Weekend Fun Blog

It's the weekend, here's a fun post and links for you. The "FAIL" blog is somewhat addictive, a collection of funny signs and bad product designs.

Muffin Fail « FAIL Blog

Here's a "chocolate chip" muffin where the design was taken quite literally. I assume the design spec from marketing didn't say "one chip."

Pastry Design Fail « FAIL Blog

Apparently, the above was a phone order that was taken a bit too literally, as well. Funny stuff...

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A Powerful Message on Lean and Healthcare

Why I Work In Healthcare | DailyKaizen

Here's a great one to end the day on... Lee Fried has a powerful post over on the DailyKaizen blog. Some unfortunately heartache for him and his family, but an important reminder of why this stuff is so important (and why Lean is so powerful in helping).

Go to his site to read the whole post and the story behind it, but he's spot on about this (and everything he wrote, actually). Lee said:

I often find myself debating with people within my industry whether standard work can be applied to patient care. I often hear back that it does not apply because ”no two patients are the same” or “healthcare is far too complex for standard work” to work. This argument is frustrating and we need to find ways to put to rest. I am sure that every industry has heard the same exact argument about why standard processes can not be applied in their field. I was telling my neighbor about what happened and he confirmed that in his industry (aerospace) twenty years ago it was the same story. “Airplanes are far to complex to be built by standard processes.”

Yes, let's put the argument to rest. Lean *does* work in healthcare. Standardized Work is saving lives in many ways, including "checklists." We need more of this in healthcare and fewer obstacles.

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Chrysler matches Toyota in a Single Skew-able Metric - Who Cares?

Chrysler matches Toyota in efficiency - Detroit News

I didn't mean for this to become "beat up on the Detroit Three" week... this comes in waves. If you don't like these posts, my short-term focus on the auto industry will probably subside for a few months again.

Chrysler is crowing about efficiency gains -- matching Toyota. That may be true if you're looking at a single narrow metric -- direct labor hours per vehicle. This metric isn't a proxy for a company's overall financial performance, as the long-term profit and outlook gap between Chrysler and Toyota is huge.

Hours per vehicle (or hour per anything) is easily skewed. You can add automation (which might cost more) or you can outsource work to vendors, so it doesn't count. Don't get me wrong, efficiency is important, but it's not worth fixating on any single metric. You can improve hours per vehicle in positive ways -- by designing the cars so they can be built easier or through shopfloor "kaizen" efforts.

Chrysler LLC tied Toyota Motor Corp. as the most efficient automaker in North America, while General Motors Corp. and Ford Motor Co. joined in virtually erasing the productivity gap between Detroit's Big Three automakers and their Asian rivals, according to the 2008 Harbour Report North America.

Matching Toyota's vaunted manufacturing efficiency stands in paradox to another report released this week showing Chrysler lagged the industry for initial quality -- even as Ford and GM made progress in that regard against Japanese companies.

That's why I would give the labor productivity news a big "Who Cares?" as a response. If Chrysler was doing so well with Lean (or the Chrysler Operating System), quality AND productivity would be improving together.

Chrysler says it's already rolled out quality-improvement initiatives so it can match its productivity gains. All three Detroit automakers are challenged to produce their vehicles in North America profitably -- something none achieved in 2007.

The fact that Chrysler focused on productivity and THEN rolled out quality initiatives... that seems like a bad sign. When I was at GM, circa 1996, we had a new NUMMI-trained plant manager. Our factory was at the bottom of the barrel, among powertrain parts makers, of productivity AND quality.

As a somewhat naive engineer, I asked the plant manager in a group meeting, "Which are we going to be focusing on first, quality or productivity??"

He answered in a very patient manner, "You can't separate the two. We'll be improving quality AND productivity. They go hand in hand. Safety, Quality, Delivery, Cost, you improve them all with these [Lean] methods."

I put "Lean" in brackets since that was a dirty word in GM at the time. We had to call it "competitive manufacturing" and we certainly couldn't call it TPS.

It's a shame Chrysler wasn't simultaneously catching up to Toyota's quality levels while they made isolated productivity gains.

I also want to point out what Kevin Meyer wrote on this topic.

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GM to try to Inspect Quality In After Letting Experience Walk Out the Door

GM preps for new hires after buyouts

This is a particularly sad story. We often debate the proper role of layoffs and headcount reductions in the Lean community. It's "conventional wisdom" perhaps in the Lean movement that we should not let efficiency improvements that result from Lean methods lead to layoffs. To do so would undercut the employee participation that is required for Lean (and an organization) to be successful in the long run.

Many consider it to be a different story if the business is shrinking because of a declining market or declining market share - case in point, General Motors. At a high level, GM's leadership has a responsibility to prevent decline -- through product design, marketing, and general management of the whole enterprise. Toyota claims to have not laid off employees in 50 years. This is partly due to continually being in a growth mode rather than constantly shrinking.

