Updated: Problems at JPS Hospital, Part 1

Update 5/1/08: The CEO is being forced out, "retiring" in September

Star-Telegram.com: | 04/27/2008 | JPS patients get shortchanged as cash surpluses keep growing

Secondary article summarizing some of the problems

I linked to this on Monday and I'm revisiting it to quote and comment on the first article of the series of articles about problems with JPS Hospital in Fort Worth.

The first article questions why a taxpayer-supported, not-for-profit hospital has a large surplus (another term for profit) yet is deficient in terms of having working equipment, space, and staff to properly care for patients who come to the "safety net" (meaning people who have no place else to go) hospital.

Boosted by tax funding other local hospitals don't get, JPS has been racking up fat surpluses -- nearly $97 million last year alone. But the cash has not helped a dedicated core of doctors and nurses overcome the system's callousness, ineptitude and filth.

Ouch. The paper's words, not mine.

Overwhelmed nurses no longer ask for the help or equipment they need, resigned to the fact that management won't listen.

"The system will transform you, so you either leave, do less than the kind of job you would like to do, meaning you have to spend less time with patients or you have to be curt because you know there is a never-ending cascade of people," said Dr. Bernard Rubin, a JPS board member and network physician.

Again, ouch. I've heard this before in some hospitals, that employees and staff don't feel listened to. That's something we work to turn around in Lean engagements -- getting administrators to listen to their staff, engaging them in improvement efforts, working more toward becoming "servant leaders." It's bad when nurses have gotten to the point of "giving up."

Administrators commissioned a consultant report that outlined deficiencies:

Even Houston-based consultants hired by JPS to study the efficiency of the hospital and clinics last year were struck by the coldness.

"Where's the caring and compassion?" asked observers from InSight Advantage, which detailed hospital conditions in nearly 600 pages of reports.

The reports were authorized by hospital administrators and cost $657,618 plus expenses, but were never presented to the JPS board. The Star-Telegram recently obtained a copy.

You'd think if you spent that much on a consultant report (not IMPROVEMENT, but just a REPORT), the CEO would be interested in the findings.

When Cecero was asked about the reports' findings, he said he couldn't answer: He hadn't read the documents or been briefed on them.

"I don't think it's my job or my role to read every report that comes through this organization," he said. "That's why we have an executive team."

What??? What a ridiculous abdication of executive responsibility.

Some more details:

Some JPS doctors explained in the survey why they wouldn't recommend the hospital. "Dignity can't be present with a small room and no curtains. The ER situation impacts this; Foley [catheter] bags showing, beds against hallways, legs hanging out, etc.," one physician wrote.

At the "Rapid Assessment and Treatment" area of the emergency department, at times 45 patients were jammed into a room with chairs for 19. The space was hot and reeking. Patient privacy was not a remote possibility, InSight reported. (See supporting document as PDF.)

"What is even more concerning is the acceptance of these conditions by management and the staff," the report says.

To counter negative opinions, JPS hired patient advocates for the emergency department. InSight called that move "sad" and a waste of resources -- customer service should be everyone's job.

That last part sounds like something Deming would have said. "Patient advocates" typically respond to patient complaints after the fact... trying to soothe over situations. I think the consultants are right that the money would be better spent on preventing problems from occurring.

In the Short Stay Unit, InSight reported that some patients spent 10 days in a hallway bed, with only a thin curtain to separate them. Up to 26 patients shared one bathroom with one sink, one toilet and no shower. Patients not strong enough to go to the bathroom had to share one portable toilet.

As for basics like thermometers, wheelchairs and IV poles -- there weren't enough to go around.

Cynthia Brannon said her sister spent a week and a half in a hallway bed waiting for surgery.

Yes, the "Short Stay Unit" is very inaccurately named. If the hospital has a huge surplus, it's a shame that they don't have enough basic supplies (or such poor organization that they can't be found). Mattresses are stained and torn, which creates infection control problems -- problems that can directly lead to patient deaths.

There are problems in the O.R. -- significant cleanliness and safety issues:

In endoscopy, where doctors look at internal organs using a scope, a patient was treated in a room that hadn't been cleaned from a previous case. That's a serious error, said Dr. C. Glen Mayhall, who studies infectious diseases at the University of Texas Medical Branch at Galveston.

Likewise, "on more than one occasion," nurses didn't realize an operating room hadn't been cleaned until they were preparing for a patient and saw blood, bone and globules of fat on the floor, the wall and the wheels of carts, InSight Advantage reported. (See supporting document as PDF.)

The CEO commented:

Cecero said that JPS has the best interests of patients at heart but that mistakes do happen. "When you see the volumes of patients we're seeing, with some of the inadequacies of our facility, it's going to happen. It's going to happen in any hospital," he said.

That really sounds like excuse making, doesn't it? Is it inadequacies with the facility or inadequacies with administrators? I know I'm being tough on JPS, not having walked in their shoes.... but you'd have to think things COULD be much better there. Is there any need to have "squalor" in this country, in any hospital? Sure, every hospital has complaints and hospitals can't just spend money blindly -- they need to run a surplus to be able to invest in their future. But it sounds like JPS isn't investing in today's needs -- safe, compassionate, quality care. Sad.

