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I’m not a racing fan, but wow this video is impressive. I can appreciate a great process and all of the planning that’s involved.

I can also see the difference between having four pit crew members and 18 crew members (or so… it’s hard to count).

What can you do to improve your processes? It takes more than “throwing people at it” if that’s even an option. What planning, training, tools and coordination are required?


Mark Graban 2011 Smaller Video: Formula 1 Pit Stops 1950 & Today... a Huge Difference leanAbout 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 VP of Innovation and Improvement Services for KaiNexus.


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officer at periscope in control room of submarine 150x150 Things That Make Me Worry About My Colonoscopy: Patient Safety leanSorry to get all Katie Couric on you, but I’m going to have a colonoscopy on Friday. I turned 40 last October and I have some family history that leads my doctor to get one done now rather than at 50.

Unlike Katie, I won’t be broadcasting mine live, but I’ll share some articles and reflections on the process and, being process focused, what could go wrong. It’s a very necessary procedure, but there are, sadly, some very unnecessary and preventable risks.

According to  Dr. Wikipedia (backed by journals):

This procedure has a low (0.35%) risk of serious complications

That’s about 1 in 300 patients, put another way.

For those of you who speak Six Sigma, that’s a 99.65% first time yield and a 4.2 sigma level.

That’s not going to scare me away.

Maybe I should have asked what my physician’s complication rates are. What are the complication rates at the surgical center where this will be done? Is this safer than being at a full-blown hospital or doesn’t it matter? Should I be more of an “engaged patient?”

Should I have asked more questions of my primary care provider? Why did she refer me to this GI specialist? Is he a “Best” doctor? Does that matter?

If I treat them as a supplier (respectfully), should I be able to walk the process and see what they do to prevent, say, instrument or scope disinfection errors?

Should I have asked:

  • Show me how you disinfect the equipment
  • Show me your training records for the people doing this work
  • Show me your equipment maintenance records
  • How do you verify that the work is being done properly?
  • Have you had any complaints or incidents in the past?

I had my pre-procedure phone call on Monday. Maybe I should follow up and ask a few of these questions, even if I can’t go “walk the gemba” to check things out myself. What would you do?

Of course, I didn’t have data or information available to me to know:

  • Which specialist is best at this?
  • Who has the highest or lowest complication rates?
  • What are the prices for different doctors or locations?

I don’t know how a busy person makes an informed decision.

These problems seem to happen way too often:

Dirty Instruments Lead to Investigation of Seattle Hospital

A Seattle hospital is under investigation after hospital officials revealed that more than 100 patients were put at risk of infection because medical instruments were cleaned improperly.

A breakdown in training resulted in instruments used during colonoscopies being improperly cleaned, hospital officials said.

Scopes used during colonoscopies were found to have been cleaned improperly last November, according to a hospital statement.

Technicians used improper cleaning techniques on the scopes between July 2011 and November 2013, hospital officials said. As a result the hospital has started notifying 106 patients who were at risk of infection as a result of undergoing a colonoscopy during that time.

We’re going to look for what went wrong and what can be done and what has been done to stop it from happening again,” agency spokesperson Donn Moyer told ABCNews.com.

Why was there a breakdown in training? What are other hospitals doing to prevent this same problem? It’s good to react using good problem solving and improvement mindsets (looking at the process, figuring out how to prevent reoccurrence), but you can prevent these incidents to begin with?

Dirty Endoscopes Raising Alarms for Colonoscopies

A new study disturbingly discovered that an average of 15 percent of flexible endoscopes used to examine GI tracts and colons at five hospitals were harboring “bio-dirt”–cells and other material from previously examined patients. This was even after the instruments had been cleaned.

And that yucky finding is likely to be matched at other hospitals across the country, according to study author Marco Bommarito, Ph.d, lead research specialist at 3M’s infection prevention division.

“During a day [a single] scope may be used on half a dozen to a dozen patients–maybe even more.”

The article also says:

A guideline issued by the American Society of Gastroenterology said documented cases of infectious complications from endoscopic procedures were as rare as 1 in 1.8 million procedures.

But Bommarito thinks the actual number might be higher. He noted that it will not necessarily be obvious that a person’s disease came from an unclean endoscope used on them.

So you have detection problems and self-reporting problems. Will some healthcare organizations cover up problems and not inform patients?

Atlanta surgery center admits error in cleaning colonoscopy equipment

“One of our physicians asked the staff, ‘how do you clean these instruments?’ It was through that process, they identified that we weren’t using the high-level disinfectant,” Hamby said.

I realize “bad process” and “bad process management” runs rampant in healthcare. Poor training. Poor supervision.

These are not worker problems — they are management problems.

Lawmakers Blast VA Over Bad Colonoscopies

“What stops contaminated fluids from backing up into this tube is this crucial green valve,” he said, illustrating with a colonoscopy tube. “Investigators found not only was this valve missing, but this tubing wasn’t being cleaned in between patients.”

In surprise inspections at 42 VA medical centers on May 13 and 14, investigators found that only 43 percent had standard operating procedures in place and could show they properly trained their staffs for using their equipment.

