, in a way, the whole concept of New Year's resolutions "batches up" improvement, which isn't a good thing. The start of a new calendar year is a pretty arbitrary, yet symbolic, day. True "kaizen" shouldn't require a particular day to prompt it...

That said, what are your "Lean resolutions" for 2008? These might be things you resolve to do, using Lean concepts or methods, or things you resolve to do in the course of implementing Lean.

One resolution for me to make sure I'm better at communication the "why" when implementing Lean, helping my clients articulate it and making sure everybody in the workplace understands why we are making changes or why we're trying new things. I resolve to continue asking people to challenge me, to ask why on their own, since the "why" conversation is a two-way street, whether explaining "why" or asking "why?"

What resolutions do you have? Or is the whole thing silly?

Happy New Year! Let me also take a moment to thank you for reading my blog. I appreciate the time that you take out of your day to check out my little piece of the internet. Thanks to all of you, especially, who interact with me via the comments or email. Here's to a great 2008.

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God Forbid You Actually Listen to the Bottom 98%

Management Leaders Turn Attention to Followers - WSJ.com

This article caught my eye, this idea that someone other than top executives might actually have some ideas.

In "Followership," a book being published this winter, Ms. Kellerman argues that a big organization's fate can be surprisingly dependent on how well it understands thousands of low-ranking employees, and makes them more effective. Entrepreneurs Ori Brafman and Rod Beckstrom took a similar perspective last year in their book, "The Starfish and the Spider," suggesting that lower-ranking employees, called catalysts, need to drive organizational change, instead of top bosses.

Considering that the Lean and Toyota Way philosophies have been, for so long, based on listening to the ideas of those who actually do the work, how is this considered innovative thought?? Isn't that the whole magic of the Toyota approach, helping make all employees effective and getting them pointed in the same direction? Is Toyota avoiding that "big companies die" dynamic better than most?

The Best Buy chain is trying, to their credit, to implement such ideas:

"Look at why big companies die," says Shari Ballard, Best Buy's executive vice president, retail channel. "They implode on themselves. They create all these systems and processes -- and then end up with a very small percentage of people who are supposed to solve complex problems, while the other 98% of people just execute. You can't come up with enough good ideas that way to keep growing."

When she visits Best Buy's electronics stores, Ms. Ballard says she asks managers: "What do you know about your customers that I couldn't possibly know?" The question encourages local initiatives that help Best Buy grow.

The idea that the "very small percentage" of top leaders are supposed to come up with the ideas, with the workers "just executing" -- that's Taylorism and MBA-centric thinking at its finest (yes, I have an MBA myself... sorry). What do you think about that question she asks her store managers. Would you phrase it that way? Seems like the right direction, but there's something about that phrasing I don't like... that "I couldn't possibly know" part could put people on the defensive (making them not want to show up the boss) depending on how the words are delivered and the organizational culture.

Anyway, interesting article and hopefully a trend that will grow -- actually listening to the people who are closer to the front lines. Shocking! Well... it's shocking, unless you've been studying Toyota and Lean.

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On Blog Vacation through Dec 29

Best wishes to everyone for Christmas and the holiday season. I'm probably not going to post again until December 29 unless there's something really pressing or interesting in the Lean world. It's time to get my book finished up and then spend time with family. Time to relax a bit. In the mean time, feel free to check out the archives or to ridicule me for my Santa hat!

Womack on Respect for People

Jim Womack's E-letters - Respect for People

I'm not sure if the link works (given the LEI's login requirement), but Jim Womack's most recent e-letter is one of the best I've read in quite a while. I think he really nails it, the compare and contrast of a Lean notion of "respect for people" and what traditional organizations mean when they say they respect people. Somewhat paraphrasing Jim:

Traditional Organizations:

• Set individual goals (top down), but give people wide latitude in how the work is done
• They "trust" their people to get their work done and solve problems on their own
• Managers and experts help people work around problems
• Play cheerleader and say "great job!"
  