As with many articles like this, the reader comments are interesting reading, as well. If you think I'm being hard on their leadership, take a look. The number of readers calling for the JPS leadership to be fired (or accusing them of bribing Congressmen and othe) far outnumber those who say the paper is being too hard on the hospital.

Some hospital staff members are commenting how we shouldn't blame the staff members. I'm certainly not. When people bring safety concerns to management and they're not acted on, that's a crying shame. It's understandable why employees would get "hardened" and be "rude" in a bad environment. The culture and attitudes are set from the top.

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Costs "Forcing" US Firms Out of China

AFP: Costs driving US manufacturing firms out of China: AmCham

"Forcing" is a strange word to use. It's really a business choice, one way or another. Chasing cheap labor... that's a choice. Chasing it to the next state or country is also a choice companies make.

"For manufacturers, the seemingly endless supply of low-cost unskilled labour may be approaching its limits," Norwell Coquillard, chairman of AmCham in Shanghai, told reporters at a briefing to launch their annual white paper.

It's a shame that so many companies prize "unskilled" labor. It reminds me of when I worked at GM and employees lamented "they said they hired me for my back and my arms, not my brains."

"...It added that 74 percent of companies were either profitable or very profitable in China"

So 26% can't be profitable, even with low-cost labor. How are companies like that going to be successful anywhere?

I wonder if China will promote Lean thinking as a way of maintaining their manufacturing base? Live by cheap labor, die by cheap labor, otherwise.

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HELP WANTED: Lean Instructional Designer

by Jamie Flinchbaugh, Lean Learning Center

The Lean Learning Center is looking to hire an additional Instructional Designer to support our product development and client design work. Below is a description. If you are this person or know of a person, we would love to hear from you. Please email us with a resume at info(at)leanlearningcenter(dot)com.

The Company: The Lean Learning Center is a leading provider of advanced learning curriculum and leadership development strategies to enable lean transformations at client companies. The center was founded in 2001 to address the gaps and barriers that are holding back companies from successful lean transformation. In addition to the advanced curriculum, the Center has developed a learning environment designed specifically for adult learning, utilizing techniques that include discovery simulations, case studies, personal planning and journaling. The company has a very large customer base, including a number or international firms, and works with companies across virtually every industry.

The Position: Instructional Designer

Position Summary: The successful candidate will work for the Lean Learning Center’s Instructional Design Studio to develop state of the art Lean training and related products for public sessions as well as custom designed offerings for client companies. This position requires a substantial amount of creativity and the ability to ‘think outside of the box.’ The ideal candidate will possess a passion for transferring knowledge and experience using a variety of innovative techniques to adult learners. Specific responsibilities will include:

• Curriculum and product design, development and implementation for Lean Learning Center public courses as well as customized training curriculum for clients.
  

• Evaluate training design and delivery and make recommendations for improvement.
• Conduct needs analyses to identify training techniques to fill knowledge gaps.
• Coordinate with subject matter experts, clients and vendors.
• Gather research for training content and products.
• Establish and manage project time frames, responsibilities and deadlines.
• Design page layouts for published materials.
• Facilitate occasional training content.
• Recommend products and services to clients from the Lean Learning Center’s products and services portfolio.
• Other occasional responsibilities as assigned such as:
• Setting up training room layouts and simulation materials
• Assembling simulations and products for shipment

Requirements:

• Bachelors degree required. Concentration in Human Resource Development, Instructional Design or Instructional Technology preferred.
• Demonstrated creativity in developing training techniques for adult learners.
• Demonstrated strong writing skills.
• Embraces change and has the ability to adapt quickly to continuous change.
• Ability to work independently in a virtual environment with little supervision.
• Ability to make presentations and facilitate occasional training content.
• High level of professionalism in working with customers.
• Excellent prioritization and organization skills.
• Advanced knowledge of Microsoft Office applications including Word, Excel and Power Point
• Desktop publishing knowledge and experience preferred.
• Previous experience with eLearning preferred.
• Strong desire to continuously learn new skills and knowledge. We are willing to teach the ideal candidate our curriculum content.
• Familiarity with Lean, Six Sigma, or Continuous Improvement methods is a plus.
• Occasional travel required.
  

Salary and Benefits: The Lean Learning Center offers a competitive salary and benefits structure based upon the candidate’s contributions to the organization and its clientele.

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Can Convis Turn Dana Around?

toledoblade.com -- Dana CEO, veteran of Toyota, hailed as mentor

Here's another nice article that gives an overview of the leadership style of Gary Convis, a long-time Toyota exec who is now CEO of parts maker Dana.

IF DANA Holding Corp.'s new chief executive officer has any words of wisdom that he tries to impart to those younger than his 65 years, Gary Convis tells them this: "Manage as if you have no power."

It was advice that the longtime Toyota Motor Corp. manufacturing executive received from his management mentor many years ago.

I could quote and comment until the cows come home -- but I'll just invite you to click on the article and take a look.

We'd all be better off if we had more leaders like Gary Convis.

