A Toyota employee, pictured at left, pulls an andon cord in a video shared by Toyota UK: Factory to Forecourt – Introduction to the Toyota Production System.

As the video explains, “every team member has the right to stop the line if he sees something that’s not quite right.” The video continues “everyone’s involved… it’s not just top down… we encourage, as we call it, bottom up… so if a team member comes to me [the team leader] and says ‘I have an idea for  this, you don’t ignore it, because nobody has a better idea than that member. The biggest asset we’ve got are the guys who work here.”

Here is the video:

It’s a really nice two-minute overview. If you have colleagues who think Lean/TPS isn’t all about engaging everybody in improvement, have them watch this video… and then talk about how you can create a similar environment where:

• Everybody is allowed to call time out when they think there is a problem (even if there’s not a physical cord to pull)
• Somebody comes to help IMMEDIATELY
• Nobody is blamed personally for creating the problem
• Nobody is punished for slowing down the work because of a quality/safety concern (even if it turns out to not be a problem)
• People work together on identifying problems and solving problems (at the root cause)

If  Toyota can do this for cars and trucks, shouldn’t hospitals do this too? As the slogan at the end of the video says: “Always a better way.”

Because the accident is a bit thick at times, I turned on the YouTube automated captions… which aren’t always accurate… sometimes comically so!

Nobody has better ideas than Batman?

I’m not sure how the word “death” appeared randomly on screen.

I’m not sure what the “carpark fool position” is

No explosions please!

I doubt they hate him:

Ah, defects in the auto-translation process…

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus.

Mark’s note: Today’s post is by a good friend in the lean healthcare world, Mark Welch (no relation to Jack). Today’s post is thought-provoking in terms of finding the balance between efficiency and building relationships in today’s workplace. He also brings up interesting points about the difference between our assumptions about customer (patient) needs and what the patients actually value.

Many of us believe, and rightfully so, that lean is 80% about the philosophy and 20% about the tools. That’s just one of the many aspects I like about lean thinking.  A big part – or rather, HUGE part of the philosophy is the way we connect with people: respectfully, listening to their ideas, helping them to learn and learning from them in turn, forgiving and not judging, working together to make work easier and for value to flow to patients/customers.  Building relationships is critical.

I also appreciate today’s technology.  Especially more recently since I’ve become an empty nester and I can Skype, text, do Face Time, or just talk on my cell phone with my kids most any time that’s appropriate – well, as long as I don’t annoy them too much.  I don’t care what anyone says – the concept of the truly “cool” parent doesn’t exist – not completely, anyway.  And if one is a “cool” parent, he or she would have to wonder to what extent that parenting is truly effective.

A recent CBS News Sunday Morning segment explored what is happening to us socially as technology has found its way to supposedly enhance our connectedness.  Essentially, it’s great for long distance connections, but it seems we’re sometimes ignoring those sitting next to us at home or when out to dinner.  Similarly, in the workplace these days it has become too easy to shoot off the email or make the quick call, even if the receiver of the message is a hallway, or even a floor or two away.  Yes, in many cases doing this is fine, but at what point do we realize that our work relationships are deteriorating?  If  we’re trying to build and/or keep a lean culture, how will we do that with minimal face to face contact, without seeing and reading a person’s body language and facial expressions – the things that make them who they are and help us truly and deeply understand them?  What do we need to do to keep them alive and thriving?  Is it sometimes too easy to use technology and let our relationships slide?

So, following lean thinking, when is it better to walk away from the phone or the computer and just go see someone?  What should be the rule of thumb?  Should there be a rule of thumb?  How important is it that the message is unambiguously understood?  Thinking purely along the lines of waste, one might think it’s more often than not better just to call or drop the quick email.  Maybe so.  Maybe not.

Let me illustrate my point.  I once did a few projects with an oncology unit and we brought some patients in for a Voice of the Patient session.  Traditional lean thinking would have it that patients abhor waiting for treatment, and if it was excessive, they did (we let them decide what was excessive).  But what they told us was that the time they spent waiting together with others who were going through the same experiences they were – the time they spent building those relationships – was truly of value to them.  Not in the way we traditionally understand value in the lean sense:  they certainly didn’t pay for the waiting and socializing, it wasn’t necessarily transforming their condition physically, etc.) but it meant something to them.  To be able to connect with a fellow cancer patient – make a new friend, get that emotional support they craved – was HUGE to them.  Yes, we improved our flow, and we didn’t get complaints that it was too good, if you get my drift, but to people dealing with a life-threatening disease, having too good of flow wasn’t quite what they wanted.  Yes, they wanted their treatment, but they also wanted people to know them and understand what they were experiencing.  They wanted that connection.

No, I’m not anti-technology.  I think it’s great.  But when improvement, be it with technology, work flow, or whatever it may be, seems like the right move from a purely lean standpoint, it sometimes pays to step back and think about what is truly most important.  In fact, what seemingly “isn’t lean” in some special cases actually is.

About Mark Welch: Mark is a Lean Coach from Spirit Lake, Iowa.  He is a 20-year veteran of continuous improvement, having helped launch lean journeys in manufacturing and healthcare.  Several of his healthcare improvement team projects have been recognized by the Iowa Healthcare Collaborative (IHC) Success Stories.  He is a frequent presenter on lean topics at the IHC Annual Conference and will present again this year on Launching Lean in Rural Hospitals.  His past certifications include Lean Healthcare from the University of Michigan, Certified Quality Auditor through the ASQ, Professional in Human Resources, and Senior Professional in Human Resources through SHRM.  He is also known for his contributions on exploring the relationship between the lean philosophy and religious faith.

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus.

Regardless of whether you think the NSA leaks that Edward Snowden admitted to make him a hero or a traitor, it begs the question:

How is the National SECURITY Agency so bad at securing its own information? They’re better at snooping than securing, I guess.

This article has an explanation: NSA leaker Ed Snowden used banned thumb-drive, exceeded access.