This most recent article about GM paints a different picture. GM is not just shrinking the workforce. They are throwing out older, more expensive workers to be replaced by newer, less expensive ones. This is not "Lean." This is not in keeping with the "respect for people" principle of the Toyota Production System.

Some 19,000 GM hourly employees are leaving as part of the labor deal GM negotiated with the United Auto Workers last year that allows the company to replace departing workers with lower-paid new hires. Most are slated to leave July 1.

That's 19,000 individuals with skills, knowledge, and experience. If GM views them merely as a back and a set of hands, then shame on GM. They might defend the decision by saying, "Someone paid $14 can just as easily turn a wrench as somebody making twice as much." What about the accumulated experience and problem solving abilities that should be there in the older employees? I guess that never was valued much??

Don't they realize the impact this mass exodus could have on quality? Oh wait, they do:

The biggest challenge for GM may be accomplishing the massive undertaking without compromising the quality of its cars and trucks. Having begun to win new respectability on the quality front, the automaker can't afford costly and reputation-marring mistakes on the factory floor, which is a risk when there is significant turnover.

"We are very intensely focused on making sure our quality isn't compromised," said Joe Mazzeo, GM's executive director of manufacturing quality. "Our customers don't know this is going on, and they don't care."

As with many business decisions, such as outsourcing or offshoring, the "savings" or "benefit" from such a move is easy to calculate. It's easy to calculate the savings from paying workers $14/hour instead of $28/hour, even considering the buyouts and "go away" payments to departing workers. But the COSTS are much less easily quantified. What is the cost of poor quality? What is the cost of poor morale, of either having to work alongside a new junior employee who makes an embarrassing low wage or the low morale of a new employee who resents the older employees who make twice as much for the same job?

How does GM plan to maintain quality? Sure, the new employees will be trained, they won't just be thrown into jobs.

Also, in an unusual step, GM will carry out quality checks of every vehicle headed off the factory floor during the initial transition. Typically, vehicles are picked at random for the checks.

The people at GM must have listened to Dr. Deming a little bit. They MUST know that you can't "inspect quality in" to a product. The need to increase inspection adds cost and must be an acknowledgment that they KNOW quality will suffer. They won't be able to catch all of the defects. The customer will notice. GM says their customers don't know this is going on. Um, maybe try to avoid being quoted in a newspaper article about how this is happening. Readers of this blog know it is happening. Tell your friends.

I doubt we'll see loads of books and Harvard Business School publications about the "General Motors Method" of throwing out expensive employees and replacing them with cheaper ones. Or maybe it's already called the "Circuit City Method." Ford has been doing the same thing, as have other auto suppliers. It's the standard playbook anymore, unless you're Toyota or a truly Lean company.

Step 1: Fire expensive employees. Step 2: Hire cheaper ones. Step 3: Profit. Oh wait, both companies are still struggling.

Can the GM leaders be thrown out and replaced with newer, cheaper executives?

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Funny Clip from "The Office"

In "The Office" season finale, there was a funny bit where the employee Creed, is asked by the new HR manager what he does there. The response is pretty funny, as he tries to remember exactly.... "I should have written it down" and he tries to remember.... "something that starts with Qual."

Creed was listed as "Quality Assurance" on an org chart earlier this season. The character has his own blog, which itself is an offshoot of a joke from an earlier season where Jim set up a Word document that he said was a blog, with a nonsensical web address.

You can watch the whole episode at www.hulu.com.

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The Risks of A Long Supply Chain

A Crushing Issue: How to Destroy Brand-New Cars - WSJ.com

While this is a story about Mazda shipping cars from Japan (a location where Toyota still makes many U.S.-bound cars, even with their North American expansion), it might give you pause if you're chasing cheap labor in China or Vietnam.



Have you fully considered the supply chain costs, not only in inventory but in the increased risk of product being damaged in transport?

I'll give Mazda credit for not letting these cars become the equivalent of dollar store castoff products -- the legal risks were too high. You could argue they valued quality and potential customer risk over the financial loss involved in just destroying the cars. I assume they had insurance (yes, this is confirmed in the WSJ print article). It's a pretty rare occurrence, but still something to be concerned about, when compared to producing locally.

Reading the article, there was quite a bit of creativity and "kaizen" required in the disassembly process. Hopefully, this is a big job they only have to do once.

But the circle of international freight continues:

"... metal shards -- most no bigger than an ashtray -- sprinkle onto a mountain of scrap near Schnitzer's dock. There, a freighter prepares to take the scrap back to Asia where it will get recycled.

Mr. Wilson looks on and concludes: "It'll all probably end up coming back as cars."