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Trouble in a Fort Worth Hospital

JPS patients get shortchanged as cash surpluses keep growing

This linked article is a preview of what I'll be blogging about next. I'm trying an experiment in posting an article first... what comments do you have? Don't worry, I'm not totally outsourcing the blogging to the readers :-)

What a mess. Reading stuff like this will help you see the opportunities for Lean -- well, it's not just "Lean" but some good leadership. Maybe a mess like the hospital described in the article is beyond repair. It's embarrassing that this is the local county hospital in my area.

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Moving a Factory to Mexico

How I Helped Move a Factory to Mexico - Business Week

Hat tip to Jennifer in Washington state for pointing this article out to me. It's the tale of an idealistic college grad whose temp job involves gathering data that will help facilitate the move of a factory from New York to Mexico.

Larry Sills, the company's chairman and CEO, says he decided to relocate the
bulk of the plant's operations to Reynosa, Mexico, because of reduced demand for
the plant's main product line (distributor caps and rotors) and competition from
China. He says the company is profitable, but not enough to justify its nearly
dozen factories in the U.S. and overseas.

It's the typical story of labor costs:

What's driving relocations like this one, of course, is the gap between the wages paid in the U.S. and elsewhere. While a line worker in a U.S. factory earns an average of about $18 an hour, the equivalent job in Reynosa, Mexico, pays up to $3 an hour, including benefits, says Ralph Biedermann, a partner with Mexico Consulting Group in San Francisco.

$3 is less than $18. End of story, right? Well, unfortunately, there's nothing in the article to say if they tried Lean methods -- attempting to eliminate waste and costs first. What about the total system costs? What about the extra inventory in the supply chain and the border delays?

The author started asking good questions, especially after learning productivity had gone UP after the Mexico move was announced (you'd expect it to go down if employees were dejected about the news):

If it had gone up, then what were the criteria for sending the factory to Mexico? I saw highly trained, highly experienced people sitting to the right of me. How much would it cost to train workers in Reynosa? How many costly molding devices would be broken? Would this closing really help? I thought about the drawbacks of committing to a strategy that means chasing the lowest labor costs around the world.

Welcome to the real world, kid. Only an experienced businessman would throw away the accumulated skills and experiences of their people, all in the name of saving a few bucks on labor (which is typically only a small part of a product's total cost, unless it's very labor intensive, like clothing manufacturing). But even high labor cost industries have examples of companies that have used Lean to compete on other factors, such as delivery and quality.

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LeanBlog Podcast #41 - Jeff Liker, Toyota Culture, Part 3

Here is LeanBlog Podcast #41 with Dr. Jeffrey Liker, Professor of Industrial and Operations Engineering at the University of Michigan. Dr. Liker is most recently the co-author (with Michael Hoseus) of Toyota Culture: The Heart and Soul of the Toyota Way and many other books, which can be found here on amazon.com. This is part 3 of our recent series. Today, we talk about the development of managers within a Lean organization.

For earlier episodes, visit the main Podcast page, which includes information on how to subscribe via RSS or via Apple iTunes.

You can use the player (use the VCR-type controls) below to listen to a "streaming" version of the podcast (or click here for the streaming audio and RSS subscription). The streaming link is faster for one-time listening (hardly any delay to start listening). Or you can use the download link to put it on your iPod or other MP3 player.

MP3 File Right-Click to "Save As"

LeanBlog Podcast #41 Key Points & Links

• From a listener: Many companies shift managers around almost constantly. How does Toyota develop their managers in a way that helps encourage "respect for people?"
• Other companies where Toyota can find similar leaders: NUMMI, Subaru
• Developing vs hiring leaders -- does your culture just evolve or do you teach the culture?
• 3 years is typically the rule of thumb for how long a manager should be in place, more important, though, is who is there in the workgroup who provides leadership? Is there someone to pick up the leadership gap if one person leavfes?
• Toyota does rotate leaders to develop people
• With the "quality people value stream," you should be developing people every day
• Dr. Liker talks about his firm Optiprise
  

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Reducing the Waste of Waiting in the NFL Draft

NFL teams play hurry-up offense in draft - USATODAY.com

I'm not a huge NFL Draft geek. It's on right now, but I'm watching some hockey (Go Red Wings!).

The NFL has cut the time allotted for each pick in the draft. Obviously, this speeds things up, but they're not really reducing the "value added" time (if you will) for each pick. The time they're cutting is primarily the "waste of waiting."

Teams are extremely prepared for the draft (which still doesn't explain the bad choices the Detroit Lions always make). They don't need 15 minutes to figure out who they want. They're typically waiting to get a call from another team about a potential trade.

I heard a commentator on the radio last week who said that teams typically wait until the last minute to make trade offers. So if that "last minute" is 8 minutes in or 13 minutes in, it really makes no difference.

Not strictly "Lean" but maybe that's an example you can use with folks at work on Monday. Not all time in a process is strictly "value added." Of course, it depends on how you define "value." If "value" is listening to folks like Chris Berman and Mel Kiper fill the time, then the fans might be losing out... you have to ask the customers. What do you think?

