Lean Blog

Be careful about "manufacturing is different." I'...

2009-11-06T11:55:47.416-05:00

Be careful about "manufacturing is different." I've done RPIs to improve oil field maintenance, Indian nation drug treatment, municipal street use permitting, accounts payable, contracting, vaccine research, etc.

We did four mornings of 5S, then one five-day RPI ...

2009-11-06T11:52:29.652-05:00

We did four mornings of 5S, then one five-day RPI in Washington state's largest outpatient pharmacy, and brought average time to fill a drug order (one or more prescriptions for one person) down from over an hour to under fifteen minutes for a "simple" order, and under 30 minutes for a "complex" order. [Complex meant 1) over 4 prescriptions, 2) patient needs an interpreter, or 3) prescription needs mixing or custom preparation.] As we rolled out the new process on Friday morning (we're talking RAPID) the first patient was a Cantonese gentleman with 25 prescriptions. He was out of there in under half an hour!

Much of the improvement had to do with setting up the waiting room as part of the process, including a staffed kiosk at the entrance to the waiting area that screened for legible prescriptions and ability to pay/fund the drug order. That way prescriptions weren't filled before payment was sorted out.

The clientele for this pharmacy as varied as possible: all races, languages, incomes, ailments: drug addicts to corporate attorneys.

In our organization we have trained associates in ...

2009-11-06T10:41:59.722-05:00

In our organization we have trained associates in Lean principles and tools and are using Events as a way for them to learn to use them. It is expected that as they see how Lean can be used to improve processes resulting in better safety, quality, delivery, and cost that they will then practice kaizen on an daily basis as well. In my mind, as the facilitator of the Events, they are a good training tool as well as being one component of continuous improvement. However, I have to remind upper management that they are not an end in themselves nor are they the heart and soul of Lean. They are a part of our people developement and, as such, have been well received by all levels of our company, even if there are not great financial results from every Event. Our associates feel like someone is now listening to them more which has resulted in improved morale. That alone is a great payback to the efforts of holding a kaizen event.

My anonymous 2 cents is that RPIs in manufacturing...

2009-11-05T23:41:11.890-05:00

My anonymous 2 cents is that RPIs in manufacturing are very much different. Manufacturers can continue to deliver from stock and reschedule deliveries while they take three or four days to organize the receiving dock. Much different than healthcare. Staff being pulled out, waiting for data, inability to run a true pilot and waiting to do something as rudimentary as changing a field in a data system are all reasons not to rely strictly on RPIs. There are times when RPIs are the right approach but if your only tool is a hammer then the only thing you can do is pound nails.

And I totally agree with Jamie that the OD and Lea...

2009-11-05T14:45:21.708-05:00

And I totally agree with Jamie that the OD and Lean people have to come together. I got into Lean from OD -- both areas complement and overlap one another.

What concerns me about reading this is that those ...

2009-11-05T14:43:00.107-05:00

What concerns me about reading this is that those new to Lean will think that if Toyota doesn't do blitzes/rapid-process-improvements(RPIs), then they don't have to. Um, wait a darn second!

We know in Seattle that both Virginia Mason and Seattle Children's medcial centers got strong cross-organizational traction in initial lean efforts by engaging many departments in five-day blitzes/RPIs. It was experiential, it got results, it forced engagement. Better, having physicians and nurses in both medical centers engaging directly in kaizen events on the line at Genie or with Toyota suppliers in Japan *really* brought home how far lean could go in reforming healthcare. (Oh, and VM and Children's got into RPIs after nearby Boeing and its suppliers conducted hundreds if not thousands of "Accelerated Improvement" blitzes. Their model was derived from Hirano's "Five Days and One Night.")

Yes, Toyota doesn't do many blitzes, but that doesn't necessarily mean in North America that we shouldn't. Let’s also remember that most of the RPIs at Virginia Mason and Seattle Children’s have been conducted by internal staff.

Bruce, I do not reject events outright. Events ar...

