Click for full cartoon

There’s a funny cartoon over at ONEFTE.com about suggestions and employee ideas. The post is titled “Where good ideas go to die.” One time in a hospital, a heard a team member say that about their suggestion box.

The cartoon helps illustrate why Kaizen has to be a non-bureaucratic approach to improvement. Kaizen is not the suggestion box. Kaizen is focused on people taking action on their own ideas, not running an idea up the flagpole for a slow, distant approval by a committee. Our upcoming Healthcare Kaizen book covers all of this and more. This video from MD Anderson discusses their Kaizen process.

On Saturdays, I like to post a video or a cartoon that takes a lighter look at Lean and related concepts. Check out those posts here.

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology, focused on improving quality and patient safety, improving access, reducing costs, and fully engaging healthcare professionals. He is also the Chief Improvement Officer for KaiNexus.

It was a very pleasant surprise that ASQ chose Ari Weizweig, a founder and CEO of Zingerman’s Deli (and other businesses) in Ann Arbor, to be the opening keynote speaker at the recent ASQ Lean & Six Sigma Conference in Phoenix. Paraphrasing Ferris Bueller’s Day Off — late February in Phoenix is so choice, if you have the means I highly recommend going. And the conference was great too.

I grew up in Michigan and lived in Ann Arbor right after college, so I’ve certainly been to Zingerman’s. Ari was a fantastic speaker, as his approach to business and leadership really resonated with me. Rather than spouting the usual MBA thinking, Ari has found his own path and I think he has a very compelling message.

Out of his first book, Building a Great Business A Lapsed Anarchist’s Approach to Building a Great Business Management principles from Zingerman’s, Ari shared his “12 natural laws of business,” which I’ll comment on here. Yes, you read that he’s a “lapsed anarchist” (something he describes in his book). That doesn’t mean he wants anarchy, but he’s just not real predisposed to answering to authority figures (or that’s how I’m paraphrasing it).

He’s certainly a capitalist, but the type who really wants to build something special for customers as well as being a great place to work and learn. There are probably aren’t enough data points to have a statistically valid comparison, but I wonder if the CEOs who were Russian History majors (like Ari) outperform the usual MBA suspects (and I ask this having an MBA myself).

Before getting into his 12 laws, the title of the talk struck a chord:

Fixing the Energy Crisis in the American Workplace

My thoughts that were spurred by the title: Why are so many workplaces so devoid of real human energy? Do these workplaces attract lifeless drones or do they manage to beat people down over time? Probably the latter, thinking of Dr. Deming’s curve showing that intrinsic motivation seemed to only go DOWN over time in the typically dysfunctional management systems. Ari said most companies are paying people full wages to work at “just 15 to 37% of their capacity.”

Ari said that “everything great we’ve done, people said it wouldn’t work” and he referenced Dr. Deming in that sometimes you have to “ignore everybody” and do what you believe in. I don’t recall that as being a key Deming teaching, but that’s who he cited. Ari cites three keys for his business success (for which “there truly is no secret”):

1. Servant leadership – citing Greenleaf
2. Open book management – citing Stack
3. Quality

Ari crafted a great analogy when he said their business is “very much like an organic garden. Each element contributes to the other. You can’t quantify how each piece contributes. Everybody benefits.” This reminded me a lot of Lean as a business system — each mindset, tool, and method contributes to the other. That’s why it’s so hard to piece meal your way into a Lean culture by choosing a tool here and there within the context of a non-Lean culture.

Ari compared the “corporate world” to monocropping. When you grow just a single crop, you get higher yields in the short-term, but then problems occur. This reminds of Deming’s teachings (and Toyota’s) that you have to focus on the long-term over the short-term.

He pointed out that a farm can’t switch from conventional to organic overnight. Doesn’t that sound like traditional organizations that want to switch to the Lean model overnight? In farming, it takes “2 to 3 years to get the soil ready,” otherwise the new crops will die because the soil is not receptive and “there’s no energy in the soil.” What’s the parallel to soil in a business? How do we make leaders and an organization receptive to Lean?

