Lean Blog Audio: Recent Episodes
Mark Graban
Mark Graban reads and expands upon selected posts from LeanBlog.org. Topics include Lean principles and leadership in healthcare, manufacturing, business, and the world around us.
Learn more at http://www.leanblog.org/audio Support this podcast: https://anchor.fm/lean-blog-audio/support
The blog post
Today, I want to share a section from my book, The Mistakes That Make Us. I'm sharing an excerpt here in this post, and I'm also making it available as a podcast episode using an excerpt from the audiobook version.
In this book, I explore how mistakes can actually be one of the best ways we learn and grow—whether it’s in business or life in general.
The excerpt I’m about to share is from Chapter Three, where I talk about the importance of kindness. Often, we think that being "nice" is enough, but real kindness goes deeper. It’s not just about being pleasant or avoiding conflict; it’s about helping others—and ourselves—grow and improve through constructive action.
In this chapter, I also touch on self-kindness, especially after making mistakes. We tend to be our own harshest critics, but kindness towards ourselves is crucial if we want to learn and move forward.
If you find this excerpt helpful, I encourage you to check out the rest of the book, The Mistakes That Make Us(including this free sample offer). It’s packed with stories and lessons on how embracing mistakes can lead to greater success. So, let’s get into the reading.
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I've blogged about this before, but I'm going back to the problems at Starbucks again with today's post.
Starbucks has a new CEO who is talking about how the coffee shop experience is broken. Many aspects of the Starbucks mobile ordering process are broken. Well, the ordering process is fine... it's the fulfillment process that needs improving.
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Read the blog post
In many organizations, moving away from a culture of punishment when mistakes are made is a significant leap forward. It signals a shift toward understanding, systems thinking, and improvement.
But once you've made that change, what's next? Do we need to replace punitive approaches with something better? If so, what? How do you ensure that your new approach leads to meaningful learning and continuous improvement?
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Read the blog post
A friend of mine–with a long history of Lean and Toyota Production System knowledge practice–recently shared a troubling story about a relative who works at a manufacturing plant. I'll call this factory team member “Guy.”
Call me cynical, if you must, but I totally believe this story, so I'm sharing it here. And my friend has zero reason to make this up.
Guy's factory has a bonus system in place that's supposed to reward employees for hitting key performance targets each month. That might sound like a good idea on the surface, but here's where it gets dysfunctional:
If there are any reported injuries, the entire bonus goes unpaid for the month.
I've shared this story verbally with a few people, and they always start smirking or chuckling. They know the answer to this question:
What could possibly go wrong?
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Read the blog post
I've been writing about learning from mistakes for a long time, including my previous books before my latest, The Mistakes That Make Us. This idea isn't new, but it's essential–especially in fields like healthcare, where the stakes are incredibly high.
From Lean Hospitals:
“Mistakes are a reality in healthcare, and while we strive to prevent them, it's crucial to create an environment where they are identified quickly, addressed effectively, and used as opportunities for learning and improvement.”
From The Executive Guide to Healthcare Kaizen:
“Leadership in a Kaizen culture means creating an environment where mistakes are seen as opportunities to learn, not as failures.”
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Read the full blog post
In writing The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation, I wanted to challenge the way we think about mistakes, leadership, and organizational culture.
Throughout my career, I've seen firsthand how the traditional responses to mistakes–punishment, fear, and blame–can stifle growth and innovation. The ideas I present in the book are meant to provoke thought and, in some cases, to stir debate.
Here in this post, I'd like to share and dig into five of the most controversial quotes and concepts from the book, explaining why they're important and how they can transform the way we work.
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Read the blog post and more
Imagine an NFL team that has been on a decades-long streak of winless seasons. The owner, who has been at the helm for most of that period, always believes that finding the right coach will solve the team's woes. But it doesn't.
Every few years (or sometimes more often), the owner blames and fires the coach and hires a new one, but the team continues to lose.
In a desperate attempt to turn things around, the owner signs a decent (but inexpensive) free-agent left guard away from the previous Super Bowl champion. This player, hailed for their leadership on and off the field, is expected to be the sole “transformational leader” and bring winning tactics and a winning culture to the struggling team. All. By. Himself.
Would you expect that to work?
I would not.
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The blog post
Think about the last time you made a major career decision. I'm thinking of one of mine, in particular.
Was it about leaving a job for a new one? Changing directions in your career altogether?
Was it a debate about which of the job offers you would accept?
How easy was that? How long did it take you?
In hindsight, some of my career decisions took too long to play out. Afterward, my wife would ask, "Why didn't you do that sooner?"
I'm also thinking of a major decision that was in the news today—it's been drawn out over the past few weeks, and it's a more important decision than one I've ever considered.
During my career, one of the most helpful concepts I've learned about is "motivational interviewing." See more blog posts about this approach. This approach has roots in addiction counseling, developed by William R. Miller and Stephen Rollnick in the 1980s to help individuals struggling with substance abuse find their own motivations for change. Its principles can be applied far beyond addiction, proving invaluable in leadership and coaching.
Lessons from Motivational Interviewing
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The full blog post
This post draws upon and summarizes content in my book, The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation.
Senior leaders must prioritize psychological safety and continuous improvement to foster an environment conducive to learning and innovation. Psychological safety is crucial for enabling employees to speak up about mistakes and ideas without fear of punishment. This executive summary outlines key strategies for cultivating psychological safety and leveraging it to drive continuous improvement.
“Psychological safety is a belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes.”
Hear my podcast with Amy on these topics.
Prof. Amy Edmondson
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The full blog post
Two data points are not a trend. Two-data-point comparisons can be mathematically correct but practically meaningless.
This is true in workplaces and news articles like this one.
Multiple two-data-point comparisons (comparing last month to the previous month AND comparing it to the year before) don't paint the full picture the way a simple run chart would.
If a hospital's margin is "23% higher" than the year before, is that a difference between 1% and 1.23% or the difference between 10% and 12.3%?
Give me more data points. Better yet, create a chart that shows trends (or the lack thereof) over time. Otherwise, we're just celebrating (or bemoaning) every little up and now.
23% sounds like a big change. But that doesn't mean it's statistically meaningful. Was it down 27% the previous month? Possibly. Some metrics simply fluctuate around a stable average.
On NPR recently, the hourly news update covered economic indicators, including the truth and data points that say:
- Gas prices are UP 5 cents from a week ago
- Gas prices are DOWN 10 cents from a month ago
So, gas prices are both going UP and DOWN. It depends on which data point you use as a starting comparison -- and what point you might be trying to prove. What are those two facts "indicators" of?? What's the longer term trend??
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The blog post with webinar link
As a Throwback Thursday, I'm sharing this webinar that I did back in 2012, as hosted by Karen Martin...
On this theme of “The Suggestion Box is Dead,” I thought to prompt ChatGPT to create an image of a burial scene and mournful employees...
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Episode blog post
There's a common misconception about Toyota's “Andon” system, often expressed as:
“When a team member pulls the cord, the line stops.”
But that's not entirely accurate, as this enlightening Toyota video demonstrates...
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The blog post
Digital transformation is about rethinking and reinventing with digital tools. For over 13 years, KaiNexus has moved beyond the outdated suggestion box model.
Traditional suggestion boxes, whether paper or digital, often fail (or usually fail!–ideas get locked away, reviewed by a select few, and lead to frustration.
We believe in dynamic platforms that foster real-time communication and collaboration.
Don't digitize the old, broken way of doing things!
Mark Graban:
Don't digitize the old broken process. Whether that's a suggestion box or anything else, digital transformation is about rethinking reinventing the way we do things with digital tools. From the beginning, more than 13 years ago, KaiNexus has never been an electronic suggestion box because suggestion boxes don't work, whether it's in paper form or an online digital form. Why is that? Suggestion boxes in the paper model have a locked box.
Ideas sit. Some special person with a key opens up box maybe once a month, maybe once a quarter. Some far off team talks about those suggestions without coming back to talk to the person who filled out that suggestion box slip. People give up on suggestion boxes, and it's understandable. So we don't want an electronic or a digital version of that.
What we do want is a digital process with proven, continuous improvement methods. We often refer to this as Kaizen, engaging people in opportunity identification, not just jumping to solutions but bringing forward a problem so we can talk about it locally and then escalate it to management by exception. Don't digitize the old, broken way of doing things.
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Blog post
Psychological Safety means everybody gets their say, but it doesn't mean you get your way.
Psychological Safety is an individual's belief, feeling, or perception that it's safe for them to speak up in a situation.
When people are rewarded for speaking candidly, that leads to rigorous debate and better decisions.
Psychological Safety doesn't mean freedom from being challenged or disagreed with.
It doesn't turn the workplace into a democracy and it doesn't mean you need 100% agreement to move forward on anything.
Psychological Safety means you can disagree with your manager or a peer… and they have the safety to disagree in return.
Psychological Safety doesn't mean shutting down a discussion because you feel uncomfortable.
What practices and behaviors have you seen in a workplace that cultivate Psychological Safety? What are some examples of rewarding people for speaking up candidly?
To me, it comes down to three high-level countermeasures for leaders:
- Modeling candor, vulnerability, and the behaviors you want to see
- Encouraging candor
- Rewarding candor
In summary, Psychological Safety is the foundation of a healthy and productive workplace. It ensures that everyone has the opportunity to voice their thoughts and concerns without fear of retribution, even if it doesn't always mean getting their way.
Again, Psychological Safety means everybody gets their say, but it doesn't mean you get your way.
When leaders model, encourage, and reward candor, it fosters an environment where rigorous debate leads to better decision-making and continuous improvement. By adopting practices that promote Psychological Safety, such as open communication, constructive feedback, and a growth mindset, organizations can unlock the full potential of their teams.
If you're looking to cultivate Psychological Safety within your organization and drive better outcomes through open and candid dialogue, I can help. With extensive experience in fostering cultures of learning and innovation, I offer consulting, workshops, and coaching tailored to your specific needs.
Contact me today to learn how we can work together to build a safer, more effective workplace. I'm happy to do a free discovery call with you.
Or check out my book, The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. Or do both :-)
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The blog post
The LinkedIn event
My latest book, The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation, is turning one year old!
Join me, along with my co-host Elisabeth Swan, for what we hope will be an engaging, insightful, and fun discussion about learning from mistakes. We'll be joined by special surprise guests who will share their unique perspectives and experiences. This isn't just a one-way broadcast–it's an interactive session where we'll conduct live polls and open the virtual floor to your questions, ensuring a dynamic and participative environment.
View this page and click “Attend” to be reminded of this when it starts. A recording will also be available on LinkedIn and my YouTube channel.
Mistakes are a universal experience, and what truly matters is how we learn from them. Together, we will explore ways to improve our ability to learn from mistakes, both as individuals and as organizations. My goal is to uncover practical strategies that can be applied in various contexts to foster a culture of continuous learning and improvement.
We also have a special reason to celebrate. The Mistakes That Make Us is marking its first anniversary/birthday on June 30th. However, since that falls on a Sunday, and let's face it, who wants to be on LinkedIn on a Sunday? I've decided to move the celebration to Friday, June 28th. This will give us the perfect opportunity to not only discuss the themes of the book but also to celebrate its impact over the past year.
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The Blog Post
I'm excited to share my breakout session at the Michigan Lean Consortium Annual Conference!
In this session, I dive into the critical role of Psychological Safety as a Foundation for Continuous Improvement.
We explore how fostering an environment where team members feel safe to share ideas, take risks, and learn from mistakes can drive remarkable progress and innovation.
