On the blog, they’ll be discussing the concepts of the book and will try to address questions they receive.
The book makes the critical point that what is important about A3 reports is not just the reports themselves (though they can be a valuable visual tool), but the thinking that underlies the process.
I’ve added their blog to our list of Other Lean Blogs on this page. Be sure to check it out.
Sometimes the causes and solutions of a problem are not obvious and require careful analysis. For example, I recently wrote about hospital readmissions, a problem identified by a study of Medicare data.
But at other times, something seems so obvious that you can only shake your head in sad wonder.
Case in point: Nearly 11,000 former members of the armed forces may have been exposed to HIV and/or hepatitis because they received endoscopies at three Veterans’ Administration hospitals in the southeast with equipment that hadn’t been cleaned properly.
The problem was first reported early this year. More recently, as reported by The Washington Post in a story by the Associated Press, the number of confirmed cases of hepatitis and HIV is growing, and veterans are frustrated that the VA is not providing much information about the situation.
From a public relations standpoint, it sounds as if the VA is handling the situation badly. However, I would like to focus on what in the VA’s processes led to the problem.
An endoscope is a narrow, flexible tube with a fiber-optic device at the end. It is inserted into the body during colonoscopies and certain ear, nose and throat treatments.
The VA said the problems with the endoscopic equipment had gone on for years, but were discovered in December when it learned the Murfreesboro facility wasn't following cleaning procedures the manufacturer recommended. It issued an internal alert for hospitals to check their procedures, and the problem at Augusta was discovered in January…
The endoscopic equipment is made by Center Valley, Pa.-based Olympus American Inc., and the company has said its recommended cleaning procedures are clear.
Without more information, it is difficult to determine why the manufacturer’s recommendations weren’t being followed. Possible causes include that the manufacturer’s recommendations actually weren’t clear, or that, clear or not, the cleaning procedures weren’t communicated properly, or that the responsible staffers were not properly trained in cleaning procedures.
Whatever the cause, the solution almost certainly involves applying several lean principles: clear communication, creation of standard work, proper training of staff, and regular reviews or audits to ensure that proper practices are being followed.
It is a shame the VA doesn’t seem to understand lean. Our veterans deserve better.
Safety is a key, if often unheralded principle of lean manufacturing. The lean concept of respect for people includes recognition that workers should not be exposed to unsafe working conditions. Many people argue that the tool of 5S really ought to be 6S, with safety the 6th “S.”
So from a lean perspective, it is worth taking a look at President Obama’s choice to head the Occupational Safety and Health Administration.
He is Jordan Barab, who spent the past two years as senior labor policy advisor for health and safety on the House Education and Labor Committee.
By all accounts, Barab is a passionate true believer and crusader for workplace safety. As a union staffer, he directed the safety and health program for the American Federation of State County and Municipal Employees (AFSCME) from 1982 to 1998.
For four years, he wrote a blog about workplace safety called Confined Space. And while he stopped writing the blog two years ago, all of the posts are still online.
I spent some time browsing the blog. On the one hand, Barab seems to understand that safety problems are rarely the result of worker carelessness, but have much more to do with poor processes or working conditions.
However, I don’t know whether he understands that the best road to improvement lies in carefully analyzing the process to understand the best way to improve it. His focus over the years has been on government mandating safety regulations.
(I’m not opposed to government safety regulations. I believe in them. I just like them to make sense for the business as well as the workers.)
One of the few references I found on his blog to lean manufacturing was when he was quoting an article written elsewhere about an incident of workplace violence at a Chrysler plant. The article he quoted suggested that the violence was at least partly the result of systematic harassment of workers by Chrysler over many months, and that “lean production” initiatives had been part of that harassment by attacking the seniority system, pitting workers against each other.
Of course, whatever Chrysler called “lean” clearly wasn’t. I hope this article or anything else he has read doesn’t prejudice Barab against lean principles simply because they were misused or misinterpreted by one employer.
Do you know anything more about Jordan Barab? Please share it in a comment.
