Joining me for Episode #339 of the podcast is Charles Protzman, author of a great number of Lean healthcare books. Today, we are talking about a book that he wrote for a broader audience, The BASICS Lean Implementation Model: Lean Tools to Drive Daily Innovation and Increased Profitability.
I first met Charlie over a decade ago when I worked for Johnson & Johnson's VauMetrix Services consulting group, and he was a significant influence on our team and our methodology.
Charlie shares stories from his early work in manufacturing at Bendix and Honeywell, where he first encountered process improvement concepts before Lean even had a name. Influenced by Joel Barker's The Business of Paradigms and later by The Machine That Changed the World, he describes how these ideas shaped his approach to both the people side and the technical side of improvement.
Charlie explains his BASICS Lean Implementation Model–Baseline, Analyze, Suggest Solutions, Implement, Check, and Sustain–and how it provides a structured way to move organizations from batch to flow. He highlights why video is such a powerful tool for observing work, engaging employees, and sustaining change. He also stresses the importance of respect for people: Lean should be about cost reduction, not headcount reduction, and leaders must make clear that employees will not lose their jobs as a result of process improvements.
The conversation also explores how Lean applies in healthcare, where Charlie has decades of experience. He reflects on the common pushback that “patients aren't cars” and explains how redefining value-added activities for healthcare–emphasizing both physical and emotional improvements for patients–makes Lean both relevant and powerful. His stories underline the universality of Lean principles across industries and the critical role of leadership in sustaining results.
We also discuss the power of direct workplace observation, something that I wrote about in Lean Hospitals, and I discussed with a healthcare CEO, Vance Jackson, in Episode #337.
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Questions, Topics, and Links:
- What's your background? How did you first learn about Lean and in what setting?
- What did you discover when you first worked in healthcare? What was most surprising? Most frustrating?
- “But patients aren't cars…” I'm sure you've heard that – so how do you respond?
- What led to you writing The BASICS Lean Implementation Model book? Who is the target audience?
- Why is direct observation such an important part of understanding the current state? How is videotaping helpful?
- Why is it important that excess staff not be laid off after Lean improvements?
- Charlie's website
- Charlie's LinkedIn page
Books by Charlie Protzman:
- Books by Charles Protzman (via Amazon)
Transcript
Of course. Here is the improved transcript.
Introduction
Announcer:
Welcome to the Lean Blog Podcast. Visit our website at www.leanblog.org. Now, here's your host, Mark Graban.
Mark Graban:
Hi, this is Mark Graban. Welcome to episode 339 of the podcast. It's April 10th, 2019. Joining me today is Charles Protzman, author of a great number of Lean healthcare books and other Lean books in general for other industries. Today we're talking about a book that he wrote for a broader audience. It's called The Basics of Lean Implementation: A Guide to Driving Daily Innovation and Increased Profitability.
When I first met Charlie over a decade ago, back when I worked for Johnson & Johnson's ValueMetric Services consulting group, he was a big influence on our team and our methodology. I'm glad to finally have him here on the podcast to discuss things, including how he navigates the differences between manufacturing and healthcare settings and why he says he looks forward to questions about “patients not being cars.”
We'll also talk about his BASICS Model. It's an acronym: Baseline, Assess, Suggest Solutions, Implementation, Check, and Sustain. We also talk about the power of direct workplace observation, something that I wrote about in my book Lean Hospitals and I discussed with a healthcare CEO, Vance Jackson, back in episode 337. If you'd like to learn more about Charlie and his work and his books, you can find links by going to leanblog.org/339.
Charlie, hi, thanks for joining us on the podcast. How are you?
Charlie Protzman:
Great, Mark. How are you doing?
Mark Graban:
I'm doing all right. My voice is hanging in there after having some illness here recently. So regular listeners might think I sound a little off, but I think we'll have a good discussion here today anyway. Charlie, I always like to let guests introduce themselves. If you can tell a little bit about your career arc and background and then how you first learned about Lean.
Early Days of Lean and Breaking Paradigms
Charlie Protzman:
So I guess back when we first did Lean was around 1985, but of course, it wasn't called Lean then. There wasn't a book out. The Lean Thinking book wasn't there. But we were working on process improvement when I was at Bendix Communications, which today is called Honeywell. We were introduced to a video called The Business of Paradigms by Joel Barker. And not too much later, a book came out called The Machine That Changed the World.
