Archive for March, 2010
An oft-repeated (including here in my blog) story in the Lean world says that the Toyoda family used “Toyota” as the company name because “Toyota” requires only 8 brush strokes to be written in Japanese hiragana characters, while the family name requires 10. This is often used as an example of early “kaizen” or waste reduction. But it’s not true?
Episode #87 is a discussion with a returning guest, Steven J. Spear, PhD, author of the outstanding book Chasing the Rabbit: How Market Leaders Outdistance the Competition and How Great Companies Can Catch Up and Win.
Click to play:
The book is due to be re-released in May under a new title, The High-Velocity Edge: How Market Leaders Leverage Operational Excellence to Beat the Competition. In this podcast, we talk about an upcoming workshop Spear is doing for the Institute for Healthcare Improvement, lessons that healthcare can learn from other industries, and the reaction of healthcare leaders to Toyota’s recent quality problems.
Sugar-coated messages are in bad taste. In survey after survey, people ask for straight talk on all issues. They don’t want artificially-sweetened words that supposedly will help the medicineâ€”that is, the tough messages–go down.
Sugar-coated messages are still a national problem though. Companies continue to spin convoluted webs trying to trap you. It’s hard to figure out what they’re trying to tell you. Because of their obfuscation, they insult your intelligence, waste your time, and show disrespect. To me, this is the exact opposite of LEAN COMMUNICATIONS, which is what I advocate and try to practice.
For example, LeanBlog.org founder Mark Graban showed me a classic example of a confusing, sugar-coated letter he recently received from a rental car company. Click on the photo (left) for a full-sized, readable view. Don’t do this at workâ€” or at home either.
Being a huge fan of Dr. W. Edwards Deming, especially so some 17 years after his death, I like any article that concludes with this line:
“The lesson of the Toyota recalls is not that Mr. Deming’s Japanese model is an anachronism. It may be more relevant than ever.”
The Canadian newspaper, the Globe and Mail ran a column titled, “How Toyota strayed from the quality-control path and lost its way.” The writer, Barrie McKenna, recounts some of the post World War II history of how Dr. Deming worked with the Japanese, including Toyota.
Dr. Donald Berwick (bio), founder of the Institute for Healthcare Improvement, has reportedly named by President Obama to head Centers for Medicare & Medicaid Services (CMS), the organization that administers programs including Medicare and Medicaid (“Berwick to be US healthcare nominee“).
I don’t know what Berwick’s politics are, having only met him briefly one time — but I do think it’s a great move to have someone in that role who is not just an MD, but someone who also recognizes the role of process in healthcare quality. Dr. Berwick has been a proponent of Lean in healthcare for many years, as a piece of the healthcare quality improvement and cost reduction puzzle. Here is an article from BusinessWeek, with a video, with Dr. Berwick (something I shared on my blog previously). You can also click the “Berwick” link at the bottom of the post for more.
Here’s some Saturday morning listening… a story from yesterday’s “All Things Considered” on the “End of the Line” at the NUMMI plant (the GM / Toyota joint venture that will produce its last car next week).
The story highlights some of the problems the old Fremont CA plant had before GM closed it the first time in 1982:
- Workers drinking on the job
- Workers having sex in the plant
- Bad absenteeism, compounded by management finding random drunks at the bar across the street to come fill in on the line
- Workers hating management so much that they sabotaged vehicles
The root cause isn’t only “bad workers.” A lot of it was due to “bad management system,” something that changed dramatically when NUMMI was formed with Toyota management principles and practices. As with many things in life, it was complicated. In this post, I’ll also share my personal experiences with one of the leaders who is quoted in the story.
My friend and guest blogger Liz Guthridge (“The Lean Communicator”) would get a kick out of this.
I was at a meeting recently and a speaker, with a background from a very famous global consulting firm, had this phrase as part of a slide:
“Integration requires a synchronization mechanism.”
I’m a very frequent computer user and I’m pretty good with the ole’ shortcut keys, on both Mac and Windows (I’m bi-lingual).
I remember when I’ve had hospital teams as clients, I’d often show them how to do basic things in Excel and they’d always say “Wait, how did you do that?” I’d forget (not notice) that I was using the keyboard shortcuts instead of mousing up to the top menu.
I try to Command-S (“save”) a few minutes every day by Control-X-ing (“cutting”) the mouse movement — using key combinations where I can, instead. OK, I’ll Command-Q (“quit”) the awful jokes here. But I won’t quit (can’t quit?) using my shortcut keys. I even know that Alt-F4 is “quit program” in Windows. I don’t know all of them, but I use them more than the average bear.
This saves me time, but it also causes problems…
Mark’s note: I am thrilled to be able to bring you this guest post from my friend and fellow lean healthcare author, Naida Grunden. Her post (and Sully’s words) are far more important than anything I could write today. More about Naida at the end of the post.
At the 10th Annual HIMSS conference in Atlanta on March 4, Captain Chesley B. “Sully” Sullenberger, who famously landed his crippled Airbus on the Hudson River on January 15, 2009, described the lessons that medicine has to learn from aviation safety. In his address, Sully described the three key safety areas that have helped transform aviation safety over the last 30 years, but from which healthcare has not yet benefited. At several points in the address, Sullenberger also noted the congruence between these three key points and Lean philosophy and practice.