Ari said it takes:

• 2 years to get stability
• 4 years to get good
• 6 years to work on being great
• 8 years to really get there

The lack of energy, Ari says, comes from violating these 12 laws — “this is how we’re running the country and it’s not a pretty picture.” I’ll share the 12 laws with my thoughts and what stood out to me, in regards to Lean management.

The 12 natural laws of business

1. You’re more likely to get to greatness if you have an inspiring and strategically sound vision.

Ari believes strongly in teaching everybody how to run a business, “even those employees who just want a job.” Part of this is having everybody understand the vision (it’s more a “mission statement,” he writes in his book). But this isn’t just a 2-line throwaway statement, it’s a multi-page document with “emotional richness” about what success looks like. “What cathedral are you constructing?,” using the parable of the rock breaker and the cathedral builder. I agree with Ari that “everybody wants to be a part of something bigger than themselves” and that vision comes from the “inside out” – and he added, “there’s no right or wrong vision, just yours.”

A strategic plan (think about this in terms of Lean’s strategy deployment approach) is the map that gets you to the destination. Without a vision, “it’s like asking Mapquest to provide a map without punching in an address.”

 2. If you don’t give customers compelling reasons to buy from you, they won’t.

Ari is a big fan of the Net Promoter Score approach and he emphasizes having “loyal” customers over just merely “satisfied.” This reminds me of hearing Bob Lutz talk in the late 90s about it being better to have a car that some people loved and some people hated, as opposed to a car that everybody thought was OK.

Ari emphasized that quality “for us is not just about meeting specifications.”

3. If you don’t create a great, rewarding place for people to work, they won’t do great work.

4. If you want the staff to give great service to customers, you have to give great service to the staff.

This all about servant leadership, with Ari saying “the staff are our customers.” This seems to be really true in service industries – that if you take care of the employees, they will take care of the customers. The way you are treating the employees flows through to the customers. In a business where employees treat  the customers badly (looking at you American Airlines), it’s not because the flight attendants and gate agents are bad people – they’ve been mistreated by management over the years. In healthcare, there are strong correlations between staff satisfaction/engagement and patient satisfaction and clinical outcomes. We have to give great service to the surgeons and the nurses, for example, making sure they have the supplies, equipment, and time required to do the job right.

5. If you want staff to give great performance, you have to give clear expectations and training tools.

Ari said “I’m preaching to the converted here” (at ASQ), but “it’s not like this elsewhere.” At Zingerman’s, “everyone’s involved in re-designing work,” which sounds just like Lean.

6. Successful businesses do the things that others know they should do but generally don’t.

Pretty straight forward — what is your organization NOT doing?

7. If you aren’t consistently getting better, you’re not going to get long-term greatness.

Just like Lean, there’s a theme of continuous improvement at Zingerman’s. They opened their own bakery to provide bread for the deli not to make more profit, but to ensure the proper quality for their sandwiches, etc. Ari told a story about how great it is when a dishwasher says to the CEO, “Why are you doing it that way? That doesn’t make any sense!!”

8. Success means you get better problems—but there will always be problems.

This really reminds me of the Toyota/Lean mindset that we always have problems and “no problems is a problem.”

9. Whatever you’re good at is likely to also lead into areas of weakness.

Ari said “the things you’re good at are the things you’re not good at.” For example, Zingerman’s is participative, but that means they can be slow. When is your greatest strength your greatest fault?

10. It takes a lot longer to make something great happen than people think.

Well this sounds like a description of a Lean transformation, doesn’t it?

11. Profit is good (he stated as “Without good finance, you fail,” I think)

Ari wants a sustainable business, not one that’s based on win/lose approaches (this reminds me of Covey and win/win). Toyota, for one, has strong long-term finances by partnering with suppliers, not by screwing them over price in the short term. The need for profit reminds me of the common healthcare saying, “no margin, no mission.”