I remember when The Machine That Changed the World came out, we were working on a project to improve our PC card assembly area. I called my director of operations, Denny O'Neill, and I said, “Denny, you got to read this book. This is what we've been looking for.” And that was really our introduction into what you would call Lean today. The Business of Paradigms video really provided the change side of it. As you know, there's really two pieces: the people side and the tool side. And The Business of Paradigms fed that people piece, and The Machine That Changed the World was really the scientific management or the tools piece. Those two things together is really what launched me down this path.
We started working in that electronics area at Bendix, and we became a model site for Honeywell. Even Harley-Davidson came in to benchmark us for self-directed teams. So that was where our journey started.
Mark Graban:
Thinking back to that time, what were the main business arguments or pressures for trying a different way?
Charlie Protzman:
Well, we just couldn't ship on time. We built communication systems for the NSA; we also built the fuses for the Patriot missile. And we were building the circuit cards, assembling them into systems, and then shipping. We were doing traditional batch production. We had a lot of expensive equipment that would put the parts into the boards automatically.
When we would get eight or 10 weeks behind on delivery, Denny would say, “Hey, why don't we set up a slide line?” And we'd say, “Well, what's a slide line?” And he said, “Well, we put two rails up and we just lay out all the parts in the order that they go in the board. And then we have people just put the parts into the boards.” We basically processed the boards one-piece flow.
So we set up the line. The lines ran great. We had fewer errors than we had with the machines. Life was good. We would catch up to the schedule within three or four weeks. And then we would go back to the machines. “Oh no,” because they weren't depreciated yet. And of course, we all know batch is much more efficient, right? Or at least that's the way they think. So, six months, eight months would go by, we'd get behind again, and then he would say, “Hey, why don't we set up a slide line?”
Mark Graban:
It goes to show that old habits are hard to break. I mean, cost accounting rules and pressures, and it really comes down to “the way we've always done it” being a really powerful force. Right?
Charlie Protzman:
Yes. The Joel Barker video is one that I show in all my training classes. It really does help you change your mindset or at least realize that we all get into paradigms and we don't realize it. The only problem with that video is that two or three years later, it's already outdated with the examples that he shows. It would be great if Joel could do another one.
The “Croc Brain” and the Batching Habit
Mark Graban:
I do remember seeing at least some of that paradigms video.
Charlie Protzman:
It really makes people think. One of the things I've learned that's come out in some of the recent literature is really the way our brains function. There's something called the “crocodile brain,” which runs all your motor functions. And the crocodile brain is always trying to keep you from taking on additional work. Batching is a paradigm. My experience is, and I honestly believe this, we're all literally born–it's like in our DNA–thinking that batch is the most efficient and the best way to go. And that's just always fighting you when you're doing Lean.
Our brains are just programmed to think batching is best. And I can prove that because you just don't walk into companies and see one-piece flow. You always see batch. And people will literally fight to keep that batching paradigm. I mean, it's like a baby holding onto a blanket. They don't want to let it go. So the training and everything has to be designed to get them to first realize they're in that paradigm. And then you've got to prove that one-piece flow is better. And that's when the light bulb goes on, and that's when we say people “get it.”
Mark Graban:
Yeah. Well, you mentioned Womack, and he's one of the co-authors of Lean Thinking. I forget if it's in that book or if it's just a story he's told of his daughter helping with some sort of mailing. She was a child, and she very naturally gravitated toward, “Well, we're going to fold all the papers first and then stuff all the envelopes.” So yeah, there's something… I try to think what evolutionary trait that is that made batching a good survival tactic back in the day, but that's not the best way to do things anymore.
Transitioning to Lean in Healthcare
Mark Graban:
So let's talk about healthcare. I first met you and was influenced quite a bit when I joined the ValueMetric Services team at Johnson & Johnson in 2005. We got training from you, and a lot of the model we were using with clients was similar to this BASICS model that you write about in your book. I'm curious to hear a little bit more about your history. When did you first have the opportunity to work in healthcare?
Charlie Protzman:
I first started working in healthcare, I think it was back in 2002 or 2003, and it was actually with ValueMetric and Jim Ellis. They were doing a value stream map back when the Learning to See book really came out. And I actually volunteered to go work with them for free just so I could learn that tool. We did a high-level value stream map for the OhioHealth system in Riverside, in Columbus. And then we broke the map down into different areas: emergency room, surgery, that type of thing. As I recall, it was about a two-week process, and it was very successful in highlighting the waste and being able to give the hospital executives a picture of what their organization was like and how it was functioning. The beauty of the value stream map tool is that it'll let you see the systems that are at work, and you can't see those just looking around the hospital areas.
