To Get Results, You Gotta do the Work

Some lessons for our lean journey can be easily seen on NBC’s The Biggest Loser in every single episode: To get results, you gotta do the work. The trainers don’t run on the treadmill for you. You must do all the heavy lifting and all the sweating. It’s hard work and requires you to change your behaviors. Nothing comes for free. And we must make the time to do it daily, no excuses.

No secrets. No magic.

Don’t hire Lean consultants to do the work for you and expect to become lean. Any improvements we might see will not stick. Lean consultants can teach, motivate, influence, demonstrate, coach, yell, scream and cuss, but you will only get results by doing it yourself.

Don’t delegate continuous improvement to your lean department. Kaizen is everybody, everyday, everywhere. A culture change towards becoming lean MUST be led by the top, no other way!

Just like you can’t sit on the couch eating ice cream and expect to lose weight, you can’t sit in your office looking at the computer screen and expect to improve your processes.

Too many executives don’t want the labor pains, they just want the baby.

YOU have to get up and get moving. Go to gemba. Don’t say I can’t, I don’t want to hear I can’t. Do what you can. Go, Go Go. You better toughin up. Improve something every day. Again. (Wow, I could get used to this!)

There are many inspirational quotes after many seasons of the Biggest Loser that may help us on our lean journey. As show trainer Bob Harper said it best, “Believe in yourself, trust the process and change forever.” And former show trainer, known for her hard-core, in-your-face style, Jillian Michaels says, “Shut up, focus and do the work” and “Get comfortable with being uncomfortable” and my personal favorite, “Unless you puke, faint or die, Keep Going!”

As an added bonus, here are a few clips of Bob and Jillian in action. Be warned: They have to be bleeped many times for rough language. One of my favorite parts is when Jillian points to her head saying” You are not getting it here”. It reminds me a little of some the Japanese consultants that used to yell at me years ago.

Boeing Delivering First 787 Dreamliner

On our kaizen tour last week in Seattle, we included a stop at Boeing in Everett, Washington to observe their production lines and witness a test flight of the first customer production 787 for ANA (All Nippon Airways). The 787 lifted to the sky smoothly from the airstrip, unlike the bumpy journey of their long and costly production start-up which is only 3 years late in delivering this plane.

On my last visit to Boeing, in January 2007, the 787 Dreamliner production hanger sat empty and idle. This is in sharp contrast to the production area today which is in full swing trying to ramp up to 10 planes per month production level and put a dent into the 821 planes in customer order backlog.

From my vantage point on the observation platform, I looked for signs of improvement in their production process comparing the 747, 777 and 787 lines. With only a short observation time, I can not see the whole story however there are some interesting things I noticed and questioned.

The 787 line is completely surrounded by staff cubicles and offices directly on the production floor. This is not the case for the other lines. It appears that the staff has located as close to gemba as possible with the 787 layout. As you can imagine, this cuts the walking down dramatically. With such a huge facility to begin with this should have a dramatic impact to productivity and responsiveness. I wonder why the other production lines have not copied the 787 line and move more people closer to gemba? I also wonder why so many private cubes and not more work team clusters?

Visual management seemed a little better on the 787 line with many project boards, information centers, etc around the area. It is too hard to tell from a distance the purpose of all these boards so I’ll have to assume at this point. All the lines had plenty of shadow boards, kanban cards, flags and other mechanisms to convey orderly design. I wonder if all these boards add value or if they are just for looks?

The much publicized paced assembly line on the 777 line has been scrapped. I applaud Boeing for experimenting with this concept. Failure in these types of experiments is not a waste if we can learn from them. I wonder what Boeing learned?



Sitting near the paint hanger were 2 of the 4 Boeing 747 Dreamlifers specially designed and built to haul large composite components from distant suppliers. Although I find the Dreamlifter impressive in design and ingenuity, I still question the strategy to make these parts off site and have them hauled in using a specialty aircraft. With two of them sitting idol, I wonder how often the Dreamlifters are being utilized?