Lean Organizations:

• Highly specify how the work is done, but give employees latitude to improve things
• Managers and supervisors get directly involved with their employees in problem solving
• Managers ask the employees how root causes can be fixed
• They challenge employees in their thinking, driving toward better solutions in a collaborative way

For anyone who thought "respect for people" meant "being nice all the time," I hope Jim's letter helps clarify the true difference. The Lean organization had far less turnover and far better productivity than Jim's "non Lean" example. Better process.... better results!

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Gaming the Numbers in the UK, Again

Blundering hospitals 'kill 40,000 a year' - Britain - Times Online:

Ah, gaming the numbers... everyone's favorite pastime. It certainly is here in the State, even though I have my second story of the year related to gaming the numbers in the UK health care system. The first was a story about ambulances fudging and cheating their way to making the numbers for on-time response.

In this story, hospitals are gaming the system by underreporting patient safety incidents.

"...the number of mistakes to which NHS hospitals openly admit is a small fraction of the total accepted by the Government’s patient safety watchdog.

It found that only 276,514 errors were recorded each year by English hospitals, even though the National Patient Safety Agency (NSPA) puts the true figure at closer to 900,000.

... almost 10 per cent of the trusts surveyed claimed an unlikely error rate of zero."

That would be quite a headline if they really had gotten infection rates to zero. Some hospitals are making great progress on that front (with methods including Lean), but zero is darn hard to get.

People underreport for many reasons - pride, fear of being sued, not wanting to admit problems. Compare that to what I heard about during my tour of Virginia Mason Medical Center. At VMMC, one of the leaders in the use of Lean, they were happy that internally reported patient safety incidents had gone up. Had the hospital suddenly gotten much less safe? Of course not. It meant that people were finally reporting errors, which was the first step in finding root cause fixes and prevention.

It's something I discuss in my upcoming book -- the need for more openness and sharing of information, both inside hospitals and across hospital boundaries. Back to work on that thing now... I'm learning you're never really "done" with a book... you just stop working on it at some point!!!

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You Can't Force Suggestions

There was a question on the NWLean email list about suggestions, in the context of The Idea Generator: Quick and Easy Kaizen, reading in part:

"My question is this; is the 2 suggestions per month per employee forced? Meaning do I require each worker to sumit their ideas or do I suggest that they do?"

Thankfully, Norman Bodek chimed in and pointed out this is never coercive. Lean leaders only fall back on positional authority and telling people what to do as a last resort. Hopefully it starts seeming silly to people to use one concept (getting employee input) via a non-Lean approach (mandating things).

The question continued:

If the answer is that I suggest they do, then what is the next approach I take if I have very little participation?

I think cases like this provide great opportunities to ask "why?" Why are employees not participating? The answers will vary depending on your environment, but it's always a good thing to ask "why?" instead of redoubling the mandate efforts.

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Airport Heijunka

DFW Airport | pegasusnews.com

DFW International Airport will distribute more than $10,000 in "DFW Bucks" on December 20 and 21 to encourage families to check in during off-peak times to avoid the Christmas checkpoint crunch, offering children 12 and under a coupon to eat free at any of the restaurants in the Airport's five terminals.

The idea is to "level load" the airport security lines, by encouraging families to come between 12 and 2. It's easier for families to get through during non-peak times (plus it doesn't clog the lines up as bad for the rest of us). My wife and I are trying to help level load by traveling on Christmas Day afternoon (a day we assume isn't as busy as the next few will be).

The DFW example seems like a good case of "demand shaping," trying to level out demand for a product or service, rather than just taking it as it comes. In the Lean approach, "heijunka," or level loading, can apply to leveling demand (an ideal condition) or leveling production (which requires inventory).

Best wishes to everyone for the holidays!

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Smart or Dumb Machines?