Oh, and did I mention that Traverse City is usually gorgeous in August?
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Blog post link
When writing or speaking, I use the words “mistake” and “error” interchangeably. The definitions in some dictionaries are comically circular.
Dictionary.com defines an error as:
“a deviation from accuracy or correctness; a MISTAKE, as in action or speech.”
It also defines a mistake as:
“an ERROR in action, calculation, opinion, or judgment caused by poor reasoning, carelessness, insufficient knowledge, etc.”
So, a mistake is an error, and an error is a mistake.
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Blog post link
I'm excited that the Shingo Institute asked me to present a webinar on June 18th.
Click here to register for the webinar
They've also published an article that I wrote:
Psychological Safety: The Key to Effective Andon Cord Pulls and Continuous Improvement
The webinar description:
Join us for an engaging webinar as we explore the transformative power of cultivating a culture that learns from mistakes, ultimately driving continuous improvement and innovation, leading to greater success! Renowned author Mark Graban will draw upon examples from a diverse array of companies, including industry titans like Toyota and agile software startups such as KaiNexus.
During this session, participants will gain valuable insights into the experiences of CEOs and other leaders, regardless of company size, who have adeptly turned mistakes into opportunities for growth and advancement. While these leaders remain vigilant in error prevention, they recognize the profound value of embracing mistakes as pivotal learning moments, particularly within environments fostering psychological safety and robust problem-solving capabilities.
Through compelling narratives, attendees will discover lessons that both educate and inspire, recognizing that in the dynamic landscape of business, mistakes are inevitable — yet it is the process of learning from them that propels us forward!
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Blog post link
The Big Picture: In the Lean community and beyond, some people mistakenly equate “psychological safety” with being comfortable all the time. This misconception can undermine the true essence of psychological safety in the workplace.
Psychological safety is not about constant comfort or shielding managers from discomfort. Synthesizing a few definitions of psychological safety, I say it's a person's belief, feeling, or perception that it's safe enough to speak candidly about things including:
- Mistakes
- Problems
- Ideas
- Differing views
without fearing marginalization or punishment.
What Psychological Safety Really Means
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Blog post
I was talking recently with a trusted friend in the Lean community. He told me a story. It's certainly believable, even if it's second or third-hand to me.
He had no reason to make up a story like this.
A relative of his works in a U.S. factory. Yes, we still have factories here.
I'll call this relative of my friend “Guy,” which is pronounced the American way, not the French way.
Guy's factory would claim to use Lean methods and might even claim a “Toyota Production System” label as its inspiration.
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The blog post
IMAGE: A sign that reads "CAUTION: DON'T OPERATE ON THE WRONG SIDE"
It's silly, right? I've never seen a sign like this in an operating room. And I'm not advocating for them. It's not the right approach for quality and patient safety.
If warning signs actually prevented mistakes, and given that a vast majority of mistakes are caused by human factors (like fatigue) and systemic factors (like being behind schedule because instruments were delivered late to the O.R.)…
1) A sign like this would be posted in every operating room
and
2) Wrong-site, wrong-side, and wrong-patient surgeries would never occur
But, of course, it's not that simple.
What works?
Mistake-proofing works.
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The blog post
TODAY marks the centennial of one of the most significant innovations in quality management: the control chart. 🎂 🎉 🎆
In the early 1920s, Walter A. Shewhart, working at Bell Labs, recognized the need for a statistical method to monitor and control manufacturing processes.
On May 16, 1924, Shewhart created the first “control chart,” a tool that distinguished between common cause variation (inherent in the process) and special cause variation (due to specific, identifiable factors). This simple yet powerful distinction laid the foundation for modern statistical process control (SPC). Control charts were dubbed “Process Behavior Charts” by Donald J. Wheeler Ph.D.)
The latest and greatest of the control charts is the “XmR Chart” — as Wheeler wrote about in Understanding Variation and I wrote about in Measures of Success (a book that has a foreword written by Wheeler).
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The blog post
Research by Ethan Burris shows that the top two reasons employees choose to keep quiet in the workplace are:
1️⃣ Futility
2️⃣ Fear
Fear of getting in trouble is a big problem. But there are also many workplaces where people say, quite literally, “I'm not afraid to speak up, it just isn't worth the effort.”
That's the Futility Factor.
Please answer this poll question via LinkedIn. And I'd love to hear your thoughts in a comment here on the blog post or LinkedIn. Please check out people's comments and stories that they shared on Linkedin.
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Episode page with links and more info
I'm very happy to announce the release of my new Mistake-Proofing course, available NOW through Karen Martin and TKMG Academy.
You can buy the course individually at TKMGAcademy.com for $129. Volume discounts are available for large teams or your entire workforce (for more information, email info@tkmgacademy.com).
The course is also part of the wonderful collection of courses in the all-access annual subscription. The annual price of $529 goes up significantly at 11:59 pm CDT on May 31st, so act now for the best value pricing.
Other TKMG Academy instructors in the series include Karen Martin, Elisabeth Swan, Mike Osterling, Tracy O'Rourke, Brent Loescher... and more.
And if you subscribe to TKMG Academy, you can participate in Karen's "Community of Practice" meeting with me on Wednesday, June 26th.
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Blog post
I love Steve Spear‘s emphasis on a Toyota-based Lean model of:
“See, Solve, Share”
See problems, solve problems, and share what worked as countermeasures. That's the ideal, and it's powerful where it exists.
At Toyota, and companies like it, there's an understanding that speaking up about problems leads to a constructive response from leaders.
That's not always true at other companies that are starting or attempting their “Lean Journey.”
The Psychological Safety that might be taken for granted at Toyota must be actively cultivated in a company before continuous improvement can really take root, let alone take off.
I think the model could also be stated as:
“See, Share, Solve, Share”
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Blog post
Research by Ethan Burris shows that the top two reasons employees choose to keep quiet in the workplace are:
1️⃣ Futility
2️⃣ Fear
Fear of getting in trouble is a big problem. But there are also many workplaces where people say, quite literally, “I'm not afraid to speak up, it just isn't worth the effort.”
That's the Futility Factor.
Please answer this poll question via LinkedIn. And I'd love to hear your thoughts in a comment here on the blog post or on LinkedIn.
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The blog post
You don't find the root cause of a problem in a conference room.
OK, so we've gotten away from the whiteboard. Now what?
You might not even KNOW the root cause by thinking and talking out where the work is actually being done.
That's one of the most powerful lessons I've learned from former Toyota people I've been able to work with.
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Blog Post
Professors Robert H. Hayes and William J. Abernathy have harsh words about a common, if not typical style of American management:
“…an overdependence on analytical detachment – what they call ”managerial remote control.”
They say it is an approach that exalts financial analysis, not line operations. It rewards executives who see their company primarily as a competing set of rates of return, who manage by numbers and computer printouts.
Further, they say, it is a seductive doctrine that promises the bright student a quick path to the top and that piles its rewards on executives who force through impressive short-term performance, at indeterminate cost to long-term health.
Fearing any dip in today's profits, American companies keep research and technology on short rations, skimping the investment critically needed to insure competitiveness tomorrow.”
These are warnings about:
- Prioritizing financial analysis over an operations focus
- Emphasized and rewarding short-term performance over long-term perspectives
Is that from a recent article that I've read? Yet another article about Boeing's troubles?
No. It's a 1982 article in the New York Times. Hat tip to Tom Ehrenfeld for sharing it with me.
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The blog post
It's interesting to observe a hospital process (or lack thereof) when a family member needs surgery. I had the opportunity to do so one day last week. I originally shared this on LinkedIn as a post and real-time updates.
Thankfully, the clinical care seemed to be good, and that family member is recovering well from the outpatient procedure.
But, the experience could have been better. I'm critiquing the process and the apparent culture, not the individuals involved. They are part of a system, which includes their job role design, training, and supervision.
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Blog post with links
The other day, I read about the passing of Donald E. Peterson, who was a key CEO for Ford Motor Company in the 1980s (from 1985 to 1990).
From the Detroit Free Press:
Former Ford CEO Don Petersen, who spent 41 years with automaker, dies at 97
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Read the blog post
How often do you hear executives blaming employees, including frontline workers, for different problems or poor performance?
I don't think that's a good look when leaders do that.
Leaders are responsible for the system, especially senior leaders. Even though they are part of a system, they have more freedom and more ability to change systems that ultimately drive most performance.
A blaming leader looks at low productivity numbers and blames “lazy workers.”
A blaming leader sees mistakes and blames “careless workers.”
A blaming leader sees employees choosing not to speak up about problems and blames “cowardly workers.”
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Read the blog post
I recently spoke and facilitated at a health system's quarterly leadership forum event on the topic of “Psychological Safety as a Pre-Condition for Continuous Improvement.” It was very well received, and I'm very passionate about the need for leaders to help every team member believe that it's both safe and effective to speak up in the workplace.
Psychological Safety plus Problem Solving is a very powerful combination.
Let me know if you'd be open to a brief conversation on collaborating for your next leadership forum or another executive event. I'm keen to share insights that can further empower your team and take your improvement journey to the next level.
Learn more here and let me know if this would help your healthcare organization (or any organization outside of healthcare):
Transforming Healthcare Leadership: Cultivate Psychological Safety for Unprecedented Continuous Improvement
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Read the blog post
I have been really enjoying this book, released in 2021, by Kiyoshi “Nate” Furuta, a retired Toyota executive: Welcome Problems, Find Success: Creating Toyota Cultures Around the World. I bought it a year ago and wish I had started reading it sooner!
Furuta is the retired former chair and CEO of Toyota Boshoku America, Inc. — an automotive parts supplier to companies including Toyota and General Motors.
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Read the episode, view video, and more
There was a fascinating article in Bloomberg BusinessWeek about GE doing its final spinoff of GE Vernova (ticker symbol: GEV) and the remaining business that Larry Culp remains CEO of, GE Aerospace (formerly GE Aviation, ticker symbol: GE).
The inside story of how GE CEO Larry Culp dismantled a 131-year-old American giant.
AN EMPIRE DIVIDED
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The blog post and video
Embracing Imperfections and Learning from Mistakes: A Leadership Insight from the 2022 AME Annual Conference...
In a riveting conversation between Larry Culp (at the time, CEO of GE and now CEO of GE Aerospace) and my good friend Katie Anderson at the 2022 Association for Manufacturing Excellence (AME) Annual Conference, valuable lessons on leadership, transparency, and fostering a culture where challenges and imperfections are openly shared were illuminated.
Come join AME at their 2024 Conference in Atlanta later this year.
Here's a short clip:
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The blog post
As we sit in seat 26A, mindlessly watching a movie, we take for granted that our cell phone (or the shirt off our back) won't be suddenly sucked out through a gaping hole in the side of a plane. That's because the odds of this happening are unimaginably low. Until now, that is. Are we entering a new era where shoddy manufacturing (or maintenance) exposes us to more risk, reversing a decades-old trend of greatly improved aviation safety?
On January 5th, an Alaska Airlines 737 MAX-9, designed and assembled by Boeing, safely executed an emergency landing after a “door plug” blew out of the plane's left side. Thankfully, the resulting hole and loss of pressure didn't suck out any passengers or crew.
Now, the window and middle seats next to the door plug were thankfully empty. That raises questions about what Alaska knew and what chances they were taking by continuing to fly the plane after previous complaints about “whistling sound” and alerts about cabin pressures on previous flights that plane took.