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Dennis Quaid on 60 Minutes

Dennis Quaid Recounts Twins' Drug Ordeal, Actor Tells 60 Minutes' Steve Kroft Medical Errors Kill Thousands - CBS News

Did you see the actor Dennis Quaid on 60 Minutes last week? He talked about the sad case where his twin babies were mistakenly overdosed TWICE at Cedar-Sinai Hospital in Los Angeles.

His babies are recovered now, thankfully. The silver lining on the sad case is that Quaid, as an actor and celebrity can become a powerful voice and advocate for patient safety and preventing systemic errors - highlighting the problem AND suggesting countermeasures and systemic fixes.

As Quaid recounted the story, he first seemed to blame the nurse: "The nurse didn't bother to look" at the dose (the correct dose, on the right, and the incorrect dose are both pictured here). Later, he mentioned, correctly, that a series of errors had occurred. As I've said before, it's too simplistic to just blame or punish a single person when an error like this occurs. That approach certainly doesn't help prevent other such errors.

He said the babies had been given TWO massive overdoses in an 8-hour period "that we know of," he said -- again, the signs that there's suspicion of a cover-up. It also highlights what a systemic error this is, that it could happen twice in the same hospital. It was a chain of errors that occurred. First, someone in the pharmacy picked the wrong dose. Secondly, a pharmacist is supposed to double-check any medications that leave the pharmacy (an inspection step). That's two people who are supposed to "bother" to look at the label. Then, there's the person who delivers the medication to the ICU. Finally, the nurse is the last in that chain. But, the nurse isn't expecting that the adult dose of Heparin is even there in a neonatal unit. So, pretty easy to let your guard down, right? I don't think that's an excuse, that's just reality.

Quaid was right to say the errors were "avoidable" -- pointing out it was the same avoidable errors as the case where three babies died at Methodist in Indianapolis.

Quaid has become pretty obsessed with researching the topic (he was shown on the computer, maybe he's been on this blog?) and discovered the errors happen "everywhere." He cited the "100,000 deaths a year" number (which comes from the late 90's study from the Institute of Medicine. Quaid said, "This is bigger than AIDS, bigger than breast cancer... yet nobody seems to be really aware of the problem." I'm glad Quaid is trying to spread the word and to help others.

There was a lot of talking about the old labeling being too similar across the two bottles. The new label (pictured on the right) is better because it's not just a different shade of blue and it requires a different motion (tearing off a paper cover) that is not required for the smaller Hep-Lock dose that is intended for babies.

The old stock (the old, more mistakable labels) was NOT recalled. Cedar-Sinai was using up their old stock first (sure, it was "FIFO" or First-In-First-Out, something Lean folks generally like), but that shouldn't have been the case when safety was at risk. What responsibility does hospital administration take for this materials decision?

The maker of the drugs, Baxter, had a spokesperson on 60 Minutes who reminded us that people were supposed to read the label (again, casting blame), even though the labels had been mistaken many times before by other nurses in other hospitals. But they redesigned the labels after earlier incidents. It was not necessary to recall, 60 Minutes asked? The Baxter spokesperson said "No, the drugs were safe" and that it was due to preventable errors in the hospital's system.

The CEO of Cedar-Sinai admits it was human error, preventable error. The CEO said "you need backup systems" and CBS's Steve Kroft asked, "but you had backup systems, you had three people." How many more backups can you add? More inspections and more backups isn't necessarily more effective due to, here it is again, "human error" in inspection. When many people are checking something, it's human nature to let your guard down because the "other person" will get it.

So what is my advice? Hospitals need to bee proactive, with this and other known risks. Leaders need to manage the process, not just reacting after bad results. If you're in a similar hospital setting, are YOUR people double-checking the medications? Are you spot checking this to see if it's really the case? There was "standardized work" (the Lean term, the hospital probably called it "policy") in place to double check the medications, but administration took their eye off the ball (if it was ever on there). We need to move from "policies" (which are never "policed") to a "standardized work system" where supervisors and leaders are working WITH their employees, checking to see if key processes are being followed, BEFORE harm occurs.

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Turn the Tables on Haier Management?

Chinese Refrigerator Maker Finds U.S. Chilly - WSJ.com:

Here's another case of where your bosses should NOT take manufacturing management practices from the WSJ. In an article about the Chinese refrigerator maker Haier and its founder, Zhang Ruimin:

"He developed a management system of strict discipline, with a strong emphasis on quality control. Workers in China who make mistakes must stand on a set of footprints outlined on the floor and publicly criticize themselves out loud, explaining why they erred and the lessons learned."

I think we should turn the tables and ask Mr. Zhang to stand on the metaphorical footprints of this blog... why would a quality "control" program like this likely do little to actually improve quality? Nobody is implying that Haier uses the Lean approach - it actually sounds very far from Lean.

Not surprisingly, this approach hasn't gone over well in their South Carolina factory:

But Haier's hierarchical culture has been a tough fit with U.S. workers. They rebelled against being forced to stand in the footprints when they made mistakes. Haier's Chinese management has tried to adjust to American tastes. Instead of humiliating bad workers, they now encourage the best ones to stand in the footprints for recognition.

When you click on the pictures for the article, you get some further explanation:

Since the plant oppened in 2000, the American workers rebelled against the "big shoe" footprints, and even rejected Haier's plan to force the best -- not the worst -- workers to stand in the footprints.

That's just silly, either way. You don't humiliate and shame people into better quality. Making them stand there as "recognition" doesn't seem to serve much of a purpose, either.

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Lean *is* About Quality, Folks

Time for a low-carb Lean Six Sigma?:

Stuff like this irritates me to no end:

"Lean Manufacturing has us analyzing process flow and delay times at each activity within a process. And while Lean Manufacturing principles help speed things up, they don't really focus on quality control. Think of it as 'improving process speed.'"

It's a huge pet peeve of mine when people create the dichotomy that "Lean is about speed and Six Sigma is about quality." Hogwash.

Lean and the Toyota Production System are primarily quality-focused systems. Lean and TPS are focused on the waste of defects and rework and the methodology gives approaches for preventing errors and improving quality (poka yoke).

The "Toyota House" diagram's two pillars are Just-In-Time (flow and speed) and Jidoka (quality at the source). The two ideas are connected -- improving flow (in itself) ends up improving quality and improving quality improves flow.

If you hear someone say "Lean isn't about quality," it's tempting to tune them out as they don't know what they're talking about. Have some people implemented something they called "lean" in an environment that didn't care about quailty? Sure -- but that's not an indictment of the Toyota Production System.

The author I linked to DOES make some good points on a related topic about how you can't just rely on measurements. Deming made this point, that sometimes the important things CANNOT be measured (as opposed to the common misquoting of Deming supposedly saying "You can't manage what you can't measure." It's a good point that I don't often see made... but I almost quit reading when I read the false statement that unfairly characterized Lean.

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The Feds Reverse Their Decision on Checklists!

Wachter's World : The Checklist Saga: Victory!

This is great news for patients and is probably great news for those of you who have been following the "checklists" saga. The federal government has reversed its earlier decision to shutdown the Michigan hospital checklist usage, recognizing that quality improvement protocols are NOT the same as experimenting with a new drug.

For those of you catching up on this story, here's my original blog post about the use of checklists at Johns Hopkins and the follow up about the government putting a stop to the program.

“We do not want to stand in the way of quality improvement activities that pose minimal risks to subjects,” said Dr. Ivor Pritchard, acting director of OHRP. “HHS regulations provide great flexibility and should not have inhibited this activity. The regulations are designed to protect human subjects.”

The Johns Hopkins study demonstrated that a comprehensive five-step program can dramatically reduce the incidence of catheter-borne infections in ICUs. HHS strongly encourages hospitals nationwide to adopt the program, which can save thousands of lives and millions of dollars each year.

OHRP noted that the Johns Hopkins project has evolved to the point where the intervention, including the checklist, is now being used at certain Michigan hospitals solely for clinical purposes, not medical research or experimentation. Consequently, the regulations that govern human subjects research no longer apply and neither Johns Hopkins nor the Michigan hospitals need the approval of an institutional review board (IRB) to conduct the current phase of the project.

Bob Wachter, in his blog post (hat tip to him for breaking this update to the story and kudos to him for writing such informative and passionate posts on the subject), wrote:

The prior OHRP decision, if left standing, could have mandated regulatory approval and the need to obtain patient and provider consent every time one wanted to improve a process and measure its impact.

The one thing that bugged me about the prior OHRP ruling... the hospitals were measuring the impact of the checklists (an important part of the Plan-Do-Check-Act cycle), therefore it became research? So it would have been OK if the hospital were just using the checklist without measuring the impact? Seems a bit irresponsible. But what is really more irresponsible is a hospital NOT using checklists (or standardized work) to ensure consistent care and patient safety.

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Hospital Safety, Quality and Advertising

I was wondering the other day about hospital advertising that you might see in your community (TV ads, billboards, newspaper ads). With the focus on improving quality and patient safety, is there a hospital somewhere that is advertising itself as a "safer" or "better quality" option? I don't mean advertising that their doctors are highly skilled or "the best." That's different than the quality provided through hospitals processes and systems, the operational aspect as opposed to the clinical/medical aspect.

There are hospitals that advertise their efficiency differences (zero waiting or short waits for emergency room treatment). Product companies, including automakers, are often touting quality (Toyota or new GM ads) or safety (Volvo) in their advertisements.

Has anyone seen a hospital using quality or safety performance as a way of attracting patients? Click comments if you have an example to share. Would hospitals accept this? Is it risky to admit that quality hasn't been perfect all along? Would hospitals find it distasteful to point out that competing hospitals in the community are less safe? I'm curious to see what happens are more quality metrics are made public, through voluntary efforts or government requirements.

I just got a postcard ad in the mail today from a hospital that touted they are:

• "leading" (based on what??)
• "board-certified physicians" (that seems like a good starting point)
• "acclaimed" (by who?) and "recognized" (another fairly empty word)
• "providing exceptional care"
  

I realized it is just a postcard, but there wasn't anything really specific there. I suspect, again, that they are referring to the quality of their physicians as opposed to the quality of their processes.

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Putting the Burden on Patients?

I saw this ad (click on the photo for a larger, readable view) in the Wall Street Journal Monday. It's an ad run by a patient advocacy organization called "RID" (Reduce Infection Deaths).

The headline is "15 Steps You Can Take to Reduce Your Risk of Getting an Hospital Infection."

It's good to make patients aware about safety risks and reasonable precautions they can take to look out for their own safety. However, it's a crying shame that it comes to this... why aren't hospitals being more responsible?

The tips basically put the burden on the shoulders of patients to "inspect" their doctor's work or to tell them what to do, including:

1) Ask that hospital staff clean their hands before treating you

2) Before your doctor uses a stethoscope, ask that the diaphragm (the flat surface) be wiped with alcohol.

9) Ask your doctor about keeping you warm during surgery.

14) If you must have an IV, make sure that it's inserted and removed under clean conditions and changed every 3 to 4 days.

This is ridiculous. Maybe the burden for cleaning the "thingy "on the "doohickey" around the doctor's neck that checks your ticker should be placed on someone who knows what the diaphragm is on the stethoscope without parenthetical explanations.

Do we see this need in other industries? The need to put the burden of safety on the customer?

I can just see it now:

15 Steps You Can Take to Reduce Your Risk of Your Plane Crashing, including:

1. Carry a handheld Breathalyzer and ask your pilot to blow into it before takeoff.
2. Ask to see your airline's maintenance records

15 Steps You Can Take to Reduce Your Risk of Your New Car Having Defects, including:

1. Have the dealer triple check that the wheels' lug nuts have been tightened properly
2. Ask to see the Statistical Process Control charts that verify that your engine's cylinder bore diameters are within design tolerances.
   

15 Steps You Can Take to Reduce Your Risk of Your New PC Failing, including:

1. Make an unannounced trip to the factory and ask that PC assembly operators are wearing proper static-protection wrist bands.
2. Ensure that the bands and their grounding are properly grounded (press the button labeled "test" on the workstation)
   

Asking patients to track such details, expecting THEM to know how often an IV should be changed is an outrage. Hospitals and physicians, please quit abdicating your patient safety responsibilities onto the patients. If hospitals were following "standardized work" practices, we wouldn't have to make patients worry about and track issues like this themselves.

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Duct Taping the Dreamliner

Flightblogger: Temporary Fasteners Causing Major Problems for 787 Program

Ok, so Boeing isn't using duct tape in their efforts to cobble together the first Dreamliner plane. But, this blog report I've linked to says they were using:

"... over-the-counter parts and prevented assembly teams from being able to document the location of these temporary fasteners on the first 787."

Why wouldn't you want to follow the Lean concept of "building it right the first time?" Boeing proclaims to be a "Lean" company, although that has been fiercely debated here and on other blogs. It seems like management might have been pushing people to hit a deadline for rolling out the first plane (a ceremonial event, right?).

Remember what Deming said about mandating quotas and targets. Does this rob people of their joy in work? Does it rob them of their right to feel good about doing quality work?

As a result of supply chain problems, the proper fasteners weren't available. To this simpleton, it seems like you might 1) delay the plane build and 2) fix the supply chain. But no, there's too much money at stake to admit a delay or a problem (of course, how much money is involved with the liability of "forgetting" to replace a temporary part with a real one?).

"Flightblogger has learned that many of the temporary fasteners, which were painted red and installed in place of flightworthy parts, were purchased from run-of-the-mill chain hardware stores, including Home Depot and Ace Hardware."

Look at all of the extra non-value added work this has created as a result:

"As a result, Boeing must now comb through the aircraft to locate, document and replace all of the temporary fasteners to prevent a single non-flightworthy fastener from flying."

They're going to be inspecting in quality, eh? Do you trust that they will find every single fastener with 100% certainty?

Quality is also impacted even if all of the temporary fasteners are replaced:

"The second is the challenge in physically replacing the parts. “Composite only like fasteners installed once,” according to one source working directly with the aircraft.

When it came time to install flightworthy fasteners, the removal of the temporary fasteners damaged some of the composite parts of the aircraft causing time-consuming repair."

So which executives are getting their bonuses because the first plane was, technically speaking, rolled out on time??

Am I being too cynical? Somebody who knows more about airplane manufacturing, please chime in. I'm just a frequent passenger and stuff like this sure worries me. How should we view this from a Lean perspective? Click "comments" to participate.

Update: The first flight is going to be delayed, partly due to the fastener issues. MSNBC story.

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The Bloodbath to Come

by Mike Lopez

All these lead paint toy scandals are only the beginning. On July 12, 2007, Businessweek ran a story, "Made in China: Faulty Tires." This story foreshadowed the bloodbath to come. For every scandal, we can expect several high profile lawsuits to follow. On this blog, we've been talking about how American businesses encouraged the bad system that allowed for all these scandals to happen and keep happening. It is a good thing our legal system sucks, too. These businesses are now about to feel the pain of a predatory system that loves to take advantage of scandals for profit. In fact, it looks like it has already begun:

1. Mattel hit with lead paint class action suit
2. Couple files suit over lead in toys
3. Toy Lawsuits Push Debate

I'm not even going to mention the many, many toy lawsuit websites that have been thrown up by ambulance chaser law firms trying to score a buck off these recalls. Personally, I'm really torn. I don't know who to root for. The business that messed up and poisoned my kid with lead or the predatory lawyers that are going to steal millions from these companies. I guess there is no one to celebrate in this case. Waste begets waste begets waste. If only someone had the decency to do the right thing in the first place, we'd be spending our money on food instead of lead detector kits. I guess Enron and Worldcom really didn't teach us anything. How about a new blog label called, "Stupid?"

No, Not Spongebob!!

LEAD SINKS SPONGEBOB CHINA GOODS

Sung to the TV theme... parody words by Mark Graban

"Who's covered in lead and lives under the sea?
Spongebob! Squarepants!

Whose China-made goods may endanger your kids?
Spongebob! Squarepants!

If dangerous journals be something you wish
Spongebob! Squarepants!

Then source it from China along with dangerous fish
Spongebob! Squarepants!

China Lead Paint! China Lead Paint! China Lead Paint!

China.... Lead Paint!

More quality problems, when will it end?

Since reports that some Chinese products are unsafe, China has defended the quality of its exports and pledged to improve controls.

American business leaders and importers also need to take responsibility, as this cartoon explains.

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The Roots of Lean

by Mike Lopez

Today and tomorrow, I have the pleasure of taking part in a Lean Six Sigma summit being hosted by our corporation. One of today's presenters was Mike Micklewright. He posed many challenging and introspective questions to our lean champions. One of his best points was that lean is not about copying Toyota and rolling out a set of cookie-cutter tools. He suggested that the roots of lean lie in three fundamental principles:

1. Elimination of waste
2. Focus on cashflow
3. Respect for people

From these three principles, Toyota systematically invented the lean system that we hold in high regard today. Although the three principles are debatable, I like the point of his thinking.

He talked a bit about how American companies used to embrace TQM, then moved to Six Sigma. He mentioned that Toyota started on this journey several decades ago. It occurred to me that there is a fundamental difference between the American experience and the Toyota experience. In the Toyota experience, they learned a basic attitude from Ford, Deming, Juran, and others. With this attitude, they continuously used basic principles to invent customized solutions for unique problems. Over decades, they continuously labored to perfect and systemize their countermeasures.

In the U.S. experience, we saw TQM, QFD, Six Sigma, and Lean roll out in our corporations as systemized best practices of leading companies. These systemized "best in class" practices consist of toolsets supported by underlying principles. Is there a big difference between TQM, QFD, Six Sigma, and Lean? Personally, I don't think so. The underlying principles all came from Ford, Deming, and Juran. The problem is each generation of "innovators" that has stamped his or her copyrighted brand onto quality has also added tools and slightly different language to help sell a new movement. Rather than build on the fundamentals (like Toyota does), we have been relearning everything over and over again. Sounds like waste to me. If only we could embrace something and commit to it for decades, we would have plenty of U.S. companies that are just like Toyota right now.

My two questions to blog readers:

1. Are there presently any U.S. companies out there with successful "home grown" quality programs built on fundamentals?

2.What do you consider to be the three or four fundamental principles of lean and quality?

Today's Editorial Cartoon

From today's USA Today, on the heels of the recent bad quality from China news, which includes:

• Baby bibs with lead found at Wal-Mart
• Tainted seafood
• "Chemical pajamas"
  

Anyway, click on the cartoon for a larger view. Maybe we need to try harder to understand the context and the complexity of China before criticizing?

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Management's Job is to be Proactive

Running a hospital: Our Joint Commission Report

The headline is my modification of a Deming expression, that management's job is prediction. Statistical process control was one way of predicting future outcomes of a process (if you have a statistically stable process, you can predict that tomorrow will be like today). Management also has to be proactive in terms of anticipating potential quality or safety problems. That's one reason management must go to the "gemba" (or "actual place") and it's a reason why they must audit standard work and safety practices on a regular basis.

The blog I've linked to above is an interesting one, written by Paul Levy, the CEO of a major Boston Hospital (Beth Israel Deaconess Medical Center). He's very open in his discussion of hospital management issues, which is very admirable and unique. In the linked post, he writes about the hospital's recent "Joint Commission" inspection and links to the full report. Again, very admirable. I'm not sure if any other hospitals are doing this. Levy and BIDMC obviously mean well and want to improve their quality and their accountability to the public. Again, hooray for that.

Since many of you reading this are from the manufacturing world, I think the best parallel to the Joint Commission is to think about ISO9000, a quality "certification" of sorts that's been mocked in the Dilbert cartoon. The problem with ISO9000 is that getting certified is often NOT a predictor of good quality. That's not just me saying that, although my own personal experience bears that out. 'A factory can document poor processes and still get certified if they follow those processes and still have poor quality. Future LeanBlog Podcast guest John Seddon wrote a whole book debunking ISO9000.

The Joint Commission has its critics also, as this story about Mass General Hospital (also in Boston) shows. Inspectors found numerous quality and safety problems, yet the hospital was still going to have its certification renewed. Quality and procedural problems included:

"...staff neglecting to wash their hands before and after caring for patients; medical records lacking dates and times; and patients on pain medication for whom caregivers had not recorded whether their pain had improved.

Why beat up on MGH for a problem that plagues most hospitals (poor handwashing, something I've written about before and something David Mann commented on)? Ok, sorry, that was sarcasm. What does the Joint Commission prize guarantee to you, the patient? It's not a guarantee that caregivers are going to wash their hands!!! Maybe it's a certification that says they're trying hard or that they care, but that's not enough.

There's more criticism of the Joint Commission in the August 6 issue of "Modern Healthcare" magazine. John Toussaint, CEO of ThedaCare, a leading example of Lean healthcare, criticized them by saying:

"... the Joint Commission's hospital accreditation criteria falls short of what's needed to ensure safe, quality healthcare."

So back to BIDMC, what problems were found in their Joint Commission report?

Problems included:

• Doctors were not following standard work (my term, not theirs) and irregularly used the hospital's "medication reconciliation" system. That system helps avoid drug interaction and allergy problems. Levy said, "Over the coming weeks and months, we will make use of the system mandatory." You might think, why not now, this week, today? Why not before? I'm sure people at BIDMC knew the system wasn't be used, why wasn't this fixed? As Levy pointed out in the comments, it is a complication that physicians are not employees, but that's no excuse -- it's just an additional difficult leadership challenge, not being able to rely on "being the boss." Toyota's Gary Convis was always quoted as being taught you should "lead as if you have no authority." Maybe Convis can run a hospital now that he's retired from Toyota?
  
  
• "Code carts" in the patient units didn't have proper security for certain medication. "We are fixing this," Levy says. Again, did this require outside inspectors to discover? It seems reasonable that a hospital would consider drug security to be an important issue. Why was it not proactively addressed? Levy commented that they did have audits and "hold managers accountable," but that's not the same as actually fixing it, is it?
  
  
• In another safety problem, Levy reported, "...some gas canisters were not properly secured. This is a true public safety hazard. If an unsecured gas canister falls and the regulator breaks off, the heavy tube can be an uncontrolled projectile." To those of you working in factories -- how often is this unsafe condition allowed to exist? Hospital administrators and managers need to be in the "gemba" auditing for situations like that. Oh, and the gaps in the fire doors were too wide. Oops, they'll fix that too, now that it was pointed out. Levy said that it's hard to find a large factory that wouldn't have that problem. Really? If so, is that an excuse?
  

Levy says this:

"The upshot is this. We did very, very well. On average, the Joint Commission finds 10 or more requirements for improvement in their hospital surveys. We had eight. Our re-accreditation is secure. The areas in which they found us wanting were legitimate and proper, and it is our job to fix them. The good news is that we were not surprised. Most of the areas they pointed out were on our agenda to fix over the coming months as part of our continuous improvement efforts."

Being "on the agenda" is not the same is being fixed! I know that we can't magically fix all problems at the drop of a hat, but all organizations need to prioritize safety and quality issues, be proactive, and prioritize things. Is it complacency that thinks, "these things have been a problem for a long time, so we can take our time in fixing them?" Maybe it's a pat on the back to the employees to say "we did very, very well" but I'd rather see the Toyota mindset of striving for perfection and not being satisfied with passing marks from the Joint Commission.

I know I'm beating up on them, and I'm sure the hospital and its leadership have the best intentions. But, given the state of healthcare quality and safety, intentions aren't enough. We need improvement! Again, I do admire the hospital and Levy opening themselves open to criticism from yahoos like me.

I did submit a question to Levy on his blog (if you haven't figured that out already) and we had some discussion, you can read it yourself in his comments section or see Kevin's post about it on Evolving Excellence. I won't rehash it all here, but it's too bad that Paul started using the "tired excuse" (as another commenter said) that patients are complex. Of course they are, but let's discuss how to fix these problems faster rather than debating whose environment is more complicated. 600,000 unique patients don't require 600,000 unique processes to support their care. I'm not talking about standardizing how doctors diagnosis and cure. I'm talking about standardizing the truly repeatable support processes (lab, pharmacy, radiology, etc.). There aren't 600,000 femurs so different as to require 600,000 different ways to x-ray or MRI them.

Please do visit Paul's blog and read his full post and all of the comments. Thoughts?

Let's Hope They Don't Name the Grey Paint Color "Lead"

China's Chery Car: Safe At Any Speed For U.S. Market? - CNBC.com

I had a number of readers email me this crash test video of a Chinese car sold in the Russia market. One reader asked what Chrysler was thinking doing business with Chery -- the CNBC columnist (linked above) says Chrysler will have to do A LOT of work to get their product up to U.S. standards. They're going to have to watch them closely to make sure they don't substitute weaker steel in actual production AFTER the crash tests are eventually passed. Can consumers trust China products after this rash of poor quality in the news?

The YouTube Video:



This is more of a business issue than a strictly "Lean" issue. Maybe it's a Lean issue going back to Deming and being careful about how you pick your suppliers, not choosing on price alone. I guess this goes for Chrysler picking its partners and us, as car buyers, choosing our car supplier to purchase from.

We have to hope that Chrysler's reputation is worth enough to them to ensure good quality products, but we would have also though Mattel's name was worth enough (and they have a new toy recall in the news today).

Here's the WSJ article on the China crash test.

Boo Mattel, Hooray Mattel

Mattel is the latest victim in the "poison products from China" series (the "poison train," as The Consumerist blog calls it). Victim is absolutely the wrong word to use, considering Mattel chose to source from China and admitted their own quality control procedures were not followed, as this news article details:

"We require our manufacturing partners to use paint from approved and certified suppliers and have procedures in place to test and verify, but in this particular case our procedures were not followed," Jim Walter, Mattel's senior vice president of worldwide quality assurance, said in a statement. "We are investigating the cause to ensure such events do not reoccur."

I'm not against offshoring or outsourcing, it's not always wrong. But, I do think many companies make dumb decisions that suboptimize around labor cost or unit cost. That's the real problem, there. That, and companies often don't take responsibility for what their chosen vendors (and 2nd tier suppliers) produce.

On that note, Mattel is taking some responsibility. As this article explains, Mattel is naming their vendor, in public and for their competitors who might also source from the same factories. Why name the vendor?

Mattel spokeswoman Jules Andres said Tuesday that all the toys that were recalled were made by the one vendor and that the company has "ceased accepting shipments from the facility."

Mattel has shared the name of the vendor with competitors who may also be doing business with the Chinese company, Andres said.

She said she did not know what other toys might have been made at the facility for other companies, but that the company felt it was important for competitors to have the information. "We do not consider safety to be a competitive advantage," she said.

It may be "almost too little, too late," but hooray for Mattel for that last statement, that safety should not be a competitive advantage. That reminds me of comments that Paul O'Neill (formerly of ALCOA and the Pittsburgh Regional Health Initiatve) made in the DVD "Good News... How Hospitals Heal Themselves", basically that patient safety and infection control information and practices MUST be shared amongst competing hospitals since patient safety shouldn't be a source of competitive advantage either. That's just being responsible to your community. It's "unconscionable" to do otherwise, O'Neill said.

Now, back to the first article and the "boo-ing" of Mattel. And, no, you Simpsons fans, I was not saying "Boo-urns" (sorry for the obscure reference there). It really is no excuse, for anyone, to say "we had procedures in place, but they weren't followed."

That's basically like saying either, "we had procedures in place and our lousy stupid careless employees didn't follow them, shame on them" (an unfortunate blame game). Or, it says "we had procedures in place, but we forgot to make sure they were being followed." It's leadership's responsibility to MAKE SURE procedures are followed. Same goes with "standard work" in a Lean context. Standard Work doesn't magically implement itself, you have to:

1. Create an environment where employees had input into the standard work, understand WHY it's important (e.g., don't poison babies), and where incentives aren't in place that encourage circumvention of the standard work.
2. Audit the standard work and audit the audits. You should try to rely on intrinsic motivation (point 1) but also provide oversight to MAKE SURE the standard is followed.
   

If Mattel's "investigation" into the problem of procedures not being followed starts with "who?" instead of "why?" they won't really get to the root cause.

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