Why Nobody Likes a Smart Machine - New York Times

Good article here about Donald Norman and his views on some of the poorly designed products and gadgets out there. One of the most influential books I've read is his classic, The Design of Everyday Things. If you're looking to understand human psychology about how we interact with machines, it's a great read.

It's also very applicable in a Lean context, related to the design of equipment, interfaces, and visual controls. I ran into someone last week, at a hospital, who was a huge fan of the book and often related concepts in the book to things they were trying to do to improve patient safety. Any other fans of the book, or Norman's other books here on the blog?

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Not following the "Standard" lets an athlete off the hook?

Jenkins beats doping charge -- chicagotribune.com

Here's an example of a testing lab not following their own industry standard work, an error that "vindicates" (in a way), an Olympic-caliber athlete who had tested positive for performance-enhancing drugs and appealed her suspension.

Jenkins' test results were compromised because both labs analyzing her sample, in Ghent, Belgium and Cologne, Germany, violated an international standard requiring tests be run by two different technicians.

"This addresses a crucial issue emerging in sports law -- has the science been done well?" Straubel said. "The standard violated is a safeguard that prevents labs from providing doctored results to mask testing process error or to intentionally harm the athlete's standing."

So why did this happen?

Asked why both labs would have made the same mistake in using only one technician, Straubel said "They thought the rule was unnecessary and they complied with it in what proved to be an inadequate way."

I think there' s a good Lean lesson in there -- you have to ensure that your employees know "Why" the standardized work is important. Even going back to the Training Within Industry model, it's important to explain "why" key points are important for quality. I'm sure this is quite embarrassing to the labs and potentially lets an alleged cheater back into unfair competition.

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The Danger of Overproduction?

PEPCON disaster - Wikipedia, the free encyclopedia

In some Saturday afternoon background TV watching, my ears perked up when I heard about this story on the History Channel, from 1988. A factory, in Nevada (just outside of Las Vegas) had produced a chemical that was used for the space shuttle program as a rocket fuel accelerant.

The show claimed that, after the Challenger disaster that grounded the program (killing demand for the chemical), the company "kept producing it anyway, stockpiling it, and hoping to eventually sell it."

According to Wikipedia:

With the space shuttle program frozen, no government instruction dictating where to ship the product, and no mandated storage procedure or proper storage facilities for such large quantities of product, PEPCON stored almost all manufactured ammonium perchlorate on-site, in plastic drums on campus parking lots. An estimated 4000 tons of the finished product were stored at the facility at the time of the disaster.

Well, wouldn't you know, an employee was careless with a cigarette -- who allows smoking in a facility with explosive chemicals!?!?!?!? -- and one barrel exploded, flying through the air, landing in the middle of the main storage stockpile.

According to fire responders, the plan at the factory had apparently been "in case of fire, run like hell," but they arrived to find employees trying to put out the initial fire with regular hoses. A huge explosion ensued with the force of 250 tons of dynamite equiv (3.5 on richter scale) that was felt at the Strip, 10 miles away.

Two people were killed in what should probably be considered an utterly preventable disaster. It makes me wonder why it was cheaper or somehow better to keep producing the product, just to pile up dangerous inventory. Is there some chemical engineering reason that someone knows about?

It seems like an interesting case study in failure mode planning, basic safety, and error proofing, not to mention the "waste of overproduction." I don't think I've ever heard of a case where overproduction had been deadly.

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LEI Webinar Tomorrow with Cliff Ransom

Our friend Kevin at Evolving Excellence has written about Cliff Ransom before, so I'm excited to see the LEI has a webinar with him tomorrow, Tuesday.

Here is the link for registration. If you have any comments or discussion points after the webinar, feel free to share them here.

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When Systemic Problems Don't Get Solved

This past week, I stumbled through a systemic problem that might not ever be solved, namely the National Car Rental service at Terminal 3 of the Toronto Pearson International Airport.