Describing the fictional Twin City Manufacturing, the authors draw on their combined 70 years of supply-chain experience to explore successful supply chain improvement requirements and improvement methodologies, along with their strengths and limitations.
They provide a road map for supply-chain improvement, focusing on how to enable and sustain long-term change.
The authors also discuss the seven factors that they believe are key to operational excellence:
1. Top company leadership
2. Improvement methodology
3. Continuous improvement strategy
4. The cause and the vision
5. The Sustainable Improvement Roadmap
6. Enablement of sustainability
7. Constancy of purpose
Those of you focused on supply chains now have a rapidly growing selection of resources. Only two weeks ago, I discussed another new book Supply Chain Management at Warp Speed.
Do you have a question or comment about a book(s) that you would like addressed in Book Talk? Email me directly at Ralph.bernstein@taylorandfrancis.com.
Rework is waste. You shouldn’t have to bring a product back to your factory for additional work if everything was done right the first time.
That lean concept can be applied, to some extent, to rehospitalizations. When a patient has left a hospital, a return visit – at least in some cases – should not be necessary.
But many return visits occur. Health Leaders Media reports on a new study published in The New England Journal of Medicine. The authors of the study analyzed Medicare claims data for 2003-2004. They found that nearly 20 percent of discharged patients are readmitted to the hospital within a month, and the figure jumps to 34 percent when looking at three months.
Not every readmission is waste. The authors of the study estimate that about 10 percent of the readmissions were planned. And sometimes patients require readmission even when everything was done right the first time.
But readmission rates vary widely among hospitals, and the authors believe that much can be done to bring the rates down. Although he doesn’t use lean terminology, one doctor seems to suggest the problem is we’re not looking at the total value stream.
"In order to address this issue, we are going to wind up addressing the most profound issues in healthcare today," says Stephen Jencks, MD, MPH, a lead author of the study and independent consultant in healthcare safety and quality. "Issues like a system which has become provider-centered rather than patient- and family-centered. If your concerns stop when the patient goes out the door of the hospital or start when the patient comes in the door of your office, you're not going to provide the care that's necessary to keep people from being rehospitalized."
Unnecessary readmissions occur because some patients and families are not properly educated about what follow-up care must occur, and the resources are not put in place to provide that care. Lacking that care, discharged patients deteriorate to the point where readmission is required.
The article mentions several recommendations for improvement, many of which involve better education of patients and their caregivers. However, my favorite has to do with the workflow involved in scheduling a follow-up appointment.
Prevent the patient from leaving the hospital without a follow-up appointment of some kind. In his study, Jencks and his colleagues found that about 50% of patients who were rehospitalized had not been seen by an interim physician after 30 days. Hospitals often say that they can't make an appointment in that short of a timeframe for a patient's follow-up care, says Jenks. "My answer is, well if you can't get it how do you think the patient's going to get it?"
In 2004, $17.4 billion was spent caring for patients readmitted to the hospital; Medicare paid hospitals $102.6 billion in total that year. This issue is significant.
Porsche is an extremely successful car company, and an article in The New York Timessuggests that success stems from a lean approach. Unfortunately, the Times gets it wrong.
The article, by Carter Dougherty, notes that Porsche goes beyond other car companies when it comes to outsourcing. Rather than just outsource production of certain parts or subassemblies, Porsche has some entire cars assembled by Valmet Automotive, a company in Finland.
In some sense, the innovation makes Porsche the only major virtual vehicle manufacturer, a company that designs and markets sports cars without actually cranking them all out on its own production line.
The bread and butter of Porsche’s work in Stuttgart is the classic 911 sports car, but with demand for that model now falling, it is pulling Boxster production out of (Valmet) back to Germany. Though the system creates fiendishly complex logistical challenges, Stuttgart can keep running at capacity, evading the industry’s hoary problem of covering the fixed costs of factories and labor.
Porsche is profitable, well-run in many ways, and taking production back from Valmet does enable it to avoid laying off its own employees. However, the Times article says the arrangement with Valmet “is inspired by Japanese models of lean manufacturing.”