From the article:

Edward Snowden, the contract employee who leaked details of the agency’s broad-scale data gathering on Americans, exceeded his authorized access to computer systems and smuggled out Top Secret documents on a USB drive — a thumb-sized data storage device banned from use on secret military networks.

“He should not have been able to do either of those things” without setting off alarm bells, said one private sector IT security specialist who has worked on U.S. government classified networks. He spoke on condition of anonymity because of the sensitivities of his current employer.

Here’s a perfect example of a policy not being policed or followed very well. The same might be true in a factory (there’s a policy that safety glasses must be worn) or in a hospital (a policy says staff members always wash or disinfect their hands before entering/leaving a patient room). The written policy is pretty meaningless if it’s not being followed.

The NY Times said he was “left loosely supervised” by the NSA and the contractor Booz Allen Hamilton. It sounds like there was some poor management or other systemic breakdowns that helped allow Snowden to get away with this.

I don’t know how the NSA or other agencies police this, but one idea would be supervisors or security being on the lookout for such devices. When one is seen, corrective action must be taken (just as supervisors have a responsibility to speak up if somebody’s not wearing their glasses or washing their hands).

Compared to glasses and hands, it might be easier to mistake proof against the use of USB devices.

Again, from the Washington Times:

A number of commercially available programs can switch off the USB port of every computer on the network.

“There is easily available software to do that,” said the security specialist…

There are different ways of blocking USB port access, with pros and cons (as written about here).

The Washington Times article talks not only about software fixes, but also physical (hardware) prevention:

“I have seen places where they used a hot glue gun to block it,” he said of the USB port.

While this article calls that a “dumb” tactic, it seems that physically blocking or damaging the port might be pretty effective (and inexpensive). I’m surprised that big vendors, like Dell, for example, don’t offer PCs with zero USB ports built in to be sold to high-security environments.

While physically disabling the port might qualify as a kaizen-style idea (being more clever than expensive), there could be side effects, such as the ports not being available for legitimate uses.

Either way, why is the NSA apparently so ineffective at monitoring its own staff and contractors, yet alone monitoring the entire world’s communications?

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus.

It’s again time to close some browser tabs and clear out the backlog of articles I’ve wanted to share but maybe don’t merit an entire blog post…

It’s time again for “Stuff I’m Reading”… Click on any header for the article I’m referencing.

Banker falls asleep on keyboard and costs bank $293 million after accidentally transferring funds

A banker fell asleep on his keyboard, in particular the “2″ key, entering a transfer of 222,222,222.22 euros. A colleague was fired for not double-checking or confirming the error. That’s why it’s called “human error” – many types of human error involved in this case.

Employee concern grows at hospital

Employees at a California hospital are concerned about the future of their organization and they’re more concerned that their ideas aren’t being heard. A board member agrees:

“It is my experience that improvement comes from the employees,” he said. “We collectively need to figure out what a good forum is to raise good ideas. I have asked that question. No one has come back with a good solution.”

I hope the hospital does more than a “brainstorming session.” They need to also help make improvement happen (maybe they should look at KaiNexus).

The $2.7 Trillion Medical Bill

This piece from the NY Times examines why simple procedures like colonoscopies are so much more expensive in the United States compared to other countries.

California Patient Gets Outrageous Clinical Pathology Laboratory Test Bill from Napa Hospital, Almost 10 Times Higher Than Similar Testing from Quest Diagnostics

My friends at Dark Daily examine why laboratory testing prices can vary so wildly…

Can a community hospital that charges inpatient prices for clinical laboratory testing to a walk-up customer find itself at the center of a media news storm? That certainly is the case in California, where newspapers trumpeted the story of an unhappy consumer stuck with a $4,316.55 bill for a panel of medical lab tests that a national lab would have performed for just $464, about 90% cheaper!

Lean Healthcare Transformation Summit 2013

Blogger Bobby Gladd posted thoughts and many pictures from the recent Summit in Orlando.

He also asked, in an earlier post and tweet, why there wasn’t more diversity in the CEO panel that I moderated. Not to sound too defensive, but we did have a woman (Rachelle Schultz) on the panel last year. If we are talking about diversity, we could question the dearth of African-American faces on stage or in the audience at the event and other lean conferences. Do organizers need to do more, as Eric Ries and The Lean Startup conference has done, to attract a greater diversity to the stage and audience?

ED flow means great patient experience − and lives saved

Another blog post from Virginia Mason Medical Center about their Lean improvements.

“The flow process works so well now that the current door-to-balloon time at Virginia Mason is 42 minutes – cutting more than half the time recommended by the ACC/AHA,” says Sharon. “This is a great boost to patient experience and to the lifesaving quality of care provided in the ED.”

That’s basically the same results as achieved at ThedaCare, another leading Lean organization. They show what’s possible… and they both show the power of Lean as an improvement process that allows YOU to figure out what to improve rather than just blindly copying “best practices” from others.

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus.

I had a speaking engagement yesterday for a large system, with the audience consisting mainly of hospital CEOs and CFOs. I was able to be around for the entire morning, which included a really outstanding kickoff talk by the system CEO (talking about process improvement as a key strategy) and followed by two internal P.I. people who gave an outstanding talk.

I tweeted some of the highlights and top quotes, which I’ve collected here in this Storify page.

The Good

Almost 100% of the presentation and comments were spot on.

One particular highlight was the emphasis on systems thinking, as evidenced by this slide:

Of course we can’t get better performance by just pushing people to try harder, care more, or work harder. We need a new system and Lean gives us frameworks and methods for redesigning systems.

I also really appreciated the presenter’s take on the Lean principle of “Pull.” Many people get this backward and they describe pull as “pulling the patient up to the unit when we have a bed available.”

As this system pointed out, pull is really about the CUSTOMER (the patient) pulling on services. The health system should strive to provide these services (like a room and a bed) at the pull of the patient… when the patient needs it, not when it’s convenient for us.