I say a "systemic" problem, because I've seen the same frustrations (for customers and employees) twice in a month now. A co-worker reports "Oh yeah, it's always a mess there, same problems, I quit using them." The normal routine with car rental involves minimal delay, especially as a frequent renter. If you even have to go to the counter (which you do in Toronto), it's a quick handoff of keys and off you go to your car.

Not in Toronto. Twice now, they haven't had cars ready for the customers. So, there's the line to get checked in and the separate line for people who waited up to 30 minutes to actually get a car because nothing was ready.

When I finally got a car (after about 30 minutes of the "waste of waiting"), I did my best to put on my "why?" hat and I asked the one employee, "why aren't there enough cars available?" (rather than just giving him a hard time or yelling).

Well, the employee went off on a mini-rant directed at "corporate," how the local outlet has been complaining about being understaffed and "corporate won't do anything about it." He encouraged me to complain through National customer service since our concerns (as customer and employee) were very much aligned.

Part of me wanted to ask, "what about improving your process so you don't need as much labor?" but I didn't have time for that... off I went. I'll assume they do need more labor. So why doesn't a problem like that get fixed? Is National waiting for all of their customers to go away? That will solve the labor crunch, eh?

I think one lesson learned is to ask why, even if you're frustrated and cranky about the situation. Don't assume that the folks at the front lines of customer service have much, if any, influence over the corporate policies that cause frustration for everyone.

If this problem has been going on for months (according to my colleague), are they unwilling to fix the problem or unable to fix it? I'm not sure which is worse...

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Reader Question on Poor Performers

Here is another reader question I received this week:

I was wondering how you deal with removing people from the company who resist change while maintaining the culture where people are not afraid to be laid off due to improvements. Aren’t there some sceptics who see the anchor draggers get fired and think it’s due to improvements, and how do you deal with this?

That's a great question. I think, often times, people know who the "anchor draggers" are anyway and can see the difference between mass firings and performance-based firings. It's tough, from an HR standpoint, as you can't necessarily tell the rest of the employees "we fired so-and-so because of their bad performance," but people usually can tell. While we don't want to use efficiency improvements, via Lean, to drive headcount reduction, morale can often be improved by getting rid of a person who is dragging down the rest of the team. The employees might thank you for "finally" taking action that they wish had been taken long ago.

Before resorting to firing, I think we do have an obligation, as leaders, to coach people to the best of our ability. The main question often becomes "is that person worth the time investment that may or may not pay off?"

How have you, the Lean Blog readers, dealt with this situation in your environment?

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A Simple Question with No Simple Answer

We spend a lot of time here talking about how to prevent Lean failures and what some of the root causes are. I received a question from a reader that I thought I'd open to the group:

What are the biggest risks to successfully implementing a lean transformation in an organization, and what actions would you recommend to mitigate those risks?

Anyone have any recent or first-hand stories to share?

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Employee Engagement Survey

As the end of the year approaches, it's always a good time to reflect, including the "am I happy with my current job?" question. Here's a link to a survey on employee engagement from the firm BlessingWhite if you want to participate.

A topic for the blog audience: Have you been able to use Lean to improve employee engagement? To me, that's one of the primary objectives of Lean, regardless of the workplace - factory, hospital, or whatever.

If you have any thoughts to share after going through the survey, feel free to add them here.

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Checklists and Standardized Work in Patient Care

New Yorker - Dr. Atul Gawande

Here is an outstanding piece by one of my favorite medical writers, on the use of checklists (a form of Standardized Work) to improve healthcare quality.

How can "a stupid little checklist" have such an impact? Take a look at the article and see.

Within the first three months of the project, the infection rate in Michigan’s I.C.U.s decreased by sixty-six per cent. The typical I.C.U.—including the ones at Sinai-Grace Hospital—cut its quarterly infection rate to zero. Michigan’s infection rates fell so low that its average I.C.U. outperformed ninety per cent of I.C.U.s nationwide. In the Keystone Initiative’s first eighteen months, the hospitals saved an estimated hundred and seventy-five million dollars in costs and more than fifteen hundred lives. The successes have been sustained for almost four years—all because of a stupid little checklist.

