Tag Archives: GBMP

Who Cares for the Care Givers?

Last month I joined Eric Buhrens, CEO at Lean Enterprise Institute (LEI) to host a leadership team from the Tel Aviv’s Sourasky Medical Center.  They were on a study mission to many of Boston’s fine hospitals and were winding up their week in Boston with a visit to LEI.  Early in the discussion one of our guests asked, “In a few words, please tell me what Lean is.”   Eric fielded this question concisely, explaining “Lean means creating more value for customers with fewer resources.”   He then asked me to relate the following story, a bit more long-winded, to amplify the concept:

I had a recent sojourn of more than a few days at one of Boston’s finest hospitals affording me a rare opportunity for extended direct observation of the process.  In Lean lingo, I was observing from the point of view of the “object” of improvement —  the part to be worked on.  In a factory, the object of improvement is a piece of material, a part being progressively converted by agents of improvement into a finished product.

Clinicians bristle at this analogy.  People, after all, are not widgets.  Of course, I agree.  Patients are each of them unique, and the task to make them well is anything but standard.  Caregivers must often make split-second decisions based upon years of experience and practice, spanning an enormous range of different potential conditions.   They are indeed agents of improvement, operating singly and as a team, with a passionate commitment to making the patient well. From scrub techs to cleaners to docs, surgeons, nurses, and administrators, these caregivers adroitly shift gears from one minute to next, at one point calming a delirious octogenarian who is screaming in the middle of the night for a pepperoni pizza and then a minute later resuscitating a gentleman in cardiac arrest.  As one of their recent customers, I extend my gratitude.

Toast-Kaizen_TabletBut, as I note in the Toast Kaizen video, “continuous improvement is not so much about the work as the things that get in the way of the work.”

Therefore, please allow me to offer an example from my extended observation.  For a period of days, I was tethered to an IV connected by about six feet of plastic tubing to an infusion pump and IV solution bag.  The dosage rate required the bag containing the elixir to be replaced approximately twice per day.  I say approximately because the flow of medicine was interrupted on average once per hour by a pump fault – an airlock in the line. When an airlock was sensed the pump would pause and alarm.  A nurse would then come by to adjust the tubing above the infusion pump, clear the fault and continue the infusion.  Depending upon the level of activity on the floor, wait time for the nurse ranged from a minute to fifteen minutes.  Oddly, if the fault was not attended to in the first five minutes the alarm grew much louder.  This I am told is a countermeasure to “alarm fatigue”,  a condition which occurs when there are too many alarms to handle at one time.  My sense is that the increased loudness did little more to alert the nurses; it was just an addition to the ongoing cacophony of alarms sounding throughout the floor.  In my own case, however, the increased loudness caused me to hit my call button.  This sent a signal to the nurse’s station that, after hearing from me that my infusion pump was alarming, would summon the beeper my nurse was carrying.  Depending upon the level of the many non-standard things that could be happening on the hospital floor, this might elicit an immediate response – or maybe not.

WhoCaresPostWhen the pump alarmed, I understood that my need was not the most critical, but felt compelled to ask my nurse – actually multiple nurses over a period of days – what they thought might be done to reduce the incidence of airlocks in the line; for example, did they think the problem was caused by equipment malfunction or set-up or the viscosity of the solution, or perhaps a software issue?  Had they investigated the problem?  I was struck by their responses.

First, every nurse assumed that my questions regarding the pump were motivated by my own wellbeing. “No,” I exclaimed, “I’m not asking for myself, I’m inquiring on your behalf.  Your time is so valuable, I hate to see it consumed by these kinds of headaches.”  Still, the response was a long-suffering “we do whatever it takes to care for our patients.”  In the minds of caregivers, clearing pump faults was just an inevitable annoyance – part of the job.  The mindset, while admirably focused on the patient, was also resigned to the status quo of common annoyances.  “At what point does an annoyance become a problem?” I asked one nurse.  She responded simply “its hard to make changes.”  Then, pausing for a second, she reflected, “One of our technicians showed me a trick a while back that he said would reduce airlocks in the line.  Let’s give it a try.”  With that, she repositioned the tubing above the infusion pump.    Subsequently, the pump did not alarm for hours – not until a refill solution bag was needed!  The breakthrough here was not so much in the deployment of a potentially better method, but the realization by one caregiver that what she had considered an annoyance was actually a big problem.

Of course, this just a single point of observation, an anecdote.  I didn’t see the nurse again to thank her or ask her what trick she had applied.  I wondered who else on the floor knew about this trick and how many pointless interruptions to their incredibly valuable work could be reduced if the trick became a standard.