The right care at the right place at the right time. That’s what Lean is all about.

The Sort of Bad

The only thing I could quibble with was their discussion of waste and “non value added activity.”

They talked about the need to eliminate ALL waste activity (that’s the goal, I guess, but a bit of a stretch in reality). We aim to minimize waste.

An example was brought up, basically saying, “Don’t freak people out by saying that regulatory requirements, like preparing for a Joint Commission visit, are waste because we have to keep doing those things.”

In any setting, identifying something as waste (not providing value to the customer) doesn’t mean we automatically stop doing it. Some waste is required.

For example, we generally consider quality inspections to be a form of waste? Why? Because we’d ideally find a way to mistake proof a process so it’s impossible to create a defect. But, until that’s happening, inspection might be the next best alternative (it’s better to catch defects than to pass them on to the customer).

Toyota, like every automaker, has inspection steps at the end of the line. They strive to “build in” quality as much as they can, with good processes and mistake proofing, but they still do final inspection.

When I worked at a GM engine plant in the mid 1990s, the people designing our factory decided that our Northstar engine was so well designed and was going to be so well built that our assembly line would not have a “hot test” station at the end of the line. The engines would be shipped directly to the car assembly plants, assuming good quality, and the first time the engine would be cranked up would be at the end of car assembly.

The assumption of quality was a VERY BAD assumption. The GM engine plant had some very major quality “spills” where defective engines were caught at the end of the car assembly line. That meant over 1,000 potentially defective engines were upstream in other cars and in our engine plant’s finished goods inventory. That’s a very expensive problem to fix, whereas a hot test station could have caught the problem much earlier (better yet would have been better process controls that would have prevented the error in the first place).

The Ugly

Let me emphasize that today’s “ugly” example is NOT from this health system, but rather from a student paper from a Big Ten university (thankfully, not Northwestern).

From the paper:

Lean doesn’t focus on quality control? Good grief. That’s “L.A.M.E.” or Lean As Mistakenly Explained if I’ve ever heard it.

They fall into the trap of saying Lean is for speed and Six Sigma is for quality. Both methods should produce better flow and better quality. They go hand in hand. The two pillars of the TPS house are, of course, flow and quality at the source (as pictured in this blog post from earlier this week).

I hope the professor wasn’t teaching the common, yet incorrect, Lean Sigma fallacy…

I certainly hope the professor corrected them on this when grading the paper… but recently history shows not all professors have a great handle on Lean.

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus.

Dr. Delos (“Toby”) Cosgrove, President and CEO of the famed Cleveland Clinic, wrote an article on LinkedIn recently: “Patient Experience: Time for Hospitals to Look Under the Bed.”

Cosgrove described his process of going to visit patients after heart surgery (good, which sounds like the Lean practice of “going to the gemba” to see what’s really happening and it shows customer / patient focus).

During one visit (“many years ago”), Cosgrove had a patient’s family tell him that he needed to look under the bed… what was there?

Cosgrove writes:

I looked, and to my everlasting humiliation, saw litter and dustballs. The patient and family felt neglected and disrespected – and they were right to be offended.

It’s good that Cosgrove would be willing to tell this story in a fairly public forum. As I wrote about yesterday, it’s important to first expose problems so we can solve problems.

When a Lean leader goes to the gemba, he or she then “asks why” and “shows respect” to the customers and those doing the work.

I’m not sure if Cosgrove’s assessment of the situation seems plausible…

Ultimately, patient experience is determined by your caregivers – all of your caregivers, not just doctors and nurses. Receptionists, housekeeping, greeters, administrative staffers – they all impact the patient experience. They need to be motivated and engaged. Patient experience should be top-of-mind in everything they do. Employees will follow the agenda set by senior leadership. Administrators need to be clear about what service and experience is and why it’s important; you can’t let employees guess. Ask employees to imagine what it’s like to be a patient or the family member of a patient. Ask them how they would like to be treated. Remind them that this is consistent with the ethical practice of medicine. Finally, explain the link to reimbursement. Medicare has begun indexing payments to patient satisfaction scores and commercial payers are following suit.

I’m not sure if staff members have lost sight of the patient being the priority. Nurses, doctors, housekeeping staff – they see patients every day.

It could be interpreted as Cosgrove falling back on a somewhat traditional management approach of blaming the workers (they aren’t aware or motivated?) I wish he had asked “why?” or at least said something about this being a system issue and not being the workers’ fault.

A Lean problem solving approach would ask WHY there is dust under the bed, with questions such as:

• Do we have the proper housekeeping staffing levels (in general and on each particular day)?
• Is there clear standardized work for how to clean a room (including under the bed)?
• Are there good management practices in place to ensure work can be done properly?
• Do staff have all of the tools and supplies they need?
• Do staff have enough time to do the work properly?
• Are staff pressured into cutting corners on quality in order to get the work done more quickly?

These are all systemic issues, owned by management and senior leadership.

I could think of a lot of potential countermeasures to ensure the rooms are always cleaned properly… I don’t think a bunch of training about “remember the patients” would really solve that problem. There’s got to be something in the nuts and bolts of the operation to be improved.

Cosgrove did make one closing point I agreed with:

The move by Medicare and other payers to reward patient satisfaction is important. But it will not make or break our institutions. The real motivation for change needs to come from the heart. Not everything can be measure by ROI. We can’t forget why we became doctors and nurses and administrators. In the final analysis, we work for a better patient experience because it’s the right thing to do.

Yes, sometimes it’s just the right thing to do.

Coincidentally, Bill Waddell wrote a post today about how manufacturing leaders can’t expect to get cycle time reduction by merely pressuring people to work faster. I think the same lesson applies in healthcare and other settings.

…these guys think you reduce the time line by measuring it and lighting a fire under people to get stuff done faster. Getting them to work faster, according to these guys requires getting people to “feel the jungle” (an absurd phrase if ever I heard one) and make an “emotional investment.”