The biggest disappointment for me was seeing all the product lines more idle than active. In other words, all the production lines had more people standing around (and sitting) than actually working on the plane. I saw the same thing 4 years ago but expected the 787 line to be different assuming a higher sense of urgency, improved production line design and lessons learned on Boeing’s lean journey. In most manufacturing plants, you can understand the lean culture quickly by simple observation. It makes me wonder about the strength of Boeing's lean culture in general?

Regardless of their difficulties, I find myself rooting for Boeing to succeed. As an American and frequent flyer, I certainly wish them the best of luck as they begin releasing 787s to their customers. Now ramp up that effort with a dose a strong continuous improvement and make us proud again!

Sometimes the Best Lean Approach is to Just Jump into the Mud

“You don’t have to be good to start, but you do have to start to be good.” Unknown Author

Regardless of task, project, or journey, everyone is faced with the same question, where do I start?

This question may take some thought before you decide on what you are going to do or it may leave you paralyzed in fear that you decide to do nothing.

Do you feel overwhelmed?

Do you lack knowledge or skills?

What if you head in the wrong direction? Make a mistake? Make things worse?

Do you fear failure?

Decide on a direction (call it a plan) and jump in the mud (do it).

Yes, you will get dirty! Change is messy and it can be scary. You might even feel some pain, more so in the landing than the jump itself. But most importantly, you make a decision to take action.

I am not saying to be reckless in your action, don’t jump off a cliff to get to the mud hole.

All action has risk. It’s unavoidable. Plan to minimize the risk where possible but it can never be entirely eliminated. So jump.

Once the action is taken, evaluate if you made an improvement or not. What did you learn? Where does it hurt? How can you do it better? (Check)

Make your improvements the new standard or adjust your actions accordingly. (Act)

Jump again. It’s the only way to improve.

You will find at the end of the day that there is no secret, no one-best-way and no perfect method, you just have to power to decide to jump or not.

Top 3 Reasons Apple will be Successful without Steve Jobs

With the recently announced resignation of Steve Jobs as CEO of Apple, many people are already speculating on the future of Apple. Certainly, the exceptional leadership, sage-like insightfulness and huge creative force of Steve Jobs will be greatly missed. However, there are three reasons Apple will continue to be successful:

1. Culture
2. Culture
3. Culture

Unlike other assets on the Apple’s corporate balance sheet or valuation on paper or products in the R&D pipeline, their corporate culture is much harder to quantify but is their single, most important strength. And it is Steve Job’s greatest contribution for their ongoing success.

I’m certainly not an expert in the inner workings of Apple’s corporate culture and not under the illusion that it is perfect, same goes for my understanding of Toyota’s culture for that matter. So simply take it as my humble opinion.

Culture matters. Big time! Cuture = People

Look at these great companies as a group, Apple, Toyota, Honda, Southwest, Starbucks, Disney, Virginia Mason, Group Health Cooperative, Zappos, TOMS. All different yet their common denominator is a great company culture with a great vision.

Here is my favorite quote by Steve Jobs, “I want to put a ding in the Universe.” What kind a corporate culture can be developed behind this vision?

Years ago this Steve Jobs’quote was taken from an Apple corporate poster, which I think gives a small insight to their corporate culture.

“Here’s to the crazy ones. The misfits. The rebels. The troublemakers. The round pegs in the square holes.

The ones who see things differently. They’re not fond of rules. And they have no respect for the status quo. You can quote them, disagree with them, glorify or vilify them.

About the only thing you can’t do is ignore them. Because they change things. They invent. They imagine. They heal. They explore. They create. They inspire. They push the human race forward.

Maybe they have to be crazy.

How else can you stare at an empty canvas and see a work of art? Or sit in silence and hear a song that’s never been written? Or gaze at a red planet and see a laboratory on wheels?

We make tools for these kinds of people.

While some see them as the crazy ones, we see genius. Because the people who are crazy enough to think they can change the world, are the ones who do.”