2009-11-05T13:52:21.495-05:00

Bruce, I do not reject events outright. Events are just one option. I agree that radical transformation takes focused effort and lots of energy. In your firm you tackle the radical transformation with a series of events over 12 - 18 months to achieve an (initial) synchronized and connected value stream. The important point: that works for your organization. Some organizations are not effective at combining their events into a synchronized and connected whole. That's where the "doing events" versus "being lean" disconnect arises. One alternative approach is to provide focused, full time resource for 12 - 16 weeks to attain the initial synchronized and connected value stream that you achieve one-week-at-a-time over 12 - 18 months. Same endpoint, different route to get there.

Anonymous and Marc, you highlight some of the "watch-outs" for the event-based approach.

Kaizen Events Revealed - My anonymous 2 cents is t...

2009-11-05T13:28:06.484-05:00

Kaizen Events Revealed - My anonymous 2 cents is that Kaizen Events are a concoction of consultants to fit into their workweek and travel schedule. I can think of a few places in healthcare were blitzes might be effective but a whole bunch of other cases where there are too many compromises trying to put things into a 3 or 4 day window. On the other hand the astute project facilitator/leader will be challenged to effectively prevent a project from staying open forever. Kaizens definitely do have closure point.

Jamie, The goal for management learning at that ph...

2009-11-05T12:22:57.275-05:00

Jamie,
The goal for management learning at that phase of our implementation more to let management see Deming's assumption of positive intent in action during an event. It was my boss's belief (mine too at this point) that a lot of control oriented, decide and announce, come back and hold accountable to a number at a later date managers (that was the legacy model, that is what it took to be successful) needed to see good things happen when real people could participate in events. By having people in the same room at the same time facilitated this learning by seeing (try teaching Deming's 14 points on an intellectual level to some people - some people don't even understand the language). The hope (and I know that hope isn't a plan) was that some would learn by doing and seeing (some people can learn better than they can be taught). Honestly, some people didn't see stuff that actually happened.
To Dale's point - my boss's other intent in doing events was that he thaught early on in an implementation events made more sense. His goal was that you could get a value stream 'synchronized and connected' in 12 -18 months, then really shift to perfecting. The Balle's talk about this -- there will always be an excuse to not pull or flow (too much instability, to much SKU complexity, too big batch sizes). My boss's point (now my belief too) is that that radical transformation from a sequence (often ill defined) of material and information through a path of disconnected operations push via an overly complex (and presupposed on a tragically flawed set of logical assumptions) MRP system to a simpler flow and pull based model, synchronized with demand is sped up significantly by using carefully selected events. It is my belief (maybe a wrong one) that that type of transformation is not required at Toyota and other places deep into the adoption of the paradigm. Most of those places are probably working more on perfecting what is already a coherent value stream. After the value stream is 'synchronized and connected' then I think the need to do events is maybe reduced.

We do use kaizen events (half day, one day or one-...

2009-11-05T11:34:48.147-05:00

We do use kaizen events (half day, one day or one-and-a-half day versions) in our hospital, but we do not use them often.

We prefer to work on coaching teams to continuously improve in small steps on a daily and weekly basis.

Our problem with daily kaizen so far is that it's less directed. Often the improvements lack cohesion. Also it's harder to get people to take time to work on improvements, though that problem is also there after the kaizen events.

Marc
St. Elisabeth Hopsital, the Netherlands

Mark W, In the organization that I am part of now ...

2009-11-05T10:45:05.884-05:00

Mark W,
In the organization that I am part of now supports lean by providing a lot of soft skill training the people who directly add value in our manufacturing processes (the people who change the form of our product). They are also working on creating better defined process for their functional work.
This doesn't have anything to do with people development but it was In an organization that I used to work for the VP of HR read about lean somewhere and wanted to 'reduce lead time on hiring people' because it had been his experience that we lost good candidates because by the time we offered many had taken employment elsewhere. He was open minded and an abstract thinker enough that with some education he accepted single piece flow as mental model (batch size reduction in practice)and standardized work as a path to this. He was able to see that what had produced results in manufacturing would also work well in paper work stuff. We had a blast. There did remain unresolved conflict about lead time vs dwell time for the announcement in the various employment media. How long is long enough to get a good pool of potential candidates. The only bad thing was that the gemba was an office in corp HQ and that meant that I had to wear business casual and shave everyday.
I am still trying to influence HR in to changing their mental model of the ideal candidate for any job to include curiosity, creativity, objectivity, and internal locus of control as elemnets of their targeted selection criteria instead of only looking at education and experience. I think it would be better to understand how results were produced and I feel that sometimes the process focuses more on the results themselves which I think can be deceiving sometimes. I think selecting on some attributes like these (and others, I know I don't know all the good attributes) would make people development easier.