Back then, as you know, ValueMetric was really more into the lab side. So OhioHealth wanted to do their surgery department. ValueMetric approached me and said, “Would you be interested in working with them on surgery?” And I said, “You know, I don't know anything about hospitals. I've been in manufacturing my whole life. I don't know if this is a good idea.” I thought about it for a couple of weeks and I said, “Well, it can't hurt me. Let's take a shot at it.” And that's when I really started learning about hospital systems.
It was very successful. We were actually able to get one of the surgeons one or two extra cases a day in the same timeframe that he had before. So he was absolutely thrilled with the process. We ended up saving them millions of dollars. Then we moved on to Florida Hospital and started working on their emergency room in Altamonte. That's where we really developed the groundbreaking emergency room process that we call, for lack of a better word, “Lean Care Tracks.” We never really came up with a name for that model, which is something that, looking back, I think we should have. But at the time, they didn't want to protect the model because they wanted it out there for everyone to use.
That's when I wrote the book Leveraging Lean in Health Care. I wrote it for two reasons: one was to show how much improvement can be made in hospitals, and the other one was to show that it can be done in every area of the hospital. Because one of the things you hear is, “Oh, well, that works for the emergency room, but that won't work for us.”
Mark Graban:
Yeah, “we're different.” I'm sure you heard it within labs. You would do some work in the core lab, and then people in histology and anatomic pathology would say, “Oh, but no, no, no, we're different.”
Charlie Protzman:
Right, exactly. And it's not like we haven't heard that in manufacturing as well.
Mark Graban:
Yeah. I'm sure you've heard people in healthcare say things like, “A hospital is not a factory,” and “patients aren't cars.” When somebody throws that at you as a reason why Lean wouldn't be applicable, how do you generally respond?
Charlie Protzman:
So, one of my early lessons was, first off, I always look forward to that comment. And really now, I just beat them to the punch. I tell them, “You know, patients aren't cars, so you have to apply the model a little differently.” It's the same way in manufacturing where people say, “Oh, you just want us to be robots.” And I'm like, “Yeah, it's batching that makes you robots, it's not Lean.”
As far as cars go, I tell them we actually changed our value-added definition as a result of that. In manufacturing, value-added is: customer cares, physical change, done right the first time. For healthcare, we changed it. We say it's: customer cares, any physical or emotional change for the better for the patient, and done right the first time. So a nurse's touch is value-added. It's always a fun discussion because that takes you down to what's value-added and what's non-value-added, and those end up being really fun discussions in hospitals, as in manufacturing.
Back in the day, you remember when we first started implementing this stuff, you couldn't say the word “assembly line” in a hospital. You'd get kicked out. But today, things have changed. A lot of hospitals are actually looking to hire manufacturing IEs and manufacturing Lean guys because they're not in their paradigms. I always thought that was a big advantage for me, that I didn't grow up in the healthcare world. I was able to see things that they couldn't.
Mark Graban:
Yeah, well, there are all sorts of examples where outside perspectives and fresh eyes are helpful.
Charlie Protzman:
I also agree with hospitals when they tell me, “We're not making cars.” I say, “You're not making cars. You guys are actually repairing cars. You're more of the repair model than the manufacturing model.”
The BASICS Lean Implementation Model
Mark Graban:
Yeah. So let's talk about the book, The Basics of Lean Implementation. What led to writing this book compared to the others you've written? Who's the target audience?
Charlie Protzman:
So this model goes back… there are several models out there for how you implement Lean, how you go from a pure batch environment to a flow-type environment. And that's whether it's a hospital, manufacturing, government, or a service industry like banking or insurance. Anything that is a process can be improved.
The first model is what I call “trial and error,” where consultants just come in and try stuff. There's one called “Demand Flow Technology.” There's another model called “Point Kaizen” or Kaizen events. And then there's what we call this BASICS model. The BASICS model was first introduced to us by another consultant named Mark Jamrog, who is really my sensei. The model is really based on what we call the “green Shingo book,” which is The Toyota Production System from an Industrial Engineering Point of View.
The BASICS model is a very structured approach to converting from batch to one-piece flow. The real secret to the model is the idea that you need to separate the product from the operator or, in the hospital world, the patient from the nurses, because they're doing different things and they take different paths.
The BASICS model really stands for:
- Baseline
- Analyze
- Suggest Solutions
- Implement
- Check
- Sustain
Like all process improvement models, it's based on PDSA (Plan-Do-Study-Act) or PDCA. The “Baseline, Analyze, Suggest Solutions” is part of planning, “Implementing” is doing, and then “Check and Sustain” is studying and acting. We found that this model is much easier for people to identify with, and the Lean tools fit it, as well as the Six Sigma tools, very nicely.
