Standard Work Saves Lives

            The headline above is a bit dramatic and probably sounds like hype. But if I am correctly interpreting the latest news from the Institute for Healthcare Improvement, the headline is correct.

            In December 2004, the IHI initiated its 100,000 Lives Campaign, an effort to prevent 100,000 unnecessary hospital deaths by improving patient care. With much fanfare, the IHI recently announced that the goal has been exceeded, and hospitals enrolled in the campaign have prevented an estimated 122,300 deaths. (There were more than 3,000 hospitals enrolled, representing an estimated 75 percent of U.S. hospital beds.)

            Measuring the number of lives saved is, I’m sure, tricky at best, and an IHI news release does not say exactly what measurement methodology was used. Perhaps they compared death rates with those of previous years.

            However, for now at least, let’s give the hospitals enrolled in the campaign the benefit of the doubt, and assume the number is valid. What does this have to do with standard work?

            The Campaign was more than just people saying “let’s save lives.” It consisted of six specific steps to be taken by hospitals – techniques that were proven to improve patients’ medical results.

            Did these techniques involved the use of new drugs or advanced surgical techniques? Nope. For the most part, they involved improving the processes that support medical care by adopting best practices. The six quality improvement changes are:

  • Activate a Rapid Response Team at the first sign that a patient’s condition is worsening.
  • Prevent patients from dying of heart attacks by delivering evidence-based care, such as appropriate administration of aspirin and beta-blockers.
  • Prevent medication errors by ensuring that accurate and continually updated lists of patients’ medications are reviewed and reconciled during their hospital stay, particularly at transition points.
  • Prevent patients who are receiving medicines and fluids through central lines from developing infections by following five steps, including proper hand washing and cleaning the patient’s skin with a specific antiseptic.
  • Prevent patients undergoing surgery from developing infections by following a series of steps, including timely administration of antibiotics.
  • Prevent patients on ventilators from developing pneumonia by following four steps, including raising the head of the patient’s bed between 30 and 45 degrees.

            Proper hand washing? Raising the patient’s head? I find these recommendations startling, for several reasons.

            First, it’s remarkable that these weren’t being done already (although to anyone familiar with lean and the process problems it uncovers, that may not be so surprising).

            Second, it is similarly shocking that hospitals didn’t already know the value of such procedures. That says something about the poor state of medical computer systems and medical research, in that it has taken so many years to accumulate and analyze data clearly establishing what works.

            Third, for those of us who work outside healthcare, this campaign sheds additional light on hospitals’ dirty little secret: While most of us know, for example, that people often die of infections they acquire in hospitals, it turns out they get infections because of poor processes. That’s the real cause of death.

            However, the good news is that people in healthcare are trying to make things better, and this campaign is a good example of that. And that brings me back to my main point.

            The definition of standard work (according to our book LeanSpeak) is “an agreed upon set of work procedures that effectively combines people, materials, and machines to maintain quality, efficiency, safety and predictability.” Much of what is described in the Campaign’s practices sure sounds to me like it fits that definition.

            IHI expects to announce in December the next stage of the Campaign as well as a new aim for saving lives. And in the interim, the organization says it will “redouble its efforts” to spread the word about the six practices while also exploring new areas for hospital improvement.

            Let’s hope so.



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We Should Have Tried Mistake-Proofing…

            You don’t usually hear a lot of talk, even in lean circles, about poka-yoke, also known as mistake-proofing. Everybody tries 5S, and there are lots of other lean tools that have probably achieved greater prominence. I’m not sure if this is because many companies don’t bother with mistake-proofing, or simply don’t bother talking about it. Maybe they don’t regard it as important.

But there’s a company in Canada that I’ll bet has begun looking for ways to prevent mistakes, even if they’re not familiar with lean principles.

According to a recent news report from Reuters, a worker at Nova Chemicals Corp. in Corunna, Ontario, accidentally tripped a switch that shut down the factory’s entire manufacturing process, halting production and forcing two weeks of repairs.

The 1,000-employee plant is one of Canada’s largest plastics facilities, capable of supplying up to 40 percent of the country’s primary petrochemical market.

As a result of the incident, Nova says it will be unable to fulfill contracts for shipments of propylene and some other products, with delays extending through two quarters. Company officials estimate this will reduce profits by $11 million.