Unclean Colonoscopy Equipment Affects 64 Colorado Patients

According to Denver’s 9News , patients who had colonoscopies between July 17 and Aug. 13 were being contacted via telephone and mail and told to be tested for HIV and hepatitis after it was discovered that the hospital’s disinfecting machine was not working properly.

St. Charles: Colonoscope Not Fully Sanitized

According to the suit, filed last week by attorney Jennifer Coughlin, the hospital failed to fully disinfect a scope that had been used on four previous patients last September.

A letter to the woman from St. Charles CEO Jay Henry acknowledged a programming error led to the final disinfecting steps to be skipped.

Hospital removes chief exec after dirty tools risked 2,500 veterans

The Miami Veterans Administration (VA) hospital is holding its chief accountable for improperly washed colonoscopy equipment that may have exposed 2,500 veterans to diseases, reports the Miami Herald.

After the colonoscopy scandal, the VA’s Administrative Investigation Board began inspecting the Miami VA facility and found it to have “poor quality control, lax supervision and sloppy procedures,” notes the Miami Herald.

Tainted Colonoscopy Equipment a Wide Spread Concern

Secretary Shinseki confirmed this was not a one-time or limited place occurrence. Shinseki went on to say this concern is shared system wide across VA hospitals, clinics, and medical facilities. 

Shinseki’s analysis concluded this problem was not the fault of a person not doing their job. Instead, this situation presented itself because of lack of proper standards being in place in all VA medical facilities. Following the investigation into the problem, more proactive procedures were put into place to make sure this practice does not continue.

Endoscopy doc ran dirty, dangerous clinic: Report 

A cluttered procedure room with five combustible oxygen tanks, “questionable” air quality, possible patient exposure to toxic fumes, contaminated garbage under the procedure table and a lack of monitoring of patients’ vital signs during procedures.

However, the most troubling of the observations are related to the possibility of dirty devices used during the scope procedures.

Some, like biopsy forceps, weren’t being sterilized using the right equipment, the report says.

During one procedure, inspectors watched the doctor dip forceps in a formaldehyde solution to get rid of a specimen and reinserted the forceps into the patient’s esophagus.

Healthcare is in no position to get on a high horse and lecture Toyota or GM about quality, eh?


Mark Graban 2011 Smaller Things That Make Me Worry About My Colonoscopy: Patient Safety leanAbout 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 VP of Innovation and Improvement Services for KaiNexus.


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do more with less 215x300 #Lean *IS* about Doing More with Less, But Be Careful Saying That lean

It’s often said that Lean is about “doing more with less.”

Historically, and practically speaking, it’s true. But, it’s a phrase that we should be careful about, for a number of reasons.

Looking back at the origins of the term “Lean” as “Lean Production” 25 years ago (read more here). Generally speaking, the term “lean” was used because Toyota (and to some extent other Japanese automakers) did more with less. That was a fact and it was backed by data.

The idea of “do more with less” is helpful as a comparison between organizations in the sense of, ew, benchmarking. It’s less helpful (or even dangerous) as a prescription for an organization.


Mark Graban 2011 Smaller #Lean *IS* about Doing More with Less, But Be Careful Saying That leanAbout 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 VP of Innovation and Improvement Services for KaiNexus.


photo by: Chris Piascik

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royal instant pudding 150x150 My Comments on #Lean Healthcare in These Challenging Times leanThanks to Dodge Communications for interviewing me for their blog: “Improving healthcare–there’s no instant pudding.”

I was, of course, citing the late great Dr. W. Edwards Deming and his “There is no instant pudding” admonition. Hospitals and health systems are facing a lot of pressure right now, especially with lower reimbursements. Lean is powerful, but healthcare leaders who expect a quick fix will be disappointed.

Part of the interview:

Dodge: It sounds like the ACA, much like Toyota’s WWII dilemma, is a catalyst for hospitals really examining their processes. But more holistic approaches, like Lean, are competing for a hospital’s attention. For example, there are groups out there pushing the latest technology for efficiency or new marketing programs. Do you see hospitals turning to Lean instead of these other approaches?

Graban: Yes and no. Lean is a powerful strategy but it’s not a quick fix. So much of what Lean is built upon is W. Edwards Deming’s philosophy. He had a saying that “there is no instant pudding.” Those quick fixes, silver bullets, generally don’t exist, or have a short-term effect and a bad outcome long-term. There’s never going to be a shortage of sellers and buyers for quick-fix, cost-cutting solutions.

Financial results are of course important, but we have to look at the long term, not this quarter’s financials. That’s really tough for a lot of people to do because there’s serious pressure. You tend to see cost reduction with Lean, but as an end result of these other things that come with it–like improving quality, reducing wait times and making a more positive work place. Lean’s definitely a more sustainable approach to cutting costs.

For example, I’ve worked with a number of hospital labs. Some have realized a 25-30% productivity improvement through Lean. Once they achieved that improvement, they didn’t lay off 25-30% of their people. What they did was take on additional lab testing volume so they could do that much more work with the same amount of people. Because of Lean, these people aren’t running around stressed–they’ve improved quality and eliminated waste and reduced turn-around time. They can do more work with the same amount of people. That’s the kind of reduction that goes along with greater quality and service.