My experience with this model is if you follow it–and I don't care what process you're working on, whether it's healthcare, manufacturing, government, transactional processes–it always works. I've never had it not work. And the question you get whenever you go to consult with somebody is, “Well, have you done this exact process before?” And most of the time I say, “No, but I'm really looking forward to working on it.”
Another secret behind the model is videotaping. A lot of other approaches would videotape changeovers, but they never would videotape anything else. It was always “go see, go do.” The BASICS approach is a “ready, aim, fire” approach. We study the process–not to death, it's not analysis paralysis–but we video the product, we video the operators, which gives you a great forum to get buy-in from the operators because they're watching the video with you along with the supervisor. When you get ideas on how to improve, they're now part of those ideas. So your resistance to change immediately drops significantly, and your chances of sustaining go up. Our experience with this BASICS model is that about 80 to 90% of these sustain, compared to a Point Kaizen event, which I would say maybe 40 or 50% sustain.
Mark Graban:
Yeah, I just wanted to share a reflection on that because from using this model at Johnson & Johnson, it's like a mega-Kaizen event. It's more than a week; it's multiple weeks, if not multiple months. And I always thought one of the keys to success is not that someone's coming in as the outside expert to fix it. You're engaging a full-time dedicated team of the people from the actual workplace, and you're teaching and coaching them to figure it out, which I think is what you're saying leads to the sustainment, right?
Charlie Protzman:
Yeah. And like you said, it's longer, and the reason it's longer is because we're actually attacking the entire process. In a Point Kaizen event, you can only hit a certain percentage of the process, so you're still going to be batching in and batching out. We've done implementations where lines were hit by seven or eight Point Kaizen events over the course of three years, and then after a six-week BASICS implementation, we far exceeded any result that they got over those three years because you're looking at the entire process.
The other interesting question you asked me was why I wrote the book on it. I wrote another book called The Lean Practitioner's Field Book, which is really more of an encyclopedia on Lean. When I submitted that for the Shingo Prize, some of the feedback I got back was, “Well, what's this BASICS model you talk about?” So I took the Shingo feedback to heart. They really didn't understand the book because the flow of that book was set up along the lines of the BASICS model. So I wrote the book based on that feedback, and I wanted to document the fact that this model was out there.
Respect for People and the Importance of Not Laying Off
Mark Graban:
So I want to come back and talk more about the observation and videotaping, but you talk about excess staff. When you do this analysis and convert from batch to flow, you learn that you've got a lot of excess capacity in the organization. Hopefully, you can grow and redeploy people. Can you talk more about why it's important that when you do identify excess staff, they should not be laid off as the result of Lean improvements?
Charlie Protzman:
Well, it's a really good question. The whole idea behind Lean is focused on the operator and how do we make the operator's job easier. If they know that you're going to lay them off when you make an improvement, people will not help you identify the waste or eliminate their job. It really becomes that simple. If it becomes just counting heads, people will only help you to the point that they're forced to, and they'll start hiding all those things. You know the guy who pulls this little notebook out of his pocket and he's got every single product in there and what the special thing is that he does for that product, but it's not documented anywhere? They won't give you that if they know that you're going to lay them off.
Lean is about cost reduction, not cost cutting. If you really want to get people's buy-in and make it a successful program, it can't be about cutting heads. Now, I do tell companies, if you end up in a business condition and you have to lay people off, that's a different story. I actually make most of my companies agree before I even work with them that people will not be laid off as a result of the improvements that we make. And I even have presidents that have sent letters out to all their employees telling them that before we started working on the projects.
Mark Graban:
Well, that was a hard-set rule at ValueMetric Services within Johnson & Johnson. People could not be laid off. Sometimes people would be redeployed to an internal process improvement team based on their experience on that first project. And a lot of people say, “Wow, I love doing this type of work. I'd like to go help other departments.”
The Power of Video in Workplace Observation
Mark Graban:
So let's talk more about this idea of workplace observation and separating the patient from the operator. I know this is powerful, but it's something a lot of people don't do. Can you talk more about why these two types of detailed process observation are so powerful?
Charlie Protzman:
So someone once said the video camera is the greatest industrial engineering tool ever invented. It goes back to Frank Gilbreth when he actually videoed the tonsillectomies on his kids. Most companies, with most of the Lean consultants they're working with, have been taught over the years to use the Lean observation form. You can go out on the floor, stand over the shoulder of the operator, and write down all the steps. That approach is actually much more similar to what Frederick Taylor used versus the process that Gilbreth used. Taylor used time study; Gilbreth used motion study.