“Threatening people is a good means of getting them to make that emotional investment in feeling the jungle. When people are working as hard as humanly possible, reduce cycle times by outsourcing or getting people to fail fast to enter a white space with a higher probability of success” – another academic soufflé of a phrase.

As Bill called it — “nonsense.”

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus.

Last week at the Lean Healthcare Transformation Summit, I really enjoyed the presentation by Jamie Bonini, General Manager of the Toyota Production System Support Center (TSSC). Jamie started his career at Chrysler (where he knew Jamie Flinchbaugh, a good friend of this blog) and both Jamies, like me, are graduates of the MIT Leaders for Global Operations program.

Jamie shared great insights on what we might call “Lean culture” as Toyota aims for and others have emulated.

Jamie described Toyota’s organization culture as an integrated system, consisting of:

Basic philosophy

1. Customer first (patient first in healthcare)
2. People are the most valuable resource
3. Kaizen (continuous improvement
4. Focus on the workplace (shopfloor focus, gemba)

Technical tools

These are the methods like kanban, just in time production, etc. As Jim Womack said in his keynote, these tools are “necessary, but not sufficient” because they have to be combined with the philosophy and managerial practices. The classic “TPS house” illustration covers these practices (or see Jamie’s diagram, below):

Managerial approach

Jamie said the key managerial role is to develop people to surface problems and to solve problems (to better serve the customer). He emphasized this many times. Managers and leaders are responsible for helping create a culture where people can surface and solve problems.

The ideal is to be notified of any abnormality immediately and to solve problems as they occur (while the situation is still fresh).

Jamie referenced back to Dr. John Toussaint’s keynote, with all of the things that went wrong during his mother-in-law’s healthcare, saying, “A problem solver would have arrived immediately to solve the root cause and prevent it from happening again.”

Unfortunately, that’s still not the culture in healthcare, generally.

That’s the power of Lean principles… it’s not about copying tools, it’s about adopting the culture and philosophy… that’s what makes the tools useful, when oriented in the direction of the customer. For example, I’m not sure how saying “no sweaters on the back of your chair” (in the Kyocera “Lean office” initiative) helps the customer at all! That’s why I called that “L.A.M.E.” and not Lean. That’s why we need to be customer driven (solving problems that matter) rather than being tools driven.

Four roles of a leader

Jamie talked about the four roles that each leader must play in a Lean transformation:

1. Show passionate commitment for improvement and TPS
2. Learn TPS principles, well enough to teach them to others (the basic principles and the details)
3. Build an organizational culture that surfaces and solves problems
4. Be active in the gemba (go and see… “genchi gembutsu”)

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus.

MP3 File (run time 24:26)

My guest for Podcast #177 is a returning guest, Bob Emiliani. In this episode, we’re talking about one of his latest eBooks: Nobody Is Exempt From Improvement. Check out our previous podcasts together – Episodes 132, 77, 48, 38, and 30. Bob is a professor at Central Connecticut State University and a prolific author on Lean management.

Also check out his new book and blog – “The Lean Professor.”

For a link to this episode, refer people to www.leanblog.org/177.

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. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus.

It was a real thrill to be able to meet Paul O’Neill in person yesterday at the Summit (he was my guest for Podcast #124). His powerful message about leadership and patient safety was well received by the audience.

Below are my raw notes as I typed live in this Google Doc. I hope the notes do his talk justice…

Notes:

• How many of you work in an org. where you can, 24×7, see the real-time OSHA recordable injury rate, etc. for your org?

  • Are “people your most important asset?”

    • “Show me the evidence” and what has been demonstrated?

• Organizations are either habitually excellent, or they’re not

  • One way to demonstrate you ARE (or on a journey)… is your goal to be the best in the world in everything you do?

  • Wouldn’t REALLY caring about the people who work you be a good start? (safety)

  • The goal is nobody being hurt

  • Working in healthcare/medical is the most dangerous industry in the US

    • 5 in 100 have an OSHA recordable each year

    • Lost workday cases (this is a report that’s hard to fudge unlike other measures) — 3 out of 100 have an injury (often serious) that causes them to miss a day of work or more

    • He was able to pull up CURRENT Alcoa data on his iPad today

      • “The culture owns workplace safety” (O’Neill has been gone 13 years now). Employees own each others’ welfare

• Why do I care about workplace safety, beyond being morally important?

  • Part of habitual excellence

  • I’m not going to believe we are serious about lean or perfect patient care until every organization here (and all care giving orgs) can say we have REAL-TIME information about workplace injuries for the “people we say we care about.” — for improvement, not for blaming and shaming

  • “I’d trade in all my awards for a country that demonstrates it truly cares about the safety of its workers.”

• When he joined Alcoa, set a goal that nobody there get hurt at work

  • National average lost workday rate was 5 out of 100, across all workplaces (in 1987)

  • Alcoa, it was 1.86, they were really proud of this, given it could be a really dangrous industry and environment

    • “Now, our goal is zero”  - people were taken aback because they didn’t think it was possible.

    • Behind his back, people said O’Neill doesn’t know about our industry and about making aluminum

    • The excuses are all the same… it would cost too much to improve safety

    • People think God wants us to get hurt?

    • Wanted to use the term “incident” not “accident” (a term that makes people think they are inevitable)

    • People don’t like to set goals they think they can’t achieve

    • A non-zero goal is not OK… who wants to volunteer to get hurt?

    • Improved 30-50% a year for 13 years

    • 0.065 is the number today

• None of this can happen without “real leadership”

• Our education system doesn’t spark people to think deeply about what leadership means

• “Do the people who clean the rooms get the same level of respect as the surgeons?”

  • I don’t know many organizations where that is literally true. It cannot be true unless the leader is completely dedicated to the idea and starts a continuous process that eliminates abusive behaviors and things that are disrespectful.

• You can’t get to zero safety incidents with cheerleading or writing it on the wall and believing, as a leader, you’ve accomplished the purpose.