In general I think there are far too many hospitals in this environment that are going strictly after cost cutting and ignoring process improvement.

I’m curious to hear what you think about my comments. Do you agree? Am I full of it? You can comment on their post or you can comment here.


Mark Graban 2011 Smaller My Comments on #Lean Healthcare in These Challenging Times leanAbout 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 VP of Innovation and Improvement Services for KaiNexus.


photo by: afiler

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Screen Shot 2014 04 11 at 8.57.11 PM 150x150 My Skepticism about GMs Speak Up for Safety Program leanI have a new article posted on LinkedIn: “My New Program: Speak Up About “Speak Up for Safety” at GM.”

GM seems to continue their “blame the employees” game, as they’ve suspended two engineers (in my mind, blaming individuals for systemic cultural problems). CEO Mary Barra says that some executives may be punished, but starting from “the bottom up” with the punishments doesn’t sound like a new GM.

I’m skeptical that a “speak up” program will do anything. The problem wasn’t a lack of employees speaking up, but rather a lack of leaders actually listening. A funny commenter, Rod Barnett,  suggested that the new GM program should be called “Listen Up for Safety” and should be directed at executives, not engineers.

I recently shared a “speak up” story about quality and, in the new LinkedIn piece, I share a new personal story about speaking up about employee safety. It includes me having hands placed around my neck in a threatening way. Good times.


Mark Graban 2011 Smaller My Skepticism about GMs Speak Up for Safety Program leanAbout 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 VP of Innovation and Improvement Services for KaiNexus.


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disco ball 150x150 What Lean is Lacking: Disco Medallions? lean

When we lament why Lean hasn’t been more widely embraced as a new management model in healthcare (or other industries, for that matter), it’s good to ask “why?” We can identify gaps and propose countermeasures that might help solve this problem.

As much as I believe that benchmarking isn’t as useful as many think it is, I did see a recent innovation in the Six Sigma world that we might want to consider… or maybe not.

As I’ve written about before, I’m not a certified Six Sigma anything. I took Green Belt classes when I worked at Dell, but was never certified. I have learned statistical methods through my engineering and business education and I use statistical process control and other basic statistical methods in the course of my Lean work (as Toyota does, although they don’t do formal Six Sigma).

I’m all for using statistics and data, as appropriate. But, I’m not a huge proponent of formal Six Sigma programs. This is probably “Six Sigma As Misguidedly Executed” (like Lean As Misguidedly Executed), but the last manufacturing company I worked for had trained and certified nearly everybody as a Green Belt. But, hardly anybody was actually using Six Sigma methods (other than full-time Black Belts).

So, even knowing that I’m not a “Six Sigma guy” and I have my concerns about formal Lean certifications, a friend asked me about a well-known consultant’s new “Executive Master Black Belt” offering. I said, “I dunno, but I’ll take a look.” A lot of it was vague and somewhat unclear – OK, a Master Black Belt who understands better how to work with senior executives. I guess that’s helpful.

Since I like to nitpick and small details often fascinate me, here is one of the things that jumped at me in the brochure (obscuring the author/consultant’s name, because it seems like the polite thing to do):

Screen Shot 2014 04 09 at 9.42.45 AM 540x214 What Lean is Lacking: Disco Medallions? lean

So you not only get certified and get a black belt, you get a medallion? You can wear your disco medallion, I mean “victory medal,” to conferences and business events?

Who would actually do that?

Disco Stu from “The Simpsons” says, “Disco Stu finally has a reason to get Six Sigma certified!”

disco stu What Lean is Lacking: Disco Medallions? lean

Good grief. What silliness.


Mark Graban 2011 Smaller What Lean is Lacking: Disco Medallions? leanAbout 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 VP of Innovation and Improvement Services for KaiNexus.


photo by: andrewmalone

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roots 150x150 Kaizen Tip: Just Do Its and Root Causes leanIn the Kaizen process, we ask everybody to identify problems (or opportunities) and then to write down an idea that could potentially solve the problem (or at least solve it to some extent). 

What’s written down on the card (or submitted into KaiNexus software) is the starting point for discussion within a team and/or with a supervisor.

When coaching an organization on Kaizen recently, I got a really good question from a physician who had taken the excellent week-long Lean healthcare training at the University of Michigan. She said that, in the Lean training, they said you should never “jump to a solution” in the course of problem solving. She raises a good point.

Many of the problems identified and brought forward through this Kaizen process don’t require any root cause analysis. That might sound shocking. Isn’t Lean all about “the 5 whys” and root cause analysis? Sure, where it’s needed. Root cause analysis happens a lot in Lean.

Some relatively problems, “Our IV trays are disorganized” have a somewhat obvious solution, “Organize the trays and remove unneeded items.”

We can just fix the trays and then recognize those who did so, share the idea with others, and then check back to see if the idea really worked and if it was sustained.