12. Great organizations are appreciative and the people in them have more fun.

Fun leads to success and success leads to fun. Ari said, “Everything we do is about believing in people and helping them to greatness.” What a great sentiment.

The YouTube video of an Ari talk, below, is probably pretty similar to what I saw, and you can read a Zingerman’s site about the 12 laws.

And here’s a shorter 10-minute interview with Ari:

photo credit: carlcollins

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology, focused on improving quality and patient safety, improving access, reducing costs, and fully engaging healthcare professionals. He is also the Chief Improvement Officer for KaiNexus.

Short post today – the sole purpose is to point you to a great Rhode Island Public Radio story by Megan Hall. She visited VIBCO after I mentioned them to her in a comment on her blog (which I discovered because she wrote about my good friend Paul Levy – check out his new book, it’s excellent).

Megan visited VIBCO, an outstanding Lean Manufacturing company and also visited Rhode Island Hospital. Check out her radio piece (and a transcript) here: “RI Hospital learning from manufacturing industry.”

You can also see VIBCO president Karl Wadensten talking with Megan on his Lean Nation internet TV show.

From Megan’s piece:

Dr. Timothy Babineau is the president and CEO of Rhode Island Hospital. He says there are lots of parallels between VIBCO’s experience ant challenges faced by the health care industry.

“Folks at VIBCO had done things the same way for year after year after year without ever questioning if it was the best way to do something and I think in health care we often suffer from that same syndrome,” he says.

Babineau first heard about lean when he was the vice president of the University of Maryland Medical Center. When he moved up to Rhode Island, he wanted to implement the concepts here. So he looked around for a place where his management team could see the ideas in action.

So Babineau loaded a bunch of Rhode Island Hospital employees into a bus and they drove down to the VIBCO factory. Two years later, Rhode Island Hospital is slowly applying the ideas it saw at the factory.

See my previous video podcast interview with Karl.

Video of Karl and Megan:

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology, focused on improving quality and patient safety, improving access, reducing costs, and fully engaging healthcare professionals. He is also the Chief Improvement Officer for KaiNexus.

Hat tip to John Shook and the Lean Enterprise Institute for pointing this out via his email newsletter – today would have been the 100th birthday of Taiichi Ohno, usually credited as one of the creators of the Toyota Production System, the basis for “Lean.”

See his profile on Wikipedia – Taiichi Ohno (February 29, 1912 – May 28, 1990)

Today is a good day to reflect on what we’ve learned from Ohno. I will go grab a book off the shelf and you can read some of Ohno for free via Google Books. You can also buy books by him or about him via Amazon.com (affiliate link). Please add your thoughts and reflections as a comment to this post. What did you learn from Ohno and how have you applied it? I’ll update the post with my thoughts.

I will ask Jon Miller, of Gemba Panta Rei and the Kaizen Institute if their founder Masaaki Imai has any reflections, as he learned from Ohno directly. I will also reach out to Norman Bodek to see if he has any comments since he published Ohno’s book Toyota Production System: Beyond Large-Scale Production. Update: I’m going to record a video podcast with Norman tomorrow and he will tell stories about Mr. Ohno.

I’m also trying to get comments from Sami Bahri, DDS (the “world’s first Lean dentist”) since he read Ohno’s work and applied it to his practice. Also reaching out to Eric Ries, who has found Ohno’s work influential in the Lean Startup methodology, as well.

Some Ohno quotes from this post’s comments:

Via Bill Waddell:

“All we are doing is looking at the time line, from the moment the customer gives us an order to the point when we collect the cash. And we are reducing the time line by reducing the non-value adding wastes.”

That same idea applies very well in healthcare — reducing the time from when a customer / patient requests an appointment / care / surgery to the point of delivering that care to the point of getting paid.

Another great Ohno-ism:

“Why not make the work easier and more interesting so that people do not have to sweat? The Toyota style is not to create results by working hard. It is a system that says there is no limit to people’s creativity. People don’t go to Toyota to ‘work’ they go there to ‘think’”

And:

No one has more trouble than the person who claims to have no trouble.