The crew performed valiantly in these circumstances, and we should celebrate them. This incident creates an opportunity for the aviation industry (including regulators) to learn how to ensure this sort of door plug failure never happens again.
Instead of blaming human error, people should ask why the company didn't have better systems to prevent or detect the mistake or mistakes that led to this incident. Some leaders throw up their hands and lament,
“It's human error… we'll never be perfect… so what can we do?”
Instead of leaving that as an unanswered rhetorical question, we need to work at it seriously. What can we do to prevent mistakes and protect ourselves from human error?
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The blog post
Does it Feel Better to Be Vulnerable or Candid in a Workplace?
I've learned so much from Timothy R. Clark of the firm LeaderFactor, author of the excellent book, The 4 Stages of Psychological Safety. I can't recommend his work enough--including his free podcasts, webinars, and more. I was fortunate to go through a formal certification course with him on Psychological Safety.
He was a guest on my podcast, "My Favorite Mistake." He was kind enough to write a blurb about my book, The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation.
Clark defines "Psychological Safety" using language that's similar to Harvard Prof. Amy Edmondson's definition. To synthesize them, Psychological Safety means a person:
Feels or believes it is safe to speak "without fear of being embarrassed, marginalized, or punished in some way" in a given situation.
The part in quotes is from Clark's definition. Edmondson says it's a belief that "one will not be punished or humiliated" for speaking up about things like "ideas, questions, concerns, or mistakes."
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The blog post
Recently, I've heard an idea a few times that I'd like to share and discuss in this post. As I'm writing this, I can't remember who to cite. That's my mistake. I'll happily correct the post if I remember or somebody lets me know who to credit. Because I love this idea... but it's not my idea.
It's pretty common for a speaker to ask the audience, at the end of a talk:
"Do you have any questions?"
I'm quite certain I've done that. Sometimes, the answer is yes. But the framing of the question is closed-ended. And the question, whether at a talk or during a meeting, might be intimidating. People might wonder, "Is it OK to have questions? Should I be embarrassed if there was something I didn't quite understand?"
That's why it seems a better question is the open-ended version of that:
"What questions do you have?"
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The blog post
It’s 9 p.m. in an operating room, just before the last procedure of a long day that had been full of delays. A nurse sees that the surgeon is about to make an incision without first stopping for the expected “timeout,” a crucial step that helps the team confirm, among other things, that the correct surgery is about to be performed on the correct side of the correct patient. The nurse is also concerned they don’t have enough units of blood on hand for this type of procedure.
The nurse pauses and wonders,
“Should I speak up or keep quiet?”
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The blog post
I'm currently working on a Mistake Proofing class for Karen Martin and TKMG Academy. Coming soon!!
In the process of writing the course and its script, I've gone back to some older source material that has been on my bookshelf for a long time. In this case, it's a book I not only own but read many years ago (20 years ago?): Zero Quality Control by Shigeo Shingo.
It was published by Norman Bodek during the heyday of Productivity Press when he still owned it.
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The blog post
A while back, I uploaded the entire PDF of my 2018 book, Measures of Success: React Less, Lead Better, Improve More, into the premium version of ChatGPT.
As an author and publisher, it's a really useful tool for generating marketing content — although maybe it's a mistake to upload my content that way. I'm sure a PDF of the book was already on the internet to be potentially scanned by ChatGPT. Please leave a comment if you think I made a big mistake there.
One use is what I'm sharing here: Asking ChatGPT to provide its summary of the book and each chapter. It did a really nice job:
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I'm excited to announce that I've registered for Katie Anderson‘s Japan Study Trip in November! Read the blog post.
Between 2012 and 2019, I visited Japan five times, and I learned something new each time. I've been really itching to go back. I'm excited to see and learn new things with Katie and her team!!
It's a great opportunity to deepen your understanding of Lean and the Toyota Production System. Visiting Japan helps one understand which of the broader cultural elements of the country contribute to a Lean workplace.
But it also helps you understand that not all Japanese companies are made in the Toyota mold. Toyota has worked very diligently to cultivate its culture and practices over time. And our organizations can do the same.
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The blog post
We can all make mistakes, so I advocate for learning from mistakes through my book, podcast, and speaking. I do my best to learn from my mistakes, so I don't repeat them. I fail to meet that standard sometimes, and I try to learn from those moments (as I shared in this recent post).
A few times now, a friend has sent me a photo or tagged me on a LinkedIn post about a sign similar to the one below. They assume I'd love the sign and the sentiment.
"Mistakes are proof that you are trying."
My response?
It depends.
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The blog post
What do Boeing frontline mechanics and engineers think about this day? What did they expect going into it? How did the day turn out? I'd love to know.
“Quality is made in the boardroom.”
I rolled my eyes hard when I read this announcement from Boeing, as part of the aftermath of the January 5th door plug blowout incident on an Alaska Airlines flight:
In recent years, there have been many complaints about the Boeing culture. Culture starts with the executive suite. They're responsible for the culture, and they're responsible for the results of bad decisions made in the boardroom or the remote C-suite. Or they should be responsible.
W. Edwards DemingBoeing to hold Quality Stand Downs
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Blog post link
I loved a recent New York Times article about Chef Gordon Ramsay, including this part:
“Ramsay said that when he makes a mistake, he owns up to it. He has been candid about the misjudgments that led to the closure of Amaryllis, his fine dining restaurant in Glasgow, and admits that he has opened restaurants that were “badly conceptualized” or opened in the wrong area. “You should never be embarrassed of failure,” he said. “But never make the same mistake twice.”
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Blog post
For a long time, I've heard the phrase “the hidden factory” used to describe various forms of waste in a factory, including rework operations and activity.
I was surprised to hear Boeing CEO Dave Calhoun refer to this in a news story using a similar phrase, “shadow factory.”
Boeing Wants to Close Its ‘Shadow Factories.' It Would Be a Positive Step.
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Read the blog post
As I recently shared on LinkedIn, I really appreciated the annual shareholder letter that was published and shared by Larry Culp, who has been CEO of General Electric for just over five years now (the first-ever outsider CEO in their 125+ year history).
Read the full letter here. I've also archived it here as a PDF.
First off, I can't help but notice that the photo shared at the end of the letter is not a corporate headshot of Larry in a power suit and tie. It's a photo from a "gemba" (or factory floor) with him wearing safety glasses, a casual shirt, and a high-visibility vest.
He certainly looks to be in his element and enjoying it. How rare is that amongst CEOs of manufacturing companies of any size? How much better off would other manufacturers (or healthcare organizations) be if they had CEOs who don't just sponsor or support Lean, but are instead leading and driving the culture change? How many hospital CEOs truly enjoy donning PPE to be at the frontlines of patient care?
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Blog post
This post is built around excerpts from the book The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. Read more about Toyota, including stories and key lessons learned in the book.
Download a free preview of the book
From the book:
Fear and punishment drive people to get better at hiding mistakes when they could channel that energy into preventing them. When they can't be hidden, repeated mistakes illustrate how punishment accomplishes nothing beyond deflecting blame from leaders.
One of my heroes, W. Edwards Deming, who also deeply influenced Toyota executives, shared what may be the most important recommendation in his famed “14 Points for Management”:
“Drive out fear, so that everyone may work effectively for the company.”[i]
Driving out fear means, in part, that everyone can feel safe to speak up about mistakes and improvement ideas, as discussed in Chapters Five and Six. Leaders can also alleviate the fear of making mistakes, to begin with, when they combine the right methods and mindsets.
Starting with mindset, as former Toyota leader Darril Wilburn says,
“It's a leader's responsibility to create a system in which people can be successful.”
Therefore, it's the leader's responsibility to drive out fear. This includes creating work systems where it's easier to do the right thing and more difficult to make a mistake. This responsibility doesn't fall solely on the shoulders of leaders. They also engage their team members in designing effective mistake-proofing methods.
Mistake-proofing, or “poka yoke” in Japanese, is a core method within the Toyota Production System. It's a mindset based on the idea that people want to do good work but are imperfect. So, leaders have an obligation to help.
You might not think of Toyota as an entrepreneurial company today, but it started small in 1926 as a manufacturer of weaving looms based on patents held by founder Sakichi Toyoda. One of his key innovations was a mechanism that would automatically stop a loom when a thread broke, preventing it from cranking out more defective cloth. This innovation also led to huge productivity increases. One worker could now oversee upward of 30 to 50 machines, walking over to respond to problems when they were detected instead of having to hover over a single machine continually.
Toyota originally used the phrase “baka yoke,” which means “idiot-proofing.” Many decades ago, that term upset a Japanese factory worker who, correctly, complained that they weren't an idiot. We should also avoid saying “fool-proofing” or “dummy-proofing,” regardless of how often we hear them spoken around us.
Professor John Grout, the former dean of the Campbell School of Business at Berry College, is an expert on mistakes, receiving some of his early education in the field from Toyota leaders. He thinks mistake-proofing should be called “slip-proofing,” as it's easier to prevent execution errors than bad decisions (planning mistakes). One common slip is closing a file without saving it. The “Are you sure?” dialogue box tries to protect us, but as John points out, we're likely to click “Yes” out of habit. That's a slip on top of a slip–one that's hard to prevent. Using software that continually autosaves your work eliminates that risk (to my benefit, as I write this book in Google Docs).
This post originally appeared at mistakesbook.com.
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Blog post link
Psychological Safety is not some nice-to-have touchy-feely concept.
Psychological Safety means that you feel safe speaking up in the workplace. That could mean:
- Asking questions
- Pointing out problems
- Admitting mistakes
- Disagreeing with your manager
- Sharing ideas for improvement
It's been pretty well proven that organizations with a higher level of Psychological Safety perform better.
A lack of Psychological Safety in a factory can turn deadly. A lack of it has proven deadly in healthcare settings too, of course.
If workers and engineers are punished for speaking up about quality problems in aerospace factories, that puts customers (and passengers) at great risk.
When people are pressured into being silent, that's a management problem and a culture problem. I'm not blaming the individuals who keep quiet to save their jobs. I do admire those who take great professional and personal risk to speak up anyway.
This WSJ article (which should be a free-reading link) talks at length about workers being punished at Spirit Aerosystems (a key Boeing supplier, formerly part of Boeing) for speaking up about quality concerns and problems.
There's so much to potentially dig into regarding decisions made by past Boeing executives about spinning off factories or outsourcing work. But I'll keep this post focused on the psychological safety elements.
I saw the punchline of this one story coming a mile away. It's not a funny situation, but I did literally laugh out loud:
“At one point, Dean said, [Spirit] threw a pizza party for employees to celebrate a drop in the number of defects reported. Chatter at the party turned to how everyone knew that the defect numbers were down only because people were reporting fewer problems.”
It's so predictable. It's happened before, and it will happen again.
Dr. Deming wrote about this dynamic 40 years ago, with a story of a factory that offered an incentive for “zero injuries.” Guess what, people stopped reporting injuries, even though people could be seen walking around with arms in slings and such.
Remember, including in healthcare, that “reported incidents” are not the same as “incidents,” especially when Psychological Safety is sorely lacking. In a true Lean Manufacturing environment, people are REWARDED for raising concerns and pointing out problems. We need more of that good Lean culture. Lives are at stake.
More from the WSJ article about people being punished for putting quality first:
The result, some current and former employees say: a factory where workers rush to meet unrealistic quotas and where pointing out problems is discouraged if not punished. Increasingly, they say, planes have been leaving Wichita with so-called escapements, or undetected defects.