Standardized Work and Lean (I'll call this article an example of "Lean" even though Gawande doesn't) are not glamorous. This isn't an exciting new drug or a flashy "gee whiz" technology. This is basic process management and kaizen 101... yet it's so effective. We need more of this in our hospitals...

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Buying a bigger pair of pants will NOT solve your weight problem.

by Dan Markovitz

Whew! Just in case you panicked at the thought of not having access to email on your upcoming flight to Slippery Rock, JetBlue has come to the rescue with in-flight internet access. You'll never again have to endure five whole unconnected hours without riveting messages from the CEO informing you that his daughter's Girl Scout cookies are on sale in his office.

Presumably, JetBlue's new service will be welcomed as a godsend by road warriors who break out in hives at the terrifying prospect of a few hours in the air without email. These folks live with some sort of imagined corporate armageddon looming over them if they can't respond to an email instantaneously, or at least within 19 seconds. To these poor wretches, I can only say: get over it. Your firm will not collapse like a dying star, nor will your clients wither away for lack of your expert ministrations. And if you really are that vital, well, you probably shouldn't be getting on a plane (at least not a commercial plane) in the first place.

JetBlue's service will also surely be welcomed by those folks who figure with an extra four or five hours of solid time paddling around in Outlook, they can really make some progress on the 639 unread messages languishing in their inboxes, as well as the other 281 messages that have been read, but need a response. To these lost souls, I can only recycle my favorite expression these days: buying a bigger pair of pants will NOT solve your weight problem. If the electronic seams of your email waistband are groaning, an extra five hours or fifty hours won't make a difference.

The problem is the lack of a decent process for handling email, not a lack of time to handle it. It's classic non-lean thinking: throw more resources at the problem by buying newer, bigger machines. This approach invariably fails to produce the desired productivity gains because the underlying process is dysfunctional.

The same is true of adding an extra few hours to your day of reading and writing email. The extra time isn't going to help you get on top of your email. It will only compound the problem. The lean approach is to improve the underlying process by which you manage email.

I've written about how to reduce the volume of email you suffer with here and here, and Merlin Mann has an excellent series of posts on how to get to inbox zero here.

Rather than waste an additional five hours getting yourself even farther behind, I'd suggest using that time on the plane to learn the lean process of handling email and finally take care of the stuff that's moldering away in your inbox. And treat yourself to an extra bag of Oreos while you're at it.

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What a Delusional CEO Drives

What your CEO drives says a lot - USATODAY.com:

One thing I love about the Toyota Way is the humility and down-to-Earth nature of leaders, it's such a contrast to the arrogance you so often see in other circles. USA Today had an interesting article about what CEO's drive and the message it sends. Some drive very practical cars to send a frugal message, others are flashy and use that to push their employees (including one who, somewhat perversely, wants employees to be in debt so they'll be motivated to sell more -- yikes).

The real laugher was this... I can only imagine that this guy is like:

"'My employees like to see me driving a nice car,' says Larry Gaynor, CEO of Nailco Group, a beauty products company, who drives a white $100,000 Porsche 911 Carrera S Cabriolet. 'It gives them a feeling the company is doing well.'

Perhaps, Gaynor says, there are other reasons employees notice what he drives. 'For years I parked at whatever spot was open,' he says. 'A couple of years ago we redid the parking lot, and some of my employees told me that I should have a reserved space.' Now, everyone now knows if he is at work, or away."

Yeah, I'm sure the employees feel so warm and fuzzy that the CEO is being paid so well. And he has himself convinced about the reserved space. Would you guess the employees are scared of him if they need to be able to tell if he's there or not? Again, all speculation, but sounds like a potentially dysfunctional workplace, don't you think?

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Quaid Case Update: Whose Responsibility is Standardized Work?

If you're a regular reader, you might recall the Cedar-Sinai medical error that harmed Dennis Quad's twins (and others).