That sounds like an early version of the oft-cited Toyota expression “No problems is a problem.”

And:

“One thing you can’t recycle is wasted time .”

(Picture from www.gembapantarei.com)

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology, focused on improving quality and patient safety, improving access, reducing costs, and fully engaging healthcare professionals. He is also the Chief Improvement Officer for KaiNexus.

I spent Monday and Tuesday in lovely Phoenix at the ASQ Lean and Six Sigma annual conference. I saw mant friends there, including Karen Martin, former (and possibly future) guest blogger Mike Lopez, and Tony Manos from 5S Supply. The conference was kicked off by a great keynote by Ari Weinzwei, a founder and CEO of the amazing Zingerman’s in Ann Arbor and I’ll blog about that real soon.

As tends to happen at conferences, I also ran into some folks I have met once or twice before. I can be really bad about connecting a name to a face when I’m surprised to  bump into a familiar face. I try to cheat and glance at the conference name tag when I can… but more often than not, the dang thing is turned around backward, so you can’t read the name! I came up with a “quick and easy kaizen” to try to address this in a simple, inexpensive way.

With the badge hanging around your neck, most lanyards have that annoying tendency to flip around and face the wrong way. The quickest countermeasure I could come up with was to write my name, in pen, on the BACK of the name badge. That way, if my name badge was backward, people could still see my name. But that didn’t help with my problem of not being able to see the names of others.

Anyway, since I was speaking about kaizen, or continuous improvement (the theme of our upcoming book Healthcare Kaizen), I decided to write up a simple Quick and Easy Kaizen report, using the model my co-author’s organization learned from Norman Bodek.

Here is my Kaizen (click for a larger view):

I think this qualifies as a classic Kaizen (small change for the better) since it:

• Addressed (maybe not perfectly) a problem I was personally facing
• I took the initiative to make the change (I don’t have a “manager” to talk it over with, in my role)
• It was quick and easy – didn’t cost any money really
• I could test the impact of the change, following the PDSA model

I was able to work this example into my conference talk to try to share the idea and get feedback.

Normally, the Kaizen process involves discussion with one’s supervisor and a team. It’s not a solo exercise. I was hoping that sharing the Kaizen report would prompt others to “steal” my idea (which is completely OK with Kaizen). During my session, I saw some people, right away, writing their name on the back of their badge.

I think a situation like this shows that people will readily choose to adopt a change that isn’t their idea — if it makes sense and if it addresses a problem they have. We don’t have to force the spread of improvement ideas. Good ideas will spread.

In the workshop, I got some great feedback, as we might get in the workplace:

• Could you use a sharpie to make it easier to read?
• Why didn’t you address the root cause of why the name badge turned backward?
• Could conferences just print your name on both sides?
• Couldn’t you just get a clip and attach it to your jacket in a way that won’t flip backward?

Great ideas and great input. I didn’t know the root cause for why badges flip backward, so I didn’t have a good countermeasure for that. But, as they say “don’t let perfect get in the way of better. Even if it wasn’t the best ultimate countermeasure, I think my countermeasure was a good start.

It was fun to see, over the next two days, how some other people had written their name on the back of the name badge. Let’s see what sort of long-term countermeasure or process change that ASQ (and other conferences) can up with for future events.

At the very end of the second day of the conference, two women who had been in my workshop stopped to thank me for the Kaizen presentation. One woman wanted me to see how the other had written her name on the back of her badge, but she had, herself, not written her name on back of her badge. “I meant to, but I forgot,” she said. We talked about how that goes to show that when you have an idea for improvement you need to:

1. Take immediate action on the idea (before you forget)
2. Have a system to keep track of that idea until it can be implemented (a visual idea board or a system like KaiNexus, a company I work with and own a small stake in)

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology, focused on improving quality and patient safety, improving access, reducing costs, and fully engaging healthcare professionals. He is also the Chief Improvement Officer for KaiNexus.

