Taking a Break

As much as I enjoy blogging, we all need a break now and then. See you in two weeks!

Book Talk: Andy & Me

In the middle of summer, people are often looking for novels or other summer reading they can take to the beach. So today I thought I would discuss Andy & Me: Crisis and Transformation on the Lean Journey – the one novel published by Productivity Press.

Originally released in 1995, Andy & Me is set in a failing New Jersey auto plant focusing on the tribulations of Tom Pappas, the plant manager. It follows Tom's relationship with Andy Saito, a reclusive, retired Toyota guru whom Tom persuades to help save his plant through the teaching of the legendary Toyota Production System.

The writer is noted lean expert Pascal Dennis, who also authored a non-fiction work, Lean Production Simplified, Second Edition: A Plain-Language Guide to the World's Most Powerful Production System. Both books were awarded the Shingo Prize for Excellence in Manufacturing Research.

So if you’re looking for an entertaining way for your mind to absorb lean principles while your body soaks up some rays, place an order and we’ll be happy to send you a copy of Andy & Me. (Sunscreen not included.)

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.

Doctors Should Not Impose Gag Orders on Patients

A successful lean strategy requires transparency. Information should flow freely, and accurate data about performance should be available to all concerned parties.

With that in mind, I was disturbed by the juxtaposition of two articles that appeared recently on the same day in The Washington Post.

One article focused on laws that have taken effect recently in Virginia, Maryland and the District of Columbia that require hospitals to report to regulators serious injuries that patients suffer in the course of treatment – often due to medical mistakes.

Overall, I view this as a good thing. The three laws described in the article have different requirements, and there will be some problems along the way, I’m sure, as regulators and executives come to learn which requirements and systems work best.

But transparency of this kind of information will, I hope, drive improvement. The article notes that, increasingly, insurance companies are refusing to pay for medical errors, which encourages hospitals to find ways to prevent them.

The other article focused on a push away from transparency. It described how some individual doctors, concerned about websites that publish ratings of doctors, are requiring patients to sign documents in which they agree not to post anything on the Internet without the doctor’s consent.

The article notes that many experts say such agreements are unethical and unenforceable.

I agree with that last point. As a journalist, I react strongly when anyone tries to put a limit on free speech.

In fairness, the doctors have some legitimate concerns. Some websites allow comments to be posted anonymously, and do nothing to verify whether the comments are true.

But a gag order is not the solution. The way to deal with misinformation is with more, accurate information. (Which, by the way, doctors would have if they measured their performance using lean methodologies.)

Your thoughts?

‘Chinese Labor Cost is Not That Big a Factor’

We lean advocates tend to rant about how so many businesses wrongly believe they need to outsource production to other countries, especially those in Asia, in order to be competitive. We argue that a lean strategy, along with recognition of the problems and costs of a far-flung supply chain, can make up for lower costs overseas.

But maybe some businesses are smarter than we think.

These thoughts came to mind after I read an article in The New York Times about the Obama administration’s lack of a coordinated policy to revive manufacturing in the United States.

The article includes comments from Douglas Bartlett, who is closing a circuit-board factory in Illinois. Bartlett says he was done in by cheaper products from China, and he contends that the Chinese products are cheaper because the Chinese undervalue their currency.

“I can compete against Chinese entrepreneurs, and Chinese labor cost is not that big a factor,” he said, “but I cannot compete against the Chinese government’s manufacturing policies.”

Currency manipulation is a serious issue, though it is not my intent to address it here. What I find fascinating is the first part of that quote, in which Bartlett says he CAN compete against the Chinese if there is no government interference.

I am saddened by the closing of Bartlett’s factory, and I agree that currency manipulation issues need to be addressed.

I simply wish to make the point that Bartlett made so well – U.S. businesses do not have to go running after cheap overseas labor in order to compete.

How to Ease the Conflict Between Medicine and Money

Culture change is often the most difficult part of a lean transformation. That may be doubly true in healthcare, where culture – how people think – is already subject to significant stress.

This problem was highlighted recently in a thoughtful essay in The New York Times by Dr. Sandeep Jauhar, a cardiologist and author of the recent memoir “Intern: A Doctor’s Initiation.”

Jauhar is disturbed by the fact that, while doctors want to focus on medicine, too often they find themselves focusing on money.