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Norman & Me

Last week, I had the honor and pleasure of meeting Norman Bodek in person for the first time. After all of our podcasts and electronic correspondence over the years, this was a real treat. I had a chance to chat 1 on 1 and to see him present to two different healthcare audiences about Lean and, in particular, Quick and Easy Kaizen (as you can read about in his book The Idea Generator: Quick and Easy Kaizen).

I'll share a few of his thoughts and insights.

First off, I thought he made an excellent point that the goal for hospitals should be "NEVER harm the patient." This is a different goal and mindset than "don't make mistakes." Saying "don't make mistakes" holds people to a superhuman level -- are we going to penalize people for mistakes? We have to create an environment of learning and open problem solving -- being open about mistakes is our way of solving that problem so we don't have it reoccur in the future.

Norman told a story (also discussed here online) about our innate creativity. He asked the room what percentage of people thought they were "highly creative." About 20% of the room raised their hands. He said that was surprising, since most studies show 2% of adults self identify as "highly creative."

Norman asked how many little children are highly creative? All of them! What happens to this innate ability we are born with? A study showed that, by the end of Kindergarten, only 90% are still highly creative. By the end of first grade, it's only 10%. By the end of second grade, the number is down to adult levels -- 2%. That's sad.

The system beats the creativity out of us. It's the education system. Norman asks what happens in first grade -- the introduction of formal grading systems that punish us for making mistakes. If we learn by making mistakes, how do we have an educational system that punishes us for that?

Norman says "you've been brainwashed... you're still creative." I guess schools (and many businesses) want people who are passive and easily controlled, so the creativity is drummed out of us.

He then told a story about visiting Japan -- this was a new one to me -- and he saw a board in a factory where there were pictures of the employees. A worker came over and started writing something down under their picture. They were writing down a mistake they had made. Can you believe it? That wouldn't fly in most organizational cultures. In that factory's culture, mistakes were not going to get you fired or punished - otherwise, who would write something down?

They embraced their problems as learning opportunities, as something to be shared.

I don't think that's something most of us can go implement until we have a highly advanced "lean culture" in our workplace.

Anyway, it was a real pleasure meeting Norman. He's currently in Japan (his 68th trip), leading yet another study mission. I hope you all get a chance to meet him -- or, at the least, listen to his podcasts and read his books.

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Cleaning up the LeanBlog Backlog

Time is short for a full post, so here's an effort to clean out the backlog and to give you some links to check out:

Friend of the blog, Mike Thelen, has an article expanding upon the "Lean vs. LAME" construct:

"I’ve seen and heard many comments from others on web logs, forums, and news outlets (some just dabbling in the lean arena, others researching, and some simply trying to discredit lean). Some say that the attitude they’ve witnessed by technical experts is usually condescending or disrespectful. They say that humility or respect doesn’t appear to be one of the prerequisites for lean or kaizen consultants. I’ve also been informed that they fail to develop people as a whole, with no concern for understanding how people interact with each other, their environment or their unique circumstances.

True lean doesn’t support this...." (read more)

It's a good question for hansei, or reflection. Do we, as consultants or professionals, treat our clients or colleagues with respect?

To compete better, local plants go lean - The Oregonian

This is a nice overview article about Lean and the success that organizations in Oregon are having. They talked to our friend Norm Bodek and he gives a provocative quote (one I heard him say in person last week... more about that soon):

"We've had this myth of individuality. Management has used that myth to dominate workers and keep them separate," Bodek says. "The shame is, we all love teams. We're excited that the Blazers did so well this year, and we hope they do better next year. It's puzzling to me why we don't have teams in every American company. It's a powerful missing ingredient."

What do you think? Is the American concept of "rugged individuality" real or a myth created by The Man to keep us down?

Derailed From The Lean Track - Industry Week

I was quoted, from a blog post, in this article about Boeing's Lean struggles.

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Reader Question: GM and Lean

From Devin, a graduate student, posted with his permission:

"I'm an operations management student who is writing a report on lean manufacturing at GM. However, the more I research, the more I find that there's far more to write about with regard to what GM is not doing than what it is.

I guess my question is, would you agree that GM has simply applied the aspects of lean that most conveniently fit its work culture? I mean, I look for examples of lean at GM, and all my research really pulls up is things like a kanban system at a Saturn plant or the use of the "five whys" for a process improvement of some sort.

It seems to me that these aspects of lean are simple enough to implement that they don't really require the cultural change of something like standardized work, but they're enough for the company to see some moderate improvements that it becomes content with, and as a result, causes the company not to explore any of the other aspects of lean."

Any GM folks care to chime in, even anonymously? Is this a fair question? How would you respond from your experiences?

This is also a classic Lean adoption question that could apply to other companies. Do you try to adopt everything from Toyota or just the pieces that don't challenge your old thinking too much?

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Thinking is For Factories, Too

Seth's Blog: Henry Ford and the source of our fear

I really like Seth Godin's blog... but when he steps into "Lean" territory, he tends to be wrong (as he was last year).