I concluded my story to the management team: “Your caregivers are your most valuable resource.  Management’s job is to create an environment in which the ‘things that get in the way of the work’ are exposed and corrected, enabling caregivers to fulfill their missions with more time and greater focus on making the patient well.”

What do you think? I’d love to hear from you.

O.L.D.

Why “Everybody, Everyday”?

Plus a big “congratulations” to MassMutual Financial Group of Springfield MA. Allow me to explain…

As an examiner for the Shingo Prize and also as a certified instructor for the Shingo Institute Enterprise Excellence Workshops, I’ve had the opportunity to visit and learn from many terrific companies. The Shingo Prize criteria set a very high standard for both results and process, evaluating the entire enterprise from the corner office to the loading dock. GBMP has long been a proponent of the Shingo Institute and the Prizes it confers each year to excellent enterprises from around the globe.

Next week, GBMP will be at the 30th Annual Shingo Conference and Awards in Orlando, Florida to celebrate with a recipient from our northeast region: MassMutual Financial Group from Springfield, Massachusetts will receive the Silver Medallion, the second highest honor bestowed by the Institute. This huge accomplishment is more impressive still because it represents the collective efforts of more than 5000 associates at the Springfield site. The spirit of improvement that has been unleashed at MassMutual is evident to anyone who visits, and we are indeed fortunate to have this kind of showcase and beacon of excellence in our region. Congratulations to the many leaders, managers, and associates at MassMutual who live the slogan, “everybody everyday.”

GBMPLogoHorz

GBMP’s Logo & Tagline since 1998

 

Speaking of “everybody, everyday”, I recently created my first VLog and posted it to YouTube here. In it, I discuss how GBMP got its logo & tagline. I hope you will view, enjoy and share it.

 


How does your organization embody the ‘Everybody Everyday’ philosophy? I’d love to hear about it.

Sincerely,
O.L.D.

 

Happy Hollow Lean

hollow leanToday is a favorite holiday for me, full of make-believe supernatural and candy, and unencumbered for the most part by significance.   For this Halloween, I’m recalling a few spirits from the past, links to earlier O.L.D. posts that may bring a smile to your face.  Some deal with the effects of management’s horrific misconceptions of about humanity and humility, and others with a too-often shallow approach to Lean tools.   A couple more focus on management myopia, and finally one or two question the infallibility of Lean consultants like me. For one night only, please join me in the Haunted House of TPS.

Hollow Lean is like Halloween, in that grown-up children dress up their organizations and pretend to change.  Looking good is important.  Risking change, not so much. Hollow Lean is that time when Lean Wizards wind their spells to lure unsuspecting customers to the dark side; to a place where respect of people implicitly means respect for some people.   The Gemba is invisible.

Sometimes managers are so fixed in their beliefs that the can’t see what is right in front of them, yet they are quick to adopt more traditional academic schemes to optimize inventories or reduce FTE’s or avoid costs.   They chop heads for short-term gain, rather than commit to fundamental long-term change.  Their traditional remedies lack the common sense and vision necessary for good decision-making, but they are comfortable choices for managers that seeking paths of less resistance.

Finally, beware the polished pitches of Lean Gurus, glib PowerPoint presenters, and motivational spellbinders.  Content actually matters. Ultimately, it’s what you, the customers, understand that’s critical; not us sensei-omatic subject matter experts. Still, I enjoy sharing; it keeps me sane.  If you have a few minutes tonight for some lighthearted Lean laughs while you’re doling out candy to the neighborhood goblins, then read away. Trick or treat!

O.L.D.

P.S. I’m really looking forward to teaching the Shingo Institute’s “Continuous Improvement” Workshop on November 15-17 and there are still a few seats available. Learn about our terrific host site O.C. Tanner here and learn more about the workshop and register here.

Back To The Future

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Here is an article I wrote ten years ago, recently resurrected from the lost letter file.  I can’t remember why I wrote it or for whom. Originally entitled, “What is Kaizen?” the article still resonates with me as I hope it will with you.

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What is Kaizen?

Over the years my study of TPS has been guided by book learning, tacit learning and more good luck than bad.   One stroke of good luck occurred in February 1987 when I picked up a copy of Kaizen: The Key to Japan’s Competitive Success by Masaaki Imai.  At that time, most literature about TPS was focusing on its technical aspects so this book, which focused on harnessing ideas and creativity, was different.   Also around that time, early TPS efforts at my company were foundering.  We had “lowered the water level of inventory to expose the rocks” and to our dismay were discovering more rocks than we’d bargained for.  We needed more problem solvers and Mr. Imai’s book quickly became a blueprint for individual and small group improvements that bailed us out of troubled waters.  It was truly good luck that led me to Imai’s definition of kaizen which I’ll paraphrase as “many small improvements that come from the common sense and experience of the people who do the work.”