Quaid and his wife are now suing the maker of the drug, Baxter, claiming the company is negligent for not designing packaging with good visual distinctions between the two doses (photo there on the linked TMZ.com page).

This week, Baxter announced an initiative to redesign the packaging of their "high risk" medications.

Considering this problem has happened before, I'm sure that effort isn't just a direct response to the Cedar-Sinai incident. It sounds like Baxter tried to get some "voice of the customer" input:

Baxter conducted multiple interviews with more than 100 pharmacists, physicians and nurses to identify areas for improvement . The feedback received from health care professionals guided the design of the new vial packaging.

In research conducted after the three-phase development program, clinicians indicated that the new packaging design enhancements addressed the current clinical needs for safer injectable drug administration and could help reduce medication errors.

“Health care professionals played a vital role in the design of the new label and we look forward to their continued input to gain key insights that will help in the development of future design enhancements, ” said Bonderud.

Baxter had already done some redesign, but Cedar-Sinai may have tried to save a few bucks by using up the old medication (in the old packaging) first. Normally "FIFO" would be a good thing, but not if the old product leads to a greater patient safety risk. In hindsight, would have been cheaper to throw the old stuff out, right?

I'm also not impressed that Cedar-Sinai leadership is apparently throwing their employees under the bus. In a statement, they said:

The medical center's investigation found that preventable errors made by pharmacy and nursing staff caused the wrong concentration of heparin to be used.

A pharmacy technician failed to follow hospital policy of having another pharmacy technician verify the medication and concentration prior to removing it from main pharmacy inventory. As a result, the technician mistakenly retrieved a higher concentration of heparin (10,000 units per milliliter) instead of the lower-concentration heparin (10 units per milliliter) used for flushing IV catheters.

The higher concentration heparin was delivered to the satellite pharmacy that serves the pediatrics unit. A second pharmacy technician, working in the satellite pharmacy, did not verify the concentration of the delivery from the main pharmacy, as required by hospital policy.

As a result, the higher-concentration heparin was placed in a location in the pediatrics unit where the lower-concentration heparin is kept. The nurses who subsequently administered the heparin to the patients also did not follow hospital policy of verifying the correct medication and dose prior to flushing the intravenous site.

The error was identified later that day by Cedars-Sinai staff, who immediately performed blood tests on the patients to measure blood clotting function. In one of the three patients, the clotting tests returned quickly to normal. The other two patients were given protamine sulfate, a drug that reverses the effects of heparin and helps restore blood clotting function to normal. Additional medical tests and clinical evaluation conducted on the two patients found no adverse effects from the heparin or from the temporary abnormal clotting function.

"Although this was a rare event, and attributable to human error, it is also an important opportunity for the entire institution to explore any and all ways we can further improve medication safety," said Michael L. Langberg, M.D., chief medical officer at Cedars-Sinai Medical Center.

"On behalf of the medical center, I extend my deepest apologies to the families who were affected by this situation, and we will continue to work with them on any concerns or questions they may have. This was a preventable error, involving a failure to follow our standard policies and procedures, and there is no excuse for that to occur at Cedars-Sinai," Langberg said.

Whose responsibility is it for the Standardized Work to be followed? Doesn't management have a responsibility to be proactively checking and looking to see if policies and procedures are being followed? It's not enough to wait and react when an incident occurs. I'd guess those same policy violations were happening every day and it finally caught up to them. Are employees responsible for following processes? Sure, but it's also management's responsibility to manage the process and the people. Does Toyota say, "well, our policy says people don't build defective vehicles"? Of course not.

Does management taking responsibility mean that we constantly hound and watch employees? No, but we have a responsibility to check to see if there are violations of policies BEFORE an injury or death occurs. Proper training and re-training should happen BEFORE problems occur. The employees directly involved in the Quaid incident are suspended. What about the managers and leaders?