My experience with the BASICS approach is our approach is 90% Gilbreth, 10% Taylor. When you're working with operators, you can do it to them or you can do it with them. The video allows you to do it with them versus to them. When you're using a Lean observation sheet, you're doing it to them. When you watch the videotape, it's a different story. You watch the operator and write the steps down. The operator says, “Well, I didn't do that,” and you say, “Well, wait a minute, let's go back and look at it again on the video.” “Oh, I guess I did do that. I didn't realize.” So it turns into an “aha” moment for them.
It gives you a way to document the steps, it gets the operators involved in the process–which is huge when you're talking about resistance to change–and you will see things on a video that you will never see just standing and watching the operation. And for sure, if you're going to do a 10-cycle analysis, it's much easier to do from the video.
The first thing I always do when I go into a company is I start the video. We have operators make a video and talk about what they did before and after. It's really fun, and the operators like it. And once you come up with what the standard work should be, we create a video of the best operator doing that job. We call it the “golden video,” and we use that for training new operators as part of our TWI (Training Within Industry) process. We'll train the new operators on the standard work and the video before they ever get to the floor.
Mark Graban:
Yeah. And like you were saying, this can all be done in a respectful, collaborative, engaging way. It's not the Taylorist approach of the efficiency expert telling people how to do their job. I've heard it described as an out-of-body experience when somebody is able to step back and watch the way they work. It helps create awareness for the things that people have just gotten used to.
Charlie Protzman:
Yeah. And even taking that a step further, that's what I call the “hidden waste” that you just see with videos. In some cases, with non-proprietary processes, we have the operators take the video home and they show their families what they do, and they love that. It's a fun tool, and people like it. We have never had an issue with unions, but there are some rules around it. You can never use what's on the video against the employee, and we put that in writing. If it's a safety issue, I'll have a manager say, “Well, what you did was unsafe.” And I turn to the manager and say, “No, the process you set up for your employee is unsafe. You're the one that needs to fix it, not the employee.” We don't blame anybody for anything. Once you blame, you've lost the opportunity to get the root cause.
Sustaining Improvement Beyond the Project
Mark Graban:
Last question here. I wanted to ask your thoughts on following up these transformation projects using the BASICS model. This big conversion from batch to flow is, in a lot of ways, a one-time event. Then there's the need for ongoing continuous improvement. What are your best practices or favorite ways of following up a project to not just ensure static sustainment, but to create more of a truly Lean organization?
Charlie Protzman:
It's a really good question. My experience with this is that the other reason I don't like the term “event” is that there's an ending to it. And we all know Lean never ends. It's a journey.
There is for sure a leadership and coaching piece to this. We're actually working on another book now called Shop Floor Management where we kind of lay this out. But once you put the standard work in place for the operators, then you need the standard work for the leaders, because part of the leader's job is to audit the standard work for the operators. And that leader standard work should go all the way up to the top.
The hard part is getting companies to realize that implementing Lean, when you bring a consultant in, should really be looked at as an investment, not a cost, because a good consultant will pay for themselves, sometimes multiple times over. We generally set up maintenance contracts with companies. I'm in touch with every company I've ever worked with. It's important to have some type of follow-up component.
My experience with it is that I insist that companies have continuous improvement in their Hoshin plan or their strategic plan as one of their goals. And the real secret for that is that you have to have goals that people are bonused on financially, and they have to be goals that are not easy to meet. When you set the goal as, “I want you to reduce the cycle time by 50% year over year,” now you've got something. Now you create a pull for those Lean resources. Otherwise, the Lean guys are always pushing. The same pull system that we talk about with Lean really starts with the CEO.
Mark Graban:
Well, I mean, the idea of leaders who are engaged and not just sponsoring Lean, but making it part of the strategic goals for the organization–I agree, that's really important. So just to wrap up here, if people would like to learn more about the book, or if they want to work with you as a consultant, what are the best ways for people to find you or to reach out?
Charlie Protzman:
The best way to reach us is they can call me on my cell phone, which is (410) 984-1158. They can go to our website, which is www.bpcinc.com. The books are available on Amazon. They're also available from crcpress.com.
Mark Graban:
Okay. Well, thanks. Well again, our guest today has been Charlie Protzman. The book is titled The Basics of Lean Implementation. It's available now, and I encourage you to go check it out. Charlie, it's great talking to you. It's been a long time, and I'm really glad to get you as a guest on the podcast today.
Charlie Protzman:
Well, it's truly an honor, Mark, and I really appreciate the opportunity. It's great catching up.
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