Episode #140 is a discussion with Scott Patten and Peter Armstrong from LeanPub.com  – they want to be THE website for publishing “in-progress books”. We’ll be talking about lean publishing and how that’s different than self publishing and about how leanpub.com works. In the upcoming part 2 of the podcast, we’ll talk more about how they are applying the concepts of the Lean Startup methodology to their service and their business.

Conflict of interest disclosure: I have published two blog compilations via their service, a Best of Lean Blog 2011 book and a Best of 2012 book that is being published incrementally throughout the year. I’m a huge raving fan of their service and the way Scott and Peter have worked with me as I learned and used Leanpub.com. 

For a link to this episode, refer people to www.leanblog.org/140.

For earlier episodes, visit the main Podcast page, which includes information on how to subscribe via RSS or via Apple iTunes.

You can use the player (use the VCR-type controls) at the top of the post to listen to a streaming version of the podcast (or click here for the streaming audio and RSS subscription). The streaming link is faster for one-time listening (hardly any delay to start listening). Or you can use the download link to put it on your iPod or other MP3 player.

A new way to listen to free streaming episodes of the podcast: Download the free Stitcher app and use promo code LEANBLOG for a chance to win $100.

If you have feedback on the podcast, or any questions for me or my guests, you can email me at leanpodcast@gmail.com or you can call and leave a voicemail by calling the “Lean Line” at (817) 776-LEAN (817-776-5326) or contact me via Skype id “mgraban”. Please give your location and your first name. Any comments (email or voicemail) might be used in follow ups to the podcast.

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology, focused on improving quality and patient safety, improving access, reducing costs, and fully engaging healthcare professionals. He is also the Chief Improvement Officer for KaiNexus.

I received some really good questions from a reader, Nick, who has recently crossed industries to bring his Lean Manufacturing experience into healthcare. Since I thought the questions might lead to a good blog post, I’m going to address them here. In his intro to me, Nick said: “I don’t like to call myself a ‘consultant’ (no offense) only because I work for the hospital and I find it carries a weight that is sometimes a bit of a burden.”

No offense taken. While Nick is an “internal consultant,” I work with hospitals as an outsider or an “external consultant.” Sadly, the term “consultant” often gets you glares or eye rolls from hospital staff…

Sadly, a consultant in healthcare often does one of two things:

1. Lays people off (hence, the glares)
2. Gives people answers and tells them what to do (hence, the eye rolls)

To the contrary, I’m a big believer in the “no layoffs due to Lean” policy and I’m always the one teaching methods that hospital staffers can use to improve their own work. I agree the word “consultant” has baggage, which is why I’d prefer “coach” or “advisor” (but not necessarily “sensei”).

Lean Program Structures

With regard to the conference, I saw that Scott & White had a presentation on their A3 process. I have heard quite a lot about their work, and was wondering if they mentioned at all how their PI department was structured. Specifically, do they work with consultants? Do they have internal PI guys like myself? Or do they have clinical staff doubling as PI staff?  Also, in your experience, which one of these models works best in working toward a lean organization?

I din’t remember the exact numbers, but Scott & White has a relatively small central team that serves as lead educators and coaches. They have used an external consultant to teach them 3P, strategy deployment, and other methods (it’s Altarum Institute, who co-presented with them at SHS). Scott & White typically pairs up a person with a clinical background with an engineer/manufacturing person. I think this is a really smart combination, as each person brings a different perspective to their improvement efforts. I’ve always thought that an internal central Lean team should be roughly a 50/50 mix of “insiders” and “outsiders.” The clinicians help the engineers learn and understand healthcare, while the engineers have a different thought process and experiences that they contribute.

Scott & White also has a program for training what they call “embedded coaches” in the organization. These are staff members who, in my description of it, work part time for a “fellowship” type period of time. Staff members enter and sometimes leave the program. Scott & White considers participation as an embedded coach to be a crucial development step for future leadership roles.