Some problems are more complex, such as “Patients are waiting too long in the waiting room.” We couldn’t really jump to a simple solution there. We’d want to do root cause analysis and maybe manage this through an “A3 problem solving process” or something more rigorous like a “Rapid Improvement Event” or a longer-project.

Or, we can break a bigger problem down into smaller pieces, taking care to not sub-optimize anything.

As Kaizen leaders, we learn how to triage things that are submitted through the Kaizen process. It this idea an easy “just fix it”? If so, we can have a bias for action and test ideas experimentally, in the PDSA approach. If it’s a more complicated problem or something with a non-obvious solution, we can start an A3 or get a Rapid Improvement Event sponsored.

This can all work together. We can’t oversimplify everything, nor should we overcomplicate everything.

A similar contrarian thought is that not every improvement needs to be a formal “Rapid Improvement Event.”


Mark Graban 2011 Smaller Kaizen Tip: Just Do Its and Root Causes leanAbout 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 VP of Innovation and Improvement Services for KaiNexus.


photo by: Vinay Kumar C

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mailbox building 150x150 This Newbie Has a Good Grasp of Lean leanI get a lot of emails from regular readers or people who have just stumbled across my blog. I try to be as helpful as I can (although I’m not really a good connection for Lean healthcare jobs that people are always looking for).

One email was from somebody who has recently discovered Lean and is reading up a storm:

“It led me to the Gemba Kaizen book which I still am trying to get through, The Toyota Way which I am also reading, Womack’s Lean Thinking, the Gemba Academy videos (the lean dishwasher being my favorite), your blog and several other popular lean sites.”

Here’s somebody who is buying inexpensive used books through Amazon and craigslist, building up an impressive initial library without spending a fortune. I wonder how many CEOs at hospitals that are “implementing Lean” have read that many books on Lean?

The reader shared a story from his job search period:

“I had to take a menial job at [a major retailer] in order to keep myself afloat due to my circumstances. My lean outlook didn’t stop. I was able to get my work done quicker than those who had been there for years because I was looking at the tasks, experimenting a little, and figuring out how to do it in almost half the time or doubling the output of my coworkers. Unfortunately, the level of management above me are not interested in the ideas of a person of my stature on the totem pole.”

What a shame. What a lost opportunity for that retailer. This is a retailer I sometimes frequent. I see their registers report a “Green” or “Red” grade to the register clerk based on how fast each transaction is, along with a percentage of Green times. It seems the store is emphasizing speed, but how does a clerk get judged on their smile, helpfulness, and general customer service? What if “going slow” is the right thing for a particular customer?

It seems that retailers like this will browbeat their employees over speed… but they won’t listen to said employees about how to do the work better? That’s sad. It doesn’t sound like a Lean environment or a Lean culture.

In a Lean culture, we listen to everybody (treating them with respect) and we let everybody participate in improvement.

The reader continued:

“It just seems like lean is the way things should be done in the first place with taking care of the next person in the process most important. If each step in the process works toward setting up the next “customer” in the process, the ultimate winner is the customer or patient.”

That’s not a bad description… not a bad understanding of Lean… again, better than some healthcare leaders who think Lean is just about cost cutting or that Lean is a way to better enforce top-down rules and procedures.

I hope the reader finds a job where he can work in a Lean culture, as a place to continue learning and a place to contribute his ideas.


Mark Graban 2011 Smaller This Newbie Has a Good Grasp of Lean leanAbout 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 VP of Innovation and Improvement Services for KaiNexus.


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Screen Shot 2014 04 07 at 11.51.35 AM 300x223 Great Steve Jobs Video (& Transcript) from 1990 on Continuous Improvement leanHat tip to Brent Brewington (@BrentBrewington) for sharing a link to this amazing video via Twitter.

Starting at about 7:54 into the video, Steve Jobs talks about continuous improvement. Here is a little more background about the video, shot in 1990, when Jobs was 35 years old and CEO of NeXT Computer.

I admit I was surprised by what I heard Jobs say. I have this mental image of him as a top-down, leader-as-expert genius who had little regard for front-line employees… but what he says in the video is golden.

Skip ahead to 7:54 if you are short on time, or the whole video is pretty interesting:

What Jobs says in that section of the video (for those who can’t watch at work)… with my comments in italics.

Steve: [7:55] In most companies, if you’re new and you ask, “Why is it done this way”? The answer is, “Because that’s the way we do it here,” or “Because that’s the way it’s always been done.” And in my opinion the largest contribution of much of this quality thinking is to approach these ways of doing things, these processes, scientifically, where there is a theory behind why we do them, there is a description of what we do, and most importantly, there is an opportunity to always question what we do.

What a timeless phrase that is, “we’ve always done it this way” and how powerful it is to challenge that. 

[8:28] And this is a radically different approach to business processes than the traditional one, “because it’s always done this way.” And that single shift is everything, in my opinion. Because in that shift is a tremendous, optimistic point of view about the people that work in a company. It says, “These people are very smart. They’re not pawns. They’re very smart. And if given the opportunity to change and improve, they will. They will improve the processes if there’s a mechanism for it.”