The reality is that most doctors today, whether in academic or private practice, constantly have to think about money. Last January, Dr. Pamela Hartzband and Dr. Jerome Groopman, physicians at Beth Israel Deaconess Medical Center in Boston, wrote in The New England Journal of Medicine that “price tags are being applied to every aspect of a doctor’s day, creating an acute awareness of costs and reimbursement.” And they added, “Today’s medical students are being inducted into a culture in which their profession is seen increasingly in financial terms.”

The rising commercialism, driven in part by increasing expenses and decreasing reimbursement, has obvious consequences for the public: ballooning costs, fraying of the traditional doctor-patient relationship. What is not so obvious is the harmful effects on doctors themselves. We were trained to think like caregivers, not businesspeople. The constant intrusion of the marketplace is creating serious and deepening anxiety in the profession…

Financial considerations have never been as prominent as they are today, probably because so many hospitals and doctors, especially in large metropolitan areas, are in financial trouble. More and more doctors are trying to sell their practices, or are negotiating with hospitals for jobs, equipment or financial aid…

Among my colleagues I sense an emotional emptiness created by the relentless consideration of money…

Reforming healthcare involves many complex issues, including insurance and reimbursement systems as well as the needs of the uninsured.

Applying lean thinking to healthcare is one part of the solution. By giving doctors and other healthcare professionals the means to eliminate waste (and cost) from healthcare processes, while simultaneously maintaining or improving quality, perhaps we can help ease the sense of emptiness that Jauhar describes.

Book Talk: Value Stream Mapping for Healthcare Made Easy

Lean tools used in manufacturing can be applied to other industries. But there may be some differences in the details of their application, it may not be perfectly clear how to shift from one industry to another, and people working in a given industry may be skeptical of how something used in another field applies to them.

That is why there can be value in industry-specific books. A good example, and one we believe should be of strong interest to healthcare professionals, is Value Stream Mapping for Healthcare Made Easy, a new book to be published next month. (Orders can be placed now.)

This book is by Amy and Cindy Jimmerson. Cindy is also the author of another healthcare-specific book, A3 Problem Solving for Healthcare.

The authors have written the book in two parts. The first part introduces healthcare workers to value stream mapping and explains how to look at any process with eyes that probe all the value-added and non-value-added activities.

The second part reviews real value stream maps at real healthcare facilities created by teams of administrators, managers, physicians, and staff members.

With growing interest in lean in healthcare, and with so many healthcare professionals still relatively new to lean, this paperbound book can be a valuable resource for those embarking on a new lean journey.

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.

Lean Job Guarantees are Practical – And Ethical

I came across a well-written expression of a lean manufacturing principle recently – in a column about ethics.

I am referring to the principle that employees who come up with process improvements that reduce staffing requirements should be promised that their jobs will not be eliminated as a result. This not only goes to the heart of the lean principle of respect for people, but is also simple, practical common sense – employees will not look for improvements if they believe doing so would jeopardize their jobs.

In “The Ethicist” column, which appears every Sunday in The New York Times magazine, writer Randy Cohen addresses issues raised by readers. Recently he received a question from a man who said he is a computer programmer in a large company in Pittsburgh, and who occasionally is asked by workers if he can automate repetitive tasks, such as data entry. The programmer said that while he can, “what happens next usually involves the person who wanted to save the company time and money looking for a box to hold their personal effects — and for a new job.”

In his reply, Cohen does not mention lean manufacturing. But he understands the principle involved here.

It would be grotesque to encourage employees to innovate and then, when they do, have a couple of goons rough them up and give them the old heave-ho. Even without the goons, it is not ethical to punish someone for doing just what you want (and urge) him to do. Someone who comes up with a useful idea should expect a bonus, not a pink slip. A management strategy that fires the most resourceful workers bears reconsidering.

All who contribute to the success of a venture should share in its rewards. At a minimum, the company must guarantee the job of so effective and dedicated an employee, perhaps shifting him or her to another position or cutting staff through attrition. If the company declines to take such steps, then you should give your co-workers an honest account of the possible consequences of their request.

I couldn’t have said it better myself.

Process Improvements Help Hospital Reduce Specimen-Label Errors

Huge numbers of patients, medications, specimens and test results circulate through a hospital, so it is critical that all of them be properly identified.