As Lean Leaders, what can we learn from Apple and leadership of Steve Jobs? Look beyond their approach to “manufacturing” (or lack thereof) or Mr. Jobs’ specific leadership style but rather in the power of their corporate culture.

Are we developing a strong corporate culture or are we just learning Lean tools?

Like It or Not, They are Watching Us

In the hustle and bustle of everyday work, amid the chaos of surviving our broken systems to get things done while juggling our efforts to fix our current processes, we can easily forget that leading by example is our most powerful tool we have for improvement and creating our work culture. Even when we don’t notice it, what we say and what we do are seen by those around us. And they are always watching! Always!

I was reminded of this last week while guiding a kaizen event during a discussion with a newly hired team member. He told me that their team leader regularly wears his safely glasses on top of his head instead of properly over his eyes while walking through the manufacturing plant. As a result, this new employee was not inclined to always properly wear his PPE (personal protection equipment). What example has been set? What kind of work culture are we creating?

This is just one small example, but what is the impact?

What about a healthcare clinician who does not regularly or properly wash their hands before caring for a patient?

What about cutting corners on quality just to get the order out? Even just this once?

What if we get upset at a situation at work, letting our emotions go and say things that would make a sailor blush?

When faced with adversity at work or doing a less then pleasant task, do we show a positive or negative attitude?

When a problem arises, are we quick to blame others or do we try to find the root cause?

What if we see this any of these behaviors by others, do we speak up or turn a blind eye and what example are we setting then?

Growing up, how many of us heard our parents say, when seen in questionable behavior, “Don’t do as I do, do as I say” and that somehow was suppose to erase the example set before us. Is this our motto as a Lean Leader?

Certainly, just like our parents, none of us are perfect in the examples we set but that should not prevent us from trying to improve our behaviors to set a better example. And a funny thing about leading by example, it takes many good examples on a consistent basis to catch on yet it seems that it only takes one bad example to spread like wild fire through our company culture.

Like it or not, we are always being watched and the example we set matters.

4 Ways to Eliminate "That's Not My Job" Thinking

How many times have you heard someone say, “That’s not my job”?

As we moved from the craftsman era to specialized, functional silos of modern management over the last century, it has become more and more common to say “That’s not my job”. That thinking is supported by our specialized, functional silo based job descriptions. And it is easily seen in our work behaviors in both manufacturing and service industries.

It is easy to step over a piece of trash at work, thinking “That’s not my job” because we have a janitorial crew to do this task.

It is easy to let a defect go down the line, thinking “That’s not my job” because it the inspector’s job to catch it.

It is easy to let patients or family members to get lost finding their way around our hospital or clinics, thinking “That’s not my job” because that’s somebody else’s job, even if I don’t know who that somebody else is.

Faced with this problem, we could easily blame it on the new generation as being “lazy” or “apathetic”. Or we could say that people are overburdened and overwhelmed with years of downsizing. Maybe we fall in the same trap and think that “it’s not my job” to change our culture.

In the kaizen way, we must eliminate “That’s not my job” thinking and replace it with “How can I improve it?” and “How can I help?” thinking. In a lean transformation, there is no “That’s not my job” thinking anymore.

As Lean leaders, we must embrace this culture change in thinking and here are a few simple ways:

Lead by example: If we want our employees to take responsibility, we need to also take responsibility. When you see a piece of trash on the floor or hallways, always pick it up yourself. Never step over a piece of trash. If you see an undesirable condition, don’t turn a blind eye. Stop the process, and fix it. Before long, people will see you walking the talk and it will become part of expected behavior.

Brainstorm and Document: What does it mean in your place of work to eliminate “That’s not my job” thinking? You may know what the means in your mind but you cannot expect everyone to know what you have in mind. And there are probably many behaviors that you haven’t thought about that would make a big impact in your business to eliminate “That’s not my job” thinking. Brainstorm with your group to discuss the new ways to act and document them. Share the list.

Training: Make it a theme in your daily huddle meetings. Improve your new employee orientation training process by adding a complete section on expected behaviors. Teach people to recognized opportunities to serve our customers and practice them. Try role playing as part of this training.

