At a recent speaking engagement (I won’t disclose where), a professor (one who teaches about Lean) made a curious comment that I’d put in the Lean As Misguidedly Explained (or L.A.M.E.) category.
The professor made a point that, when working in healthcare, we have to be careful about applying all methods and tools from Toyota. I agreed with that part of his statement. We’re not literally hanging “andon cords” or putting tape around every piece of equipment just because a factory does it. We have to be solving hospital problems and not just copying tools. I get that.
His example, though, was a bit off base.
The prof talked about “takt time” (or the rate of customer demand) and how we balance the service or production time to match up with takt. Again, that’s correct.
In his hypothetical, he said let’s assume that a doctor’s office is supposed to be seeing a patient every 20 minutes. What if the patient has been in the room for 19:59 already.
The prof said, “Toyota would tell you to kick the patient out of the room at 19:59 because you have to keep on takt time.”
I think we were in agreement that you shouldn’t kick a patient out of the room as if a timer bell went off. There’s going to be variation in healthcare and we have to plan for that and make sure patient care comes first. We need to have a reaction plan for how to try to get back on schedule (and part of that approach could be to have buffer times for charting during the day instead of doing all of the charting at the end of the day).
I explained, to the professor and the audience, that Toyota would do no such thing and there’s no Lean principle that says kicking the patient out of the room would be appropriate.
Even on a Toyota assembly line, with relatively low variation and highly-engineered repetitive jobs, a worker might have 60 seconds to complete their work (based on takt and balancing the “cycle time” of the line to that).
If, in a particular job cycle, there’s a problem with a part or the worker drops a bolt — let’s say they can’t get their work done in the schedule 60 seconds.
The worker is expected to reach up and pull the cord. The team leader comes to help. And, if the problem cannot be resolved, the LINE STOPS. You don’t kick the car out because its time is up.
If the work really took 90 seconds for that particular car, you’d take 90 seconds. Quality comes first.
Interestingly, a tour guide at a Toyota plant I visited said they SOMETIMES let a problem move ahead in the line to be fixed later, that this is sometimes a judgment call depending on the problem and how it would get fixed for a particular car. This is certainly not the Toyota orthodoxy on “quality at the source”.
Now, if a problem is occurring frequently, I think it’s safe to say the team leader and production worker would try to fix the root cause of the problem using the Kaizen approach. It’s important to understand WHY the problem occurred so you can prevent it from happening again.
Either way, you wouldn’t kick the patient out of the room.
About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the Chief Improvement Officer for the technology company KaiNexus.