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.

Canadian Politician: Elect Me Because I am Lean

In what may be a first, and is certainly a first to me, a Canadian politician is claiming that his work with lean manufacturing makes him a better leader.

Mark Taylor is running for the federal council of the Green Party in Canada. The council is the party’s governing body.

Like other candidates for the council, Taylor responded to a questionnaire they were all sent. An engineer by profession, he referenced lean manufacturing in describing his qualifications.

My company is a practitioner of Lean Manufacturing and I am learning skill sets there that are directly applicable to the Green Party. Consensus building, constant improvement and the efficient use of resources are just three of many tools in the Lean tool box that will help.

I know nothing about Canadian politics, and I am not endorsing the candidacy of Taylor or anyone else.

But I hope Taylor’s comments are an indication of growing respect for lean principles.

A Nursing Home Death Should Raise Process Issues

When a problem exists – and is recognized as a problem – the lean approach is to ask “why” as many times as necessary to identify the cause of the problem and develop a solution,

A recent tragic incident in California cries out for that approach.

The California Department of Public Health levied a $100,000 fine (the highest possible under state law) on Aviara Healthcare Center, a nursing home located in Encinitas (San Diego County).

A news release from the department describes in clear, simple terms the reason for the fine.

The facility created a hazard by improperly storing a large mechanical patient lift in a hallway. A patient grabbed the lift during a fall, tipping it over. The resulting injuries led to the patient’s death.

The first question is why the lift was being stored in the hallway. Is there a specific place where it should have been stored? If not, why not? Is there no storage space for it anywhere? Are there no procedures in place for checking lifts in and out of storage, or for returning them to storage once they have been used?

But those aren’t the only questions. Imagine that the lift had not been in the hallway. Was there anything that could have been done to prevent the patient from falling? Are there railings in the hallway, for example? Falls are a common occurrence among elderly, infirm patients, and not all falls can be prevented. But the question is worth asking.

Unfortunately, I suspect that these questions may not get asked. Too often in this kind of situation, those in charge focus only on the obvious – i.e., a patient died and we got fined for leaving a lift in a hallway, so let’s not leave lifts in hallways. They may not know how to think in lean terms to identify broader issues in their processes.

That is not always true. Sometimes a serious incident such as this one can serve as a wake-up call. I hope it does in this case.

Simplicity Helps Improve AIDS Treatment Programs

One of the more counterintuitive aspects of lean is that the best approach may involve spending less money. People tend to assume the most expensive is always the best. But sometimes a simple, low-tech approach produces the most significant results.

Therefore, I was pleased to read a recent article in The Wall Street Journal describing efforts to find new ways to run AIDS treatment programs – by studying what is being done in Africa.

With health-care costs soaring in the U.S. and more than 50,000 new HIV infections every year, many are starting to ask: If it can be done over there, why can't we do it here?

The obstacles range from the complexities of insurance reimbursement to regulations designed to protect patients. Another hurdle is cultural: There is a deep-seated reluctance to accept that simpler and less expensive treatments like those used abroad might be good enough.

"We're building Cadillacs, and they're offering us VW Beetles," says William Vodra, who drafted U.S. Food & Drug Administration rules while working at the agency, and now specializes in regulatory issues involving medical products as a lawyer at Arnold & Porter in Washington, D.C.

One example cited in the article (written by Amy Dockser Marcus) involved appointment procedures at a University of Alabama AIDS clinic.

"Project Connect" is based on a program used in AIDS clinics in Zambia. In the Alabama program, patients were given appointments with doctors within five days of calling the clinic. Blood tests were taken during the first visit. A social worker did an interview, trying to identify and address any issues that might prevent patients from coming back. The no-show rate dropped from 31% in 2007 to 18% through June 2009.

Another example involved using non-medical personnel to help patients stick with treatment.

For Heidi Behforouz, it has been an education. Dr. Behforouz started running the Prevention and Access to Care and Treatment Project in Boston based on a program first used successfully in rural Haiti. PACT trains community health workers to persuade AIDS patients to adhere to treatment regimens. The hope is this will reduce rates of emergency-room use and hospitalizations, big drivers of health costs.

The strategy appears to work; according to data PACT collected, total medical expenses for 20 patients fell 40%. But PACT, which is expanding to sites in New York, still pays for the program out of private donations and fund raising, since insurers don't cover it.