• “Show me organization with a Vice President of equal opportunity & I’ll show you an organization without equal opportunity”

• It’s the duty of a real leader to articulate aspirational goals that are meaningful (the goals aren’t from on high, but from a discussion about what the aspirational goals SHOULD be).

• “Alcoa will never again budget for safety.” If there is a need, I’ll find a way to pay for it. People couldn’t believe the CEO was saying we’ll spend whatever it takes for safety. If somebody identifies anything, just fix it. That’s the supervisors’ responsibility.

  • O’Neill gave his home number to the workers… and told them to call if the supervisors weren’t doing that. He got a call 3 weeks later… employee reporting a broken roller conveyor that had been broken for 3 days and people are having to lift 600 lb ingots to walk them around the broken conveyor and somebody will get hurt. “This isn’t exactly what we thought you meant.”

  • O’Neill called the plant manager immediately, got him out of bed. Told him the story. I want you to go down to the plant and get that fixed and call me when it’s fixed… and I don’t want to ever get another call. 4 AM, it got fixed, and he got another call.

  • The story of that spread through the informal network… that he was serious and there could be no barriers to safety improvement. That was the beginning of a culture of safety.

• He told Wall Street analysts that safety numbers would be a “leading indicator” of how we are improving, in general. There was buzz that a CEO was talking to analysts about safety.

  • “Most organizations are just riding a log down a river.”

• Working to do things perfectly leads to better financial results than any sort of financial engineering.

• O’Neill told his finance people, “If you ever calculate the cost savings from improving safety, you’ll destroy my moral authority on this…”

  • Internal politics, back biting, etc. is a waste of human energy that could be used to create value for customers.

• Who doesn’t want to work at a hospital that’s working toward zero infections?

• O’Neill had “Management Training” changed (the term) to “Leadership Training”

  • Root of management is manipulation in Latin.

• He credits early education in computer programming as a way to think more systemically.

• Back in the late 1960’s, the VA was autoclaving hypodermic needles because it was deemed cheaper than reusable needles… instead of looking at the total experience of a system where patient was exposed to an infection they shouldn’t have had.

  • “Accounting got confused with economics”

• Replaced Lawrence Summers as Sec. of Treasury (his staff assistant was Sheryl Sandberg, now COO of Facebook)

  • Transition meeting on a Saturday morning. Summers didn’t know the lost workday rate in Treasury (didn’t know the idea of the rate even meant)

  • “Floating on top of the organization versus really caring as a leader.”

  • Sandberg said she would get the data. Rate was about the national average.

  • Quickly reduced it 50%… what is the occupational risk of IRS workers?  O’Neill says people generally don’t understand how there is safety workplace risk for hospital workers…

• It is possible, with empowered people who are doing the work, to achieve what we want – to have a perfectly safe medical enterprise.

• On theoretical limits, “If God doesn’t stop you from doing it, you can do it!”

  • Compare everything you do to what perfect looks like. It’s like draining the swamp.

• Alcoa market value increased 800% in 13 years by paying attention to the NON-financial measures… the finances took care of themselves

Below is a photo taken by Bobby Gladd. See his blog post about the Summit here.

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus.

Things are underway at the 2013 Lean Healthcare Transformation Summit. We have 600 attendees from 39 states and 8 countries.

I will be tweeting, as will others, at the hashtag #HCsummit13.

John Toussaint, MD will be doing his keynote at 8:30 AM EDT. I will be taking notes live in this public google document (also see completed notes below).

Notes

• We need to revitalize this industry

• The people in this room are trying to transform the industry

• 3 pillars for this summit and transformation

  • Care redesign (including Lean)

  • Paying for value

  • Transparency

• Tish’s story (80 year old patient)

  • Many, many errors and problems in her care

  • “Her morning meds were given at night and her night meds were given in the morning… but they [the nurses] ignored her.”

  • Surgery to correct a hospital-acquired infection

  • Waiting, waiting, waiting

  • Cultured specimens were lost by the lab

  • “Tish noticed nobody who entered the room washed their hands other than the phlebotomist. The antiseptic dispenser was empty.”

  • “It takes guts to tattle on your nurse.” Nothing changed.

  • Her wishes and concerns were ignored

  • A major hospital well known for good safety

  • “Is this your health system??” – rhetorical Q

  • “After two weeks in the system, she was WORSE then when she started.”

  • After three weeks, she was finally better.

• “It doesn’t have to be this way.”

• Tish is John’s mother in law

• What’s the problem? Unfortunately, this is going on a lot in patient care… harming patients.

• What are some of the root causes?

  • The overall value stream of cancer care is not viewed as an overall system

  • Even though we claim to be highly integrated, we are not

  • Lack of an operating system to help fix things – see article

  • We’ve got a problem with our management system – the most important critical factor missing in healthcare is a management system that supports improvement.

  • Need to shift from the top-down command and control model to a lean management system

• What can we do about it?

  • Shows a ThedaCare cancer value stream map for the entire care process

  • Lean management system – connects people and process working for a purpose

  • “Management by process” – not “management by objective”

    • A3 thinking

    • Daily status sheet

    • Daily performance and defect review huddle

    • Unit-based leadership teams

    • Standardized work for leaders and supervisors

    • Standardized work audits

    • Visual process tracking

    • Andons

• “No meeting zones”

  • 2 hours each morning – so what happens?

  • People leading in the gemba, leading by asking questions

  • One Iowa org implemented 12,000 staff ideas

• Video of a team “defect huddle”

  • Lab orders remaining on care plans – RNs don’t know if they’ve been done or not – why do they remain there?

    • Do we have a timeline for when we can come up with a suggestion?

    • Asking employees to help solve the problems and improve the process

  • Our job as leaders is to help them unravel the giant hairball of problems

• Standardized work for leaders – daily stat sheet (status sheet)

  • Asking questions, going off a guide of what to ask and investigate

  • As a CEO, are you going to the gemba for 15 minutes every day? (at least?)