Tell Stories: In meetings and newsletters, tell the stories of employees where they improved or helped beyond that “old way of thinking”. Maybe an employee saw a family looking lost and learned that they wanted to know where the Hospital cafeteria was located. Instead of telling them the directions, the employee said, “I’ll take you there, follow me. It's my pleasure, I have the time to help you” even if the employee would be late for a meeting as a result. Praise the employee for their action instead of punishing them for being late.

These are just a few simple ways but these ways are hard to do. Be prepared, it will take hard work and sustained effort to make this cultural shift.

As you eliminate “That’s not my job” thinking, more opportunities for improvement will become visible, teamwork is strengthened, processes will improve and customer satisfaction levels will increase. The best part is that it does not cost a lot of money to eliminate “That’s not my job” thinking.

I'm just fine! Wish I Could Say the Same for Health Care in this Country.

This morning, I read the following email sent to me by my good friend, Jeff Fuchs written to his lean students after a recent medical visit to his local emergency room. Jeff is the Director at The Maryland World Class Consortia and a great lean thinker!


I have copied it below with permission and some edits to remove classroom specific instructions to his students. Please read his story about his patient experience. As Jeff and I both hope, may it help stimulate some healthy and thoughtful commentary as we look to improving not only outcomes but the entire patient-family experience.

From: Jeff Fuchs
Sent: Monday, July 25, 2011
To: (All his Lean Students)
Subject: "I'm just fine!" Wish I could say the same for health care in this country.

All,
I am getting back in control of my in-box after my unfortunate absence on the last of our three days together week. My sincere apologies. As the message header indicates, “rumors of my demise are greatly exaggerated.” Just a reminder: You still have your homework. You still have your capstone projects. And now you have your make-up training on cellular production. More on all that in a while.

I am sorry for throwing your day off last Thursday, but I had to bring my body into the shop for some unscheduled maintenance. As we all heard Sir Ken Robinson observe on Wednesday’s video, some of us just view our bodies “as a way of getting our heads to meetings.” Proper upkeep falls by the wayside from time to time, and this is what happens. A bit of detail is in order. I was up to answer nature’s call at 4:15 a.m. on Thursday, and instead of the usual heartbeat, “thumpita-thump, thumpita-thump, thumpita-thump…,” what I felt was more like “thumpita-thump, eeerrk! thumpita-eeerrk! thumpita-thump…errkk!...”

I grabbed my keys, wallet, cell phone, and a good book and drove to the Emergency Room. You may have missed your day of training, but let me tell you that “class was in session” at the Baltimore Washington Medical Center ER when I showed up for school at 5 a.m. Four hours later, (Let me say that again, “FOUR HOURS LATER”) we were still monkeying around with forgotten paperwork, twice redone blood draws, shift change meetings over my bed, staff that was making three trips to my room to restock inventory, and rolling me through a series of three “patient inventory” transactions between some lab and back to my ER bay of “move, wait, process, wait, move, wait” for X-ray, sonogram, and ECG, respectively.

I told you folks. I TOLD you to your face! “When I am through with you, if I am successful, I will make you as miserable a human being as I am. You will see broken processes all around you.” Welcome to my world. Behold, the sad customer/piece of meat-inventory:


Now seriously, don’t he look sad? Pity the poor victim of broken process.

Naturally, in a case like this I couldn’t resist going into Consultant Mode. In spite of being hooked up to the monitor, IV, oxygen, etc. like a marionette, the monitor kept losing my continuing thumpita-errk heartbeat, so the nurses had to keep walking back to the main desk an average of every 11.3 minutes (but who’s counting) to see if I was dead yet and to reset the monitor. How thoughtful of them to give me an ER bay where I could see their goings on. Their wasted motion, their absence of mistake-proofing or visual controls, their failed attempts to communicate with each other, failed service opportunities, excessive patient transportation, and more. How very thoughtful.