To be fair, Cedar-Sinai is making a number of systemic changes (including moving from using heparin to saline, which is much safer, they say). But, they've also added MORE double checks (adding more of a method, relying on inspection and "be careful," that didn't work 100%).

I hope other hospitals, where the same risk factors exists, will be more proactive. We need to make "preventable" errors into "prevented" errors.

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"Not Conducive to Suggestions"

My ears always perk up when I hear the word "suggestions." Again, it was in a football context. But unlike the ASU Sun Devil example, it was the other way around.

As my new team (the Cowboys) was still losing to my old hometown team (the Lions). The Lions have been notorious this year for hardly ever running the ball. The announcers told a story where one of them (Joe Buck?) asked if the Lions' offensive linemen ever suggested running the ball more, and the answer was "The atmosphere's not one that's real conducive to suggestions right now."

The season is collapsing for the Lions (which is partly why I gave up on them so long ago). A team that started 6-2 is now 6-7 and probably won't make the playoffs.

Is this like our workplaces? Things go badly and the leaders, in their pride, won't listen to the employees? Maybe during bad times is exactly when you should be asking for suggestions, or at least creating a "conducive" atmosphere.

The fans make suggestions all the time.... "Fire Millen!" they chant (Matt Millen is the team president who somehow still has his job with a track record of losing). When will the Ford family hire an Alan Mullaly for the football team? I hope Mullaly doesn't turn into a Millen for the auto company!

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Waste in the 787 Development Process

Boeing Scrambles to Repair Problems With New Plane - WSJ.com

Interesting article in today's WSJ about the ongoing problems in bringing the new 787 "Dreamliner" to market. Sounds like a nightmare of a process.

Look at the waste highlighted in the article. On the Lean theme of "doing things right the first time":

"The first Dreamliner to show up at Boeing's factory was missing tens of thousands of parts, Boeing said."

Ok, you'll say, I don't understand the complexities of modern global supply chains. Maybe I don't, but look at the rework involved:

"When mechanics later opened boxes and crates accompanying the fuselage sections, they found them filled with thousands of brackets, clips, wires and other items that already should have been installed. In some cases, officials say, components came with no paperwork at all, or assembly instructions written in Italian, requiring translation.

Boeing officials thought they could work through this unexpected twist in a couple of weeks. Instead, they had to put the plane up on jacks and remove its engines and tail to get to tight spots."

Is there any concept of "stopping the line" in the development process here? Better to scramble and go out of process with a lot of rework than to take the time to do it right?

Boeing says:

Rejecting the idea that Boeing might be better off increasing production more slowly, Mr. Carson says, "I couldn't stand the pain of telling a customer it's going to be worse for them, just to make my life easier."

It seems like they aren't subscribing to the idea of "going slow to go fast." Boeing set up this global supply chain and chose the suppliers. Now, they seem to be dumping on the suppliers, saying how they wouldn't use some of them again. And there might be good reasons for that, but how many were set up to fail through poor selection or poor planning?

I don't know all of the answers here, of course, but it's a real eye opener to see that much waste in their efforts to bring a new product to market. How would Toyota do this differently?

Toyota Worker in Japan Dies After Excessive OT

Two article links, sent to me by a few readers:

Court: Toyota Employee Was Worked to Death

Widow of Toyota worker questions labor practices

At a first quick read, this seems like a "Japan problem" more so than a "Toyota problem." But, even if that is the culture in Japan, where people work themselves to death (and the law/regulatory structure allows it to happen), shouldn't Toyota hold itself to a higher standard, given their "respect for people" ideal? Shouldn't we hold Toyota to a higher standard?

To those who have read more or thought more about this, what do you think about the situation? To those who know Japan better, how do you read this situation? I'm curious what you think, click "comments."

Here's Kevin Meyer's take over at Evolving Excellence.

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Six Sigma Ranch and Winery

Six Sigma - People

I might not be able to blog much the next few days, so I'll pose this fun question. Has anyone heard of the Six Sigma winery, founded by a former GE executive?