The switch in question exists so that anyone seeing a serious problem can shut down production. It was triggered by a contractor’s employee installing a structural steel platform. WHY he hit the switch is not yet clear, and Nova is conducting an investigation.

Let’s assume for the moment this worker did not press the button simply for the fun of it. At least for now, let’s say he meant to do something else and hit the wrong switch.

Maybe he was careless. Maybe he wasn’t paying as much attention as he should have. But I also have to believe that the switch wasn’t marked as clearly as it might have been, and perhaps was too easily accessible.

The best way to solve problems is to prevent them from occurring in the first place. Perhaps this story can serve as a wake-up call for those companies that have not made mistake-proofing a priority.

Otherwise, we’re likely to see more stories about $11-million-dollar mistakes.



The Human Side of Lean

            Surveys can be useful, but they have their limitations. I'm not sure whether a survey can identify the best management practices, but it might give some indication of what a company should be doing. So with that qualification, I found interesting a new survey of employees and supervisors, which claims to identify five key management practices that can predict successful lean transformation.

            The survey is described in a recent issue of Target, the magazine of the Association for Manufacturing Excellence. The authors are Dr. Monica Tracey, assistant professor in the Human Resource Development Department at Oakland University and a founding member of the Pawley Institute; and Jamie Flinchbaugh, co-founder and partner of the Lean Learning Center. Jamie is also author of the book The Hitchhiker’s Guide to Lean.

            There were two versions of the survey – one for employees working under direct supervision, the other for supervisors and managers charged with ensuring lean practices within their departments. Each survey contained more than 60 questions. The authors obtained 154 responses to the worker survey, and 72 responses to the manager survey.

            So what does it take from a management perspective to make lean work? The five variables are:

  • Development of teams as a supporting structure of lean.
  • Calculation and communication of metrics.
  • Communication among organization members, particularly across organizational barriers.
  • Communication to employees regarding their specific role in lean transformation.
  • Acknowledgement and celebration of successes toward lean transformation.

            None of this is particularly surprising, but the list can serve as a useful bit of education for companies new to lean that tend to think conducting kaizen events is all they need to do.

            The only quibble I have with the survey relates to the description of the results. The Target article suggests that the findings are of most use to HR departments, and says the survey revealed “not only how HR, but leadership creates better organizational conditions to support lean transformation.”

            Further, the headline on the article is “How Human Resource Departments Can Help Lean Transformation.”

            Yes, HR can and should help, but the survey findings are really about overall management strategy and tactics, not just what HR does. In that sense, the article presentation is a bit too narrow.

            Near its end, the article offers HR departments specific recommendations. These recommendations are, again, not exclusively for HR departments, though they should certainly be involved in each of area.

The suggestions are to engage in further research on: how to create and maintain a lean culture; how to recruit and hire a lean-ready person; how to pay and reward a lean employee, further explore the skills and capabilities to maintain lean leadership over a long period of time.

Good suggestions all – but not just for HR.


The Low Rates of Lean Implementation

Even though lean concepts have been around for decades, why is it still true that so few American companies are embracing them? I don't know, but I certainly find the evidence discouraging.

            According to a recent survey by the Aberdeen Group, less than a third of manufacturers have been involved with lean for four years or more. (The actual numbers are 31 percent for discrete manufacturers and 28 percent for process industries.)

            The totals jump to 71 percent and 59 percent, respectively, when the category is broadened to one year or more.

            Not surprisingly, there are significant differences between industries. More than half of aerospace/defense companies say they have been involved in lean for four years or more, while the comparable figure for the automotive industry is 48 percent. Computer companies are also above average.

            The lowest rates of adoption are in food and beverage, and consumer durables. Consumer packaged goods, metals, and industrial equipment are slightly better.

            In presenting the results during a recent Industry Week Webinar, Jane Biddle, VP of Global Manufacturing Research at Aberdeen also set forth a familiar list of characteristics of the best in class:

  • Mastered the basic tenants of lean
  • Dedicated to continuous improvement
  • Top management is committed
  • Embracing a ‘culture of lean’

            So what else is new?

            We’ve heard it all before, but the majority of companies still aren’t hearing it.

            Don’t get me wrong; I believe that support for lean is spreading in the business world, and not just in manufacturing. But there’s still a lot of work to be done.