Data and Facts

Were there any examples where teams successfully used facts over numerical data during a lean project?

Nick is referring to a quote from Taiichi Ohno:

“Data is of course important in manufacturing, but I place the greatest emphasis on facts.”

See a blog post of mine about this idea.

Meaningful data for process improvement is often missing in healthcare settings. For example, if we are creating a value stream map of a patient’s visit to the emergency room, we might have data on the overall average length of stay, but we probably don’t have data on the components of that stay. How long do patients wait before triage? Are “door to doc” times actually accurate and meaningful if the clock doesn’t start ticking until the patient registers? If so, that data is skewed because there might be a line waiting for registration.

Even if you have data, it’s usually in the form of monthly reports that are lagging and hide too much information in the averages. That’s why it’s so important to go to the “gemba” or the point of patient care to observe the process first hand. Instead of just relying on averaged data, we’ll observe an actual patient’s journey through the E.D. We can collect data first hand, but we can gain and learn so much more with our eyes and ears (asking questions and talking with patients and staff).

Projects and Thinking

If you were to estimate, of the presentations/topics/speakers [at SHS]  who said they were using lean thinking, about what percentage of them were working toward a lean organization, and what percentage were “doing lean projects.” Additionally, about what percentage of them were improving the right things, i.e. working toward becoming an ACO versus saving $5,000 on supplies because of 5S.

The percentage of presentations at the Society of Health Systems conference that focused on management systems (rather than tools or a simple case study) has increased over the past four years that I’ve been attending. People are presenting about more hospital-wide issues instead of local department projects. We had sessions on the culture of Kaizen or continuous improvement, including my own, Lean space design, strategy deployment, and other high level topics. Other presentations were focused on important issues like patient flow in children’s cancer treatment. See a PDF of the conference sessions, including the Lean Six Sigma track.

 Top Down or Bottom Up?

Lastly, specific to your talk, in your opinion where should continuous improvement start? Is it better to start Bottom-up, or Top-down? Or does it not matter?

I fall back on the sage advice of John Shook, who says that Lean is “neither top down, nor bottom up” as a management system. We discuss this balance a lot in Healthcare Kaizen. It’s pretty common for Kaizen and Lean efforts to start in a “bottom up” way, where people are choosing to work on things that matter for their patients and their department.

I like to use ThedaCare as an example of an organization that has this balance of “top down / bottom up.” ThedaCare has their Strategy Deployment process (as shown in this DVD) where the the senior leaders work in a collaborative way to define the strategy and “true north” objectives for the organization. Note, this is different than top-down “goal deployment.” There are some improvement events that are selected based on these true north objectives and goals that are set for the year. Front-line staff can initiate Kaizen initiatives that are aligned with those true north goals or they can work on things that just made work easier and better for the patient.

So, things often start “bottom up” but should evolve to a system that’s both top down AND bottom up.

Thanks to Nick for the questions.

 photo credit: o5com

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology, focused on improving quality and patient safety, improving access, reducing costs, and fully engaging healthcare professionals. He is also the Chief Improvement Officer for KaiNexus.

Thanks to Dean Bliss for sending an article to me about some of the great Lean healthcare work taking place in Iowa. I’ve visited Iowa a number of times to give talks and visit hospitals and I know many of the leaders from their involvement in the Healthcare Value Network. There have been many people who moved over from the best Iowa lean manufacturing companies to help improve Iowa Healthcare (including Dean). New Shingo Award winner John Toussaint, MD even went to medical school in Iowa. What’s in the water there? :-)

Before getting into all of the good stuff, there are two things that bothered me a bit:

• The headline about “squeezing costs”
• The line about “speeding up” processes.