Listen to that again – people are smart. They’re not pawns. Given the chance to improve, they will. I couldn’t agree more. I really cringe when I hear leaders say things like, “People hate change.” No, they hate top-down solutions that are forced on them. Given a chance to identify problems and implement solutions, through a process like Kaizen, they’ll do it and they’ll be quite enthusiastic about it.

shareasimage 2 540x304 Great Steve Jobs Video (& Transcript) from 1990 on Continuous Improvement lean

[9:03] That optimistic humanism I find very appealing. I think we have countless examples that it works.

I love that phrase, “optimistic humanism.” I also have countless examples that this works (as Joe and I have documented in our books). As I was explaining to a client a few weeks ago (the medical chief of a institute in a well-known academic medical center), the reason we practice Kaizen is that we’re OPTIMISTIC that things can be improved and that people are creative. We don’t point out problems just to bitch and moan and complain… we do so because we believe we can make things better.

Interviewer: [9:16] Part of this way that this optimistic humanism is expressed in companies are the things to which the people who control corporations say yes, to requests and recommendations that are made to them. What kind of things are you saying yes to, here at NeXT, as a result of Dr. Juran’s teachings or exposure that you might never have said yes to before?

Steve: [9:40] Your question actually capsulizes what’s wrong. The whole philosophy behind these newer quality approaches is that people shouldn’t have to ask management permission to do something that needs to be approved. Authority should be vested in the people doing the work to improve their own processes, to teach them how to measure them, to understand them, and to improve them.

Amen to the idea that employees shouldn’t have to ask permission. They should have the right to improve their own work processes. This is a core component of the Lean and Kaizen mindsets. We can help people better understand their work (something I do as an outsider by teaching basic Lean principles). We can set goals as leaders, but let employees decide how to measure their progress and decide what improvements to make.

[10:08] And they should not have to ask for permission to improve their processes. A lot of the philosophy behind this quality stuff carries with it a flattening of the traditional hierarchical organization and a distribution of authority, to the people who are best in a position to decide what should happen to improve these processes, the people doing the work themselves. The permission that’s given because of this quality philosophy is the permission to not have to ask permission.

Again, I was really surprised that he said all this. Did his mindset change in the last 20+ years of his life? Was Apple managed like this, at all? Would the 2010 Steve Jobs have been surprised by what 1990 Steve Jobs said?

If you’d like to post a comment, scroll down beyond the transcript:

I had a transcript made from the video, which I’m happy to share below (with emphasis mine).

Full Transcript

Interviewer: [0:01] Steven or Steve?

Steve Jobs: [0:03] Doesn’t matter. Steven P. Jobs is fine. Steve Jobs is fine.

Interviewer: [0:07] And your [inaudible 00:10] ?

Steve: [0:14] President of NeXT Computer, Incorporated.

Interviewer: [0:16] What has your life come into contact with that of Dr. Joseph Juran’s?

Steve: [0:23] At NeXT, we decided to try to figure out what all this ballyhoo about quality was about, so we started looking into a lot of things — came in contact with a lot of people. Dr. Juran was one of the few people that I met that had a real down-to-earth approach to it, that didn’t think that quality was the second coming, but he approached it much more scientifically, and that resonated with the engineers and other technical people here at NeXT, as well as the executives.

[1:09] Dr. Juran’s visited us several times always wearing his characteristic bow tie. We’ve learned a lot from him.

Interviewer: [1:18] What are some of the things that you’ve found most valuable?

Steve: [1:25] The things that we’ve learned most from Dr. Juran are to look at everything as a repetitive process, and to instrument that process, and find out how it’s running. Then start to take it apart and re-put it back together in ways that dramatically improve its effectiveness in a very straight-forward way, no magic, no pep rallies.

[1:49] Just looking things directly in the eye, seeing them as repetitive processes, and re-engineering them. Most of the quality stuff, as I’ve understood it, is really a lot about re-engineering your repetitive processes to make them much, much more effective — combining them, eliminating some, strengthening others.

Interviewer: [2:09] It’s easy to see why broadcasters would want to do a program on Madonna or Arnold Schwarzenegger. Why should the American people be interested in seeing a documentary on this old guy with a bow tie in Dr. Juran?

Steve: [2:38] America’s in a tough spot right now. We’ve forgotten the basics. We’re so prosperous for so long that we took too many things for granted and we forgot how much work it took to actually build and sustain those basic things that were supporting our prosperity. Things like a great education system, things like great industry.

[2:58] We are now faced with relearning those things, going back to the basics and relearning them. That’s why Dr. Juran is so valuable, because he is standing right on the basic heart of the matter of why we are being out-manufactured, why we are being out-planned by Japan.

[3:24] It is not because the Japanese are tricking us, it’s not because the Japanese are better intellectually. It’s because we are being out-planned, we are being out-strategized, we are being out-manufactured. There is nothing that can’t be fixed. But we’re not going to fix it up here. We’re going to fix it by getting back to the basics of what we need to do.

Interviewer: [3:50] There aren’t an awful lot of living legends around these days. When Joseph Juran walked in through these front doors, what struck you about Dr. Juran, the person?

