Tag: Standard Work
Today’s post is being hosted by the Lean Enterprise Institute and their “Lean Post” blog… click on the headline below or the image to read:
It’s a post that encourages people to “ask why” when thinking about standardized work, 5S, and other Lean practices.
I recently stumbled across a very interesting and well-produced mixed-media presentation that starts with the sounds of snow crackling under a pair a boots… a video clip that illustrates Delvecchio Finley, the CEO of Harbor-UCLA Medical Center, making a snowy trip to ThedaCare, in Appleton, Wisconsin to learn about Lean and healthcare improvement.
Check out the presentation by Russell Mitchell here. Make sure you are at a computer with speakers or headphones. You might want to view it in a conference room with a team to be able to discuss it.
They introduce a pretty good definition of Lean at the start:
“Lean is a bottom-up approach to identifying and fixing broken systems–for example, a medication delivery system responsible for high rates of hospital errors, or a patient intake process that produces long backlogs and waiting times that muck up schedules and frustrate patients. “Bottom up” means that Lean relies on people closest to the work to fix systemic problems.”
Mark’s Note: I’m just getting back from vacation, so we’re wrapping up the guest posts. Today’s post is by Christina Kach and you can read her previous guest posts here. Check out her updated bio at the bottom of the post. I’m sure there will be a lot of good discussion on this post, so please add your thoughts…
I may never have been interested in Debate Club, but I appreciate a respectful and thoughtful discussion on topics whether it’s with likeminded people or people with different viewpoints who add a fresh perspective. There have been some thoughts on my mind lately from the world of Lean that I think could lead to some of that thoughtful discussion. Here’s what I’m thinking. And I don’t believe there are any right or wrong answers.
As Lean Practitioners, we can often be quick to criticize companies or departments with weak or misguided Lean programs. I offer this question: is it better to at least be trying to do Continuous Improvement work, or not bother unless it is planned out correctly?
Although I don’t get to play much anymore, I used to be a pretty serious drummer (I almost said “musician,” but that invites jokes that drummers aren’t really musicians). I was more of a percussionist — playing everything from timpani in the orchestra to marching band drums and the drum set in jazz bands.
I always loved playing and came to appreciate different styles of music. In most forms of music, the sheet music (the standardized work) is very highly specified. You play what’s on the page, every single note is given to you. In jazz, however, the sheet music is more of a structure, in which different members of the group are allowed to play solos of their own creation…
Mark’s note: Here’s another great vacation guest post by Jeff Hajek:
By Jeff Hajek
Despite having been fairly main stream for going on three decades now, there are a surprising number of misconceptions about Lean. Here is a list of 11 of the top things people misunderstand about continuous improvement.
- Lean means getting rid of inventory. The reduction in inventory is actually the result of Lean, not its method. All of the associated improvements like pull, poka yoke, Standard Work and the like are the tools of Lean that lead to flow and the ability to reduce inventory. Arbitrarily cut inventory and you’ve got problems. There is a caveat to this. Many practitioners of Lean, myself included, advocate slowly reducing inventory until something breaks. Then you fix that something. Do this enough times, and suddenly, you’ll realize that you’ve got flow.
Recently, the Wall Street Journal put some focus on the issue of so-called “door to balloon” times in our hospitals. “Door to balloon” is a measure of time from a patient with a serious type of heart attack (“STEMI“) arriving at the hospital (door) to the moment when the arterial blockage that affects the heart is cleared via angioplasty (balloon).
As they say at ThedaCare and other organizations that have used Lean methods to dramatically reduce this time, “time is muscle,” as a faster DTB time means less damage to the heart, faster recoveries, and better patient outcomes (and, undoubtedly, lower costs).
I recently ran across a Michigan startup company called OPS Solutions that has some interesting technology that could be applied in many settings for standardized work and error proofing applications. Michigan is my home state and I’m always interested in new companies there, so I had a chance to talk to two guys from the company.
I decided this was something worth sharing on the blog to get your input and ideas. As with some other posts, this is not an advertisement or endorsement.
A few thoughts while waiting for a Sunday flight… at least it’s a Sunday flight towards home.
One reason traditional organizations (and traditional leaders) struggle with Lean is because the mental models are different. The problem isn’t understanding tools; the problem occurs when people are forcing Lean methods into a traditional setting. What might work great in a Lean culture, might cause nothing but trouble in a traditional setting – all because of the mental models. When we implement a new method from another organization, we might do well to ask “What existing mental models is this going to conflict with? What might the side effects be?”
I received an email from a reader that I’m sharing and commenting on with permission.
“Dear Mark: I am a lean coordinator for a manufacturing company and it was a real shock to see some of the waste during a recent hospital visit to see a dying family member. He was 92 years old and had a DNR in place. He was having trouble breathing and a Rapid Response Team was called into place. Now, again, he was dying, so my first thought was that this seemed unnecessary. But, as they were preparing to treat them, the waste and confusion was obvious.”
First off, there’s nothing about “Lean” per se in this linked article from Quality Digest: “New York Pediatric ICU Ward Off Central-Line Infections for Entire Year“. That said, there are elements that are very similar to both Lean and the checklists methodology.