“It is known at Spirit that if you make too much noise and cause too much trouble, you will be moved,” said Joshua Dean, a former Spirit quality auditor who says he was fired after flagging misdrilled holes in fuselages. “It doesn't mean you completely disregard stuff, but they don't want you to find everything and write it up.”
And also:
On the Spirit factory floor, some machinists building planes say their concerns about quality rarely get conveyed to more senior managers, and that quality inspectors fear retaliation if they point out too many problems.
Union representatives complained to leaders last fall that the company removed inspectors from line jobs and replaced them with contract workers after they flagged multiple defects. “This is leaving them with great quality and safety concerns,” one of the representatives wrote in an email to union officials. “Also feeling retaliated against for doing their jobs.”
That doesn't give me more confidence about flying on Boeing airplanes. I hope the culture at Airbus isn't as dysfunctional.
‘This Has Been Going on for Years.' Inside Boeing's Manufacturing Mess.
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Blog post with more info and links
Congratulations to my podcast(s) guests who were named to the Thinkers50 list of influential management thinkers!
I am thrilled to extend my heartiest congratulations to a remarkable group of individuals who have recently graced the stages of my podcasts, “Lean Blog Interviews” and “My Favorite Mistake.” These brilliant minds have been recognized on the prestigious Thinkers50 list for their groundbreaking contributions to the field of management thinking. Each has shared their invaluable insights with us, and it's a true honor to see them receive this well-deserved accolade.
⭐ Amy Edmondson (both podcasts)
⭐ Erica Dhawan (MFM)
⭐ Daniel Pink (both podcasts)
⭐ Zeynep Ton (Lean podcast, twice)
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Blog post with link to purchase and more
I have a limited number of copies of my book Measures of Success: React Less, Lead Better, Improve More that are available for about half of the Amazon retail price — and this includes free shipping.
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Blog post
tl;dr summary: Karyn Ross enlightened me about World Kindness Day and provided invaluable feedback on my book, The Mistakes That Make Us. Her insights particularly helped me replace the term “grace” with “kindness,” enhancing the book's inclusivity. She also helped me better distinguish between being “nice” and “kind.”
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Blog post
A Question -- Email From a Listener:
But I was prompted to think about this recently when I received an email from a podcast listener:
"So I heard an interesting distinction between Gemba and Genba today.
The M version is a place of work
The N version is a place of investigation (used by Japanese police).
So you go to the place of work before you go to the place of investigation."
Hmmm. I had never heard that. So I thought I'd do a little research and check with friends who have varying levels of Japanese language skills.
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The episode's blog post
Leaders and organizations have a choice:
1) cultivate a culture of fear and punishment or
2) a culture of learning and innovation.
That choice significantly affects happiness and performance at all levels within the organization.
A culture of fear and punishment drives mistakes underground. An organization with a culture of fear cannot learn from mistakes because people don't feel safe admitting them.
People who do admit mistakes to their manager aren't more virtuous or courageous; they likely are in circumstances where they are able to feel safe doing so. Instead of telling people to be brave, leaders must help people feel safer.
Those who fail to learn from mistakes are doomed to repeat them.
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Read the blog post
In this episode, Mark recounts an unexpected ordeal in an Italian hospital after his mother-in-law broke her arm while on vacation. Faced with difficult choices about surgery and travel, the family navigates a foreign healthcare system. Amid the stress, a seemingly small act of kindness by a hospital staff member leaves a lasting impression, exemplifying universal compassion.
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Direct blog post link
It’s not unusual to see individuals get blamed for systemic errors and problems.
Case in point, this article:
Delta Air Flight Attendant Makes Expensive Mistake After Emergency Slide is Accidentally Deployed Shortly After Landing in Dublin
It seems like a fact that the flight attendant deployed the slide. But is the mistake their fault?
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To read the article and comment, click here or leanblog.org/audio340.
This is an article that I wrote, published on the Quality Digest website.
It begins: "I can’t count how many times during the past 20 years I’ve heard executives complain that their people aren’t enthusiastically participating in their lean program. Leaders lament that while the company has spent a small fortune to put everybody through continuous improvement training, hardly anybody submits ideas. The problem isn’t their employees; it’s a cultural problem and, therefore, a leadership problem."
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Blog Post
I was very excited to learn about an event that is being produced by GE, next Wednesday, September 6th, in New York City. I'm thrilled to have been invited to attend in person, along with other "Lean Influencers," including my friends Katie Anderson and Jamie V. Parker. We will be fortunate to be there in person to share highlights from the event via social media, blog posts, podcasts, and more -- on Wednesday and beyond.
See the LinkedIn Event page:
The Lean Mindset: The Pursuit of Progress
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Blog post
From the post:
This is really hard to write, as I was stunned and saddened by the recent passing of a good friend and colleague, Chris Burnham. Word had started to spread on LinkedIn and I feel bad about having to share this news here.
You can read his obituary here:
There will be a celebration of life event on Sunday that I will be fortunate to attend. Chris was, most recently, the Senior Director of Lean Strategy at KaiNexus, a company I have been involved with since 2011. Many of his colleagues will also be there to pay our respects, to honor him, and to support his loved ones.
I say this with all sincerity that Chris was one of my favorite people in the Lean community. I appreciated his positive and thoughtful approach to Lean and to our work. We shared a love of discovering new Bourbons to share and discuss, which then lubricated the social fun and work discussions.
Christopher Burnham Obituary
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Blog post
When you do work related to processes, quality, improvement, and learning from mistakes… the universe has ways of testing you (or playing a prank on me). As I share at the end of the post, I failed that test in one way. A big way.
My wife and I had a 3-piece sectional couch that we've recently replaced, so we were looking to donate the old one to a good cause.
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Blog post
This is something from my book, The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation, that I shared on LinkedIn recently.
Here's something I figured out thanks to education in a combination of fields, including Lean management and psychological safety. I wish I had understood this much sooner:
“Speaking up isn't a matter of character or courage–it's driven by culture. People feel safe to share when their leaders and colleagues treat them with respect. Instead of asking people to be brave, leaders must create conditions where people can feel safe.”
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Visit our website: https://leanblog.org/audio
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Blog post
This post shares a story I heard at the Michigan Lean Consortium annual conference earlier this week. They've been kind about sharing ideas and doing a book club discussion around my new book, The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation.
During a book signing session at the conference, an attendee, Cori, told me a story that's too good to not pass along. I'll do my best to be true to the details of the story.
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Blog post page
Below is some material that I wrote, but didn't use, in my book The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. Maybe it was a mistake to cut it. But the material wasn't really related to my podcast. It was based on some interactions with some Veterans Administration Health Care leaders after giving a talk on learning from mistakes last November.
What is culture?
Some say it's simply how we do things in this organization.
The late Edgar Schein, a famed MIT professor, wrote that we can observe and describe culture through artifacts, espoused values, and assumptions.
One example of an artifact is a small card given to me by a U.S. Veterans Health Administration site leader who is building a culture of learning from mistakes.
On one side, the card said the holder was “free to fail.” The card framed a “FAIL” as the:
“First Attempt In Learning.”
An Artifact from a Veteran's Administration Healthcare Site
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Blog post with photos and more
I was saddened to learn today that Masaaki Imai passed away, as announced this week by the organization he founded, KAIZEN Institute. He was 92.
Mr. Imai was well known for his books, including KAIZEN, his follow up Gemba Kaizen, and his latest, Strategic KAIZEN™ (published in 2021). He traveled the world teaching people about continuous improvement.
I'd like to first express my deepest condolences to Mr. Imai's family, friends, and colleagues.
I had the fantastic opportunity to meet Mr. Imai a few times -- once in Seattle when he was visiting and speaking at a healthcare organization, and twice during Japan study tours organized by Kaizen Institute. Thank you for your contributions to the world, Mr. Imai!
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Read the blog post and get links
My new book, The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation, is still only in a draft state before final proofreading (actually, the proofreading is taking place now).
Trying to get some proof copies printed by Amazon sure does open up the possibility of mistakenly hitting "Publish Your Paperback Book" instead of "Save as Draft."
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Blog post link
The following material was found on the “cutting room floor” for my upcoming book, The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. And I've supplemented it with some new material to flesh it out into a post.
Come to the live book cover reveal event tomorrow (Tuesday, May 2) if you can!
I've asked more than 215 people the same question (releasing 208 episodes to date):
“What's your favorite mistake?“
You might wonder why I seem to be so obsessed with this question. It's not because I love embarrassing people or because I want to gloat about the mistakes of others. I ask this question to learn and improve myself as a person and leader.
The book and the podcast series are meant to be reminders that we shouldn't mock people for their mistakes. We shouldn't be too hard on ourselves, even if that's easier said than done.
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Link to the blog post at Value Capture's website
As we explore concepts like psychological safety and Diversity, Equity, Inclusion, and Accessibility (DEIA) in this blog post series, I’d like to kick things off with a look at some serious problem statements that we must address. I’m thankful for the organizations, including Value Capture clients, who aim to close these performance gaps in systematic and sustained ways.
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Episode page and blog post
If you're interested in my upcoming book (available June XX, date TBD), The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation, the Kindle edition is available to be pre-ordered now through Amazon!
The date is set as June 27th, but it will likely be available sooner. Amazon (and their KDP platform) make it easier to pull a date forward… and they punish you for pushing a date back.
The book will also be available at the same time in paperback and hardcover formats. I'm going to work on an audiobook version over the summer.
Amazon also makes it more difficult for me to make a paperback or hardcover book available for pre-order. But again, I think it will be on sale early- to mid-June.
You can also enter this contest to win a free signed copy of the paperback edition.
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Blog post for this episode
Here's another reader question, this one received from The Netherlands, a country I have loved visiting over the past eight years (see my blog posts about the country and Lean healthcare efforts there).
Here is the question, in part:
Your work has been an inspiration here, so I started to research the origin and dissemination of lean in healthcare in the USA. Your first book, can be considered a standard work in this field and won a number of awards. But what I couldn't found in my search, was your motivation to write it. Can you please answer that for me: what triggers made you decide to start practicing lean in healthcare?
In a nutshell, here's the answer...
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Blog post for the episode
I'm happy to announce that I've finished the manuscript for my upcoming book (a real one, not an April Fool's Joke).
The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation
It's taken about a year from saying, “I'm going to write a book based on the My Favorite Mistake podcast” to completing the book writing.
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Blog post including a link to buy the book
Tomorrow is the 4th anniversary of the paperback release of my book Measures of Success: React Less, Lead Better, Improve More.
Long story short, I'm running a limited-time sale to celebrate.
Looking back to the release, I took an odd approach, perhaps, in that the eBook and Kindle version were available first, in August 2018, I think.
I wanted to test my hypothesis about people being willing to buy the book. Once I saw eBook sales start coming in (and getting positive feedback), I made the investment in getting the paperback book created (a professional page design and layout process). By the way, the phrase “self-publishing” is a misnomer. My company is the publisher, but I didn't do it myself!
For my next book, The Mistakes That Make Us, my company will be the publisher again, but the plan is to launch Kindle and paperback versions together at the same time. Probably this summer. But I need to finish the manuscript first! I'm almost there. That's my main focus these days, finishing that up.
Amazon has sold over 5,000 copies to date (a total of both formats). A relatively small number of books have been sold through other channels, including direct sales through me. One advantage of being the publisher is that I can see real-time data from Amazon and IngramSpark. For previous books, I have to ask my former editor to run a report.