The subtitle is a better reflection of the work taking place. The headline and sub read:

Squeezing health-care costs
A majority of Iowa hospitals are using lean techniques to increase efficiency, improve care

I don’t think of “squeezing” as being a word with positive connotations. Growing up around the Big Three and starting my career at GM, “squeezing” was a pejorative, meaning that an automaker was just bullying the supplier into providing lower prices. In comparison, Toyota was known for partnering up with suppliers to reduce waste and do things that would actually reduce costs, allowing Toyota to share in some of the savings. Chrysler was, for example, shifting to that more collaborative style, but then Daimler bought them, and they went back to the old way of just demanding a price reduction each year.

The U.S. federal government (Medicare and Medicaid) seems to take the lead in “squeezing” hospitals and doctors. The argument in favor of just arbitrarily slashing prices (because you can) is that it “forces” the supplier (the hospital or the doctor) to get more efficient to keep their margins in line. But, squeezing leads to many dysfunctions — it often bankrupted some auto suppliers and it might lead to quality suffering if the supplier is just slashing costs instead of really reducing waste (as Toyota would teach them to do). There are some cases of private insurers working with healthcare suppliers to partner up on reducing waste and sharing the savings… that’s more of the Lean model.

It is not the fault of the Iowa healthcare folks that the headline and this other line from the story made me cringe. Ala Toyota senseis…. we can talk about the problems first, then get to the good stuff.

I left this comment on the news story site, if they publish it:

Thanks for a great article that highlights the important improvements that are taking place in Iowa healthcare.

 This one sentence prompts my comment:

“Lean techniques focus on speeding up processes and reducing waste by identifying and eliminating steps or activities that don’t add value.”

When talking about Lean, to say we “speed up” processes really means that we are minimizing delays and waiting time and we’re eliminating non-value adding steps, as you say.

Unfortunately, hearing “speed up” makes people think the focus is on doing the real value added work faster, which isn’t the focus of Lean. Speeding up the work makes us think of the Lucy and Ethel chocolate factory scene from I Love Lucy, which is a stressful workplace that put out bad quality.

Lean healthcare is about reducing waste so that healthcare professionals aren’t stressed, which allows them to provide the best patient care possible, as IHS and Mercy are demonstrating.

 OK, now to the good stuff…

About Iowa Health System, from the article:

In 2009, Iowa Health hired its first lean specialist, Valerie Boelman, an industrial engineer who had formerly worked at two Iowa manufacturing companies, as its process improvement coordinator.

“We had a lot of good people internally who knew quality and health care, but we didn’t really have the expertise in process and inventory and those kinds of things that we needed,” Nessa said. “So rather than try to train internally, we made a purposeful decision to go out and hire that expertise, and we’ve continued to do that. We’re now using some of these people to infuse these skills into other areas of the organization.”

Read more: http://bit.ly/zv5iys

It’s great to see a hospital being open to bringing in people from other industries, as it’s the combination of experiences and skill sets (inside and outside eyes) that leads to great improvements.

And their results from the use of Lean and Six Sigma:

“We’re touching really every part of the institution right now, from clinical to non-clinical areas,” Nessa said. Since 2009, her team has led 25 quality improvement projects and contributed to more than 100 additional projects. Last year, the team generated more than $1.7 million in savings for Iowa Health – Des Moines.

And about Mercy Medical Center and their hybrid “Lean/Six Sigma” approach:

“This team is really focused on improving processes to improve quality, patient safety and service to our patients; those things always come first,” he said. “But we’ve also been able to eliminate waste and reduce costs.”

In the past eight years, Mercy’s process improvement team has completed more than 300 projects, Varnum said. Last year, the hospital saved more than $3.3 million through improvements put in place through the team’s work.

That’s yet another example of an organization that shows Lean isn’t about “cost cutting.” If you do the right things for the patients and for the staff, cost and financial impact will follow.

And Mercy also realizes that Lean is not about layoffs:

As one example of a cost-saving project, Mercy eliminated approximately $500,000 in annual labor costs by streamlining the movement of soiled linens, equipment needing sterilization and trash handled by its reprocessing department. With the more efficient processes, fewer people are needed to do the work. “And we accomplished this with no layoffs of staff,” Varnum said. “We actually transitioned these people into other areas of the organization. It’s just a great example of how it’s supposed to work.”

