Can’t Always Believe Somebody Saying “Toyota Would Tell You To…”
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.
The professor made a point that, when working in healthcare, we have to be careful about applying all methods and tools from Toyota. I agreed with that part of his statement. We're not literally hanging “andon cords” or putting tape around every piece of equipment just because a factory does it. We have to be solving hospital problems and not just copying tools. I get that.
His example, though, was a bit off base.
The prof talked about “takt time” (or the rate of customer demand) and how we balance the service or production time to match up with takt. Again, that's correct.
In his hypothetical, he said let's assume that a doctor's office is supposed to be seeing a patient every 20 minutes. What if the patient has been in the room for 19:59 already.
The prof said,
“Toyota would tell you to kick the patient out of the room at 19:59 because you have to keep on takt time.”
I think we were in agreement that you shouldn't kick a patient out of the room as if a timer bell went off. There's going to be variation in healthcare and we have to plan for that and make sure patient care comes first. We need to have a reaction plan for how to try to get back on schedule (and part of that approach could be to have buffer times for charting during the day instead of doing all of the charting at the end of the day).
I explained, to the professor and the audience, that Toyota would do no such thing and there's no Lean principle that says kicking the patient out of the room would be appropriate.
Even on a Toyota assembly line, with relatively low variation and highly-engineered repetitive jobs, a worker might have 60 seconds to complete their work (based on takt and balancing the “cycle time” of the line to that).
If, in a particular job cycle, there's a problem with a part or the worker drops a bolt — let's say they can't get their work done in the scheduled 60 seconds.
The worker is expected to reach up and pull the cord. The team leader comes to help. And, if the problem cannot be resolved, the LINE STOPS. You don't kick the car out because its time is up.
If the work really took 90 seconds for that particular car, you'd take 90 seconds. Quality comes first.
Interestingly, a tour guide at a Toyota plant I visited said they SOMETIMES let a problem move ahead in the line to be fixed later, that this is sometimes a judgment call depending on the problem and how it would get fixed for a particular car. This is certainly not the Toyota orthodoxy on “quality at the source”.
Now, if a problem occurs frequently, I think it's safe to say the team leader and production worker would try to fix the root cause of the problem using the Kaizen approach. It's important to understand WHY the problem occurred so you can prevent it from happening again.
Either way, you wouldn't kick the patient out of the room.
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First, you’re absolutely right. That’s not at all what “Toyota would say”. None of Toyota’s rules are applied dogmatically, either because it wouldn’t be appropriate to or because they don’t execute perfectly to their intentions.
Second, and I believe more important, is why the listener would care what Toyota thinks. Most of the people listening to such advice, WWTD or What Would Toyota Do, don’t make cars. When I was at Chrysler (a long time ago), we did make cars. There were a lot of things we copied from Toyota, and a lot more that we learned from Toyota, but copying them was the wrong path. The best we could do would be 2nd best, but more important, Toyota had different problems and different conditions which meant their solutions to their problems might be different than our solutions to our problems.
No one should set the goal of being the Toyota of their industry. They should seek a vision of what they want to become, and then learn and experiment their way to that vision.
I love how you bring things back to common sense, Mark. The principles and tools of Lean are there as a foundation, not an absolute. Why is it that sometimes people completely lose sight of this?
Thanks for keeping it real.
I am sitting on a flight to Orlando (for the Lean Healthcare Transformation Summit) and we are delayed because they are having to fix something on the engine.
I hope the professor I’m writing about here wouldn’t say, “If Toyota ran an airline, they’d say ‘push back from the gate so we can be on schedule and hit takt time!'” or something silly like that.
It is difficult in the heat of fixing a defect to simultaneously think about the principle of finding and understanding the root cause of the defect or abnormality. The decision about where to repair a specific abnormality is less important than the principle of problem solving and building in quality at the process where the defect originated. Unfortunately the focus often comes down to applying TPS / Lean principles in isolation as opposed to as an action oriented system that continuously exposes and takes action on opportunities for improvement.
Thanks for keeping the principles and dialogue together as a system.
Two sides of the coin:
“Sometimes I think of how easy it would be to apply Lean in manufacturing where cycle times can be repeatedly performed within fractions of a second.”
“The problem with healthcare is there is too much variation and no standards. If only healthcare were like manufacturing , then it would be so easy!”
I’ve heard both the above misguided statements.
Yes, healthcare is different! The organizations that are doing the best in Lean are adapting Lean to fit the environment rather than using cookie cutter manufacturing approaches, no matter what people have interpreted Toyota would do.
Here is my own “what Toyota said” statement:
“Toyota would say not to do what Toyota does in every situation.”
A famous Lean CEO said in 2007 (2008?) that it was the challenge of Healthcare to adapt to Lean. His colleague in 2013 is now saying that Lean has to be respectful and adapt to the existing cultures (Mark, you and I were at both of the presentations).