This dialogue has some elements of the discussion ...

2009-11-05T10:40:35.775-05:00

This dialogue has some elements of the discussion a few days ago with Chris Kutalik of Labor Notes: what lean is and what it isn't. While continuous improvement (kaizen) is one of the principles of lean, events are not. Events are an implementation approach. I think people sometimes confuse the two, believing that events equate to lean. Overall performance results depend on a variety factors, or course, but choosing a primarily event-driven approach does not guarantee success.

As an employee of Toyota I can say that most kaize...

2009-11-05T10:26:24.499-05:00

As an employee of Toyota I can say that most kaizen does happen at the individual level.

There are also team events but in my experience they were never held for the purpose of Management to LEARN about kaizen.

Team events are more often applied when an improvement transends several job roles or multiple departments.

We've been trying to drag in HR groups into the le...

2009-11-05T10:17:54.410-05:00

We've been trying to drag in HR groups into the lean fold for years and even wrote some papers on it.

They have two roles - one is applying lean to your own processes, but the other is using HR levers to help the organization move lean forward.

Sometimes the lean and the OD (organizational development) people need to come together and lead together, instead of fighting each other.

Jamie

David facilitated the A3 portion of the University...

2009-11-05T09:43:17.035-05:00

David facilitated the A3 portion of the University of Michigan's Lean Healthcare Training when I was there last June. He struck me as very deep into the people development side of Lean, and this is consistent with his discussion with you, Mark. Develop your people and the improvements will follow. This makes me wonder if any HR people working at organizations who have adopted Lean have tapped into how powerful it can be at developing people... Has anyone following the Leanblog had any experiences with HR being involved with the people development side of Lean? I'd be interested to hear some of your observations.

Yeah, Bruce, I think the point of David's comment ...

2009-11-05T09:26:38.243-05:00

Yeah, Bruce, I think the point of David's comment (to a training class group) was not that kaizen events are to be completely avoided (great point about Toyota being in a different place), but rather to think of the learning AND action components.

I've seen too many dysfunctions when an org. relies only on events. But that doesn't mean I'm opposed to events. We have to think....

The problem is that intention to learn and actuall...

2009-11-05T09:00:31.100-05:00

The problem is that intention to learn and actually learning is not the same thing. People fail to put in the system that enables this. It doesn't have to be complicated. Here's two things I recommend.

First, set learning objectives and manage them with the same rigor that we would manage performance objectives. Don't be vague. Get specific.

Second, add some structured reflection to the process. It can be simple. Take ten minutes at the end of the event to ask people "what did you learn during this experience that you can apply in your job?"

Learning isn't an accident. You have to plan it to make it happen.

Jamie Flinchbaugh
www.jamieflinchbaugh.com

I look forward to his post. To blitz or not to bl...

2009-11-05T08:19:30.428-05:00

I look forward to his post. To blitz or not to blitz is a great question. When I worked for a major tire company we were moving away from doing blitzes because Toyota didn't rely on them. We hired a new boss for our group who insisted that we continue to do blitzes for the reasons of teaching management and to drive transformation. One thing that he taught us was that you can't emulate Toyota on all levels because Toyota probabaly isn't looking for and doesn't need transformation on the same level that many 'old model' stressed businesses need. The blitzes were good ways to get get a lot done in a short time (the star bursts on your future state map). This is a good thing when you are looking for fairly radical transformation.
Also, I don't think week long events are mutually exclusive with other more continuous forms of kaizen.
Should be a good post - I liked his books.

This is exactly what US health care needs right no...