  • Examine your management system – can it actually support the continuous improvement your staff are trying to make happen?

  • Good (in Mark’s opinion): staff tracking metrics by pencil at the gema

    • Bad (in Mark’s opinion): simplistic “red/green” analysis around an (arbitrary?) target. Need better SPC analysis to avoid overreacting to every up and down in the data (see here)

• John talks about the mentoring from Paul O’Neill (he is speaking later today)

  • 3 questions – can you say yes every day?

    • Is everybody treated with dignity and respect by everyone?

    • Does everybody had the tools, training, and encouragement to do the work that gives their life meaning?

    • Have people received recognition?

• Results

  • NYC HHC has saved nearly $250M over 5 years, for example

    • It’s management by process so we can get results

  • Reduced cardiac mortality through use of Lean methods (2.5% lower… not much, but it’s lower)

• “This operating system is critical for delivering results.” But we need more than the management system too. Also requires:

  • Transparency of patient outcomes:

    • Study – MDs that report quality of care measures improve more quickly (Health Affairs)

    • The systems that would create this transparency are a mess – no standards, information is locked up for experts to get out

    • Much of Tish’s story could have been improved by having better information flow

    • Need more “Business Intelligence” applied to healthcare

      • See CBIN effort

  • Payment reform

• Has anybody put it all together?

  • HealthPartners in MN – web and mobile transparency… rating the MD clinics on cost and quality, star rating

    • http://www.healthpartners.com/portal/1919.html

  • Paying differently based on results

    • Withhold payment portion and then pay if they hit metrics

    • Bonus and public recognition for top 1%

    • Triple Aim savings (cost, quality, etc.) – shared savings

    • Trying to “pay for value” in MN and WI

  • Involving the patient to redesign care

• Wisconsin Statewide Value Committee

(end of talk)

Q&A comments:

• Most organizations haven’t mapped out their existing state. They don’t know how they are performing.

• Reimbursement is a challenge and a problem in every country

• How many of Tish’s problems could have been avoided? 90-95%? One or both hospitalizations could have been avoided?

• Q: How do we get MDs to follow standardized work?

  • John says we need to look at the system… the system is designed for people to not follow SW

  • (Mark’s commentary… we can’t force anybody to do anything)

• don’t just Plan and Do and Run – focus on Study and Adjust!

Photo below by Bobby Gladd. See his blog post about the Summit here.

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus.

From 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.”

NO!

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 schedule 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 is occurring 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.

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus.

I flew back safely from Finland on Saturday – or I should say British Airways and American Airlines flew me safety, including in the 747 pictured at left. 15 hours across three flights. It was a long day. But, I wasn’t really worried about my safety because of the great track record that the aviation industry has demonstrated (and taught to industries like healthcare).

That said, mistakes still happen. We’re all human. But, what does an industry do and how do they react when a mistake is made? Recent events with a British Airways flight are telling.

As reported May 25: “BA Plane ‘On Fire’ As It Flew Over London.” See also this picture. Some people initially jumped to the conclusion of “terrorism” (which serves as a good reminder about not jumping to conclusions when problem solving).

From that initial report:

“The airline has begun a full investigation into the incident and is working with the Air Accident Investigation Bureau to establish the cause.”

Unlike medical errors (or “adverse events” or “sentinel events”), which are generally underreported, a burning plane over London is a VERY visible problem. The public demands answers and investigations. In healthcare, people might say “well, nobody was hurt” (which is true in this BA fire incident… the plane landed safely, but I’m sure it scared some people).

Within a week, explanations started coming out in the news. With my Lean hat on, I’d hope and expect that the aviation safety experts and the airline would be looking for process improvement opportunities rather than just “naming, blaming, and shaming” an individual or two.

I had four different British newspapers with me to review on the trip from London to Dallas/Fort Worth and they all had coverage of the BA plane fire.

This headline seems to ascribe blame:

Blunder by engineers led to near-disaster on BA flight

Saying:

A passenger aircraft was forced to make an emergency landing because BA maintenance staff failed to secure engine covers after routine servicing.

So the fact appears to be that engine covers (on both engines) were not secured (latched) properly.

But rather than asking “who messed up?” we could ask “why did that occur?”

The failure by staff at Heathrow to complete standard safety checks resulted in a near-catastrophe in the London skies last week, accident investigators revealed yesterday.

The phrase “failure by staff” is a collective blaming. Sure, somebody (or bodies) didn’t latch them properly. Did somebody also not double check? What are the standard procedures? Why did this not happen? How often does this error occur?

This article focuses on the lack of inspection:

Failure of ‘walk-around inspection’ blamed for British Airways’ Heathrow emergency landing after engine caught fire

One reaction from the British government:

 …the Air Accidents Investigations Branch (AAIB) rushed out a report urging airline ground staff and pilots to check that the engine panels are properly closed before departure.

In healthcare, my experience is that asking staff and surgeons to be careful and double check things doesn’t always work… unless those checks are built into a checklist that’s used and verified 100% of the time. Being aviation, this guidance might be more effective than it might be in healthcare, but it begs the question about why this check or inspection wasn’t being done before.

Previously:

Airbus stresses that the pilot conducting a walk-around “must be positioned on the side of the engine and crouch” to make sure the panel was properly closed.

So why wasn’t that done?

Also,

The AAIB stresses that the sole objective of its investigation is to prevent future accidents, not to apportion blame. But the interim report indicates that engineers failed properly to close the panels; that the pilots did not spot the error during the “walk-around” inspection; and the problem was also missed by the push-back crew.

It’s not unusual for aviation to emphasize blame-free investigations with a focus on preventing future occurrences.

The above quote also goes to show how errors often slip through because multiple points of inspection fail (perhaps one person thinks the other will catch a problem, so, being human, we let our guard down, especially if a certain problem rarely occurs).

And this article had some other detail:

Maintenance blunder blamed for jet’s forced landing at Heathrow

There’s a bit of blaming:

It is understood that an engineer who performed scheduled maintenance on the aircraft overnight has admitted to failing to secure the latches.