Thus, many small improvements chipped away at and eventually dislodged the rocks that threatened to sink our TPS efforts.   As a manager, my tacit learning from this experience was that shop floor employees were brilliant and creative – some more than others, but all of them smart, proud of their work and extremely willing to be problem-solvers.  Of course there are a lot of books that tell managers that, but that’s academic.  To really understand it we have to practice it!  While Mr. Imai explicitly described the nature of kaizen with many tangible examples, he was quick to point out that understanding kaizen requires practice:  learning by doing.  Toyota refers to this as “tacit learning” as opposed to academic or book learning.  Anyone who has learned to ride a bike can understand what tacit learning is.  It’s visceral and emotional as well as intellectual.  It’s not academic.  And I had a serious need for more problem-solvers. So there’s another stroke of luck:  Our self-inflicted crisis (hitting the rocks) created a need – and opportunity — to take a chance.   While I like to think myself egalitarian, if there had not been a crisis, the opportunity to expand the problem-solving role beyond a few support personnel and supervisors might not have occurred.

Never-ending improvement – that’s kaizen. This is what I learned by “riding the bike.”  But the common translation of “continuous improvement” doesn’t do it justice because it doesn’t connote the changes that also occur within the persons who have created the improvement. The act of being creative to solve a problem or make an improvement has not only educated us but also inspired us to go further. Now tacit learning kicks in again: Concerns by supervision that work will not get done are replaced by more time to do work. Unfounded fears that “employees will mess up” give way to positive anticipation.   More ideas from more employees offered more freely and more frequently generates an organizational confidence to do more than what was previously thought possible. Every day is a day for more improvement.  My tacit learning?  That kaizen is for “Everybody, Everyday” (GBMP’s slogan.)  The momentum and pace of improvement is governed by the breadth and depth of learning and participation of every single person in the organization.  True, there are some employees with more ideas than others, but the act of each and every employee offering his or her creativity changes the organization.

All of this learning proceeded from a definition of kaizen offered by Masaaki Imai.  Unfortunately not everyone subscribes to his definition.  The notion of “small changes” it seems was a turn-off to managers looking for faster progress, managers who subscribed to the “big brain” theory:  breakthrough and innovation emanating from the creativity of just a few smart people.  The idea that many small ideas from the shop floor were going to make any difference at all was (and still is) summarily dismissed.  This is indeed unfortunate because even though its success has been documented countless times over the last three decades, only tacit learning can teach managers the real power of kaizen.

To parody an old proverb:

“You can lead the manager to the shop floor,” as they say, “but you can’t make him see.”

And sometimes you can’t even lead him to the shop floor!  The word “small” is really a misnomer, perhaps a bad translation from Japanese, because while the cost of the small changes may be small, the effect may be huge!  I have witnessed many small changes that were worth ten dollars and many that were worth tens or hundreds of thousands of dollars.  As one former skeptic reported to me recently, “I can only assume that the dramatic improvements in quality are attributable to the small changes we made, and these summed up to a gain I would not have imagined.”   Tacit learning.  Another manager in the same conversation stated “We’ve made more significant headway in the last six weeks than in the previous six years!  Tacit learning for her:  “Many small changes for the better” add up to improvement much faster than we think.

Still many managers remain immune to this evidence.  The big brain theorists have morphed kaizen into events.  Not something done by “Everybody, Everyday”, but some thing done apart from the work, largely organized and directed by people other than those who do the work.  I first witnessed this practice in 1989 as a visitor in another New England manufacturer at a week long “kaizen event” billed as “5 days and one night”.  I was invited as a participant even though I did not work at the company and knew nothing about its factory. Coming from a situation where improvements were mostly grassroots generated and implemented, I found the whole situation stunning.   Employees from the work center where I was participating were tangentially involved at best.  Most stood sullenly on the sidelines.  One employee confided to me that they would change everything back after we left.  He referred to the process as the BOHICA method, an acronym that I will not expand (but you can guess.)  In this situation employees had become objects rather agents of change, a situation all too comfortable for many managers.  For these employees “kaizen” meant “messes created by managers that produced fabricated gains.”   Implicit in their understanding of kaizen was that management had no regard for employee initiative or creativity, that all of the ideas were coming from the big brains.