Steve: [4:09] I had an opportunity to meet a few great people in my life and they all have had one characteristic in common, which is that they treat everyone the same, whether it’s the janitor or the president of the company, whether it’s the president of the United States or someone in a rural slum.

[4:30] They treat them exactly the same. If a question is asked, they will directly answer that question to the best of their ability. The look in their eyes is exactly the same and that was certainly true of Dr. Juran.

[4:42] Any question asked was the most important question that could have been asked at that moment as far as Dr. Juran was concerned. The caring and straightforwardness that he expressed toward every individual made a big impression on us.

[4:59] Of course, his awesome knowledge of the subject. But beyond his awesome knowledge of the subject, the way that he viewed people so optimistically that even the most foolish question was addressed with the greatest desire to transmit what he had learned in his life.

Interviewer: [5:19] Everybody now certainly uses quality, whether it’s in the advertising or in internal literature, American flag, Apple Pie, Motherhood [inaudible 05:32] . It’s almost the price of admission in lots of industries.

[5:32] And yet so many corporations, large businesses in particular, have such a hard time getting things moving, seeing results, getting people somehow facing the right direction. What holds them back, do you think?

Steve: [5:47] It’s funny. The group of people that do not use quality in their marketing are the Japanese. You never see them using quality in their marketing. It’s only the American companies that do. And yet if you ask people on the street, which products have the best reputation for quality, they will tell you the Japanese products.

[6:05] Now, why is that? How could that be? The answer is because customers don’t form their opinions on quality from marketing. They don’t form their opinions on quality from who won the Deming Award, or who won the Baldrige Award. They form their opinions on quality from their own experience with the products or the services.

[6:25] One can spend enormous amounts of money on quality. One can win every quality award there is. And yet if your products don’t live up to it, customers will not keep that opinion for long in their minds. So, where we have to start is with our products and our services, not with our marketing department. We need to get back to the basics and go improve our products and services.

[6:50] Now, again, quality isn’t just the product or the service. It’s having the right product. Knowing where the market’s going and having the most innovative products is just as much a part of quality as the quality of the construction of the product when you have it.

[7:08] What we’re seeing is the quality leaders of today have integrated that quality technology well beyond their manufacturing, now going well into their sales and marketing and out as far as they can to touch the customer, and trying to create super-efficient processes back from the customer all the way through to the delivery of the end product so that they can have the most innovative products, understand the customer needs fastest, et cetera, et cetera.

Interviewer: [7:31] You’ve had a remarkable opportunity to do an Act One, an Act Two, maybe there’ll be an Act Three, an Act Four. I’m not sure whether you came into contact with Dr. Juran back in the days of Apple…

Steve: [7:45] No, just at NeXT.

Interviewer: [7:49] What did you do differently at NeXT as a result of having been in contact with Dr. Juran that you didn’t do back in the days of Apple?

Steve: [7:55] In most companies, if you’re new and you ask, “Why is it done this way”? The answer is, “Because that’s the way we do it here,” or “Because that’s the way it’s always been done.” And in my opinion the largest contribution of much of this quality thinking is to approach these ways of doing things, these processes, scientifically, where there is a theory behind why we do them, there is a description of what we do, and most importantly, there is an opportunity to always question what we do.

[8:28] And this is a radically different approach to business processes than the traditional one, “because it’s always done this way.” And that single shift is everything, in my opinion. Because in that shift is a tremendous, optimistic point of view about the people that work in a company. It says, “These people are very smart. They’re not pawns. They’re very smart. And if given the opportunity to change and improve, they will. They will improve the processes if there’s a mechanism for it.”

[9:03] That optimistic humanism I find very appealing. I think we have countless examples that it works.

Interviewer: [9:16] Part of this way that this optimistic humanism is expressed in companies are the things to which the people who control corporations say yes, to requests and recommendations that are made to them. What kind of things are you saying yes to, here at NeXT, as a result of Dr. Juran’s teachings or exposure that you might never have said yes to before?

Steve: [9:40] Your question actually capsulizes what’s wrong. The whole philosophy behind these newer quality approaches is that people shouldn’t have to ask management permission to do something that needs to be approved. Authority should be vested in the people doing the work to improve their own processes, to teach them how to measure them, to understand them, and to improve them.

[10:08] And they should not have to ask for permission to improve their processes. A lot of the philosophy behind this quality stuff carries with it a flattening of the traditional hierarchical organization and a distribution of authority, to the people who are best in a position to decide what should happen to improve these processes, the people doing the work themselves. The permission that’s given because of this quality philosophy is the permission to not have to ask permission.

Interviewer: [10:49] The two quality gurus in America today, who seem to be getting the most press and the most notoriety, are Joe Juran and Dr. Deming. Obviously, you’re familiar with Dr. Deming and the Deming Prize. What do you see as the significant contributions of those men?

Steve: [11:11] I’ve never met Dr. Deming and I’ve never read his books. So, I’m ignorant, I can’t tell you.

