Tag Archives: lean in healthcare

3P – Putting People Phirst

With our 10th Annual Northeast Conference just eight days away, I’ve taken a little poetic license with the conference theme, Putting People First, to highlight just one of the outstanding teams who will be presenting at the conference:

3p Phirst

The “ideas of many” built from cardboard and brown paper.

Two weeks ago I had the honor of attending the ribbon cutting for the West Suburban Cancer Center in Needham, Massachusetts.   This innovative center was conceptualized in the spring and summer of 2012 by a diverse, dedicated cross-functional team of approximately 30 docs, nurses, technicians, physicists, architects, facilities engineers and administrators using a technical method referred to as Production Preparation Process, or “3P”.   While the structured, rapid brainstorming and prototyping methods used to design the new center design were important to the success of this large project, far more crucial were two principles that guided everyone’s thinking:

  1. A single-minded Patient First principle focused everyone’s thinking on the best possible experience and outcome for the patient and patient’s family rather than just maximizing local efficiencies of the providers.   Patient focus groups provided an essential perspective that kept the team grounded. Using tabletop models to simulate the patient flow, in one instance reducing patient moves from twenty-two to five, the team was guided by the philosophical position that the needs of the customer must come first.
  1. The project’s mantra, “The ideas of many are better than the experience of one,” challenged team members to collaborate in a way that encouraged everyone’s ideas.   With encouragement of BIDMC management and support from facilities and architects, the new center was actually designed by the people who work in the space. In the words of one team member, “We ended up with a design that no one could have foreseen when we started the project.”

As I entered the new cancer center and surgical pavilion, I recalled the original cardboard and brown paper structures that the team had built in order to test and improve their design. At the entrance, I was greeted by one of the physicians who participated on the 3P effort.   She remarked excitedly, “This new design really works!” That excitement was shared by other team members who attended the grand opening, and, I must admit, by me also. The technical achievement was outstanding, but would never have been possible without the focus on people.

There is so much more to this success story than I can relate in a post. I hope you’ll join me on October 1 and 2 at the MassMutual Center in Springfield, Massachusetts to hear more from this team and others who are ‘putting people first’. Still time to register and recharge your Lean efforts.


I’m Against It!

A recent viewing of a Marx Brothers film caused me to reflect on one of the questions I’m frequently asked, “How do you deal with people that are against Lean?”

i'magainstitMy stock response is to quote Shigeo Shingo’s advice that “99% of objection is cautionary,” that is, persons who appear to vigorously object to Lean are really just asking for more information. I confess that, while this answer puts a positive spin on objection, depending upon who is doing the objecting, it doesn’t really answer the question.

For example, very early along in my TPS discovery process while I was away from the plant for a week’s vacation, two of my fellow middle managers, armed with apocalyptic predictions about employee empowerment, took advantage of my absence to make an end run to the corner office. Upon my return, our CEO confronted me: “I understand that you’re turning all of the decision-making over to the employees,” he said.

In another context, I might have taken his words as a compliment, but given the tenor of our organization at the time and the stern visage before me, I quickly understood that I’d been thrown under the bus.   A practiced counterpuncher, I was fortunately able to respond with a few compelling examples of decisions made by frontline employees to make improvements or solve problems, thus diffusing my adversaries’ arguments.  I thought to myself, “Thank goodness I didn’t take a two-week vacation. I might have been fired by then.“

There are several points worth noting here.

  • First, had our CEO occasionally visited the front lines, he would have been in touch with what was actually happening and would not have been vulnerable to the emotional arguments of naysayers.   Unfortunately, too often in the early stages in Lean transformation, the CEO is only passively involved.
  • Secondly, at least some of the time, factual arguments will trump emotional ones. The top manager usually has no ax to grind with any department or division; his/her interests lie in the prosperity of the entire organization.
  • Third, middle managers are often troubled by a perceived loss of authority among their direct reports. If front line employees are empowered, does that make the managers less powerful?
  • Fourth, middle managers may resist a change that they perceive is a threat to their turfs.   For example, “quality at the source” may be seen as an attempt to eliminate the inspection department. Or Kanban may be perceived as a threat to production scheduling.   If improvement implies organizational change to their turf, territorial imperative kicks in.
  • Finally, early Lean successes will sometimes create professional jealousy. Managers may perceive the rising star of a lean leader as a threat to their own advancement. For these managers, the response to the change leader’s ideas is likely to be “whatever it is, I’m against it.”

To be sure each of the concerns above could be characterized as “cautionary.” At a later point in the Lean journey, many managers will come to realize that their early concerns were horse feathers; organizations and individuals do change — for the better.   But in the earlier going, change leaders need to be mindful of and responsive to managerial objections. How we do that is the topic of my October 14 Tea Time with Toast Guy Webinar.


