My wife is a leader in a business (not GE) that does aircraft engine “MRO” work – maintenance, repair, and overhaul. I've been able to visit her shop floor (her “gemba”) and we noticed similar parallels between their work (bring engines back to prime “health”) and what's done in healthcare. This parallel was also explored in this recent article from GE Healthcare that was published by The Guardian in England: “What lessons can healthcare learn from industry?”
There are interesting and sometimes humorous parallels between engine MRO and human healthcare:
- Engines need regular preventive maintenance, inspection, and repair during their life cycles (something people should get, as well)
- Appointments are scheduled for the engines with a list of ways in which the engine is “ailing,” but there is a lot of variation in the work because “every engine is unique,” as they might have the same design and the same parts, but each one wears a little differently (just like people).
- Each engine gets assessed to discover what other work should be done – the engine is “admitted,” some parts are x-rayed, and sometimes a tiny camera is inserted deep inside the engine via a long, flexible tube (ouch!).
- Quality should be the first priority, as it can be a life-or-death issue if the work is not done properly.
The main difference, of course, is that the engine (as the “patient” in an MRO shop) doesn't have feelings to be aware of and to address, but emotions can run high if the customer doesn't get their engine discharged to them on time.
GE Healthcare, in their article, writes about how NHS organizations in England have learned about Lean and Six Sigma by visiting a GE engine MRO site (and a GE Healthcare site) in Cardiff, Wales.
I would agree that there's a lot to learn from a well-managed industrial site and I'd add that there's much for industry to learn from visiting a well-managed hospital (for example, some manufacturers have gone to visit and learn from my friends at ThedaCare).
One key cultural lesson that is valuable and transferrable, as expressed by GE:
“We reward our employees for flagging any quality issues, even if they have been at fault themselves. If there's a quality issue, whatever the reason, we want to know about it, and we'll applaud that. A blame culture is the last thing we want when we're dealing with something as critical as aircraft engines.”
Many organizations in the “Lean Healthcare” community, along with those in the modern patient safety movement, emphasize the need to move from a “name, blame, and shame” culture in healthcare. When people are under pressure to cover up problems, patients suffer. We can't fix the system and prevent future problems if current (and potential) problems are not discussed openly.
Another quote from a GE leader:
“Kevin Gauci, production manager at the Life Sciences facility said “With this sort of size and scale, the right sort of leadership is imperative. A collaborative leader operating with humility and respect is key. I like to think of it as a reverse pyramid – the guys on the shop floor are the priority – they're the heartbeat. Everyone else needs to help those operators who are touching the products to do their jobs and get these products through the system. I guess there are parallels there with the nurses, doctors and surgeons on the front line with the patients every day.”
ThedaCare, for example, uses the servant leader reverse pyramid model, as I saw again last week. Their CEO, Dr. Dean Gruner, is listed at the bottom of the organization chart since he supports people doing the work, instead of being a top-down “command and control” leader.
An NHS leader (from a hospital I was able to visit with LEI and Dan Jones in 2009) said:
Deborah Burrows, head of transformation at Portsmouth hospital explained “We have tried to implement Lean at Portsmouth, so this visit gave us the opportunity to see Lean operating in a different environment and to look at the processes, without getting sidetracked by all the healthcare going on around us! I've been very impressed by the standard metrics GE uses, so everyone reports in the same way and it's all understandable and transferrable between departments.”
I cringe a bit at the phrase “implementing Lean” because it sounds like we're installing a new countertop in a kitchen instead of working on an ongoing culture change and transformation. “Implement” isn't a good word, because it seems to imply being “done” at some point, instead of continuing to manage in a new way and always improving.
The other thing I'm not crazy about is the whole “red/green” business, as a visitor commented on:
“how GE manages operational performance day to day, saw the scorecards and dashboards used to keep metrics ‘in the green'
Unfortunately, I see a lot of this in Lean healthcare, even some very well known hospitals. Once you understand Statistical Process Control and common cause variation, the overly simplistic comparison against a goal (red = worse than goal and green = better than goal) just doesn't hack it anymore. If average performance is right at or near the goal, having to “find a root cause” for every red data point is generally a waste of time since the red data points are often just caused by normal variation or noise in the system. Improving this sort of system requires fixes to the everyday system, not reactions to specific data points.
The goal is not “keeping metrics in the green” (as this can be done by cheating or fudging the numbers) – the goal is meeting customer needs and working continuously toward a state of perfection.
I'm going to write about this again in a future post.
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