People that truly understand Lean probably don’t have to use “Toyota says…..”, statements at all because they can talk to the principles.
Let’s go do good work!
Based on the information given, it appears that the professor has misunderstood takt time. Some people see takt as some sort of operational rule (i.e. “no patient stays longer than 20 minutes”) or performance goal (i.e. “we gotta hit 20 minutes/patient”), but it’s not. Takt time is a target condition to be achieved consistently through cycles of PDSA experiments. Having some takt-based operational rule or performance goal would just invalidate the experiments, which is basically just gaming the numbers. That’s not what a lean-thinking company does, so any company that would push a customer out at 19:59 is by definition not a lean-thinking company.
There is a particular hospital where I live which emphasizes The Toyota Way and states to nurses intravenous starts should take no longer than 15 minutes. This facility has chopped Toyota to pieces, making The Way a piecemeal project. There are too many variables in patient care to try to define blocks of time for given tasks. If a patient is dehydrated, on steroids, obese or morbidly obese, etc., an intravenous start may take an hour, or worse, the patient may require a central line due to lack of access.
As a Toyota customer for many years, I do not agree with how some healthcare execs apply The Way. What Toyota has always shown me as a customer and its employees is respect. Basic decency and respect is absent from much of health care. I highly respect Toyota and am a lifetime customer. Indeed, my car often gets better treatment than what I have received in the health care system. Perhaps it’s time for health care execs to stop assigning acceptable time allotments for tasks and roll up their sleeves and actually witness first-hand the multitude of variables involved in delivering care.
Most nurse managers pay lip service to The Way, shun the best employees to appease their adorers, and truly couldn’t manage fruit flies. A patient asked me to massage certain part of his body. Of course, I didn’t and wouldn’t, ALTHOUGH there were nurses who did as he asked. The House Manager stated, “we should appease him in the name of customer service. He’s a big donor to the hospital.” [Follow the money, you’ll always find the answer.] When you have no respect for your staff and expect them to degrade themselves to the level of prostitutes, The Toyota Way is the least of your worries, though I doubt Toyota would tolerate such behavior.
Health care is in dire need of change. Basic decency and respect would be a good start. Thank you.
Well “appeasing” a patient because he’s a big donor is disgusting and inexcusable. You’re right – talk about having no respect for their staff. It’s hard to believe, but I guess I believe it.
It’s one thing to have a planning standard that says it should take 15 minutes to do an IV… that planning number/time would be used for determining proper staffing levels (to ensure that people aren’t overburdened and to ensure that high quality work can be done).
That’s very different than having a “quota” or “target” to say you CANNOT ever exceed 15 minutes. You’re right, there’s a lot of variation in healthcare and some patients will take longer. We can’t just plan based on the average, we have to account for variation. We can’t pressure people into working too fast.
Yes, it’s a good first step to go and see the waste and problems first hand. I hope executives don’t see any “appeasing” going on.
In addition to a planning standard, having a time standard can be the basis for identifying the exceptions. Not for the purpose of enforcing compliance or punishing deviation, we hope, but for problems solving and improvement. Why did it take longer? If asked with respect it can lead to improvement for the patient and the process. That’s very different from “You’re not allowed to take longer”, which is a corruption of standard work.
Yes, the “why did it take longer?” question needs to be a question of helpful inquiry. Let’s understand the cause in a non-blaming, collaborative way.
It can’t be in the tone of what’s really a statement, such as “why the hell did it take so long? get it down now!!”
Here’s a comment I added on Michel Baudin’s blog post on this (with slight editing):
You’re right Takt time is not a “rate.” Imprecise wording on my part. Takt = working time available / customer demand.
And, takt time, of course, has the controllable variable of how many working hours you have in a day.
But, essentially, it’s customer demand… I think we’d agree that the production rate must be in balance with the demand rate.
Interesting counterpoint of a 50 minute therapist time slot…. but that “your time is up” expectation is made clear from the very beginning (which begs the question, is the therapist selling time or value??). A primary care, dentist, or emergency room encounter (and other examples) do not have a promised time expectation or limit. I think the expectation is “we’ll do what is needed for your care” in an appropriate amount of time.
Well said. Don’t surgeons use something equivalent to “tape to make visible if the right tools are ready”? It sure seems like something like that would be wise to me.
The whole idea is to take principles first (and then tools) that are helpful and apply them to your situation/system. The business type will affect decisions (likely software businesses or hospitals will be more similar to those in their industry than others due to some features of that that of business) as will your specific organization.
If you design a system to have much more cross training of people then it will allow you to take advantage of that compared to another organization that instead focused more on specialization.
The decisions you make about individual aspects of the management system will impact what options are sensible for you in any particular instance. It is helpful to challenge yourself by thinking what would others do with this type of dilema but it is helpful not in letting you copy something they do but rather to provide you a new perspective.
Generally speaking, I think manufacturing people overstate how organized and fine tuned an operating room setting is…
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