Interviewer: [11:15] When you think back, 5 or 10 years, Dr. Juran is going to be gone at some point. All that’s going to be left are his tapes and his books. What are going to be your fondest memories of Dr. Juran?

Steve: [11:37] The thing that strikes me most deeply about Joe Juran is the fact that at his senior age his mind is as alive as anyone I know. He has an energy about him that propels him around the globe on planes, to come visit companies like NeXT, to spend draining days trying to transmit what he’s learned his whole life to people.

[12:08] You ask, why does he do this and where does he get the energy for it? There is clearly something in his heart that’s propelling him. His pocket book’s not what’s propelling him. His heart is propelling him. I have a very deep respect for that thing in his heart that he’s trying to take everything he’s learned in his whole life and teach the next generation, before he can no longer do that.

[12:42] He’s flown out here several times, cross-country, to try to make NeXT the kind of company that he would like to see more of. He will gain nothing from it himself, except to know that his ideas will live on beyond him. I really respect that. I’ve found him to be an incredibly warm individual with something big in his heart.

Interviewer: [13:11] You raise an interesting point, that he treats everyone the same. I don’t know how much private time you spent with him in a lunch or dinner apart from the ceremonial stuff…

Steve: [13:20] A fair bit.

Interviewer: [13:22] You could tell us. What’s Dr. Juran really like?

Steve: [13:26] He has much more of a sense of humor than he lets show when he’s talking to groups, a pretty wicked sense of humor, actually. [laughs] I just imagine, when he was young, he was a pretty wild character.

Interviewer: [13:49] Everyone we’ve spoken to has always alluded to Dr. Juran’s humor. We always say, “Give us an example.” Can you give me an example of the “Juran” humor?

Steve: [13:58] My memory’s not that good. I don’t remember anecdotes and things like that. I remember laughing a lot with him.

Interviewer: [14:04] Last question. Not smart enough to ask you, what, you think, ought to be on a video tape with the life of Joe Juran. Maybe if you don’t say this, nobody else will.

Steve: [14:31] I don’t know. I never visited him at his home. You learn a lot by doing that. I never met his wife, and you learn a lot by meeting someone’s family. Joe Juran is clearly a person that spent his life on one thing. He found his great subject early in life and he pursued it over decades. He’s made a deep contribution that will last well beyond his physical years. Like most people that do that, there is, below the surface, great sacrifices they’ve made to do that.

[15:33] In some cases with their family, in some cases with a lot of other things they might have wanted to do with their lives. I don’t think Joe Juran would be an exception, as a matter of fact I think he would follow that. I imagine that if one scratches the surface a little bit, one will find some sacrifices in his life that he’s made. Follow the pure path that he has that most people don’t see. Then, maybe, you have a chance to explore. I don’t know them myself. You can sense that they’re there.

Interviewer: [16:15] Actually, that one was not the last question. You suggested something. Clearly like Joe Juran, your life has been focused with a like passion. You have seen that passion fulfilled and you’ve seen promise realized, quite early.

[16:32] When you think back, Joe Juran’s early success was certainly in Japan, well in the late ’50s, I think 50-54, and yet it has taken literally 30 to 40 years before America has come around to giving Joe Juran the recognition that he really does deserve, in his teachings and his philosophies. What do you think it is in Joe Juran that has sustained him for 30 to 40 years, where those audiences were not so willing to listen?

Steve: [17:00] That’s a very good question. Most people that are able to make a sustained contribution over time, rather than just a peak, are very internally driven. You have to be. Because, in the ebb and tide of people’s opinions and of fads, there are going to be times when you are criticized, and criticism is very difficult. When you’re criticized, you learn to pull back a little and listen to your own drummer.

[17:32] To some extent, that isolates you from the praise if you eventually get it, too. The praise becomes a little less important to you and the criticism becomes a little less important to you, in the same measure. You become more internally driven. Joe Juran has, clearly, had those experiences and become very internally driven. I think he felt the bedrock of the truth of his pursuits. That’s what kept him going. I think that the great satisfaction that he got from Japan did not end in the ’50s.

[18:15] He probably looks at Japan as something that he helped nurture along, and as every decade has passed, he sees his ideas blossoming even more. I’m sure he gets tremendous satisfaction from having injected a very important ingredient into the early, post-war culture of Japan, and he probably sees that in every branch and leaf of a fairly large tree.

[18:39] What he’s trying to do now is to make sure that he gets that into the future culture of American industry as it rebuilds itself. If he is successful, which I think he is on the verge of being, that in his last breath he will feel comfortable knowing in the decades to come that his work will get recognition.

Interviewer: [19:06] As we say, thank you, Mr. President.

Steve: [19:09] OK.

[19:10] [background conversation]

[19:17] [cuts off]


Mark Graban 2011 Smaller Great Steve Jobs Video (& Transcript) from 1990 on Continuous Improvement leanAbout 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 VP of Innovation and Improvement Services for KaiNexus.


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morrie rath chicago al baseball  loc 150x150 Learning Not to Blame: Baseball Edition leanFollowing up my post about not blaming a bartender, here’s another look at learning to cast aside our old habit of blaming individuals… this time, baseball related.