In his recent post, he explores the history of how Ford-ism (and I'd add Taylor-ism) impacted fundamental assumptions that we hold in current-day worklife. Kind of an interesting read.

But his concluding statement is fundamentally flawed:

"Obedience works fine on the well-organized, standardized factory floor. But what happens when we start using our heads, not our hands, when our collars change from blue to white?"

I emailed Seth (who always responds) and told him that he had that wrong. A "well-organized, standardized factory floor," such as Toyota, doesn't lend itself to "obedience." Toyota wants its people to think -- hence the "Thinking Production System "" (I know, sounds like a slogan, but it's a good one.)

The concept of obedience, asking people to just do their jobs without thinking or participation in kaizen... that's not ideal in a factory, or a hospital, or any other environment. What does white collar or blue collar have to do with it? Many people, in any setting, regardless of their education level, want to have their ideas valued, they want to contribute to improvement. It's wrong to belittle blue collar workers as not being interested in that.

As managers and leaders, we have to recognize that there might be fear. We have to explicitly give employees permission to give their suggestions and to make changes. Again, this is pretty universal, be it factories or hospitals.

I do agree with Seth that insecurity and fear are bad things - they do not lead to kaizen, efficiency, or quality.

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Google-Funded eSolar project shows signs of Lean Thinking

By Jason Turgeon:

Google made headlines last year when it announced it that it was going to devote a significant chunk of cash to developing renewable energy that was cheaper than coal (the RE eSolar, a small startup that appears to be applying Lean principles to the thorny problem of how to bring the high costs of solar electricity down.)

First, a solar primer. There are two ways to make electricity with solar power. The high-tech way is through solar photovoltaic panels (aka solar PV). These are the panels that Google installed on the roof of its Mountain View campus, and although they turn solar energy directly into electric energy, they're still ridiculously expensive to produce. There's also some concern that the technology used to produce this "clean" power isn't necessarily so clean.

The second method of converting solar power to electricity is to concentrate the rays of the sun using mirrors. These mirrors usually focus on a central tower, which collects the heat and uses it to boil water, which turns a steam turbine to produce electricity. That's pretty much the way a coal-fired power plant works, only without the coal. And although this is cheaper and easier than solar PV, it's still not cost-competitive with coal.

Enter eSolar. The steps they've taken sure sound a lot like Lean. From an excellent article on Cleantech.com today, here are some key quotes:

"We can build these units smaller. This lets us build closer to cities. It lets us avoid some of the traditional roadblocks associated with large transmission projects," Robert Rogan, exec. VP of corporate development at eSolar, told Cleantech.com...."And we've got the ability to scale this very rapidly through
our existing manufacturing."

Hear any Lean concepts in this approach? This also crosses over into Bright Green environmental concepts, because shorter supply lines mean less waste and less infrastructure.

Google has said it believes it needs to get in the range of 1 to 3 cents per kilowatt hour for solar or other renewables to be competitive with coal....Rogan said his company has been very cost conscious. The company said its heliostat mirrors, designed to track the sun, were made to fit into shipping containers to keep transportation costs low, and are pre-assembled at the factory to minimize on-site labor.

More signs of Lean, although I'd like to see something in this about respect for people.

"Minimizing the shipping costs on the hardware is just one example of that very tightly cost-based approach to designing," said Rogan...."Our towers are very short. This, again, makes them very easy to assemble on site, faster to install, and ultimately much lower cost than building a 30-story skyscraper," he said. The company has also cut the amount of steel and concrete used in its systems by keeping the heliostats small and low to the ground, reducing their wind profile.

Again, a nice intersection of Lean and Bright Green. Besides the inherent "greenness" of a solar project, they've figured out how to do more with less.

"Another nice benefit of this pre-fab, modular, scalable approach is that we can incorporate, in the future, all varieties of storage." "Currently, we're not discussing our specific storage plans, except to say that we don't view it as being a barrier to entering the market," he said.

This somewhat resembles the flexible workspace approach of Lean. You can read a bit more about the company's lean approach here.

All in all, it's great to see Lean and Green integrated in such a fashion. Hopefully there will be a lot more of this kind of thing coming soon. Happy Earth Day, everyone!

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A Funny Fake News Story for Earth Day, A Sad Reality

Following up on Jason's post last week about China and pollution, here is a video from the fake (but deadpan funny) Onion News Network (nice article about them in the NY Times today, I've subscribed to their video podcast from the beginning).

The video's not much of a cheery thought for Earth Day. Honestly, Earth Day isn't anything I've really paid too much attention to. Stay tuned tomorrow from a much more earnest Lean & Green post from Jason.

One thing to keep in mind maybe tomorrow -- does ANYBODY (your friends or the mass media) point out how much pollution China is adding to the Earth and the atmosphere?

In The Onion clip, the fake Chinese spokesman is proud of China's status as the #1 producer of pollution, saying:

“The labor of the people made the sky black with the smoke of progress”

Now, unfortunately, by even posting this, I run the risk of protests from the Chinese government, as evidenced by their attacks on CNN's Jack Cafferty. China doesn't support freedom of speech in their country, why would they support it here? Calling the Chinese government "goons and thugs" is not a blanket attack against all Chinese people around the world. Sheesh. But, I digress. I'm not nearly big enough for them to come after me. Thanks for all of the pollution and thanks for all the defective, poisonous products, China.