Subsequent to that experience I’ve heard the term kaizen used as a euphemism for job cutting and outsourcing, and as a task force method to “get workers to work harder.”  Several years ago I had to even sign a contract before I started to work with a company stating that I would never use the word kaizen in the presence of employees, lest they become enraged; so distasteful was their previous experience.  Less damaging, but still confusing, is a growing tendency to break kaizen into “minor” and major”, a token gesture most often to allow a certain number of non-mandated improvements and differentiate them from the “real” events.  Others shoehorn every capital investment into the kaizen court.  Some might be kaizen, some innovation; but even a warehouse expansion has qualified with one company as a “major kaizen.”  (I thought that was waste of storage.)   Companies who can afford it are establishing mezzanine departments to foster kaizen, but too often only those in the new department are focused on improvement.  Management and supervision distance themselves, and the whole process becomes an extracurricular activity.   In these environments no real change is occurring to the organization.  It’s status quo, business as usual.

A respected friend in the TPS business remarked to me recently that maybe the term “kaizen” is itself becoming a point of confusion, that maybe it has been carved up too many times and now, like “continuous improvement”, is devoid of meaning or emotive power; this, the word that Mr. Imai explained thirty years ago is the “Key to Japan’s Competitive Success.”  Sadly, my friend may be right; maybe we need a new name.  We’re good at renaming Toyota words after all.  If such a move could enlighten us and direct our thinking to Mr. Imai’s definition, I’d support it.  But for me, it’s still, and will always be, kaizen:  many small (but organization transforming) improvements that come from the common sense and experience of the people who do the work.  “Everybody, Everyday”.

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Thanks to all of my readers for subscribing, reading and occasionally commenting on my blog. The very best wishes to you all for 2017.

O. L. D.

How to Rework a Charlie Brown Tree

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Last weekend, as I forked over $70 for a “live” Christmas tree, I had a flashback to a very different experience when I was still a kid.  My family had a tradition of waiting until Christmas Eve to trim our tree.  Late in the afternoon of the big night, I’d accompany my Dad to the local holiday tree sale to pick out our balsam fir.  Alas, by the time we shopped, the yard was totally picked over.  It never dawned on me then that my Dad’s timing was tactical.  He negotiated a price that was pretty close to free for a haggard specimen that, unbeknownst to the seller, was soon to be transformed.  My job was to walk around the now empty lot and pick up scrap branches that had been cut from earlier sales.  What commenced shortly thereafter was nothing short of a Christmas miracle.  We performed tree surgery, not in this case to remove branches, but to add them.   Using clippers and a hand drill, the rework process took about ten minutes.  I held the patient in place while my Dad cut and transplanted limbs in holes predrilled to fill gaps in the greenery.  He took special care to match the size and pitch with surrounding branches, yielding a particularly authentic appearance.   When the cosmetic restoration was complete, the tree was delivered inside to await the trimming ritual.  Complete with lights and tinsel and ornaments, this work of art was virtually indistinguishable from its high-priced cousins.

Now, today it seems laughable that anyone would go to these lengths to save money on a Christmas tree.  In fact, my family wasn’t poor.  We could have afforded a fully intact tree.  For my Dad however, a product of the Great Depression, the values of frugality and resourcefulness were ingrained.  He was preeminently generous to everyone around him, but never spent a penny when it was not absolutely necessary.   Long before Charlie Brown’s tree and long before I learned about the Toyota Production System, I witnessed a basic Lean principle in practice:  “Don’t spend money, use your creativity first.”

Arguably, with the recent purchase of our pricey 2016 tree, I’ve not done right by that principle.  So, as penance and also as a tribute to my Dad, I’ve recreated the magical tree rework process from sixty years ago and videoed it for your holiday viewing enjoyment.   Yesterday, I visited a local Christmas tree stand and bargained my way down to $7.00 for a  tree.   Granted, the tree needed a little rework, but I also picked up scrap branches. Here is a short video of that process:  Reworking a Charlie Brown Tree.   Enjoy!

Paraphrasing Rudyard Kipling’s poem, Trees,

“Blogs are writ by fools like me,
But only God can make a tree.”

My Dad, however, came pretty damned close!   From me and everyone at GBMP, Merry Christmas, Happy Hanukkah, Happy Kwanza or whatever you choose to celebrate.

O.L.D

P.S. Give yourself the gift of education in 2017. GBMP is offering twenty two Shingo Institute Courses – between January and November from New Hampshire to South Carolina and lots of places in between. Find a course near you and join us in 2017.