And they realize that Lean has to involve everybody:

Every project involves front-line staff from the department that’s involved “so they’re part of the process work being done,” Varnum said.

Congrats to these organizations… you can read more and see more data and examples of their results in the article.

 photo credit: Kables

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology, focused on improving quality and patient safety, improving access, reducing costs, and fully engaging healthcare professionals. He is also the Chief Improvement Officer for KaiNexus.

Congratulations to Dr. John Toussaint and Roger Gerard, co-authors of the outstanding book, On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry, for being one of this year’s recipients of the Shingo Research and Professional Publication Award (as announced by LEI). Congrats also go to whole team of people who were involved from ThedaCare and the Lean Enterprise Institute.

Conflict of interest disclosure: I played a small role in reviewing  and giving feedback on drafts when I was employed by LEI, but I receive no financial compensation for this work.

You can buy the book in printed form via LEI or Amazon or you can buy the Kindle format (just $7.99!). This is an important book about Lean leadership and culture change, regardless of your industry. Buy it for yourself, give it to your hospital C-suite (or, if a patient, try to leave a copy behind with you….)

I’ve always recommended On the Mend as a companion to my Lean Hospitals, as John and Roger tell the very personal story of a single organization in a way my overview book never could (and I was honored that John wrote the foreword for my 2nd edition)

If you’ve read the book, feel free to share comments and congratulations on this post or write a review on Amazon if this book has been as meaningful to you as it has been to me.

It’s also worth noting that Toussaint’s 2nd book, Potent Medicine, will be out later this year.

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology, focused on improving quality and patient safety, improving access, reducing costs, and fully engaging healthcare professionals. He is also the Chief Improvement Officer for KaiNexus.

Simon Le Bon of Duran Duran

I was driving the other day, listening to the 1980s music channel on XM Radio. The DJ announced a song by Duran Duran and it really sounded like “Juran Juran,” reminding me of the quality legend Joseph M. Juran. It made me chuckle to think of a band fronted by Juran (and maybe Dr. Deming playing keyboards).

I started a silly Twitter game asking people to come up with additional jokes with the hashtag #QualityTermBandName. Surprisingly, I got quite a few funny suggestions, my favorites in bold (and you can add more on Twitter or by posting a comment). Some of these are songs (and some of them in the hashtag were, as well). There were amazingly few repeats amongst the tweets….

The first reply came from @SimonCunnane:

Fleetwood Womack

Simon also suggested:

• Maroon 5S
• Metallika(izen)
• The Kan Band
• Plain White T(aichi)’s

Then, @jeromytimmer tweeted:

Before Pink Floyd David Gilmour was in a band called Sigma 6. #QualityTermBandName #forreal

Wow, that’s a great piece of trivia.

Jeromy also suggested:

• INXSPC
• Men At Work (Cell)
• The Mudas of Invention
• Air Supply Chain

Other suggestions rolled in — posted here in no particular order:

@iamvinnyp tweeted:

• AC / D(MAI)C

@Jaco4u contributed:

• David Lean Roth
• Alice in Supply Chains (I suggested they do a cover of the song “Supply Chain of Fools.”)
• Jidokas Priest
• A song by the Beatles: Hey Junka
• Ohno Doubt

@martinburnsuk come up with:

• A song by the Village People: It’s fun to stay at the PDCA (I would call the band the Villiage Pareto, though)

A cynical contribution from @Kevin_Meyer

Contributed by @oshendoschen:

• The No-Gos
• Journey (real band)
• Fishbone (real band)
• John Leanon and Poka-Yoke Ono

From @ChristinaKach:

Photo Credit:

Duran Duran photo credit: DDFic

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology, focused on improving quality and patient safety, improving access, reducing costs, and fully engaging healthcare professionals. He is also the Chief Improvement Officer for KaiNexus.