A hospital in South Carolina found that misidentification is a serious problem – and one that can be easily addressed, at least partly through lean approaches.

An article from HealthLeaders Media describes how Self Regional Healthcare (SRH) in Greenwood, S.C., put together a cross-functional team to study safety “events” (read: problems). The team found that the majority of safety events were identification events – primarily specimens that were either mislabeled or not labeled at all.

By developing and implementing an improvement plan, the hospital reduced ID events by 65 percent after only one month.

Part of the plan involved technology – a network of scanners and bar-code printers used to coordinate patient ID bands with the labels on medications and specimens. The team took a system designed to coordinate the patient and medication bar codes and extended it to cover specimen labels as well.

But to the credit of the team, its members recognized that addressing the problem involved more than just technology.

"Things like where the patient received their bar-coded arm band, who collected the specimen versus how and when it was labeled, and how the specimen was then sent on to the lab all varied depending on the area," says Leisa Butler, RHIA, CPHQ, performance manager in the quality management services department. "So as a team, we decided to come up with a core common process."

In developing a common core process, the team decided that there could be no exceptions to key components. This was decided as a means of decreasing the variability found during the initial assessment. However, the team decided to allow specialty areas to add a step in the process, if necessary. For example, in the OR, there are additional steps for processing and transferring specimens.

Along with that process, Butler and her team noted that steps could be added, but no steps could be left out during the processing or transferring of specimens.

"If an event occurs that deals with specimen labeling or ID labeling, then the standard flow chart must be reviewed, and it has to be noted where in the process things failed," says Butler.

I applaud SRH for their efforts, and hope they serve as a model for other hospitals.

Who Knew Fiat was a Lean Company?

And the foreign automaker doing a good job of implementing lean manufacturing is… Fiat.

Fiat?

Yes, Fiat. The Italian car company has transformed itself from a maker of poor-quality cars 20 years ago into a nimble, highly efficient producer of high-quality small vehicles. Hordes of executives from Chrysler, which is now effectively controlled by Fiat, are traveling to Fiat’s plant in Tychy, Poland, to see how it’s done.

A recent article in The New York Times describes the plant.

At Tychy (pronounced TICK-ee), one secret is flexibility: The latest robotic technology is balanced by workers who can quickly shift models to match demand. That is one reason Tychy is operating around the clock, six days a week, while most other auto plants in Europe and the United States are running at a fraction of capacity, increasing costly nonproductive downtime.

And according to the director of the Tychy plant, Zdzislaw Arlet, it’s all about lean.

Mr. Arlet is also constantly on the lookout for time- and money-saving improvements, adding that he himself looks to Toyota’s famous Kaizen system for inspiration: Instead of filling up cars at different production points with brake fluid, gasoline, water and other liquids, one machine on each of Tychy’s three lines fills each vehicle.

“A car comes off the assembly line every 55 seconds,” Mr. Arlet said. “In 1996, it took twice as long.”

An infusion of lean thinking by itself won’t be enough to save Chrysler. But it helps give the Detroit company a chance.

Book Talk: Learning Packages

Today I want to discuss the learning packages we sell, and hopefully spark a dialogue about what types of learning materials you would like to see.

The learning packages are based on our popular Shopfloor books, a series of easy-to-read paperbacks, each focused on a specific aspect of lean. With clearly written copy and illustrations, these are a useful learning tool for employees on the shop floor.

To facilitate their use in training or instruction, for many years we have sold some of the more popular Shopfloor books in learning packages. A typical learning package includes five copies of the Shopfloor book, a Leader’s Guide, one copy of another relevant book, and additional materials on CD. Learning packages generally sell for $350 to $375 each. (In some cases, the Leader’s Guide can also be purchased separately.)

The packages we offer include:

• 5S for Operators Learning Package
• Cellular Manufacturing Learning Package
• Focused Equipment Improvement for TPM Teams Learning Package
• Kaizen for the Shopfloor Learning Package
• Kanban for the Shopfloor Learning Package
• Mistake-Proofing for Operators Learning Package
• Quick Changeover for Operators Learning Package

The question I have for those of you who work on the shop floor is whether this type of package appeals to you, and whether there is any other type of package – with different materials, or a different format – that would be of equal or greater interest.

As lean advocates, we at Productivity Press recognize that we need to focus on providing value for our customers, and that our customers define value.

What do you value?

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.