Alert: Our 10th Annual Northeast Lean Conference is now less than a month away. I hope to see many of my readers there as the theme, “Putting People First,” is recurrent in the O.L.D. annuls.   For the last four years my posts have dealt primarily with management’s responsibility to create an environment that’s favorable to problem solving and continuous improvement – and that too is the theme of this year’s conference. I hope to see you all there!

BTW: Attend my next free Webinar next Tuesday, September 9, and you could win a FREE registration to our 10th Annual Northeast Lean Conference. The topic: “Getting Suppliers Involved – Do’s and Don’ts.”  Register here.

Frankenstein Equivalents

frankensteinI was speaking with a friend about a recent downsizing at his church. After nine years, a popular priest had been reassigned to another parish. In an apparent effort to cut costs, a new priest would now split his time between two parishes in neighboring towns. When I expressed some regret about Father S’s departure, my friend replied, “It’s not so bad. If you look at total staffing, the number of FTE’s hasn’t changed much.”

For the uninitiated, FTE’s or Full Time Equivalents, is a ratio between the total number of paid hours during a period and the number of working hours in that period. The ratio units are FTE units or equivalent employees working full-time. In other words, one FTE is equivalent to one employee working full-time – sort of.

For example, having one priest, presumably with more assignments, commuting between two parishes did not seem “equivalent” to me, but I kept that thought to myself. My friend, a doctor at a nearby hospital knows all about FTE’s. It’s a codeword in healthcare used to describe head chopping in the name of cost reduction. It’s a convenient way to dice up people’s work and then, like Dr. Frankenstein, sew them back together as if they were a whole.

frankenstein2In healthcare, the priest is replaced with a doctor who literally runs between campuses, or a nurse who covers two floors simultaneously. At the front door of a business, the receptionist is gradually loaded with new tasks until there is no time left to greet visitors. Or maybe the receptionist is chopped altogether, and that work is sewn onto another job somewhere in the office to create an FTE. Now there is only a phone and phone list in the lobby. On paper these may look like improvements but, in real life, who benefits? Saving lives, saving souls, saving customers – they all require whole persons, not pieces stitched together as FTE’s.

How about in your organization? Are you employing real persons or Frankenstein Equivalents?   Share a story.


Don’t forget: Our next Tea Time with Toast Guy Webinar will be on Tuesday, August 12 from 3:00 – 3:45 p.m.   The topic is “Creating a Realistic Pace for Improvement”. Read more and register here. Bonus!  We’ll select one person from the list of participants to win a free registration to our October 1-2 Northeast L.E.A.N. Conference. Learn more about the conference here.

Lesser Gods

lesser_gods2I learned recently of the passing earlier this year of person I worked with twenty years ago at my last job in manufacturing.   Manny S. was a ‘lesser god’, a term which is meant neither to canonize nor demean him.   He wasn’t perfect – not by a long shot – but boy could he get things done!   If you asked him to help with a task it would be done before you finished the sentence. While others moved with exasperating deliberation to solve problems, Manny needed only seconds to take action.   I wrote a post in 2011 that illustrates his exemplification of the adage “Fix problems instantly.”   I’ve heard and repeated this adage many times, but Manny lived it.   From him I learned the effect of following the adage. But for this short tribute, the Lean world will never know who he was.   He wasn’t an engineer or a manager or a black belt, and didn’t have a great deal of formal education.   He never wrote a book or white paper, never gave a speech and never posted a blog. But he taught me something.

Words like “sensei” and “guru” have entered the English language, primarily I think, as catchy alternatives to “consultant.” (No one would ever have referred to Manny as a “sensei.”)   These persons who have come before are presumed to be the sources of Lean understanding. We idolize the most famous as gods of Lean. In fact, most today are no longer primary sources, but more like reporters or interpreters, who, thanks to the Internet, have a reach far greater than the original authors of TPS.  I cringe at the sensei and guru titles – way too presumptuous. I prefer “co-learner” not only because it’s a touch more humble but also because it implies reciprocity – collaboration in which we learn from each other. Like how Manny and I learned.

To be sure there are experts like Deming or Ohno or Shingo who have come before us, true Senseis through practice and application.   The rest of us are way down the totem pole: lesser gods. But, if we work at it, we can learn from each other.   Contributions from folks like Manny may not be trending on Twitter, but that doesn’t make them less important. For those of us who consider ourselves teachers or consultants (or even senseis) if we keep our eyes and ears open, there are co-learning opportunities right in front of us everyday. One of the greatest joys of my work is the co-learning gifts I receive from my customers.