After three hours of fear, boredom, and frustration cocktail, I used a pen left behind by one of the nurses and began sketching out a nurse/patient spaghetti map of my morning on the back of an IV wrapper I found on the floor, along with a crude value stream map. (There are a few things wrong in that last sentence. Please use a black or blue ink pen to circle them. We’ll review your answers next session.) The ER staff found my doodles and efficiency ravings…amusing. I’m sure they did not have much time to be interested in the “bored consultant in room six” at the same time they had to deal with the cut up guy the cop brought in handcuffs, the construction worker who just fell off a scaffold, the guy sleeping on a gurney in the hall who nobody knows where he came from, or the other poor folk who needed their full attention.

The attending physician diagnosed me with “atrial fibrillation”, an eminently treatable condition. We’ll see in a couple weeks what the follow up says. They admitted me for observation, where I was subjected to other process design and systems management horrors which I shall not relate to you with at this time. Suffice it to say, I got an education in that fourteen hours. The lesson for me: Healthcare is broke. It’s broke bad. I mean, if I had a clone army of a thousand Lean Jedi Knights, we’d be swinging our Lean Lightsabers for decades trying to unhose healthcare in this country. Lean Facilitator Certification Program students, your future in this industry is secure.

By the way, one final note on my lean healthcare field trip. The “good book” I mentioned that I snagged on my way out the door was Toyota Kata, the one I described with such admiration on Tuesday morning, lamenting that I had not had the time to read it. Well, there you go. I plowed through half of it. Would have gotten further, but had to watch a really good Jerry Springer and eat my tasteless hospital food (Overcooked mac and cheese, gray asparagus, canned pears, and a drink that arrived completely frozen solid.). So, remember what I said: “A true lean leader is a lifelong learner.”

Put your left hand on the computer screen, raise your right hand, and repeat after me: “A-true-lean-leader-is-a-lifelong-learner.”

Here’s me “enjoying” my incarceration:



Pick up a copy of Toyota Kata. Will change your life. It’s an easy and interesting read. You can finish it in a weekend. Or two bad Emergency Room visits. Whichever.
Thanks, all. I look forward to seeing you again soon!

Very best,
Jeff

Jeff Fuchs
Director
The Maryland World Class Consortia
401 East Pratt Street, 17th Floor
Baltimore, MD 21202
http://www.mwcmc.org/

Thank you Jeff for sharing your story. Despite your scare, you maintained your wit and humor. I wish you a speedy recovery and may God bless you! My prayers are with you.

Masaaki Imai on Gemba Walks in Seattle

Masaaki Imai June 2011 KAIZEN Institute USA forum

View more presentations from Mike Wroblewski

Last week I had the wonderful opportunity to go Gemba Walking with Masaaki Imai to several Seattle Companies. I will talk about that experience in a follow up post but thought you might like to see Mr. Imai in action in this slideshow.

Children’s Hospital of Saskatchewan Getting Lean

One of our hospital clients that we are helping guide on their lean journey, in particular, using the 3P lean approach, is Children’s Hospital of Saskatchewan. It is amazing to see the lean thinking that has grown since we started this build project. As you can see in this video, many care providers are participating in this design following the 7 flows with a patient centered focus. One point not highlighted is that several customers (recent patients) also participated in the 3P process to provide their input.

At this time, we have not completed the 3P process. Next up is the design development where we will mock up life size scale rooms to test out the layout and process improvements before we start construction of the new Children’s Hospital.

Stay tuned as we progress on this lean journey!

Dilbert on Kaizen

Here is a recent Dilbert strip poking fun at Kaizen. Kaizen is NOT something that is done to people as it seems in this joke yet in many companies that is the sad reality. This joke also gives new meaning to having someone with outside eyes on the kaizen team. When done in the correct spirit, kaizen is powerful.

Did this Material Come In?

On a recent business process kaizen to improve a warehouse receiving process, our team was focused on improving the time from when the material arrives at the dock door and it is entered “correctly” into the system as received. On too many occasions, the material does not get entered properly in the system and ends up lost somewhere in the facility.