To anyone who would accuse me of hating China or the Chinese people... I don't. I do hate rampant pollution and, more so, the trampling of human rights by a totalitarian state.

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Updated: Holy Takt Time!

So I was watching some of the lead in to the Papal Mass in New York's Yankee Stadium. The reporter was talking to a priest about giving the Holy Communion to about 60,000 people within a span of 15 minutes. They chatted about the logistics... talking more about the challenge more so than a precise solution.

My warped Lean mind starts thinking "takt time." Appropriate, perhaps, since "takt" is a German word and the Pope himself is German.

Takt time is calculated as (Available Time / Demand).

(15 min * 60 sec) / 60,000

That equals 0.015 seconds per Catholic.

Assuming a fast pace and it taking 3 seconds per attendee, they would require 200 priests or laypeople giving communion. We'd calculate that by dividing 3 by 0.015 = 200.

I'm sorry I doubted them, I bet they can pull that off!!

Updated: The NY Times has a helpful graphic about this. They said 530 priests, so it must be more like 7 or 8 seconds per communicant. That's still pretty fast. This article says it took about 30 minutes to actually give communion, so it worked out to more like twice the expected time.

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The Dispersion of Toyota Talent

One of the most fascinating trends out of there is the spread of Toyota folks into other old-line automakers or parts suppliers -- Gary Convis, Jim Press, and Jim Farley, to name three. What impact can they have outside of Toyota? It remains to be seen and it's a story worth following. How much impact can one man have on the culture of an entire organization, even if they're at the top?

The big news this week was the hiring of retired Toyota executive Gary Convis as CEO at Dana, a parts maker and auto supplier. Convis is one of my favorite role models and examples of Lean leadership. Even though Dana has had some success with Lean practices (including some Shingo Prizes), it didn't save the company from bankruptcy.

Dana Puts Convis at the Wheel - WSJ.com

From the WSJ article:

Toledo automobile-components supplier Dana Corp. will announce Thursday the hiring of longtime Toyota Motor Corp. manufacturing whiz Gary Convis as its new chief executive.

I'd argue that "manufacturing whiz" only scratches the surface of his leadership talent. When you see quotes from Convis like this (from previous articles):

•

“You respect people, you listen to them, you work together. You don’t blame them. Maybe the process was not set up well, so it was easy to make a mistake.”

That type of mindset and leadership should translate well to an entire company. Will Convis be able to stem the tide of traditional blaming and strict top-down leadership? Will Convis be able to spread the "respect for people" philosophy throughout Dana? Will he have the runway to be able to do that? Or will Wall Street and the investors want short-term focus? Will Convis be able to live the Toyota Way? Will he even try, given this is Dana?

Back to the WSJ article, it gives the required analyst quote, for whatever dubious value they add to the conversation:

Lehman Brothers automotive analyst Brian Johnson said the paring of Mr. Convis with Mr. Devine should give the company a management team that is capable of strengthening relations with customers and Wall Street.

He said Mr. Convis's immediate challenge is "delivering the performance improvement" and driving the company "to a leaner manufacturing philosophy."

Well, duh, of course Convis is supposed to help improve performance. You might think, from his choice of words, that this analyst doesn't understand the Lean approach. "Leaner?" Lean isn't an end point, it's a philosophy and a business system. What does "leaner" mean? That Dana will have MORE of a long-term focus than Toyota? What the heck does that mean? It would be more accurate to say something like "driving the company to more fully implement the lean manufacturing methods and philosophies." Or how else would you put it?

Either way, I hope Convis is wildly successful at Dana. That would be a nice data point to prove that the Toyota Production System works well in other companies.

A Star a Toyota, a Believer at Ford - NY Times

The second related story is about Jim Farley and his move from Toyota to Ford. It's a fascinating profile - we learn, among other things, that he is a cousin of the departed comedian Chris Farley (there is a passing resemblance).

More importantly, Farley shares his passion for Ford and his drive to help save the company.

Now Farley isn't leading change from the top, but he can influence the culture. Hopefully, he can bring the customer obsession from Toyota:

Mr. Farley rode the fast track at Toyota. He moved to Europe in 1995 and helped introduce versions of the Yaris minicar and the Corolla compact. He also became obsessed with what cars people drove and why.

“I used to walk parking lots all the time, all over Europe,” he said. “When I’m in a new situation, my formula is to really find the truth in things, to observe and get close to the truth.”

The truth, as he saw it at Toyota, was all about the customer — unlike at some other automakers that let executives dictate what cars to build.

“One of the many things that Toyota does really, really well is that it can put the voice of the customer right there at the table in front of the chairman of the company, in a way that even he can’t change it,” he said.

Farley learned to go to the "gemba," to actually observe and talk with customers. This is a long-standing pattern in Toyota (including the stories of Japanese employees coming to the U.S. to drive minivans across the continent to understand customer needs here).