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Blog post This article caught my eye today, and it's a change of pace to think about and write about mistakes other than my own (and I made more today — but healthcare mistakes are more important).Penn Medicine hospital cited over wrong-site surgeryIt's a mistake to perform surgery on the wrong leg. Not an “unintended mistake” (which is redundant). All mistakes are unintentional. Intentional harm could be called sabotage or assault....--- Support this podcast: https://anchor.fm/lean-blog-audio/support
Read the post for this episode
Following up on my blog post about GE CEO Larry Culp's AME keynote speech, I wanted to share some of the discussion from his "fireside chat, absent the fire" (as Larry called it) with Katie Anderson (as we discussed in our podcast episode).
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Blog post
It was a real treat to hear Larry Culp, the CEO of General Electric and CEO of GE Aerospace, speak at the AME 2022 annual conference in Dallas. He recently reached the four-year mark of his tenure as GE's first-ever outsider CEO (read the 4-year update that Larry posted on LinkedIn).
Below are some highlights and quotes from his 15-minute remarks, along with some of my commentary and thoughts.
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Blog post
A culture of learning makes the difference, not "low inventory"
Last year, I wrote a post that criticized those, including the Wall St Journal, who claimed that Toyota was "abandoning" the Toyota Production System or that strategically adding some inventory meant they were moving away from "Just in Time" approaches:
Toyota leaders, including my friend Jamie Bonini, were quoted in this new article by HBS professor Willy Shih in HBR:
What Really Makes Toyota's Production System Resilient
Did TPS hurt Toyota during the pandemic?
NO
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Blog post - https://leanblog.org/audio321
Elon Musk tweeted this yesterday: "Please note that Twitter will do lots of dumb things in coming months. We will keep what works & change what doesn't."
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Blog post: http://www.leanblog.org/audio320
Contact me to talk about psychological safety - measure, learn, improve
“Simply put, we cannot get to zero harm without psychological safety.”
I wrote that as part of this page on the Value Capture website:
Psychological Safety and its Essential Link to Continuous Improvement I've come to understand that psychological safety is a precondition for “implementing #Lean” or however you might say. Toyota seems to strive for (if not have) a relatively high level of psychological safety.
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Episode #319 -- read the blog post that contains video of the webinar
A contractor unplugged my WiFi router.
Or was there more to it than that? Instead of blaming somebody else, what mistakes did I make that led to the Q&A section of my webinar being knocked offline?
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Blog post: https://www.leanblog.org/audio318
The Wall Street Journal has an epic track record when it comes to always getting it wrong when they write about Lean or the Toyota Production System. They always focus on just the “just in time” pillar, ignoring “jidoka” (built in quality) as the other pillar (per Toyota). They ignore many other aspects of TPS, like the culture and the management style.
See some of that track record, including recent pandemic supply chain articles.
You're normally better off reading about Lean from the source.
But, they did better in this recent article about General Electric and CEO Larry Culp (who knows Lean very well from his time as CEO of Danaher):
Larry Culp Rewired GE. Then He Unwound It.
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Blog post: https://www.leanblog.org/audio317
Oh, how I enjoyed this article a month ago when it was sent to me. It's from 2003, but it was new to me:
Why dolphins are deep thinkers
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Blog post: https://www.leanblog.org/audio316
I received a question from a healthcare leader who had read about the “idea card” format and method that Joe Swartz and I shared in our Healthcare Kaizen books.
I read your post about the Idea Card. Amazing! Have a follow up question. What does Kaizen suggest about how to incentivize people to submit ideas?
She's asking about the “Kaizen” style and approach to continuous improvement.
I'll share some of my reply along with some relevant excerpts from the book.
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Blog post: https://www.leanblog.org/audio315
I'm really excited to be hosting and moderating this webinar next week, the second in our new Value Capture Webinar series.
The title is "Applications of Lean Leadership Methods in Home-Based Care."
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Blog post: https://www.leanblog.org/audio314
In this era of Covid--19 vaccination, I'm still pretty much sidelined and not on site with any clients, although I did get to visit two mass vaccination sites (in addition to the one that vaccinated me).
I have tried really hard to be a cheerleader for continuous improvement and, in particular, for sharing continuous improvement ideas through the free VacciNexus platform and through other channels.
I believe, of course, in the power of many, many small improvements being driven by front line staff and their managers. That's the focus of my Healthcare Kaizen books. I also realize there's a time and a place for process re-design and for being innovative (thinking of it as step-change improvement.
In this post, I share and discuss improvements large and small.
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https://www.leanblog.org/audio313
tl;dr summary: Lean isn't just efficiency... it's safety, quality, delivery, cost, and morale. People often misunderstand that -- they don't know or they were taught the wrong things
I often have the opportunity to teach a group of experienced healthcare professionals, from a wide range of disciplines, about Lean. My session is part of a longer professional development program that's framed as "clinical outcomes and patient safety."
Lean has a lot to contribute to those outcomes, and you can see a collection of results here or here.
Since my last session had to be virtual, due to the pandemic, I took advantage of the opportunity to use some interactive tools from Mentimeter.com. This is something I'll continue doing even when I have the chance to teach in person, as people can vote or give input from their phones, anonymously, while sitting in class.
One question I asked the group was:
What does "Lean" mean to you in terms of improvement?
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https://www.leanblog.org/audio312
In this post, I'm going to share some reflections from one of my workplaces, some things that occurred last week. I'm going to be vague, so forgive me for that. It feels right to be less specific in this case, or at least that's the cautious (and maybe respectful) thing to do.
When wearing one of my different "hats" with one of the organizations I work with, something went wrong. It wasn't something I did (or I would own up to that in specific ways). But the mistake affected me and the work I was doing.
When a preventable process problem occurs, the engineer in me finds it relatively easy to be logical and think through "what happened?" instead of "who messed up?" A few deep calming breaths help, as well.
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http://www.leanblog.org/audio311
I'm not a Buffalo Bills fan (a.k.a. "The Bills Mafia"), but I did attend one game at what was then called Rich Stadium in 1998 when I was a grad school intern at Kodak.
Even without being a fan, I wish I could have written a headline for this post that said "Buffalo Bills Kaizen Their Way to a Super Bowl." Readers of this blog, of course, know that "Kaizen" is a Japanese word meaning "good change" and it's framed as an approach to engaging everybody in small improvements to the way they do their work.
So what does this have to do with football? Football is a workplace, even if it's college. I blogged about my alma mater, Northwestern University, using the word "Kaizen" (and the mindset) within their football program.
This article about the Bills isn't new, but I recently discovered it on Twitter:
Sean McDermott, Bills use 'Kaizen' strategy to stress constant improvement From the article...
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https://www.leanblog.org/audio310
During this "let's try to get people vaccinated" phase of the Covid-19 pandemic, almost every article that I've seen about the vaccine and its distribution mentions the need to not waste precious doses.
There are many opportunities for error with the different vaccines. If some of them aren't stored properly at the correct temperature, the vaccine degrades and gets wasted (or worse, gets injected and gives a false promise of effectiveness).
Good process design (lessons I learned as an engineer) means being proactive and thinking about what could go wrong -- and then designing the process in a way that prevents errors or mistakes. The ideal would be "error proofing" that makes it impossible to make a mistake.
Or, we could make it more apparent that a mistake has been made (for example, a temperature-sensitive label on a vaccine bottle that would let you know if it's been out of the correct storage temperature too long). A countermeasure like this might prevent the mistake of using expired vaccine.
But how can we prevent the storage problem (and the waste of the vaccine) to begin with?
I wasn't planning on blogging over the holidays, but this article caught my attention:
Wisconsin hospital tosses 500 doses of COVID-19 vaccine due to 'human error' (See the full post at the link https://www.leanblog.org/audio310)
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https://www.leanblog.org/audio309
Subscribe now to "My Favorite Mistake"
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http://www.leanblog.org/audio308
You might have heard of a "social media takeover" where a brand with a large following gives control of their social media feed to somebody who is promoting a cause or a social message.
One person I've followed on LinkedIn is Deondra Wardelle. She is a Lean practitioner (like me) and she's a Black woman (unlike me).
So, thinking back to the idea of a "social media takeover." I was inspired by Deondra, so I asked her to accept a "blog handover" as I'm calling it. My initial thought was to give a platform for her to write and talk about anything she wanted, to give more exposure to her voice.
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http://www.leanblog.org/audio307
Today, I wanted to share an excellent article written by Dr. John Toussaint (of Catalysis) and Ken Segel (of Value Capture)...
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http://www.leanblog.org/audio306
I'm excited to announce that our book Practicing Lean is now available as an audiobook through Audible.
As we did with the paperback and Kindle versions of the book, 100% of royalties will be donated to the Louise Batz Patient Safety Foundation (it's been almost $5000 so far).
You can buy or subscribe through Audible.
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http://www.leanblog.org/audio305
It's possible that I could start traveling again for my healthcare consulting work next month... or maybe in July. My colleagues at Value Capture aren't sure yet how this will work out, but clients are sharing their current plans for starting to re-open -- to a new normal, not the old normal.
As I mentioned (if not buried) in a post last week, my wife and I relocated from Orlando to Los Angeles last week because she is starting a new job (we will still have our permanent home in Texas).
Anyway, as the consultants start to think about traveling again, I have compiled some thoughts from my own research and experience since I'm the only one who has flown or stayed in hotels over the past two months, due to the relocation.
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http://www.leanblog.org/audio304
It was a sad weekend, hearing about the passing of Paul H O'Neill, Sr. on Saturday. He was 84.
I had the good fortune to meet and spend time with Mr. O'Neill on a few occasions and I'll share some reflections in this post. My condolences go out to his family and friends, and especially to my Value Capture colleagues who worked with him at Alcoa or at the firm over the past 15 years.
Here are his obituaries from the WSJ, the New York Times, and the Pittsburgh Post-Gazette. You can also read more about his life on a memorial page that his family set up and people are sharing memories there.
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http://leanblog.org/audio303
This is from the 3rd edition of my book Lean Hospitals. I've copied and pasted from the book with no additional edits, although I'll bold italic some parts for emphasis. I'll some closing thoughts at the end.
For a more complete PDF excerpt, click here (requires Dropbox access).
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http://www.leanblog.org/audio302
Thanks to Elisabeth and the team at GoLeanSixSigma.com for inviting me to contribute some thoughts in this piece:
How Lean Six Sigma Can Help Fight the Coronavirus Pandemic
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http://leanblog.org/audio301
It's great to see examples of manufacturing companies being flexible and adaptive in these challenging times. Lean methods are often providing a huge boost in what can be life-saving efforts.
Lean often gets mislabeled as a “low inventory” system (or “zero inventories”) but that misses the point. We don't just lower inventory at all costs (anybody can make that mistake without Lean) — we have to create systems and supply chains that might possibly allow for low inventory.
.....
But back to the one manufacturing company that inspired this post. It was great to see this article (hat tip to Brad Miller):
How to pivot an entire company in a week–and remain profitable See more in the blog post (link at top)
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http://www.leanblog.org/audio300
I had a phone conversation yesterday with an emergency medicine physician after her shift at an unnamed hospital in an undisclosed state.
She had a number of frustrations to share and she doesn't really have an outlet (and doesn't want her name out there for fear of retaliation). More importantly, this isn't about one institution. She works in a well respected system. So this lack of preparedness and leadership could be widespread. When I posted my concerns about hospital preparedness for Covid-19, I guess they weren't unfounded.
I'm sharing these concerns in a public way because I think it's important to try to inspire other healthcare professionals and improvement specialists who CAN be on site to drive improvements.