Typically, the invoice would arrive in Accounting some time later and the Accounting would write “Did this material come in?” on the invoice copy if the system did not show receipt of the material. Then forward the copy to Purchasing. Purchasing would contact the supplier to confirm shipment and send out a search party into the plant to locate this missing material.

This problem is so common that Accounting got tired of hand writing “Did this material come in?” on the invoice. To kaizen this process, they purchased a hand stamp with “Did this material come in? to eliminate the wasted time hand writing.

How often do we improve the wrong tasks? It is not true kaizen to improve something that should not be done at all. Before we jump to improvements, ask what the function is and what the value is. Take the time to look deeper. Our kaizen should look at improving the value. In this case, why did the material not get entered properly in the first place?

That’s just what our kaizen team investigated. After several rounds of experiments, we improved the receiving process and the time to “correctly” enter the material into the system was reduced by 86%. In addition, we set up a measurement system to closely monitor the process for sustainability and further kaizen. Soon this stamp can be eliminated.

Stand Up Meeting Humor

I found a copy of this recent Dilbert Comic Strip on a stand up meeting white board taking a poke at stand up meetings. Funny except for hitting people with office supplies. But it does cause me to reflect on stand up meetings...are they done just because others are doing it? What is the value of our stand up meeting? Can we improve?

Free Lean Healthcare 3P Training

Coming up next week, Chris Schrandt and I will present for an afternoon on the theme of Using 3P to Support Healthcare Facility Design. Both Chris and I are active in health services design projects Canada, the USA and New Zealand. We each bring over 20 years of direct experience in applying TPS principles to manufacturing and service organizations. So if you are interested in learning more about 3P design, please join us next week in Seattle.

We will cover the following topics:

What is 3P (Production Preparation Process)?
7 Wastes and how they affect Health services
Who is our Customer(s)?
Understanding the 7 Flows in a Health services facility
Applying 3P: step by step overview


Kaizen Institute is organizing this forum in collaboration with Gemba Academy and Qualis Health. It will be held in Seattle, Washington on Thursday March 17, 2011. This seminar is free of charge.

The registration details are as follows:

Cost: FREE

Date: Thursday, March 17th, 2011

Time: 1:00 PM - 4:00 PM

Location: Qualis Health
10700 Meridian Ave N #100
Seattle, WA 98133-9008

Contact: Nancy Evans
Tel: +1-888-464-3622

Old Lean Dude

My friend, Bruce Hamilton (aka the toast guy from the Toast Kaizen DVD) has started a new blog called Old Lean Dude. In his blog, Bruce gives an insightful look with his lean thinking to help us better understand the Toyota Production System. Sharing his reflections and observations on the lean philosophy we can develop our eyes for improvement.

Check out Bruce’s posts and comment back to him for two-way communication. Ask him about learning directly from the master, Shigeo Shingo. Ask him why is the sink filled with dirty dishes and isn’t a dishwasher really a batch process?

Impossible Dream

There a many times traveling on the lean journey that we get frustrated, worn down and tired. The journey is not an easy one when face day after day with naysayers and harsh critics that cling mightily to the status quo and it’s illusion of security. We face a constant struggle as change agents in seeking zero defects, zero accidents, on-time delivery in the most efficient method possible on a journey that never ends.

It would be easy to just give up and go home rationalizing in our weary minds that at least we gave it a good shot. Most practical, rational leaders might think that way. Maybe we settle too easy in compromise. Perhaps we think it is an impossible dream.

But as lean thinkers we know there is no limit to the world of possibilities with the power of kaizen. We know that developing leaders and empowering others is the right way. We know that in face of adversity we build our character, our strength. We may fall down but we find the courage to get back up. We dream the impossible dream.

Impossible Dream Music by Mitch Leigh and lyrics by Joe Darion
To dream the impossible dream
To fight the unbeatable foe
To bear with unbearable sorrow
To run where the brave dare not go

To right the unrightable wrong
To love pure and chaste from afar
To try when your arms are too weary
To reach the unreachable star

This is my quest, to follow that star
No matter how hopeless, no matter how far
To fight for the right, without question or pause
To be willing to march into Hell for a heavenly cause

And I know if I'll only be true
To this glorious quest
That my heart will lie peaceful and calm
When I'm laid to my rest

And the world will be better for this
That one man scorned and covered with scars
Still strove with his last ounce of courage
To reach the unreachable star!

The video clip was one of my favorite versions of this song, sung by the extraordinary and incredible Jim Nabors (playing the role of Gomer Pyle on the TV series I loved watching as a kid). He has one of the finest and most amazing voices in the world!

For all the lean change agents, keep fighting and reaching the unreachable!

Book Review - On the Mend

One of several books that helps me enormously to better understand the lean healthcare world is On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry written by John Toussaint, MD and Roger Gerard, PhD with Emily Adams. This book makes it simple to understand some of the challenges we must prepare ourselves for in leading change in a healthcare and the application of lean management principles in the healthcare environment.

On the Mend is part storytelling, part case study and part inspirational in writing about the lean transformation of ThedaCare, a four-hospital healthcare system in Wisconsin as seen through the eyes of the authors who lead this revolution. ThedaCare’s lean transformation journey began in 2002 and continues to this day, and the book highlights their early years through 2009.

What I enjoyed most about this book is the easy writing style that made great use of patient examples and conflict issues that brought the story to life while tackling important questions like, “How do we define value anyway?”

There were many topics covered that I found intriguing like the use of the “Collaborative Care Unit” concept. I enjoyed reading about the improvement process of a common heart attack (an ST segment elevated myocardial infarction or STEMI) to go door-to-balloon in 90 minutes or less. And why that is critical. Also covered well was the use of familiar lean tools and ideas like value stream maps, asking the “5 Whys”, PDCA, 7 wastes, spaghetti diagrams and standard work, only these were translated for the healthcare point of view. The authors focused more on the application of these tools and left the technical “how to do” for others to explain.

The authors did a nice job of emphasizing that the lean healthcare focus is on the patients and the care around them, identifying value for the patient and minimizing the time to treatment. Ultimately, it comes down is finding better ways to save lives and improve outcomes which are goals we all can rally behind.

I highly recommend On the Mend to both healthcare and non-healthcare lean leaders to read and then read it again. There are many valuable insights to any lean journey found here to helps us find our way. However, don’t read this book and expect to find any silver bullets. As we know, silver bullets do not exist in lean, only hard work and dedication to the continuous improvement process.

Overall, I think the lean healthcare journey is best described in this book in the words of the authors, “There are no right answers or everlasting solutions, only incremental improvements to be tested and implemented as employees get closer to the goal of identifying what is value to the patient, then delivering it reliably.”

Full Disclosure: I did receive a complementary copy of this book from the publishers to review.

Ambiguous Visual Controls

It has been extremely exciting this past year to enter the lean healthcare world to learn, share and improve processes with the spirit of kaizen. I will certainly post on my lean healthcare experiences later this year. For now, I'd just like to share an ambiguous visual control that that I stumbled upon during one of my Hospital visits. Do you think this causes any confusion?

I am Insane

During a recent kamishibai training session, I received the best compliment of my lean sensei career to date. At least I’m taking it as a compliment. The President of the company said to me, “You are insane.”

After conducting a session on leader standard work, I introduced the use of kamishibai boards to senior management which in this case included the President and his staff (plant manager, department heads of sales, engineering, etc). Kamishibai boards are a simple audit card system using layered audits. Audits are one of the key elements of a lean management system to identify process problems and engage all levels of management closer to the process. It forces the attention of management to focus on the process.

We went to a newly constructed audit board created by the team leaders and supervisor, reviewed how to use the audit cards and practiced doing a real audit using the cards. At first, the senior management was a little apprehensive to go out to gemba to audit the process but grabbed an audit card anyway and started their learning process.