Dr. Behforouz presented data to an advisory council that recommended to the Massachusetts State Legislature that community health workers be trained and reimbursed, but the process for approval is likely to take years before it is implemented, if ever. "This is still a nascent field," Dr. Behforouz says. "They don't wear white coats. Their training is different than doctors or nurses. It's hard to get them recognized as health-care workers."

In other words, the biggest obstacles standing in the way of low-tech approaches tend to be cultural. That is so often the case with lean.

By the way, while lean is not mentioned in the WSJ article, I do regard some of what it describes as lean approaches. In the Alabama example, the focus was clearly on eliminating wasted time in the appointment and intake process.

Have you ever achieved improvement with a low-tech counterintuitive approach? Share your experience below.

Book Talk: Innovative Lean Development

Steelcase is a company with a solid reputation of implementing lean principles – in all areas, not just manufacturing. Now two of the company’s internal lean consultants have written a book about lean in product development.

Innovative Lean Development: How to Create, Implement and Maintain a Learning Culture Using Fast Learning Cycles by Timothy Schipper and Mark Swets focuses on the six key areas necessary for dramatic development: innovation, rapid prototyping, knowledge capture, learning cycles, process stabilization, and lean management standards.

This book, available next month, is a manual that serves as a template for starting and maintaining the lean process. It includes both explanations and real examples, and explains how to integrate innovation into product development processes, including IT development.

Innovative Lean Development joins other books we publish on product development, including The Toyota Product Development System by James Morgan and Jeffrey Liker, and Value Stream Mapping for Lean Development by Drew Locher, to name just a couple.

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.

The Key to Mining Safety is… a Whiteboard

We lean advocates love simple visual controls. And I recently saw a television program that included a marvelous example of such controls.

I was watching an episode of “Build It Bigger” on the Discovery Channel. The episode focused on efforts to dig a water tunnel in California to bring water to the southern part of the state.

The tunnel, which extends for many miles, is under construction far below the surface of the ground. It uses highly sophisticated machinery to chew through the dirt and rock, then install pre-fabricated concrete sections into five-foot-wide rings that form the wall of the tunnel. The miners install four to six rings per day.

But what caught my eye was what happens before the workers go underground.

A large whiteboard stands near the tunnel entrance. The names of all workers – and any visitors – are listed on the whiteboard. Two hooks are next to each name, one in a column labeled “In”, the other column labeled “Out.” A plain metal tag hangs from each “Out” hook.

Just before heading into the tunnel, each miner moves the tag by his name over to the “In” hook. The result: The whiteboard clearly displays which workers are in the tunnel at any given time – valuable information in case of a problem or accident.

I can’t think of any other system – a computer display or anything else – that would work better than this simple whiteboard.

Can you?

Financial Incentives May Help Reduce Hospital Readmissions

I wrote a few months ago about how many patients are readmitted to hospitals for costly visits that could be avoided. That posting described the results of a recent study that included suggestions to reduce readmissions, including better patient education and better scheduling of follow-up appointments.

A recent article in The Washington Post covers much of the same ground, but also talks about using financial incentives to address the problem.

Right now, hospitals -- such as Inova Mount Vernon -- that do a better job of preventing readmissions sometimes end up losing money because the health-care system doesn't pay for the extra work they do. Some health reform proposals would change the way hospitals are paid, so that stopping readmissions becomes good business.

One idea is to bundle the payments to hospitals, doctors and perhaps nursing homes or rehabilitation centers, to cover both the hospitalization and those first critical weeks after discharge.

Another proposal is to have Medicare penalize hospitals with high readmission rates for eight common chronic diseases. Members of both parties have been looking at ways of paying primary care doctors more to help patients manage their chronic diseases and avoid trips to the hospital every few weeks or months.

The key to reducing readmissions is to improve hospital processes. Financial incentives do not do that directly. But they can serve as a driver – a burning platform – to get hospitals to focus on what needs to be done.

Do you agree?

What Anecdotes Tell Us About Culture at a General Motors Plant

Sometimes the most intriguing insights about lean come not from general statements, but from anecdotes. A recent article in The New York Times Sunday magazine falls into that category.

The article profiles the devastating effect the collapse of GM is having on middle-class blacks in Michigan, for whom the automaker has been a major source of employment.

Mark Graban wrote about the article in the Lean Blog, highlighting a few passages he thought had lean relevance. I agree with his comments, and I’d like to mention some additional sections.

The article, written by Jonathan Mahler, focuses on Marvin Powell, who started working at a GM plant in Pontiac 13 years ago when he was 26 (and is now losing his job).

I am fascinated by the description of the plant at the time Powell started.