I also hope it serves as a reminder to the public to NOT GO to the hospital unless it's a life-or-death emergency right now. "When should I go to the hospital?" and more questions were be covered in a webinar that was done on Wednesday. Listen, watch, or read a synopsis here.
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http://www.leanblog.org/audio299
I normally love the public radio program "Marketplace" and have listened to it (on radio or as a podcast) for 15 years or so.
But, I was very disappointed with this recent piece, which you can read here:
"Just-in-time" manufacturing model challenged by COVID-19 Yes, many factories have been shut down in China, which disrupts global supply chains. However, if you're a company that decided to move all of your production to China (to then ship out to customers around the world), that wasn't a "Lean" strategy.
It's really difficult to support "just in time" delivery over such long distances. If it were a "Lean" approach to move all of your production to China, then Toyota would have done that. But, Toyota didn't.
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http://www.leanblog.org/audio298
I've been thinking a lot about hospitals and how they're preparing for the expected tsunami of Covid-19 patients who will need ICU beds and ventilators (when it's expected that there won't be enough of either).
There have also been recent preparations (and ongoing actions) to screen patients who arrive at emergency rooms and outpatient clinics.
I was at one organization last week that was in the process of installing new protocols and procedures in an outpatient clinic setting and I was able to have a tiny amount of input into that. Now, I'm home and trying to help remotely with the situation.
I hope this blog post helps more broadly.
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http://www.leanblog.org/audio297
Looking back at a blog post and an article from 2012 and 2014...
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http://www.leanblog.org/shingo2020
Thanks to the Shingo Institute for inviting me to facilitate a half-day workshop at the Shingo Conference, being held this year in Orlando, April 16 and 17. The workshop covers concepts and methods from my book Measures of Success: React Less, Lead Better, Improve More.
I hope you can join us for the conference, as this is an event I have enjoyed in the past — and if you're going to be there, please say hi and, better yet, come to my session.
My workshop will be a concurrent session on Friday at 8:30 AM. Here is a video they asked me to make where I share a little bit about the workshop:
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http://www.leanblog.org/audio295
Here's an article from Bloomberg BusinessWeek:
GE's Larry Culp Faces Ultimate CEO Test in Trying to Save a Once-Great Company
Very early on, the article mentions Culp's advocacy for "Toyota-style lean manufacturing." Or is he pushing "Danaher-style lean manufacturing" and is that different? And does that matter?
Culp was "in his element" visiting a GE factory in Pensacola -- can that be said about most CEOs?
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http://www.leanblog.org/audio294
Today, I'm sharing a question from a reader who started their career at Toyota and now works at another company. See previous posts with reader questions.
The reader has given me permission to share this -- to get your input -- and there are no identifying details included:
I came across something interesting at work around goals that I wanted to share with you and perhaps get your thoughts.
At the beginning of the fiscal year, our manufacturing sites submitted their cost savings targets to me. I looked them over to make sure they both seem reasonable yet challenging and asked questions as needed. From there, I submitted them to the operations VP for final approval. The VP accepted them without question.
We're at the end of the first quarter, and 3 of the 9 sites are not meeting their run rate target...
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From 2014 -- http://www.leanblog.org/audio293
We had an excellent English-speaking tour guide for our visit (she lived in Hawaii at one point). As we talked through the facility (up in a "catwalk" that gave good visibility down into the process), she would occasionally stop at pre-determined points to explain something about the process or about the Toyota Production System and its elements.
At each stop, there was a box with a microphone and other audio/visual equipment and speakers. She didn't have to carry a microphone with her.
The guide was carrying a bag, something between a briefcase and a large purse.
One of our sharp-eyed tour attendees, a Chief Medical Officer from a Canadian hospital, noticed a hook that she would hang her bag on while stopped and talking. He asked her about the hook.
Sure enough, it was a Kaizen improvement! And, it was her idea.
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From 2012: http://www.leanblog.org/audio292
Dr. Iida talked about the connections between "Kaizen" (small improvements) and innovation (larger improvements) and how, together, they lead to breakthroughs. He also talked about how one is absolutely necessary for the other to occur.
Dr. Iida has been the CEO for just over 20 years and his hospital receives visitors from around the world, including Europe and Africa. They were on the verge of bankruptcy when he took the job in 1991 and they are now "in the black" and had the money to build a new hospital, while most Japanese hospitals are losing money today, he said.
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http://www.leanblog.org/audio291
Last week was our fifth annual KaiNexus User Conference (or "KaiNexicon" as we now call it).
One of our keynote speakers was Jess Orr, a former Toyota engineer who shared perspectives on what it was like to now lead continuous improvement in another company. Jess has previously presented three webinars for us at KaiNexus (see links at the end of the post) and she always has something insightful to say.
I took a lot of notes during her talk, so here are some of the highlights as I captured them.
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http://www.leanblog.org/audio290
So, upon some reflection, it seems like "Just Do It" isn't really the right phrase to use. A classic suggestion box system has cards that start with listing a suggestion. That's, in a way, jumping to solutions. Kaizen isn't a suggestion box model.
Maybe "Just PDSA It" is a more accurate phrase to use?
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http://www.leanblog.org/audio289
In the huddles, the manager and team talk about problems, issues, or opportunities for improvement.
In some huddles, the team might say, "We can't think of anything that came up yesterday."
But, then, as the huddle progressed, the team was asked if anybody should get recognition or kudos for something they did.
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http://www.leanblog.org/audio288
http://www.kainexus.com/webinars
Today, I'll be hosting and moderating the latest in our KaiNexus Continuous Improvement Webinar series.
I'm really excited that the presenter will be Mark Valenti -- he's been a bit of a mentor and coach for me on the topic of "Motivational Interviewing," something I've really found helpful these past few years.
Click here to register for the webinar, which is intended to provide tips for leaders and managers (and a transcript can be found at the end of this post):
From Ambivalence to Action: Leadership Lessons from Motivational Interviewing The webinar is today at 1 pm ET. If you can't attend live, please register anyway and you'll be sent a link to the recording.
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http://www.leanblog.org/audio287
General Jim Mattis has been making the rounds to talk about his new book that is out today: Call Sign Chaos: Learning to Lead.
"Learning to Lead" sounds like it could be the title of a book about Lean management. We're learning how to lead people, to lead improvement, to lead organizations. You might say we're "practicing leadership," myself included.
A few things jumped out from an article and an NPR interview with Mattis that made me think about Lean and the challenges we face in various workplaces.
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http://www.leanblog.org/audio286
This past weekend, an old friend came down from Michigan to spend two days in the Dallas area.
Amongst the activities and catching up, we went bowling -- something I did a lot of as a kid and something my friend and I usually do when we get together.
I ordered a drink -- not a Lean whiskey, perhaps surprisingly -- but this:
"An UN-sweetened iced tea, please"
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http://www.leanblog.org/audio285
This is a radio segment from the KOGO morning news on August 23rd, 2019.
LaDona Harvey: When it comes to your career path, your family’s financial future, or even a weight loss journey, focusing on little setbacks can throw a real wrench in your progress.
Ted Garcia: Joining us on the KOGO news live, the author of, “Measures of Success. React Less, Lead Better, Improve More,” Mark Graban. Good morning, Mark.
Mark Graban: Good morning.
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http://www.leanblog.org/audio284
Here is an article that caught my eye recently, from HBR:
"How One Health System Overcame Resistance to a Surgical Checklist"
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http://www.leanblog.org/audio283
Anyway, this article caught my eye the other day:
Top Chefs and Restaurateurs on the Best Lessons They Learned from Failures Check out the article for the detail, but here are the five lessons and I think they apply to Lean and other things we practice, with my commentary…
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http://www.leanblog.org/audio282
Hat tip to Stan Feingold from StoreSMART (a Lean Blog sponsor) for sending me this article:
Bob Lutz Talks Panel Gaps, Tesla, and Why Every Detail Matters -- Getting it right starts at the top.
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http://www.leanblog.org/audio281
When we have really sticky, complicated problems (like the widespread healthcare patient safety and quality problems), I think it's interesting to think about problems in the following terms... for a particular problem, which is true?
- It can't be solved (in general)
- That organization can't solve it (don't know how?)
- They won't solve it
- They don't need to solve it
When we look at patient safety, there are many examples that show improvement is possible. So, it comes down to a question of "can't, won't, or don't need to?"
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http://leanblog.org/audio280
I guess I'm wired for improvement. Or, it's just become a habit. Or, it's both.
I celebrate moments when I can identify an opportunity for improvement in my work. I tend to be pretty transparent about problems and even mistakes (like forgetting my socks).
The Toyota-ism of "No problems is a problem" resonates with me. Identifying a problem shouldn't bring blame and shame... it's the first step in improving the way work is done.
I'm fortunate that we've built a culture at KaiNexus where problems and opportunities are celebrated. It's safe for people to speak up and problems lead to improvement, not punishment.
Our book Healthcare Kaizen shares stories and examples from organizations that have built a strong and sustained culture of continuous improvement. I almost take it for granted that improvement is a positive thing.
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http://www.leanblog,org/audio279
Registration is open for "Kaizen Live!" -- the 2019 edition.
Joe Swartz and I are excited to announce that we are hosting the fourth site visit to his organization, Franciscan St. Francis Health, in Indianapolis. It's being held October 3 and 4, with an optional workshop on October 2nd.
Click here to learn more. You'll find links to the registration page and be sure to check out the early registration and group rate discounts that are available.
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This is an interesting article:
Inside Toyota's Takaoka #2 Line: The Most Flexible Line In The World I had a chance to visit the 'Takaoka #1" line in February 2018 as part of my tour with Kaizen Institute. This article makes me wish we had been able to see Takaoka #2, but that sounds like a somewhat rare and special opportunity (even more special than visiting Toyota is normally).
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From 2013 -- http://www.leanblog.org/audio277
A principle that has been often discussed (and hopefully practiced) in the Lean community over the past few years is usually described as “respect for people.”
A certain British rabble rouser recently said the following at a Lean conference: “All this respect for people stuff is horse sh*t,” and it is a “conventional Western management interpretation.” He mocked the idea of “respect for people programs,” although I'm not sure where such a standalone program has ever been attempted. That sounds like a strawman, the idea that a company would have a “respect for people” program.
Let me explain why he's wrong — “respect for people” is not horse sh*t” — and we can explore some great links on “respect for people” in this post.
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https://leanblog.org/audio276
"Over the past year, I've heard about the “OKRs” methodology that is used in tech companies like Google. OKRs stands for Objectives & Key Results. The approach (along with examples and case studies) are laid out in the book by venture capitalist John Doerr, Measure What Matters: How Google, Bono, and the Gates Foundation Rock the World with OKRs." There are things I like about this model... and it reminds me of the Lean "Strategy deployment" practice... but I think it would be better with "Process Behavior Charts." #okrs #OKR #leanstartup #leanmanagement #business
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I always enjoy the KaiNexus User Conference (now called KaiNexicon starting this year) and they ask me to give a talk each year.
Last year, I gave a talk called “When Being Right is the Wrong Strategy for Change” and KaiNexus recently shared a nicely-shot video of that talk on YouTube. So. I'm sharing that here... and the blog post has a transcript I had done, annotated with some slides and links. You can also read a shorter summary via the KaiNexus blog.
http://www.leanblog.org/audio275
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http://www.leanblog.org/audio274
I find it really interesting when scientific facts and truth get superseded by new evidence. Science isn't supposed to be stubborn… it's OK to cast aside the old status quo when we learn something new (pay attention, “flat Earth” crowd).