It also sounds like he will open up channels of communication:

“At Ford, it was like the boss was always right,” he said. “But it is fascinating how quickly the people I work with were able to shift to where they had their own opinions and expressed them.”

Tie that back to the Convis quote. Convis is a servant leader. He listens to his employees. That's the magic. I hope that's what they can both help bring to Dana and Ford. If it can work there, it can work anywhere.

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A Lean Hospital Example in Houston

St. Luke's adopts business approach to efficiency | Houston Chronicle

Here's a nice case study / profile article in the news about St. Luke's Episcopal Hospital in Houston, Texas.

The first photo caption has a great example of using Lean to improve patient care:

"Studies show us time and again if you walk into the emergency room with chest pains there's a 90-minute window where you get the best outcome ... This lean system has helped us hit that target every time now for 10 months.

Dr. David Pate, the CEO of the hospital, touches on some really key points, including the need to improve value streams instead of just suboptimizing departments:

First, it's important to understand the whole system. We map everything that happens to patients. Then we want to identify and eliminate all the bottlenecks and wasteful processes.

We don't want to optimize departments. If I put pressure on the cath lab people to make it the most efficient and profitable it can be, their cost-cutting will cause problems in another unit. We won't have the staffing we need to give people great care no matter what time of day they come in.

So optimizing a department is useless. What we need is the ER and the cath lab working together as fast and best as they can. (Doctors in the cath lab run a line through a blood vessel and to a patient's heart to diagnose and possibly treat blockages.)

He talks about the "customers" in the system:

We're shifting the whole model. We used to build everything around what worked for the caregivers. Now we make it work for us (the hospital generally) and the patient.

Our customer is the patient and, in many cases, our secondary customer is the physician. You know, they could choose to practice anywhere. So it takes lot of work to bring physicians on board, but our physicians have stepped up. In fact, they're the reason this is working.

The article also touches on Lean methods including eliminating wasteful steps in processes and using 5S to improve organization of supplies and equipment.

Why should a nurse have to leave a patient's room to go down the hallway to get tape for the IV when we know that will be needed every time? Now every room is set up with specific supply drawers. What is stocked is uniform.

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Lean and Ben Franklin

Lean Learning Center: Newsletter

The latest issue (#12) of the "Lean Progress" newsletter from Jamie Flinchbaugh and the Lean Learning Center is available now.

There's always great content in the newsletter. One piece I particularly liked was called "Lean Thinking from Benjamin Franklin," written by Debra S. Levantrosser, the Executive Director of Lean and Business Improvement at Johnson & Johnson.

I always enjoy reading about "Lean history" -- the origins of Lean thinking from sources such as Henry Ford, Samuel Smiles, the Training Within Industry program, etc.

Levantrosser's piece draws parallels between Benjamin Franklin's writings, philosophies, and business concepts and modern Lean thinking. Franklin's time as Postmaster General is highlighted as an early adaptation of Lean principles in efficient government operations.

Check it out, it's a very noteworthy piece. If you haven't already registered for Jamie's site, you'll have to do so to read the newsletter. But, that effort is well worth the time for the content that you'll receive.

An excerpt, reprinted with permission:

"...Franklin lived other lean principles. Innovation and experimentation, servant leader mentality, communication, customer-service orientation, striving for perfection and supporting small, incremental changes were central to the implementation of his virtues.

Regarding innovation, he experimented with ideas until he found something that was successful and met a customer need and was often many steps ahead of his customers’ thinking giving them more than they even thought possible. He finally created a new street lamp to keep the streets successfully lit all night and that could be repaired easily if broken. This may sound like an inconsequential improvement but going from little or no light to full light had a direct positive impact on crime and business performance."

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New Lean Enterprise Institute Survey

I'm not sure if the survey is available online, but I'm sure many of you just received the annual email survey from the Lean Enterprise Institute.

Last year, we gave some constructive criticism and feedback to our friends at the LEI that the survey was:

1. Somewhat blame-ridden ("who" is not buying into Lean?)
2. Lacking "upper management" as a category (if we're going to point fingers -- which we shouldn't -- we should include them)

Again, the question posed is:

What are the biggest obstacles to lean implementation at your facility?"

In the spirit of kaizen, the folks at the LEI have changed their survey to include lack of upper management support as an obstacle to Lean. In many organizations, factories, or hospitals, Lean efforts are initiated at middle management levels. If upper management does not support the Lean vision and approach, that can lead to the degradation of Lean efforts.

I guess this change the survey at least creates "equal opportunity" for the blaming. I still think we shouldn't blame. We should ask why people (at any level) don't "buy in" to Lean.... what are they afraid of? What do they stand to lose? What don't they understand about Lean?

If we expect people, at any level, to "buy in" to Lean, then our responsibility is to SELL Lean ideas. Be a leader, sell others on why change is necessary and why Lean is an approach that will work.

What are your obstacles to Lean implementation? Can you do a "5 Whys" analysis of the obstacle?

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Mike Micklewright, Deming Impersonator

You might recall that I posted back in January about a “Deming impersonator” who was presenting/performing. Thank to that post, I was contacted by Mike Micklewright, the creator and performer of the impersonator (in addition to being President of his firm, Quality Quest). He kindly sent me a DVD of “What Would Deming Say?” and I have to say I really enjoyed it.