There’s a bit more systemic “why?” involved:

During preflight preparations the standard practice is for at least one of the plane’s pilots to inspect the aircraft externally. On the engine covers of this type of aircraft, however, the inspection is difficult because the latches are positioned below the engine, which has a clearance of just two feet (60cm) off the ground. The AAIB report said that an engineer normally needs to lie on his or her back to secure the latches.

An engineer “blundered” but so did the pilot for not catching the problem. But, the engine was designed in a way that makes inspection “difficult.” Does the airline make it easy for a pilot or engineer to lay down on the ground? Is there a pad or a mat? Or something like an auto mechanic would use (it’s, strangely, called a “creeper.”)

It’s hard to assign a single “root cause” to a situation like this, eh?

What are some possible countermeasures the airlines could take?

• Ask Airbus and/or the engine makers to redesign where the engine cover latch or, at least, its location.
• Make sure the pilot checklist has this inspection step and have senior leaders verify proper use of the checklist.
• Add a sensor or interlock that alerts the pilot in the cockpit that the latch isn’t closed proper (like a car’s “door ajar” warning).
• Punish and fire the engineers and pilots involved in this incident.

What would you do? It’s unclear exactly which action or actions will be taken by the airline (although, thankfully, blame and punishment seems unlikely).

Jock Lowe, a former director of flight operations at BA, praised the response of the crew to the emergency and said it was clear that human error was to blame. “Unfortunately, as long as we have human beings in the loop, mistakes will occur,” he said.

He added that it would have been difficult for the crew to spot the maintenance blunder because of the position of the latches but conceded that was what a visual inspection was designed to do. “Perhaps one of the pilots should have picked it up.”

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus.

Thanks again to Aalto PRO and Aalto University for bringing me to Helsinki. It’s been a great week!

We had about 100 healthcare professionals gathered (about half of those being doctors) gathered yesterday to discuss Lean healthcare (info on the session).

As a speaker, it’s always interesting to see what quotes or nuggets people send out via Twitter (in addition to getting face-to-face feedback about the discussions being interesting, helpful, or inspiring).

Read more via a “Storify” summary of tweets along with some of my added commentary that’s embedded.

Thanks to the Finnish attendees for their interest in Lean healthcare and best wishes for your future improvement work! Kiitos!

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus.

MP3 File (run time 25:14)

Joining me once again for episode #176 is my good friend Norman Bodek, who has been a guest many times here. Today, we are talking about his latest book, The Harada Method: The Spirit of Self-Reliance. You can also learn more about the book and Norman’s workshops at his website, PCSPress.com. As always, it’s great to hear Norman talk about his interests and what he has learned in his trips to Japan, including Harada’s work.

For a link to this episode, refer people to www.leanblog.org/176.

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. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus.

I’ve had a really nice time during my first 30 hours in Helsinki, Finland. It’s been warm (72 F) and sunny — and more than 18 hours of sunlight each day, to boot. I will blog more substantively about my gemba visit to a Helsinki-area hospital yesterday.

But, I’ve had some really good food (lots of fish, including smoked and cured) and some local beer. Tonight, I had a glass of wine in the hotel restaurant (pictured here) that violated the Lean principle of “visual control” — but I, as the customer, enjoyed that extra ounce or so of wine.

A larger picture, below, shows the etched white line that shows the waiter how much wine is supposed to be poured. Some restaurants, like my local San Antonio pizzeria called “Dough,” use the restaurant logo as a more subtle pour line (one they are usually pretty disciplined about).

From the restaurant owner’s perspective, the line is meant to prevent “over pouring,” which from their standpoint is giving the customer too much product for their money. The customer (like me) might view it as value, but the owner might view it as waste and lost profit. This is a recurring theme on the show “Bar Rescue” (as my friend Chad Walters has blogged about at LeanBlitz.net).

Bartenders might view an over pour as something that generates customer loyalty or higher tips (the tipping is not an issue in Finland, as a service charge is included in the price). Owners often view it as “theft.” I imagine some owners might take a long-term perspective that it’s better to lose a little bit of profit today (the margins are pretty high on bottled wine, anyway) for a long-term customer relationship (which is probably not a concern in a touristy area like I’m in now).

In the Lean approach, a visual control is something that helps us do our job better or more accurately… or it allows the team and management to see immediately if there is a problem). I’d call it “visual management” if it is a status indicator that somebody uses to take action.

Visual controls might show how much inventory should be stacked on a shelf or when patient flow is really suffering. In a way, a healthcare waiting room (the number of people in it) might be a natural visual indicator of how many patients are waiting. Of course, in some hospitals or clinics, the wait is normal and there’s really no management response (such as opening more rooms/bays or bringing in extra staff).

In an office like that of “The World’s First Lean Dentist,” Sami Bahri, DDS, seeing ANYBODY in the waiting room would indicate a problem and an unusual situation since his patient flow is normally so good.

In this case, I probably should have taken a quick sip or two to get the wine down to the line, lest anybody get in trouble! When leaders see a problem, they should normally look for a systemic root cause rather than just leaping to blame and/or punish an individual.

What are some visual controls you have incorporated into your workplace?

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus.

I’ve added to a new post to my LinkedIn Influencers series: “The Ability to Iterate is Not an Excuse to Do It Badly the First Time.”

It’s about the new American Airlines digital airport signage that’s being rolled out across airports — signage that I think is a big step backward in readability…. but they look pretty.

I’m certainly an advocate of “continuous improvement” and the Plan-Do-Study-Adjust cycle, but there are times when we need to test ideas and “get them right” before putting them in front of customers, right? How do we strike the balance?

You should be able to read the LinkedIn piece even if you’re not a LinkedIn user. Feel free to comment there or here on the blog.

I’m in Helsinki, Finland through Saturday. I get to do some gemba walks at a hospital on Tuesday afternoon and I’m speaking at a Lean Healthcare conference on Thursday. I’ll do my best to post updates this week on these travels and visits.