There are a lot of these themes, also, in a book I've been reading, The Case Against Sugar, by Gary Taubes. Some of the established science about low-fat diets being good for us might not really be true.
How does this all apply in medicine and our practice of Lean?
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I haven't read it, but Marie Kondo's book The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing has been a pop-culture phenomenon the past few years.
I've seen some compare her process to the Lean practice of “5S.”
Kondo says you should only keep an item if it “sparks joy.”
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Here's an interesting column from Becker's Hospital Review, written by Michael Dowling, President and CEO, Northwell Health.
I'm guessing he created the headline, since the phrase “give a damn” doesn't appear in the article:
"Michael Dowling: CEOs — Give a damn about your people" Who are the CEOs he is speaking to who do NOT give a damn? What inspired him to write this?
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Yesterday's blog post was about a situation (with my podcast hosting service) that triggered memories of my time at General Motors in 1995. Today's post is about a recent article on Boeing that definitely caused me to think of that broken, dysfunctional “pre-Lean” culture that I suffered through (and learned from) in my first year at GM.
In 1995, nobody claimed GM was Lean so the expectations were low. They were who they were and my new plant manager in 1996 started to change things. Boeing is a company that has been pointed at as a great example of Lean Manufacturing, so it's troubling to read reports that suggest otherwise.
From the New York Times:
Claims of Shoddy Production Draw Scrutiny to a Second Boeing Jet Workers at a 787 Dreamliner plant in South Carolina have complained of defective manufacturing, debris left on planes and pressure to not report violations.
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Episode #270
Ever since I started podcasting in 2006, I've been using a company called “Hipcast” to be the “hosting” company for the podcast audio files and feeds. For those of you not familiar with podcasting, that's the website where I upload podcast audio files… and they then serve those files when requested by services like Apple Podcasts or Spotify.
This has been an aggravating week or so, since Hipcast has been having a lot of technical issues going back to last Tuesday or so. Their website has been down, the podcast feeds (RSS feeds) have been broken. People haven't been able to listen to my podcasts unless they had already downloaded the episodes through their app.
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Is "Kaizen" a Slogan or a Methodology for the Seattle Mariners?
Here is an interesting article that a few people pointed me toward the other day about the Seattle Mariners team:
Mariners Sunday mailbag: Explaining the Japanese origin of the team's new slogan
“Manager Scott Servais does have a mantra each year for the team, which is supposed to serve as a reminder of their purpose and responsibility…
This year, Servais chose a Japanese word: Kaizen.
An avid reader, Servais got it from a book by Masaaki Imai called Kaizen: The key to Japan's competitive success.”
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Today, I'm writing about another view, from an article co-authored by our friend Dr. John Toussaint and the CEO of ZSFGH, Dr. Susan Ehrlich:
Changing Leadership Behavior Gets Real Results As I blogged about yesterday, new leadership behaviors (sometimes as the result of getting a new leader) can make a huge difference for an organization — this was true during my time at General Motors and I've seen it in healthcare.
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Today, I'm reading the latest issue of Health Leaders magazine (March/April 2019) whose cover features a number of stories about nursing retention.
The lead article shares some data about recruitment and retention. The article says that 17% of “newly licensed RNs” leave their first nursing job “within the first year.” 33% leave within two years.
Instead of blaming nurses for leaving, better organizations are looking in the mirror to see what they can do to improve the work environment. That's always been one of my primary motivations for Lean in any workplace — providing a better, more fulfilling work setting.
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Here's an interesting recent article from the Wall Street Journal (you might require a subscription to read it):
The Economy's Last Best Hope: Superstar Middle Managers Anemic growth, millennial malaise, you name it–blame a lack of inspiring bosses I'll comment first that organizations that have high aspirations of “Lean Transformation” need to have “transformational leaders.” Sadly, those transformational leaders seem to be few and far between. How many organizations have “bureaucrats” at the helm?
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Lean Should be the Solution to Hospital Overwork or Understaffing
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When I had the chance to go back to Japan last October with Honsha, there was a big focus on what the former Toyota people kept referring to as "a development company." The meaning was that Toyota (and companies with similar performance) focus first and foremost on developing people.
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Value is Defined by the Customer (and not all Customers are the Same)
http://www.leanblog.org/audio263
It's said in the Lean methodology that “value is defined by the customer.”
Value can be defined as, in most cases, “Something the customer is willing to pay for.” In healthcare, this gets complicated when patients aren't the ones paying and when patients need care instead of wanting it.
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For Big Leaps With New Year’s Resolutions, Start With Baby Steps
Thanks to the Lean Enterprise Institute for publishing my article about Kaizen, new habits, and New Year's resolutions:
Take Baby Steps Towards Improvement
Get the link: http://www.leanblog.org/audio262
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Back in 2013, I wrote a post that I published as part of the LinkedIn Influencer series:
The Carrot and The Stick “On Steroids” Please check it out. I hope it makes you chuckle and think.
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It's been a while since I've contributed something to the Lean Enterprise Institute's online publication, The Lean Post (see past articles).
Today, they're allowing me to introduce some ideas from my book Measures of Success. Many "Lean thinkers" just haven't been exposed to these ideas. Many haven't read Deming or Wheeler... it's not their fault for not knowing of Process Behavior Charts and methods like this.
But, I hope this post helps people see that "bowling charts" and "red/green" analysis are not the only way (or the best way) to look at metrics.
My article:
"React Less and Improve More by Using SPC More Effectively"
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A retired labor leader from the automotive industry (who reads this blog) sent me a link to this article:
RedforMed: 1,800 Vermont Nurses Are On Strike Demanding Their Hospital Put Patients Over Profits
The article isn't from a newspaper; it's from a site that provides "independent and incisive coverage of the labor movement and the struggles of workers to obtain safe, healthy and just workplaces."
Again, for the record, I'm all in favor of "safety, healthy, and just workplaces." That's what Lean management aims to deliver.
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http://leanblog.org/audio258
“ER wait times down, but only slightly” or ER wait times are virtually the same?
This article was sent by a friend and blog reader from Winnipeg the other day:
“ER wait times down, but only slightly”
Oh good, the waiting times are down. But what does “only slightly” mean? Have ER wait times gone down in a meaningful way? Or are they just comparing two data points? Is this “down” a signal or is it just noise in the system? These are the types of questions that can be answered by methods in my new book Measures of Success: React Less, Lead Better, Improve More
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The Catch-22 of #Lean & Kaizen: You Get More ROI by NOT Focusing Only on High-ROI Projects
http://www.leanblog.org/audio257
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Leaders & Lean: We Need to Better Support Doctors and Other Providers
When surgeons have no better options than complaining about process problems on LinkedIn, are their leaders and organizations really properly supporting them? In this post, we'll explore questions of blame, accountability, and engaging people in process improvement... being of better service to them.
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My Talk in Vegas: Leadership Lessons from Statistics and Psychology
Today, I’m giving a keynote talk at the Lean & Six Sigma World Conference being held in Las Vegas. I don’t normally attend or speak at “Lean Sigma” events, but I had an opportunity to give a new talk that touches on two of my favorite themes in recent years – the need to apply statistics and psychology to our “Lean Management” practices or Six Sigma or whatever.
I also bury the lede and talk about the soft launch of my book "Measures of Success."
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What's Going on at Tesla? Is @ElonMusk Following up on Employee Injuries?
There's a lot to admire about Elon Musk. I admire his risk taking and his entrepreneurial spirit. I use PayPal a lot (one of his early companies) and I admire the innovation of Tesla and SpaceX. But, I question how much Musk and Tesla have been willing to learn from Toyota.
I saw this article last year and never got around to blogging about it:
"This Email From Elon Musk to Tesla Employees Is a Master Class in Emotional Intelligence"
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The chain Whole Foods is reportedly having inventory shortages and morale problems. It sounds like a real mess, but thankfully nobody is calling it Lean. Their "Order to Shelf" system reminds me of "Pull to Order" work that I was involved in at Dell about 20 years ago...
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Tour Preview: The Japanese Health Care System at a High Level
As I prepare to go back to Japan, I'm sharing some insights about the Japanese health system from the excellent book "The Healing of America," by T.R. Reid.
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The WSJ Overgeneralizes about The "Japanese Model," Not All Companies Are Toyota
Not all Japanese companies are the same. "Lean isn't easy" if you're a Japanese company. Toyota has created something special, since "Toyota culture" is not exactly the same as "Japanese culture."
The WSJ says the "model is cracking."
Do scandals involving quality and ethical lapses involving companies including those and Nissan tarnish Lean and the Toyota Production System? No. That's as silly as thinking the Wells Fargo banking scandal tarnishes Silicon Valley (although the Valley does enough to tarnish itself).
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Lean Can Be Very Fragile, Especially With Executive Changes
Lean can be very fragile. History shows that Lean can fall apart even in an organization that is years into a "Lean journey" with strong CEO involvement.
How is this possible? If often happens when a new CEO is brought in from the outside. In the case of the manufacturing company, Wiremold, it happened when they were acquired by a French company, Legrand.
As an aside, the team that coined the term "Lean" almost used the term "fragile," as I blogged about here.
Back in 2007, Bob Emiliani joined me for Episode #30 of the podcast. As we revisit the podcast and the new transcript I had made, what are the lessons for manufacturers or hospitals?
What's the risk that's created when new leadership takes over?
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Employee Complaints About Lean in Healthcare, Even at Some of the Best Organizations
Last week, I blogged about some employee complaints related to rotating day and night shifts at the Toyota San Antonio plant. In that post, I mentioned that employees who post on Glassdoor.com and other sites might not be a representative sample of the full employee population.
With that in mind, what happens when we search the Glassdoor surveys of some well-known "Lean hospitals?"
I posted a few of these employee comments on LinkedIn the other day (a short post that has received over 50,000 views and prompted a lot of discussion).
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Somebody Did Get Unjustly Fired in Hawaii, But System Problems Should be Blamed
TL;DR Summary: "Employee 1" (the guy who pushed the "wrong" button) got fired. But the FCC report says: "The report finds that the false alert was not the result of a worker choosing the wrong alert by accident from a drop-down menu, but rather because the worker misunderstood a drill as a true emergency. The drill incorrectly included the language "This is not a drill." So, the language from the drill didn't meet the standard for what the drill language is supposed to say. So, how is it fair to fire the worker who heard "this is not a drill?"
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I often get asked a question along the lines of "So, what exactly do you do?" Today, I give some updates about my various projects and partnerships, including continuing with KaiNexus (with a different title) and a new partnership with Value Capture.
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I've written about many of these ideas and themes before in various blog posts, but I wanted to consolidate my thoughts on the Lean concept of "standardized work" in a single place. This is partly for my own personal reference (and future linking), but also can prompt some discussion amongst my friends, the Lean Blog readers.
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What We're Looking Forward to Learning at the Toyota Plant Tour
Tomorrow, with the entire KaiNexus team, I'm going to visit the Toyota truck plant in San Antonio, the plant referred TMMTX. The 15 of us will be there in closed toed shoes and all other required clothing to learn about the Toyota Production System, Kaizen (continuous improvement), and Lean.
I've blogged about it on the KaiNexus blog. I asked the KaiNexus team to say a little bit about what they hope to learn in the visit and you can read their comments it here.
In this post, I share a 24-minute tour preview webinar that I put together, links to past tour blog posts, and more.