What would a "Lean winery" look like, I wonder? Why can't we level load grape production throughout the year? That's a joke... :-)

I'm sure you could apply kaizen, waste reduction, and "respect for people" in a winery as much as any organization, be it a factory or a hospital.

Still Squeezing the Suppliers?

Marketplace: Supplier gets dwindling sums for its parts

This story has been in the blog backlog, but it's always an important topic, the idea of not just squeezing your suppliers on price. It's not a good idea to just demand lower prices, without partnering up on shared improvements. Why are so many auto suppliers bankrupt? The lack of partnership in the industry has to be at least a part of it.

We see the same dynamic in healthcare, where "reducing costs" often means "squeezing the suppliers" (the doctors or the hospitals). Forcing a "price reduction" is not the same as true cost reduction. That's not sustainable, continually forcing the price down because you have market power. Maybe that's one reason more healthcare organizations are looking at Lean. With the pricing pressure, one to keep their profits up is to reduce cost (and a lot of that has to do with improving quality).

Many doctors are backing out of the Medicare and Medicaid system and more are dropping insurance plans that squeeze them too much (via the Kevin M.D. blog).

"We were spending inordinate amounts of time and resources on things that have nothing to do with the quality of patient care," said gynecologist Felice Gersh, medical director of the four-doctor practice. "I would be more than happy to be a member of all the health plans if they paid me reasonably and quickly."

Sounds like a lot of waste and Non Value Added activity? I know my dentist's office complains that my dental insurer purposely delays payment or loses submissions, another form of "squeezing."

Back to the Marketplace piece, a long-time supplier complains:

Myers says over the years, GM has pressured him to keep prices so low that his last price increase was in 1984.

AL Myers: The methods that they're using now border on cruelty to animals. They're so relentless and so overbearing with their requests for price reductions that they really don't care whether you go out of business or not.

A GM spokeswoman says the company goes to extreme lengths to keep suppliers profitable. Because when suppliers go out of business, she says it's disruptive and costly to find new ones. But in 2005, GM said it would slash purchasing costs by 30 percent.

So is GM helping take 30 percent of the cost out of the supply chain, or are they just squeezing and paying less?

I think, for both the manufacturing sector and for the sake of healthcare, that we need to find more ways to be Lean, to find true cost reductions (again, quality improvement and partnership are a good start), instead of just slashing what we spend.

The Many Errors in Thinking About Mistakes

Article - New York Times

Here's a really interesting article that talks about our attitudes about mistakes. In the Toyota mindset, mistakes are something to learn from (and to prevent from reoccurring), an idea that can be traced all the way back to Samuel Smiles, who was an influence on early Toyota thinking. Based on the many mentions of Smiles in David Magee's book, I was tempted into buying a copy of Smile's book "Self-Help," but I haven't had time to read any of it yet.

Anyway, back to the NY Times article.

“Studies with children and adults show that a large percentage cannot tolerate mistakes or setbacks,” she said. In particular, those who believe that intelligence is fixed and cannot change tend to avoid taking chances that may lead to errors.

Often parents and teachers unwittingly encourage this mind-set by praising children for being smart rather than for trying hard or struggling with the process.

There's some research, also cited right after that in the article, that suggests people are more willing to try difficult tasks (thus risking mistakes) after they are praised for "trying hard" instead of being praised for "being smart." Being labeled smart puts pressure on people, that smart people don't make mistakes. How can we apply that in the workplace and break that mentality?

“One thing I’ve learned is that kids are exquisitely attuned to the real message, and the real message is, ‘Be smart,’” Professor Dweck said. “It’s not, ‘We love it when you struggle, or when you learn and make mistakes.’”

Many Lean-related thoughts in the article, including this one:

After all, nobody wants a worker who keeps making the same mistake, and “if we fail and don’t learn from it, it’s not an intelligent failure,” he said.

Professor Gully and other researchers have looked at ways of training people to do complex tasks and found that in som