First off, a huge thumbs up and thanks are due to Eric Ries and his thought-provoking “Startup Lessons Learned” conference on the “Lean Startup” methodology that was held Tuesday. I am thankful that Eric made live streaming video of the conference available for free to groups that met up around the world (including our group in Dallas). Please thank him by pre-ordering a copy of his book The Lean Startup via his website or via Amazon). I also made the notes I took available via Google Docs. (Some other good notes here).
This post is about one little thing that Eric said during his opening remarks, the notion that time and motion study, as a practice, has been “discredited.” I'll argue it's important to not throw away this crucial tool for manufacturing and healthcare improvement – but we need to understand what related mindset should be discredited.
video of Eric's excellent talk (which is worth watching for many reasons, even if you're not involved in a startup)…
RATS. The video is not available anymore in November 2014.
Taylorist Time Studies
At one point, he correctly calls out Frederick W. Taylor, one of the fathers of industrial engineering, to criticize his outdated separation of thinking and doing, that improvement was only to come from the educated expert class. Taylorist mindsets are very embedded, even 100 years later, in MBA education and common business management mindsets.
Many industries are still attempting to recover from the Taylorist mindset by, among other things, adopting the Lean mindset that improvement is for everybody – that those doing the work need to be the ones improving their own work. Unfortunately, many organizations are still based on the Taylorist approach, without any attempts to correct course.
Many of Taylor's approaches contributed to the Toyota Production System and Lean. But, many of Taylor's management mindsets should be discredited – namely this separation between thinking and working. Taylor wrote that the man doing manual labor must be stupid (and “phlegmatic”!), otherwise he wouldn't be doing such work. Again, a pretty outdated concept and a polar opposite of the Lean “respect for people” view.
Here's a photo of a classic stopwatch wielding time study man, from an old Ford video…
Taylor and Frank Gilbreth, the other father of industrial engineering, used time and motion study. Their time and motion study seems to be all about the expert observing others and that expert dictated what changes should be made to the work. The people doing the the work had change forced upon them. Many organizations still rely far too much on experts to tell workers what to do. Time and motion study was also, unfortunately, used to set production quotas. This created pressure for people to “hit the numbers or else,” and as Dr. Deming taught us, this hurts quality and demotivates people.
Lean Time Studies
I'd like to report that time and motion study is alive and well and it's being used to great benefit. I believe the difference that makes this “lean time and motion study” (if you will) is that experts are teaching the people doing the work to do time and motion study on their own work (as part of a broader Lean education approach). The people doing the work are then the ones to come up with their own improvement ideas, often based on the insights they come up with after being taught Lean principles.
I've taught nurses, laboratory technologists, physicians, pharmacy technicians and other healthcare professionals how to do time and motion study on their own work and within their own teams and departments. This time and motion study helps people identify waste and unnecessary variation in their work and it also helps them see how different roles fit together (or don't fit together) in a system (or a non-system).
There's nothing wrong with time and motion study when you're applying it your own work or when it's peer to peer. People can use videotape (as Gilbreth used film) to analyze work – except in the Lean mindset, we let people watch the videotape so they can see themselves working – and they can (and do) come up with ideas for improvement.
A Doctor Time Studies Himself – Patients Win
I've blogged about a Dallas cosmetic surgeon, Dr. John Tebbetts, before and I mentioned he use of Lean methods in my book, Lean Hospitals. Dr. Tebbetts applied Lean methods and used time and motion study to videotape his own work in the operating room. He used the videotape to identify wasted motion that just took up time or caused internal bleeding or trauma to the patient.
Shorter surgeries, by eliminating waste (not working faster), means less time under anesthesia and faster, less painful recoveries for patients (and fewer infections). It also means he is more productive as the surgeon. He has published this work and the results in peer-reviewed journals.
Dr. Tebbetts initiated his own time and motion study out of his own motivation to improve. His patients benefit, he benefits – it's win-win. Time and motion study is great, *if* it has the Lean mindset and not the Taylorist approach.
“Subject” or “Scientist”?
One other comparison was found in an article published in the journal for the Society for Hospital Medicine last year. In one article, the University of Michigan Health System used industrial engineering students (correction: “undergraduate business administration students”) to shadow hospitalists (physicians), performing time and motion studies. One thing that made me raise an eyebrow was that the students timed how long hospitalists were in the bathroom. It raised the issue of whether these students were being little Frederick Taylors.
I co-authored a companion piece that was published in the Journal with Amit Prachand, a former industrial engineering classmate of mine from Northwestern University, who now works in process improvement at Northwestern Memorial Hospital in Chicago.
We asked this question:
Were the hospitalists playing the role of “subject” or “scientist” in the time and motion study?
We couldn't tell because we weren't there, but wanted to raise the issue so that other hospitals would consider the Lean approach over the Taylorist approach.
The hospitalists would be “subjects” if they were merely observed by the outsiders. They would be “scientists” if they were engaged and involved in the improvement of their own work.
Which of those approaches better exemplifies Toyota's “respect for people” principle?
So, please, don't throw the tool out with the old mindset… time and motion study still has an important place – just use it the Lean way. Teach people to do their own and don't use the data to create quotas that must be hit – especially in relatively high-variety settings, including healthcare.