Sorry, but simply transferring work to a supplier is not lean. Eliminating waste from a process is lean; making the process someone else’s responsibility is not.
Ironically, the description in the article makes Valmet sound like the lean company in this relationship because it demonstrates impressive flexibility.
Ilpo Korhonen, Valmet’s president, a cerebral engineer with an M.B.A., is constantly calibrating his work force to match Porsche’s needs with the deft touch of an artist applying the final brushstrokes to a masterpiece. In each of the last three months, he idled about a third of Valmet’s 600 employees before ramping up again in January and February, and then shifting down with 190 layoffs in March.
“We are adjusting capacity almost daily,” Mr. Korhonen said.
Managing the inflow of parts that go into a high-performance Porsche is another tricky task. Many suppliers are concentrated near Stuttgart, but Valmet has to arrange deliveries to Finland, and often in smaller quantities.
Hence the “milk run,” as Mr. Korhonen calls it. Trucks are perpetually swinging through Germany, Poland, Sweden and Finland to collect the components that go into the Porsches assembled in Uusikaupunki…
But Valmet’s greatest challenge is, in the end, existential. Its contract with Porsche expires in 2012. The German company will move its outsourced assembly to Magna Steyr, a company in Austria, which has the resources to assist Porsche in some development work.
Valmet workers are already clearing space in the factory to manufacture the Karma, a plug-in electric hybrid designed by Fisker Automotive, a California start-up. It will also soon produce a luxury golf car for a Danish customer and expects to sell other engineering services as automakers create derivatives of existing models, Mr. Korhonen said.
And when the well-to-do rediscover their love of Porsche sports cars, Valmet hopes to produce those, too.
“Eventually we will ramp back up,” Mr. Korhonen said. “We expect the market to recover.”
I would suggest that the true hallmark of a lean company is that it doesn’t outsource, but finds its savings by streamlining its processes – not offloading them.
Sproull, an experienced manufacturing executive and consultant, believes your goal should be to focus your efforts on those areas that will make the greatest difference. He says the way to do this is by drawing the best from Lean and Six Sigma by employing principles drawn from the Theory of Constraints.
The result is a “time-release” formula designed to take advantage of the cyclical nature of improvement to implement change that is perpetually effective.
I find this encouraging because I’ve long believed the debate over whether lean or sigma (or TOC) is best is pointless. Each has its strengths and is particularly useful in some situations, and the point should be to select the approach and the tools that are best for your company’s situation. Sproull’s concepts – which go beyond some other efforts that combine lean and Six Sigma without TOC – may expand your toolbox.
Sproull’s approach deals with cost accounting, variation, waste, and performance measurements, among other areas, though focusing on the right areas to optimize is probably the biggest benefit.
Do you have a question or comment about a book(s) that you would like addressed in Book Talk? Email me directly at Ralph.bernstein@taylorandfrancis.com.
I’m generally a fan of Amazon.com. They know how to focus on providing value for the customer (a lean principle) by offering a wide range of products on a user-friendly website that eliminates a lot of waste from the process of ordering.
But my respect dropped a notch when I received a package from them the other day.
It contained four items I had ordered: two books, a backpack (which was fairly flat) and an electric toothbrush (sealed in a fairly small plastic package).
The box they came in was unnecessarily large. The four items took up no more than a third of the space in the box. The rest was occupied by air-filled plastic bubbles, each about the volume of a grapefruit, serving as padding.
I understand that Amazon cannot perfectly match the size of the shipping box to the size of the order every time. But I thought they could have done a better job on this one.
Our apologies to those of you who tried to visit the Productivity Press website this morning and found yourselves redirected to the website of our sister company, CRC Press. Productivity Press books also appear on the CRC Press website, which was just redesigned. Somehow, when the new CRC website went live, it inadvertently redirected Productivity Press visitors. That has now been corrected, and we are back to normal. We're still here, and we have plenty of new books coming out in the months ahead. We're glad to have you with us!