Standardized work has led to so many documented improvements in healthcare. There are still some (who might be lurking and reading this) who scream loudly about Lean turning people into unthinking robots, leading to poor quality. Lean standardized work and checklists aren’t about shutting off your brain – it’s about shifting from a current state where it can be true that “everybody does it different” to a middle ground where there’s a standard method BUT people have the professional judgment to deviate from that when necessary.
The Steven and Alexandra Cohen Children’s Medical Center of New York has reached a real milestone due to these sorts of methods…
Mark’s Note: Here’s part 3 of a series by our guest blogger, Andy Wagner – a series that started here.
Many of us work in an environment that our host, Mark Graban, would characterize as “non-Deming”: LAME more often than lean. After several months of long hours and work stress affecting home life, I made up my mind to do something about it. The answer, following a very evolutionary, unintentional path, became my Standard Work, and I have to tell you, I’m thrilled with progress to date, as described in posts one and two of this series.
I spent a weekend getting my personal email down to less than 5 messages, it’s been there since late December. At work, my team and I are “green” on our Product Audits this quarter, and we’ve gone nearly thirty days without a gage out of calibration. We used to be the worst in both categories.
Mark’s note: Today is the first of a series of guest posts that will appear over the next two weeks from a variety of bloggers while I’m on vacation.
Tracey Richardson is a consultant and LEI faculty member who previously had 21 years of experience with Toyota, starting as a Group Leader in 1988.
In today’s blog post, Tracey talks about the important role of a middle manager as a servant leader and a person who develops other people. Her contact info is at the end of the post and her blog is http://thetoyotagal.blogspot.com. Thanks to Tracey for her contribution!
ThedaCare, the health system in Wisconsin, often gets a lot of attention for the Lean improvements in their four hospitals, but they are also doing some excellent work in redesigning primary and specialty care, as well (as highlighted in this article: “ThedaCare Encircle Health focus on lean practices“).
John Toussaint, CEO Emeritus, recently blogged about the Director of AHRQ, Dr. Carolyn Clancy and her visit to ThedaCare and their Kimberly Clinic (see video there, too).
At last week’s Shingo Prize conference, I was very excited to meet Dr. Stephen Covey (my podcast is here), but I was just as excited, if not more so, to meet Dr. Brent James, the noted healthcare quality expert from the Intermountain Healthcare system. Dr. James was on the cover of the New York Times Sunday magazine in November 2009 with the cover headline: “If healthcare care is going to change, his ideas will change it.”
Almost every healthcare quality leader I’ve met in the Lean world has gone through Dr. James’ famous quality improvement class in Utah, as described in the book The Best Practice: How the New Quality Movement is Transforming Medicine.
I’ll share some notes I took during his breakfast talk last Thursday.
Interesting news from Idaho, where an outside Lean consultant has been named interim CEO of St. Luke’s Magic Valley Medical Center (see “Consultant to fill in as T.F. hospital CEO“).
From the article:
Mike Reno, a consultant helping St. Luke’s Magic Valley Medical Center adopt the “Lean” production system used by Toyota Motor Corp., will head the Twin Falls hospital over the next year as it searches for a new CEO.
Is this a first in American healthcare, an outside Lean guy taking over a hospital?
You might be familiar with the case where the actor Dennis Quaid’s twins were harmed by an overdose at the famed Cedar-Sinai Hospital in Los Angeles. I blogged about it originally in late 2007 as the post “How Often Must the Same Mistake Be Repeated?” The post title referenced the fact that the exact same set of circumstances led to the death of three babies in Indianapolis in 2006 (see “Lack of Error Proofing Kills 3 Babies”). Here is a complete list of my blog posts mentioning the Quaids.
Thankfully, Quaid’s twins survived. Dennis and his wife Kimberly have been using their celebrity status to try to bring positive change around patient safety – particularly with a systems focus. Dennis is getting out there again as the “frontman” for a new push to raise awareness about systemic medical errors, including an upcoming Discovery Channel documentary called “Chasing Zero: Winning the War on Healthcare Harm.” More about the show, including video clips, here.
I have been a big fan of the author Daniel Pink (@danielpink on twitter) since I heard about his most recent book Drive: The Surprising Truth About What Motivates Us and I saw him speak near Harvard back in January.
I loved the book, as it was reminiscent of Dr. W. Edwards Deming’s ideas on employee motivation — how the best path to success comes through tapping into peoples’ intrinsic motivation instead of trying to bribe them with rewards or financial incentives (“bribe” was the word that Dr. Deming often used). Not a flattering word, is it?
There is a video online of Dan Pink talking at the TED Conference (18 minutes) about his book and the important ideas within. I’m linking since I can’t embed the video on my site, running on WordPress.org. I’ll share my thoughts below.
Unlike Thursday’s joke, this is real. It’s a video posted by the Association for Manufacturing Excellence (AME), featuring a full-time Lean professional, a “kaizen facilitator,” who is in the third year of coaching a youth (teenagers) hockey team in Ontario.
In the video, he talks about applying some Lean tools, but also and more importantly, a Lean mindset to their practice, their preparation, and their game performance.