Mike is by no means a dead ringer for Dr. Deming, but with the glasses, the suit, and the close-cropped hair, he approximates what a “young Dr. Deming” might have looked like. Mike has obviously studied the speaking patterns and mannerisms of Dr. Deming and a comparison with Dr. Deming videos on YouTube confirms he does a pretty good job. I had my dad (who had gone through Dr. Deming’s 4-day seminar) watch it and he thought it was a pretty good effort, as well.

In his hour-long presentation, Mike not only repeats some of Dr. Deming’s key messages, he also brings along a trusty overhead projector, which he utilizes the way Dr. Deming did. It makes you wonder if, were he still alive today, if Dr. Deming would have clung to his transparencies, even in an era of PowerPoint.

In addition to covering some of the history of quality improvement and Dr. Deming’s work, Mike also gives some interpretations of what Dr. Deming might have said about more “modern” business issues. These topics include the use of Six Sigma and Toyota Production System principles, as well as outsourcing. He emphasizes that Lean is about “respect for and involvement of the people.” He takes on the ills of the business world that still surround us, including short-term thinking, annual employee reviews, and focusing on outputs and specifications instead of process.

Mike/Deming said:

“One of the main root causes of Toyota’s success is self reliance. By trying to become more like Toyota, we are becoming less like Toyota. This is the paradox. Nobody taught Toyota tools – 5S, kaizen, value stream mapping. These were outputs of their own system. Today, American companies buy Lean tools, Six Sigma, ISO-9001, sourcing from China and India, instead of developing internally. We are NOT self reliant.”

You can contact Mike through his website, especially if you're looking to hire him to speak at an event, meeting, or workshop. You can also find links to articles, including this clever one about the "Society of the Anti-Deming" (SAD) and their alternative universe 14 points.

Mike has agreed to do a podcast with me, at least part of it in his Deming impersonator mode. If you have any questions for "What Would Deming Say?", post a comment or email me here and we'll try to incorporate them. Stay tuned.

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Lean and Green thoughts on China

By Jason Turgeon:

China's everywhere in the news these days. It seems like you can't open a newspaper (or a feed reader) without reading an article about the summer Olympics, its booming economy, the situation in Tibet, and growing unease over the environmental consequences of China industrializing in the same way the US and Europe did. To capture the moment for us, National Geographic ran an excellent special on the Wenzhou region of China, home to a huge chunk of the world's commodity manufacturing sector. From buttons to bra straps, this is the new home of manufacturing, and as such it should be an area that's of equal interest to both Lean and Green thinkers.

The story follows a family-run manufacturing startup as it tries to break into the lucrative world of manufacturing bra rings (the part you struggled so hard to unclasp in high school) in the city of Lishui. It's simultaneously exhilarating and depressing. On the one hand, there is this spirit of unbridled entrepreneurialism of the sort that made the internet bubble so exciting. On the other hand, in their mad dash to industrialize the entrepreneurs and their complicit government leaders are duplicating many of our worst mistakes. This is not a story of flow, or the elimination of waste, or of respect for land and people. Instead, this is the story of a region that celebrates the best and worst of unregulated capitalism.

The family leases a facility in a brand-new industrial development, built in the least environmentally sensitive conceivable manner on land that's practically stolen from the peasants who are forced to sell it at below-market rates. The facility ramps up production on a commodity that's completely dependent on a machine that only one person really knows how to operate well, a machine that seems engineered to waste energy and a machine which constantly threatens to break down, bringing production to a halt. The same peasants who are no longer farming are now working 50 hour weeks for minimal pay. The factory starts production with no customers, amassing a huge backlog of product while it waits for sales to start up. And then, one day barely a year after it opened, its owners jump to an even newer development, leaving behind nothing but a legacy of waste.

What's so heartbreaking about this story is that Lean and Green both work so much better if they're applied from the start, in the design phase. But time and again, we see this kind of completely unplanned development. The business owners in this story, who don't have much of an education, aren't portrayed as the kind of people who think much past next week, certainly not the kind of people likely to embrace lean concepts or worry about the environment. The government officials pushing the new development along brag about the number of hills they've flattened and wetlands they've filled in the name of this development.

It's not explicitly stated in the story, but the impression is that any concession to forward-thinking practices, to environmental considerations, to an applied thoughtfulness in the way they do business, would be immediately written off as too expensive and impractical. But what's more expensive? Spending your increasingly thin profit margin on wasted energy? Moving your factory multiple times? Coming back in 40 years and trying to undo the environmental damage you've left behind?

I guess the larger question for the readers of this blog is how do you get people like this--business smart entrepreneurs who only understand the bottom line--on board with Lean? And at the same time, how do you convince the local governments that pushing development in a more sustainable manner will attract a better clientele, cost less over the long run, and be better for the citizenry? It seems to me that these are two sides of the same coin. Readers with experience in this kind of rapid-growth situation and/or Chinese manufacturing, please leave your thoughts in the comments.

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