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus.

I’m happy to announce that I’m collaborating with Jim Benson and Tonianne DeMaria Barry, fellow Shingo Research Prize recipients, and experts in the “personal kanban” methodology (listen to my podcast with Jim) on a day-long workshop in Seattle on July 29:

An Introduction to Lean for Knowledge Work - click to register

It’s being held right before the annual “Kaizen Camp” event being held the next two days at the same venue.

I’ll be teaching half of the day – material based on “Healthcare Kaizen” but generalized a bit for audiences including healthcare, government, software, and retail. I’m also doing a half-day session in Dallas / Fort Worth on June 25.

With high degrees of variation and reliance on problem-solving and creativity, “knowledge work” is fraught with uncertainty. Whether you’re in health care, law, engineering, software, accounting, or administration, finding processes that tame uncertainty, help you complete what you’ve started, alleviate frustration, and surface areas in your work that could benefit from improvement seems like a tall order. Join Shingo Research and Professional Publication Award Winners Mark Graban, Tonianne DeMaria Barry, and Jim Benson for a one-day introduction to Lean for Knowledge Work and learn simple, effective practices that will help you:

• Estimate work;

• Surface and address areas that provide no value;

• Understand the nature of your interruptions;

• Communicate workload to others;

• Effectively collaborate;

• Better manage work-in-progress;

• Get more done by doing less at a time; and

• Continuously improve your work, working relationships, job satisfaction, and stress level.

Register today and receive Mark’s Shingo Research Award Winning Healthcare Kaizen

& Jim and Tonianne’s Shingo Research Award Winning Personal Kanban

This event is limited to 36 attendees and is expected to sell out quickly.

click to register

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus.

This article appeared back in March… March of 2013… as in this year: “Windsor Chrysler workers reduce waste to be world class.” I mean, good for them, but they are just now getting to this (even if the effort started in 2009 or so)… in the auto industry? Many hospitals were applying Lean thinking before then. Was that Chrysler plant expecting Toyota to just go away? I worked at a GM plant from 1995 to 1997 and the writing on the wall was clear that Lean / Toyota Production System was the winning formula.

Thankfully, they have gotten results in the areas you’d expect:

By eliminating waste, Windsor Assembly has achieved cost savings of $232 million since the inception of WCM [world class manufacturing], said Dan Omahen, plant manager. Workplace injuries have been reduced by 81 per cent, he added.

On the quality front, the number of minivans requiring warranty repairs has decreased by 69 per cent.

At least Chrysler / Fiat realizes it’s about people:

At the heart of WCM is employee engagement, said Omahen. Since the implementation of WCM, employees have contributed 97,778 ideas for improvements and 77 per cent were implemented.

“There’s several important pillars here, but the most important one we realize is the people.” Omahen said as he motioned towards a wall of the front office that displays the most outstanding cost-saving ideas by employees. “We want people to take ownership when it comes to driving change.”

Omahen has adopted the language of WCM, referring to employees’ ideas as kaizens — the Japanese word for  improvement. One kaizen, for example, came from an engineer whose project saved more than $59,000, he said.

In fact, more than 80 per cent of [plant manager] Omahen’s time now is spent on the factory floor talking to employees.

That’s the leadership style I saw from the second GM plant manager I worked under (he was one of the first GM at the NUMMI joint venture plant with Toyota). Being at the “gemba” (the workplace) and working together on improvement, not just dictating answers to people.

From the Chrysler article:

“Before WCM, we were dictated to,” said Mark Dana, an hourly worker who leads a team of about 10 employees in the plant’s tire assembly area. “Now workers have a say, and as a team, we work to solve problems together.”

That’s the Lean / TPS leadership style. Congrats to Chrysler for finally getting on board…

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus.

My co-author Joe Swartz and I are happy to announce that our book Healthcare Kaizen was named a recipient of the prestigious Shingo Professional Publication and Research Award. The award will be formally presented to the co-authors in early 2014 at the Shingo Prize annual conference. A formal release will be coming out in a few weeks, but we were told we could share this news.

Joe and I are honored by this designation and we thank our mentors and teachers, including Norman Bodek and Masaaki Imai, both of whom contributed “front matter” to be included in our book. Thank you, thank you to them.We also thank all of those whose Kaizen improvement work has inspired us – including the amazing people at Franciscan St. Francis Health System, Joe’s organization, as well as all of the healthcare professionals Mark has worked with at numerous organizations who were willing to share their improvement work. We share this honor with all of them and hope their work continues to inspire others to improve healthcare.

Thanks again to the Shingo Prize Organization for once again honoring my work, after my first book Lean Hospitals also received this recognition in 2009.

Buy the book via Amazon.com or our publisher Productivity Press. Speaking of Productivity Press, thanks go to our acquisition editor, Kris Mednansky, and the team there.

This Award is named in honor of Dr. Shigeo Shingo, credited as one of the creators of the Toyota Production System. It’s also an honor to included with such an illustrious list of previous Research Award winners.

About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus.

MP3 File (run time 28:17)

My guest for podcast #175 is Mike Taubitz of the firm Sustainable Lean and FDR Safety. Mike is a retired GM employee (including a stint as Global Safety Director) and we met at the Michigan Lean Consortium conference in 2011. We quickly discovered our shared interest in Dr. Deming, Lean, and, most importantly, safety improvement.

I hope you enjoy our chat about his background and lessons from his career, the integration of Lean practices and safety improvement, lessons from Paul O’Neill and other great topics. Like my dad, Mike is a graduate of the then General Motors Institute (now Kettering University).

Some key quotes:

• “It’s not just what you do, but why.”
• 5S is not just neat, clean, and organized – it’s about team identifying waste and developing standards
• We are “a nation of solution seekers” instead of working on “foundational thinking.”

For a link to this episode, refer people to www.leanblog.org/175.

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. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus.