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?
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!
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.
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?
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?”