Mark’s note: It’s great to welcome Andy Wagner back to the blog. Read his older posts here.
General Motors, Chrysler, and Toyota have been dominating the headlines in recent months with their financial and, now, quality troubles, while some surprising things have been happening to the Detroit Three’s perpetual number two player: Ford. The company posted profit in 2009 and expects to end 2010 with its second profit after three years of loss, despite an economy that’s still stuttering. Lincoln claimed the top spot on JD Power’s Dependability Survey, sharing it with Porsche. The 2010 Motor Trend Car of the Year was the Ford Fusion, a car quickly gaining on Accord and Camry in sales, boasting a hybrid version with best in class 41-mpg fuel economy. Now Ford shares are at a five year high on Wall Street.
At the heart of the turnaround: Toyota fan and Ford CEO Alan Mulally.
In recent years, healthcare has been learning a lot of lessons from aviation — including checklists and “Crew Resource Management,” as written about in the excellent books The Checklist Manifesto and Why Hospitals Should Fly. Aviation has gotten much safer over the past few decades, due mainly to improvements in teamwork and human factors.
Two recent episodes, one from commercial aviation and one from a major Boston hospital, illustrate that neither industry has everything solved in terms of error proofing and designing systems that ensure quality.
Anyhoo, Gemba Academy is celebrating its first anniversary and is celebrating by offering a free 11-disc DVD Lean training package to the first 500 people who sign up for a 6-month or 12-month online training subscription to the entire training set. That way, you have the DVDs to use if you don’t have a reliable internet connection. There’s a video on this page that describes the offer if you’d like to learn more about that and other offers.
Episode #86 is a conversation with David Lawrence Sundahl, PhD, Managing Director of Rule 4 Consulting. They are a firm that works with healthcare providers to drive improvements using Lean and what they call “Adaptive Design” methodologies. Sundahl was a contemporary of Steven Spear at the Harvard Business School and also worked with Dr. John Kenagy, author of the book Designed to Adapt: Leading Healthcare in Challenging Times.
Click to play:
Regular followers of my blog know that I’ve been creating audio podcasts since 2006. Later today (at 3 PM), I am publishing #86 in the series, an interview with David Sundahl, PhD of Rule 4 Consulting. I’ve made mistakes every few podcasts, including:
- Linking to the wrong file name on the post page for the podcast (leading to a 404 error)
- Forgetting to update the main podcast page when a new episode is out
- Loading the wrong streaming player onto the podcast page (leading to Episode 51 playing on the page for #52
- Forgetting to update the guest info (leading to guest #58 being listed in podcast #59’s iTunes info)
I’m not a dummy (I’d like to think) and I have enough experience with Podcasting that I know the steps involved and I’ve certainly published most of them without error. That said, I’m a huge fan of the Checklist approach, as written about by Dr. Atul Gawande in The Checklist Manifesto: How to Get Things Right and Dr. Peter Pronovost in Safe Patients, Smart Hospitals: How One Doctor’s Checklist Can Help Us Change Health Care from the Inside Out. Checklists have a huge impact in healthcare – reducing errors and infection rates, improving outcomes for patients and reducing costs for the healthcare organizations.
I’d be a major hypocrite if I didn’t use checklists myself…
Today, I’ll simply point you to a blog post by Mitch Ditkoff called “Top 100 Lamest Excuses for Not Innovating.” Many, if not all of these could apply to not improving a process, not embracing Lean, not doing “kaizen” each day.
The Top 3 certainly apply:
1. I don’t have the time.
2. I can’t get the funding.
3. My boss will never go for it.
“I don’t have the time” seems to be the main reason, or excuse, given in healthcare. Staff and managers know there is waste and processes are broken, but they can’t break the cycle of being too busy to improve… so things get worse. As with many of these excuses, you can ask about and look for the root cause of the excuse. How do you free up time? Find a way…
As an American, and a Red Wings fan, it pains me, in a way, to write about Sidney Crosby and the Canadian team’s overtime victory in the gold medal game. I’m currently in Edmonton and get to take in the Red Wings / Oilers game tonight, so life is good.
In the paper this morning, I saw a story that made me think about errors and standardized work. We’ve been talking about human error recently with these two stories:
- A Pharmacist’s Jail Cell Interview – What Good Does Blame Do?
- Detroit Firefighter Not Thinking, Parks on Train Tracks
Now to the story of the puck and how this relates…
Those who follow Lean healthcare know that Virginia Mason Medical Center, in Seattle, is one of the world’s leaders in improving care through Lean methods. They were featured last year on the CBS Evening News, for example.
The LeanROI.org site, the same one that earlier featured a six-part interview with ThedaCare’s Dr. John Toussaint, now has an interview series with the CEO of Virginia Mason, Dr. Gary Kaplan.
Stepping away from serious issues, let’s talk about things that can really get heated — like washers and dryers (rim shot). Sorry for the bad joke… plus, I’m a drummer, so I love the chance to do a nice rim shot to punctuate a joke.
The New York Times had a piece of hard hitting journalism about home appliances last week (“For the Dishwasher’s Sake, Go Easy on the Detergent“). I don’t think this was front page news, but there were elements of Lean concepts that might apply in the home. It has been a while since I’ve had a good “Everyday Lean” post.