Modern organizations (in healthcare and business) tend to blame an individual when something goes wrong. It’s commonplace in our societies and it’s, basically, human nature to blame. But, Lean and the Toyota Production System teaches us to NOT blame individuals and to, instead, look at the system. Dr. Deming, who influenced Toyota greatly, said that 94% of problems are due to the system. The exact percentage is unknowable, but the point is to not jump to blame.

So what happened in Major League Baseball last week?

Texas Rangers Fans

Fans of the Texas Rangers (or maybe, more broadly, attendees of the Rangers’ opening day game) were accused of being thoughtless jerks for littering and piling up beer cans around a statue that was placed outside the stadium honor a fan who died when he tragically fell from the stands a few seasons ago.

See below and click on the image below for the full photo and article.

Screen Shot 2014 04 05 at 9.51.17 AM Learning Not to Blame: Baseball Edition lean

A number of tweets were sent around that blamed the fans for being “disgusting” and “not having common courtesy” as if they were intentionally dishonoring the man who fell.

We could write off people as being jerks, or we could think about the system they’re a part of. What are some of the factors:

  1. Beers inside the stadium are very expensive (which probably drives people to drink outside before the game, whether they should or not)
  2. As some people stated in online comments, there weren’t enough trash cans outside the stadium (because people aren’t supposed to be drinking that much outside and there are security concerns about bombs that lead to trash cans being scarce)

So, do we blame the team for charging high prices for beer (they probably should, to help reduce drinking and driving)?

Do we blame the terrorists?

Do we blame overreactions to terrorist threats, such as removing trash cans?

I don’t think I’m “making excuses for people,” if you want to call it that.

I’m just trying to exercise that part of my brain that asks, “What are possible systemic causes?” instead of just asking “Why are people such jerks?” I’m not there in Arlington, so I can’t “go to the gemba” (the actual place) to investigate first hand… but I think asking questions can be a good start. Maybe I can ask my friend and fellow blogger/podcaster Ron Pereira, who is local and a Rangers’ fan, to check this out. Are there enough trash cans outside the ballpark?

When we make it easy for people to do the right thing, it tends to happen. Hospitals love to lecture staff about washing their hands, but the gel or foam dispensers in the hallways are empty far too often. Do we blame the people or understand the system so we can fix it?

Would another set of fans, put in the same situation, do the same thing (leaving trash around)? If so, it’s likely a systemic problem (and I’ll choose to not blame society).

Cubs Outfielder Junior Lake

I long for the simple days when baseball teams had TWO uniforms – home whites and road greys… sort of like my hometown Detroit Tigers still wear today.  Nowadays, teams have dark jersey tops, alternate uniforms, throwback hats, etc. There are many combinations that a team might wear throughout the season.

The different uniform combinations are a mistake waiting to happen.

And it happened this week (click on  the photo for an ESPN story). Junior Lake, at left, wore the wrong road jersey to start the day (the correct jersey is shown at right).

Screen Shot 2014 04 05 at 10.12.00 AM Learning Not to Blame: Baseball Edition lean

 

It’s easy for broadcasters and fans to pick on Lake for “his mistake.” You can hear the blaming in the headlines, articles, and tweets… “Junior Lake’s Jersey Snafu,” his “mistake,” etc.

Was it Lake’s fault? Did he pack incorrectly for the trip? Of course not. His job is to focus on baseball. The team has a support staff who is supposed to take care of this — a system.

After the Pirates’ final out in the bottom of the first inning, Lake immediately went into the clubhouse to change. He said he got confused because both jerseys were hanging in his locker, and he chose the wrong one.

You could ask, “How hard is it to pick the right one?” but I could ask, “Why would you hang two different jerseys in a locker?”

This isn’t Junior Lake’s fault. This was a systemic error.

Why did they even have the wrong uniform with them that day? According to Paul Lukas and Uni-Watch.com:

I posed that question to a Cubs PR rep, who got back to me with the following: “We had both uniforms packed, since each day’s starting pitcher may decide which uniform the team wears while on the road.” So there you go.

Would you blame a nurse for grabbing the wrong medication out of a drawer, when the med wasn’t even supposed to be there and when the support system failed to put the right thing in the right place? Hospitals do this all the time and it’s not fair to the people working in the system.

Good factories, like Toyota, have great systems in place to make sure the right part gets to the right place at the right time. Hospitals (and baseball teams, apparently), not so much.

Would another nurse (or another player) make the same mistake in the same situation? If so, it’s a systemic problem.

Multiple nurses gave the wrong medication to the Quaid twins over the course of a day. That screams “system problem” to me.

Other players have worn the wrong jersey before (including last year). System problem! I agree with Lukas’ assessment that this will happen again, since the Cubs have 13 different uniform combinations.

How can we shift organizations away from blaming individuals? We can probably start by looking in the mirror. I try to be better about it myself. Maybe we can all try to set that good example — look for the system problem, not the individual problem.


Mark Graban 2011 Smaller Learning Not to Blame: Baseball Edition leanAbout 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 VP of Innovation and Improvement Services for KaiNexus.


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