Almost immediately, I was getting feedback like, “How do expect me to know if the setup was right and completed in the expected time?”, “If we do these audits, it will take us all day to finish them.”, “How can I tell if the prints are the correct level?”, “How do you expect me to know if we are working to standard?”. It was a little surprising just how much negative pushback was given and this is from the senior staff, the leaders of the lean system.

My response was, “How do you think you will know the answers?”

After a round of discussion among the group, the President spoke up and said, “Mike, you are insane.” He went on to say, “You mean to tell us that we are expected to know our processes on the shop floor?”

I smiled.

Annual Management Improvement Carnival 2010 Training within Industry

For the fourth and final blog review in my contribution to this year’s Annual Management Improvement Carnival, I will feature the Training within Industry blog written by Bryan Lund.



Bryan Lund started his blog back in September 2007 with his passion for TWI and continuous improvement. I saw first hand Bryan’s passion during his excellent presentation at the 2007 Reliable Plant Lean Manufacturing Conference where we both were speakers. He gave a teaching demo of the Fire Underwriters knot exercise for us to understand the TWI instruction process.

Bryan’s blog, Training within Industry, is an outstanding blend of posts on teaching, improving and leading continuous improvement along with personal reflection to stimulate our own lean thinking. Bryan Lund lives and works in the Burlington, Vermont area.

Here are a few of his best for 2010.

Management Reality
Bryan Lund discusses daily self-discipline and his approach as he takes on a new position in his company with the help of TWI pocket card checklists.

Gandhi gets Lean
Bryan Lund faces the challenge of influencing the behavior of one piece flow over batching 5 at a time with a little inspiration from Gandhi.

Do Not Write Work Instructions
Bryan Lund teaches us to stop and think before we jump to writing work instructions by going through a 5W1H thinking exercise.

5S Thinking
Bryan Lund reflects on the purpose of 5S and questions the tracking success metric of the 5S audit score.

Stealing Monkeys
Bryan Lund encourages us to not steal monkeys off the back of others in the name of help them.

Kaizen Teian First, Kaizen Events Last
Bryan Lund presents his thoughts on growing individual kaizen skill before leaping to the large improvements of kaizen events.

Please be sure to continue reading Bryan Lund’s blog, Training within Industry, in the future and comment on his posts.

Annual Management Improvement Carnival 2010 My Flexible Pencil

For the third of four blogs reviews in my contribution the 2010 Annual Management Improvement Carnival, I will highlight My Flexible Pencil written by David M Kasprzak.



This is another excellent new blog I stumbled upon this past year which just started last March. I was fortunate to have met David in October at the Northeast Shingo Prize Conference along with bloggers, Tim McMahon and Mark Hamel. At the conference, we attended several sessions together and had multiple opportunities to share ideas and thoughts on continuous improvement. David takes his lean thinking beyond the traditional shop floor and directs his focus on organizational effectiveness and leadership.

David lives and works in the Greater Boston area, dealing with the many challenges of fostering the lean approach at his company, the setting for many of his stories.

Here are a few of his best for 2010.

Why Performance Appraisals are Still Used and Why Team Building Still Suffers
David Kasprzak theorizes the often criticized performance appraisal system with lack of true teamwork in companies today.

The Rules are the Problem
David Kasprzak shares a great story illustrating that the way in which you approach a problem determines the way in which you solve it. I especially like the “Make it look like this” solution.

Employee Recognition Doesn’t Require Vision. It Requires Visibility
David Kasprzak reveals a compelling point of view in support of an open office environment in leading by example visibility.

Rube Goldberg Leadership: Waste and Value
David Kasprzak insightfully applies the 7 wastes to leadership that is thought-provoking.

7 Reasons I hate my desk
David Kasprzak questions whether the most common office standard, our desk, adds value or not.

Change Management and the 5S Framework
David Kasprzak uses the 5S Framework beyond the traditional physical environment and applies it to management systems.

Please be sure to continue reading David Kasprzak’s blog, My Flexible Pencil, in the future and comment on his posts.