2009-11-04T17:09:48.218-05:00

This is exactly what US health care needs right now, is a process that will cut wasteful spending and maximize doctor patient interaction.
"The administration of the existing health delivery system is bloated with waste and unnecessary cost. If information was shared by all providers of health services and all insurers by using computerized systems to store all medical records, it would cut costs and reduce errors that would save and improve lives.

What we need in a health system is uniformity in pricing for procedures and services and modalities of provision of testing and procedures for diagnosis and treatment. By providing coverage to the uninsured, which initially will cost the taxpayer, it eventually will save us hundreds of millions of dollars." Eva Mor http://www.ourblook.com/component/option,com_sectionex/Itemid,200076/id,8/view,category/#catid107
Eva Mor is the author of Making the Golden Years Golden, and has some very sincere and insightful views on health care from a professional perspective.
It is a very strong issue, but until we can actually understand that insurance isn't the entire debate, health care will not improve. The clinical side of health care needs as much focus and modification as policy.

Bryan, It's really easy for the union to just sit...

2009-11-04T16:42:49.796-05:00

Bryan,

It's really easy for the union to just sit there and take pot shots. It's a political position - union leadership gets elected. So they pander to their voters the same way a congressman would. Tell 'em what they want to hear and put on a show, then you keep your power.

What I find most interesting about the Labor Notes...

2009-11-04T15:00:38.704-05:00

What I find most interesting about the Labor Notes page is that there is no alternative offered. Only criticism. Armchair quarterbacking from any position, other than the genba itself, is quite easy. I find it amusing that in the side bar of the Labor Notes page, there are many links to a cleverly branded "Troublemaker's Blog" and shopping cart links to purchase "Troublemaker Gear".

Whether union or non-union, we have to ask critics if they are going to continue to be part of the problem using antagonism or try to improve their situation with a non-zero-sum paradigm.

We totally agree. Scoping becomes the challenge w...

2009-11-04T12:00:31.901-05:00

We totally agree. Scoping becomes the challenge with shorter duration efforts, but success is more likely with tightly scoped objectives as well. I think healthcare, being young at this, is being encumbered by the RIE. It has its role, no doubt, but it is definitely not sized to meet the needs of most healthcare professionals.

Interesting article and nice to see a successful b...

2009-11-04T09:38:37.516-05:00

Interesting article and nice to see a successful breaking out of the traditional RIE paradigm. This goes to show that the TPS truly works best when people/organizations think for themselves and do what works best as opposed to blindly copying what maybe works for others.

At my hospital we're becoming much more flexible with our approach, with projects sometimes going days, weeks, or even months if necessary. However, I sometimes feel we lose continuity when we accommodate our schedules more than we do the need to solve problems. It's something we have to decide for ourselves...

Let's face it - most "lean" deployments or transfo...

2009-11-04T06:53:33.193-05:00

Let's face it - most "lean" deployments or transformations are not ultimately driven by a vision of "long-term mutual prosperity" as at Toyota. Even if the operations people and some others higher up get the significance of this as a foundation of success, if the sole purposes of enterprise remain maximizing return to shareholders and maintaining management in the lifestyle to which they have become accustomed, then it is pretty likely that there will be an atmosphere (and a reality) of taking advantage of front-line workers. I'll echo (and paraphrase) Bob Emiliani's comment - if you don't change the way you think, why would you expect different results?

This is one of the core problems with transformations that start at the middle. It's not just about "getting the execs on board" with change (they are generally pretty enthusiastic when the bottom line starts improving). There is a culture of division between management and labor that our correspondents at "Labor Notes" are well justified in recognizing and calling out.

I saw W. E. Deming in a video conference in the early 90's (the year, and his age, I think!) when he delivered one of his great lines (paraphrasing): "Think win-win? What other option is there? There is no such thing a win-lose because that always turns into lose-lose."

As we explore "Lean not LAME" or whatever it ends up, let's catalog some North American examples of "long-term mutual prosperity" resulting from a business following the Toyota way.

-ALB

I think about the last time I heard "The best lean...

2009-11-03T20:25:04.003-05:00

I think about the last time I heard "The best lean practices outside Toyota..." comment. Then it was Delphi...

Time for Hansei...