Last weekend, at a patient safety conference, I heard a physician talk about “robust process improvement” and this, thankfully, included an endorsement of Lean methods.
That’s the good news.
Today’s post is published over on LinkedIn, as part of the “Influencers’ program that I’m a part of.
It’s a silly piece (in honor of “Muppets Most Wanted” being released on home video today) but it has a serious message.
My blog will turn 10 years old in February, 2015. You’re probably either thinking, “Wow, that’s awesome!” or “Get a life, dude.” :-)
Here’s a look back at some of the posts from August 6 in past years… what was I writing about?
Long-time readers might remember this post of mine from February 2007:
Please check out that post. It’s a classic example of what I shortly thereafter started (in March 2007) calling “L.A.M.E.” or Lean As Misguidedly Explained.
In March, I wrote a post titled “Is it Lean’s Fault or the Old Management System’s?” about how people’s complains about Lean are actually often complaints about old management mindsets.
Since the healthcare improvement work I do is apolitical and non-partisan, I’m generally not one to butt into the political affairs of Canada or other countries. But, when I hear complaints about Lean or when it’s being called a “scam” and a “cult” by some in Saskatchewan (read here), my ears perked up and I started talking with some folks up there. My goal isn’t to blindly defend Lean, but to first understand, but also trying to clarify myths or misunderstandings where I can.
I’ve had some contentious discussions (a union president who arrogantly replied, “No, I’m good” when I offered to send links to medical journal articles about Lean), but also some lovely chats via Twitter and email. Yesterday, I had a long and interesting phone call with Murray Mandryk, a political columnist for the Regina Leader-Post. He apologized repeatedly (as polite Canadians do) for “dragging me into” this political fight of theirs. I told him that it was, if anything, my fault for diving in.
The start of the article:
It’s easy for an organization to say they are “doing Lean” or they have “started a Lean transformation.” They might hire a consultant or put out a press release… or maybe there’s an optimistic (but premature) news article about how the hospital or health system is going to turn around with Lean.
The problem is the culture doesn’t change overnight. Leaders have years or decades of old habits (bad habits) that run counter to Lean thinking. They might be (might!) be trying to change, but people will still fall back into old habits, especially when under pressure.
I read this valid complaint from somebody on a LinkedIn group…. it led to a “facepalm” that I managed to catch on camera:
I interviewed with a medium sized company for a quality Manager position a while back. They were convinced that 5S is lean. They referred to 5S as the “five pillars” of lean. A lot of companies took a short seminar on one of the tools and are convinced that lean is a single tool, or a tool box. Most did not take the time bring in a consultant or hire a experienced Continuous Improvement person, and just did a low effort follow the fad approach.”
An old friend of mine (whose name and company remains confidential) recently saw me reference an old blog post on Facebook. I had posted a link to this old post about Kyocera’s “Lean Office” initiative that focused on neatness and, among other things, said employees could not hang sweaters on the back of their office chairs.
Being a “5S cop” and telling people what to do with their office space doesn’t seem to have any real benefit to customers, so I question if it should really be called Lean. God forbid that somebody decorate their cubicle wall a bit (as pictured at left).
The Kyocera efforts still seem more like what I have dubbed “L.A.M.E.,” or Lean As Misguidedly Executed. My friend’s story is pretty bad, as well.
In my experience, you have to be cautious when somebody says either, “Lean says you should….” or “Toyota would tell you to…” because those statements, even if stated authoritatively, can be wrong.
At a recent speaking engagement (I won’t disclose where), a professor (one who teaches about Lean) made a curious comment that I’d put in the Lean As Misguidedly Explained (or L.A.M.E.) category.
I’ve had people suggest writing something about Lean in ambulatory care and outpatient clinic settings. Or maybe an introductory Lean book for another industry.
What I’ve decided to work on (and have already written, actually) might surprise you. But, I think you’ll like it. And your kids will like it too!
Today I’m linking to a guest post that I wrote for my friend Marc Rouppe van der Voort who works at St. Elisabeth Hospital (Tilburg, Netherlands) and has a blog in Dutch (with auto Google translation). Marc used to maintain a separate blog in English (which he stopped because Google does such a good job he can blog just in Dutch… a Kaizen opportunity he took advantage of).
I’ve written before about my admiration for the St. Elisabeth philosophy of “loving care,” which is supported by Lean. Marc asked me to write a post with my thoughts on the subject.
I was preparing for the Gemba Academy webinar that I’m doing next Tuesday (you can still sign up) on Stories about the Eight Types of Waste in Healthcare.
I found this fun picture from about 2008 that I decided to incorporate into my talk. I was leading some 5S work in an X-ray area, where the focus was on preventing delays to patient flow by making sure staff had the right supplies available in the right locations. The team played a prank on me while I was away from our conference room. :-)
I sometimes do a “What I’m Reading” post where I share links to good stuff I’ve read recently. Today, I’m dedicating such a post to some recent missives from my friend Paul Levy and his excellent blog, “Not Running a Hospital” (he’s a former hospital CEO). Paul is currently at the IHI National Forum and tweets updates (along with the #IHIForum24 hashtag). Wish I were there.
My whole career, I have worked with the Lean methodology (aka the Toyota Production System). I’ve just really never done much with Six Sigma. I’ve read about Six Sigma and I took a Green Belt course when I worked at Dell in the late 90s. I’ve studied and used statistical methods (especially what I learned in my Industrial Engineering studies and at MIT), but I’ve never done anything I would call Six Sigma in my career.
I have respect for Six Sigma as a discipline, just as if I were a chef, I would have respect for pastry chefs. They can co-exist in the kitchen and you might both use whisks, but you have slightly different training to do different things – these roles aren’t interchangeable and neither are Lean and Six Sigma. That’s one reason I get riled up about so-called “Lean Sigma” or “Lean Six Sigma.”
As the creator of the admittedly awkward L.A.M.E. acronym (meaning Lean As Mistakenly Explained or Lean As Misguidedly Executed), one burden is that I often get emails tipping me off to L.A.M.E. sightings.
In a nutshell, it’s L.A.M.E. when a company does something awful that’s not at all in line with accepted Lean or “Toyota Production System” principles. Or, it’s L.A.M.E. of the other form when a writer misunderstands Lean (or intentionally misrepresents it) and writes something off base.
Today, I have three L.A.M.E. sightings from around the world… (somebody please make me a better graphic!!) If you’re not a regular reader, see my “What is Lean?” page as a starting point or the 14 principles of The Toyota Way.
A few years back, I coined a really bad acronym: L.A.M.E. One of the things it can mean is “Lean As Mistakenly Explained.” It’s inevitable to see articles about the Lean Startup methodology that fit into this category (or maybe L.S.A.M.E.???).
The Inc. article “What’s Wrong With the Lean Start-up” has a number of flaws and bad assumptions that would put the article into the L.S.A.M.E. category, as well as L.A.M.E. Ironically, the author of the piece, Jon Burgstone, teaches entrepreneurship at Berkeley — is he hanging out with fellow Cal professor Steve Blank, a guru in this methodology? It seems not.
Update – My “Office 5S Gone Wrong” video has gotten more than 150,000 views on YouTube since I created it back in 2010… Some of you who are new to the blog might not have seen it yet:
You might remember my blog post from 2007 titled “Bad Lean/5S Hits the UK Media.” It featured a link to a news story from the UK that included the picture at left. An accounting firm was implementing “Office 5S” in a very top-down and, arguably, misguided way, including marking where your keyboard, phone, and computer monitor go. You might also remember my criticism of Kyocera’s Office 5S program from 2008.
This is an illustration of directly copying a tool without thinking through why that tool is helpful. Does it help to label where your phone or keyboard goes? Probably not. It’s an example of directly copying tools from a factory in a way that might not be appropriate, it’s also likely to tick people off in the organization.
You might also have seen the first video animation that I did last week about the waste of getting new recycling bins. I’ve created a new video that shows what a “bad office 5S” scene might look like… something that’s “L.A.M.E.” not Lean.