It was stressful at first. The line moved faster than he anticipated, and as a new hire who could be let go without cause during his first 90 days, he didn’t want to be the one to slow it down.

Contrast that with a well-run lean plant (Toyota), where a worker is more likely to get into trouble for NOT stopping the line if there is a problem.

But even more fascinating is this description of what I will call the plant’s extra-curricular activities:

Adjusting to the culture of the factory was a challenge, too. A practicing Christian, Powell was taken aback by what he saw taking place around him. The plant was a world of temptations unto itself, with drugs, alcohol, numbers runners, bookies and even “parking-lot girls” who would come to the plant during lunch breaks to service male workers. “Anything you can find outside the plant, you can find inside the plant,” Powell says. “You either get caught up in it, or stay apart from it.”

Even in a well-run plant, I’m sure, auto employees work hard. And everyone likes to blow off some steam. But this description goes beyond that.

Now I’ve never worked in an auto plant. I don’t know whether this kind of situation was unique to that one plant (which I doubt) or whether similar situations exist in Toyota plants (which I also doubt).

The Big Three rarely showed their workers the kind of respect for people that is a fundamental lean principle. They tended to treat workers as drones, expecting them to get the job done, with management not seeking (and even discouraging) ideas or feedback from workers. In such an environment, workers can feel unappreciated and discouraged, which can increase desire for, shall we say, diversions.

Of course, that’s largely speculation on my part. Do any of you have experience with this kind of working environment? What do you believe were the causes?

Book Talk: Freedom from Command and Control

I’m posting Book Talk a day early this week, because of the holiday tomorrow. And in the spirit of Independence Day, I thought it might be appropriate to write about Freedom from Command and Control: Rethinking Management for Lean Service by John Seddon, a book originally published in 2005.

Why? Because the word “freedom” is in the title. Because this book talks about the importance of not being dictatorial, and having employees engaged and involved – maybe not to the point of being a democracy, but certainly in a collaborative way. Even the cover of the book is red, white and blue.

But seriously… Seddon demonstrates that decision-making based on purpose-related measures (such as putting customers first and improving services) can help managers reconnect with operations, see waste, and exploit opportunities for improvement.

This book is focused on service industries. Seddon argues that service is fundamentally different from manufacturing, and shows how Toyota production principles must be transformed for application in service organizations.

For those of you who work in service, this book can be a valuable addition to your library.

Happy 4^th of July!

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.

Report: Medical Schools Should Teach Doctors About Lean

I’ve taken some liberties with the headline on this posting. The report to which I refer is a new document from the Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare. And the report did not actually say lean should be on the curriculum of medical schools.

What it did say is that medical schools need to change their curriculums. And part of that change involves focusing on what sound to me like lean principles.

Reforms in payment policies need to be accompanied by reforms in medical education. This pairing is important to ensure that students and residents learn the skills they need to provide care and leadership in new delivery models under restructured payment and incentives.

These skills include quality measurement and practice improvement, care coordination, multidisciplinary teamwork, cost awareness, and interpersonal skills. Research on internal medicine residency programs found several gaps in formal instruction on many of these skills.

Coordination, teamwork and measurement of cost are all central to a lean strategy, just as interpersonal skills are part of the fundamental lean principle of respect for people.

And let’s not forget about the central goal of lean, process improvement.

A Commission-sponsored study, conducted by RAND researchers, found that, although most internal medicine residency programs provide at least some instruction and experience in topics associated with quality and efficiency improvements, their curricula fall short of recommendations from the Institute of Medicine (IOM) and other experts…

The IOM states that physicians must be able to assess the quality of care they provide and implement changes in their practice for improvement…

The RAND researchers found that, while many residency programs provide some exposure to quality assurance and system change, only a small share require residents to complete their own systematic data collection, analysis, and resulting system change. Fewer than half the programs (11 of 26 programs) have lectures or computer-based training on quality assurance, but more (18 programs) require that residents work on quality assessment at the hospital. Fewer than a third (seven programs) have established curricula in which residents collect and analyze data on their own patients. The same share of programs introduces residents to chronic disease registries and provides lectures or computer-based training on implementing system change. Fewer still (four programs) have residents work directly on projects to implement system changes.

The section on medical education is actually only one part of the wide-ranging, 299-page MedPAC report, which is entitled “Improving Incentives in the Medicare Program.” For those interested in healthcare reform, it makes for interesting reading.

And I’m glad to see that lean principles are part of it, even if the word lean is not mentioned.