Can you think of any lesser gods in your organization? Unheralded change leaders whose actions teach us the principles of Lean? Share a story.


BTW: Speaking of unheralded change leaders…The Silver Toaster Award for Employee Excellence in Lean will be awarded again this year at our 10th Annual Northeast L.E.A.N. Conference in October in Springfield MA. It’s a tremendous way to recognize the hard work and dedication of your most enthusiastic employees. All nominees get free registration for the 2-day event and a plaque and a tee shirt during the award ceremony  on the first morning of the conference – so send a team to cheer them on;  Nominations are due in less than one month, on August 1st, so don’t wait to download the application form. Read more and get the form here.

And a reminder – I’ll be discussing Kaizen in the Office during my monthly free webinar tomorrow, July 8 from 3:00 – 3:45 pm. Hope you can join me. Register here.


Across a large swath of the U.S., the winter has been especially cold, snowy and dreary this year.  So here’s a post with a link to a cheery video at the end, just to pick my spirits up – and maybe yours too.

The English language can be confounding.  For example, the word turkey is slang for “a person considered inept or undesirable” while the idiom cold turkey describes the actions of one who abruptly gives up a habit rather than through gradual change.  Finally, talking turkey means “to discuss a problem in a serious way with a real intention to solve it.”

To provide some redeeming social value, let me frame these idioms in terms that are very important to the social science of Lean.  First the turkeys:

A long, long time ago, after a short stint as a materials manager, I was promoted to vice president of manufacturing.  It was, in fact, my good fortune to enter production knowing nothing about it, lest I might have fancied myself an expert. Instead, I relied on people who were already there to help me learn.  Having begun my career in the ‘creative’ world of marketing, a block away from the factory, I had previously been given to believe that manufacturing was ‘cut and dry’; a repetitive, mindless environment.  What I soon discovered after my promotion, however, was that the production floor was filled with innovative if not spiteful employees who managed to build products despite errors in drawings and bills of material, despite malfunctioning equipment and despite a lack of respect for the irons they pulled out of the fire everyday.  When I shared my early concerns with other managers I was cautioned not to spend too much time with malcontents from the factory floor.

I was floored.  “What are these guys thinking?” I asked my welding supervisor, Lenny, as I related the malcontent story.turkey_mug

Lenny gave me wry smile and replied,  “You’re heading in the right direction. Don’t get discouraged.”  I thanked him and thought to myself, “This is different. I’m the manager and he’s coaching me.” Later in the week, I found a gift on my desk (the coffee cup at right) from an anonymous friend.  The thought and particularly the background behind it helped me through a few struggles.

Now for the idiom cold turkey.   This is a model referred to in the Lean world as “blitz kaizen” – a big, sudden change of habits.   These events are typically characterized by major layout changes.  Machines and people are moved close together to facilitate material flow and teamwork – both great objectives.  Problem is, the machines are fine as objects of improvement.  We can push them around as often as we like.  Not so much with people.  We struggle with change even when it’s self-initiated, and we really don’t like being pushed around.  We like to be the agents of change, the innovators, not the objects.  Our habits don’t change on a dime.  Gradual, continuous improvement works better for us than cold turkey.

If we want to engage “everybody everyday” we need to talk turkey to get the root cause of real problems – especially managers.  Recently during a factory tour at a potential customer, a manager proudly shared his huddle board strategy with me: “We require each department to identify and solve a problem every day”, he said, “just like your slogan “everybody everyday.”   Gazing at the huddle board I asked an employee, “How important are the problems on your huddle board?”

Her reply: “Sometimes they’re important, but one way or another we have find a problem to solve every day.”

“How’s that working for you?” I asked.

“Okay,” she responded tentatively, “but we seem to have more problems than solutions.”  Seemed like they were counting problems not solutions – not talking turkey.

Finally, the frivolous clip that was the inspiration for this idiomatic post: Talking to turkeys.  Just a reminder to myself that we all need to lighten up some times.  To all my snowbound frozen Lean friends, take heart.  Spring is less than a month away.


GBMP Event Notes:

Alert: Because of my travel schedule the next Tea Time with the Toast Dude webinar will be Monday, March 3rd from 3:00-3:40 p.m.  It’s short and it free!  The topic will be “Lean Compensation Issues.”  Please click here to register. 

NEW! GBMP is excited to announce, as a licensed affiliate of The Shingo Institute and with two certified instructors on our team, the first Discover Excellence 2-day workshop in our region this year. The program introduces Guiding Principles on which to anchor your improvement initiatives and fill the gaps in your efforts towards ideal results and enterprise excellence. Read more and register here.