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What the Book "Lean Thinking" Said About Healthcare in 1996
http://www.leanblog.org/audio244
When the book Lean Thinking (by Jim Womack and Dan Jones) was originally published in 1996, it seems likely that hardly anyone was applying Lean principles in healthcare. Sure, you had organizations applying TQM or CQI principles (or even some of the lessons of Dr. W. Edwards Deming). Joan Wellman did some of her first Lean healthcare experiments in 1995, but there weren't any "Lean healthcare" case studies yet. What does their book say?
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The Response to the Hawaii False Alarm Can't End With Firing Someone -- This and other nuclear threats due to bad systems
http://www.leanblog.org/audio243 Saturday, you might have seen the news about a "false alarm" push alert that was sent to many iPhones and other smart phones in Hawaii. An alert was also sent out over many TV channels through the Emergency Response System.
Is the response one that focuses on blame and punishment? Or is it focused on understanding how systems fail and how to improve them to prevent future recurrence?
How does this all apply to your organization?
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Did Toyota's Mindset Really Leave the (Now) Tesla Building?
Tesla builds cars in what used to be the NUMMI factory, a joint venture between Toyota and GM (which meant it was run as a Toyota plant with "Lean" practices). Before that, it was a dysfunctional GM plant. Now that it's a Tesla plant, did they learn from Toyota or does it seem more like "the old GM?"
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A Powerful Message from Toyota's President, Akio Toyoda: No Best, Only Better
In today's post, I share and write about this message from Akio Toyoda that was posted online:
“Making Ever-better Cars and Human Resource Development: The Forces That Power Sustainable Growth“
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Should #Lean Conferences Add a "Code of Conduct" for Speakers and Attendees?
In today's post, I pose a question: Should the major Lean conferences adopt or adapt a practice that's now common at tech events, including Agile and Lean Startup events: a "Code of Conduct" for participants and attendees. Is this a countermeasure to a problem that doesn't exist in the Lean community? Or, is it still good to proactively encourage people to speak up to conference organizers if they are subject to bad behavior during the event? In this post, I get feedback and thoughts from the Lean Enterprise Institute, AME, Catalysis, Lean Frontiers, and the Shingo Institute.
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ChangeChampions at Franciscan St. Francis Health - in Supply Chain and Beyond
Today, I'd like to share the second in my series of articles about "Champions of Change." Here, we feature my friends at Franciscan St. Francis, the health system of my Healthcare Kaizen co-author Joe Swartz.
As I wrote about in the first article in this series, successful and innovative organizations have "champions of change" at all levels of the organization, and we see that at Franciscan.
You can read the article over at Becker's Hospital Review:
Champions of Change Make the Difference at Franciscan Health Or you can download a PDF from Cardinal Health.
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I've been going through the book by the late Peter Scholtes: The Leader's Handbook: Making Things Happen, Getting Things Done. His work builds upon the legendary W. Edwards Deming and Russell Ackoff, among others.
I often quote Scholtes (something also attributed to Peter Senge and others) as saying:
"People don't resist change, they resist being changed." I think that's very insightful and that thought has led me to study change management, "motivational interviewing" and other related topics. It turns out that having the right answer and pushing it on others isn't the best strategy for effecting sustainable change. I had to learn those lessons the hard way and I'm still learning.
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Who are the "champions of change" in your organization? Is your CEO a champion of change? How many of your front-line managers and staff are champions of change? Are you? What does it mean to be a champion of change? Today, I'm sharing an article that I've written on this subject... and I'd love to hear your stories about champions of change. Please share your stories on Twitter or LinkedIn with the hashtag #ChangeChampions. Or, you can post a comment below. Click the following link to download a PDF version of the article: "The Essential Ingredient to Improving the Hospital Supply Chain" You can also read the article on Becker's Hospital Review.
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Of Course Doctors Hate Being "Excluded" From Attempts to Improve
Thanks to those of you who sent me this HBR article:
Doctors Feel Excluded from Health Care Value Efforts
Long story short... brought to you by Bain consultants: Doctors don't like being excluded and organizational satisfaction goes up when you engage and include people. Brilliant!
Obvious?
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Come Join Me to Study Lean & Kaizen for Healthcare: Japan 2018
In the past year or two, it seems like I have heard more about people and organizations leading Lean study trips to Japan. This has gone on for decades, but there seems to be a resurgence.
I first partnered with Kaizen Institute in 2012 to lead a "Lean Healthcare" study tour, we did another in 2014, and we're actively planning our next trip in early 2018.
Click here to learn more via a web page that I run. You can also click here for a PDF that previews the 2018 tour. Registration has not yet opened, but contact me if you'd like to be notified with details.
The dates are February 26 to March 2, 2018. Details are still being finalized, but the tour would start in Tokyo and end in Nagoya. The plan is to not just visit some hospitals that are leaders in Lean and quality improvement practices, but to also visit Toyota and some other world-class organizations.
The trip costs 5400 euros, which is currently about $6300. This cost includes everything from the start of the tour on Monday morning to the end on Friday evening. Your airfare to Japan and back is a separate, independent cost to you.
In the past two trips, we've had a very international group (a majority of attendees have been from Europe and Asia). This creates a special opportunity to not just learn from our Japanese hosts, but to compare notes and learn from others around the world.
Our trips are intentionally a mix of hospital visits and other types of organizations that we can all learn from. It's great to see a Japanese hospital with a CEO who has been leading their quality and continuous improvement efforts for 20+ years and to hear their perspectives. At the same time, the hospitals we have visited were, at the time of our visits, relatively new to formal "Lean" practices - as they were building upon their "Total Quality Management" engagement and improvement practices... something that was NOT a fad for these hospitals or their leaders.
These trips are rich learning experiences. It's not just the formal visits, but the time talking on buses and trains, the meals together, and the networking and sharing that, for me, has continued with attendees long after the week is over.
Here are my past blog posts about visiting Japan, with a few links below.
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it's great to see an 11 year old thinking like an engineer and an entrepreneur. He's the son of a Toyota "operational excellence" consultant. For those who try to unfortunately equate Lean to a "clean desk policy," the father's desk is a great argument against banning family photos and an illustration of why Lean isn't about putting tape around everything...
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The Lean Enterprise Institute (a former employer of mine from 2009 to 2011) has announced a new CEO, the third in their history following founder James P. Womack and his successor, John Shook.
Their press release:
Lean Enterprise Institute Names Eric Buehrens New CEO
The start of the release:
"The nonprofit Lean Enterprise Institute, a global leader in lean thinking and practice, today announced the appointment of Eric Buehrens as its new CEO. The appointment took effect October 1, 2017.
A proven lean thinker and leader, Buehrens led lean transformations at Beth Israel Deaconess Medical Center, where he served as COO and Interim CEO, and at Reliant Medical Group, a Massachusetts group medical practice, where he was COO."
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Three or four months ago, in the midst of a discussion on LinkedIn about patient safety, somebody made reference to a 1966 cover story from the magazine "Look." Look was a very popular competitor to "Life" and the "Saturday Evening Post," so this was written for a very general public audience.
The cover tease reads:
"OUR HOSPITALS ARE KILLING US An alarming report on conditions in many American cities"
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Free Webinar Today on #Lean Collaboration Across Companies and Industries
I hope you'll join me today for a KaiNexus webinar that I'm hosting. The topic is near and dear to my heart (as well as to others at KaiNexus): collaboration, learning, sharing.
Effective Collaboration Across Organizations and Industries Our presenters will be Teresa Hay McMahon, the Executive Director of the Iowa Lean Consortium and one of the ILC members, Stephanie Hill, Corporate Continuous Improvement Manager at Kreg Tool Company. Kreg is, coincidentally, a KaiNexus customer.
It's at 1 PM ET, but if you can't attend it live or didn't see this post in time, you will be sent a link to a recording if you register.
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Texas Hospital Saves Money Occasionally With Lean Six Sigma... But Can Do More, More Often?
I saw this headline the other day about University Medical Center in Lubbock, Texas:
"UMC finds savings through waste"
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This Organization Chose Not to "Deploy #Lean" Because a Leader Thought it is Not Customer Focused?
I posted an article on LinkedIn last week as a companion article and summary of my podcast with Dean Gruner, MD, the recently retired CEO of ThedaCare.
That article:
"A Retired Hospital CEO Shares the Employee Feedback That was 'A Bucket of Cold Water to the Face.'"
There have been over 125 comments so far... but one has me scratching my head.
It read:
"I looked at deploying Lean within our PNO, and ultimately decided against it, in part for two reasons:
because Lean is about doing the same thing, albeit better and it is not as much customer/outwardly focused as we need in healthcare." Lean is not customer/outwardly focused? I hope this isn't a widespread perception or belief out there. I hope I'm overreacting to something that's not really a problem... but I wrote the post anyway.
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I've long been appreciative of the work that Toyota does, through their non-profit TSSC subsidiary, to help non-profits and community organizations improve.
The latest example of that is some work done at Children's Health in my other backyard, in Dallas:
"Children's Health Joins Forces with Toyota to Improve Patient Safety and Quality of Care"
As it says in the release:
"Through a collaboration with Toyota, Children's HealthSM, the leading pediatric health system in North Texas, announced today it has successfully reduced rates of central line-associated blood stream infections (CLABSIs) by 75 percent with patients in the gastroenterology unit."
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One challenge with teaching Lean is that there isn't aways a consistent definition that's used by everybody. Some of the definitions are really bad. Some of them are just different from others. Let's start with "different." Is a lack of standardization in definitions of Lean a problem?
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I'm excited to announce that the audiobook version of our book Practicing Lean is complete! It's available for purchase via LeanPub.com and it might be available through other channels in the future.
The audiobook is nearly seven hours of audio, which is the entire book, completely unabridged.
As per the LeanPub.com approach, you can choose your own price. The suggested price is $24.97, but you can pay as little as $9.97 -- and you can pay as much as you want, considering ALL proceeds are being donated to the Louise H. Batz Patient Safety Foundation (about $2500 so far).
Click here and choose the "Book + MP3 Audio Book" option, along with your price and you'll be able to download all of the MP3 files.
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Let's start by stating the obvious: it sucks to wait 24 hours or more on a stretcher in an emergency department hallway waiting for a real hospital bed. It's sad and frustrating to have a couple of blog readers from Canada send me this story from Quebec:
Quebec wants 24-hour cap for patients waiting on stretchers in ERs Barrette says there would be consequences for hospital staff, doctors who don't comply
I think there's agreement that waiting 24 hours, 12 hours, or four hours for a bed after an admission is a problem. That's a problem worth working on.
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This is an elaboration on something I originally posted on LinkedIn.
I saw somebody touting an approach that would guarantee "maximum efficiency for your management gemba walks."
Ah, the efficiency trap. Is efficiency really the goal here?
Efficiency is usually defined as outputs divided by inputs. Visiting more departments more quickly would increase "efficiency."
Shouldn't the goal there be "maximum effectiveness?"
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Any rare event creates a number of challenges when it comes to manufacturing and supply chains. We're seeing a pretty historic "spike" in demand for products like the inexpensive glasses that allow one to safety view the eclipse (our friends in the totality zone can look at the totally-eclipsed sun safely, but that's the only time).
You could call it "supply chain challenges" or a "lack of planning on my part," but I cannot find eclipse glasses anywhere. There are MANY articles online about this widespread problem -- it's been impossible to buy "eclipse glasses" anywhere. Why is this? What could have been done?
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Highlights of "Boss Level Podcast" - Gen. Stan McChrystal and the Book "Team of Teams"
I've read most of retired General Stanley McChrystal's excellent book Team of Teams: New Rules of Engagement for a Complex World (I start a lot of books and finish a few). Amazon reminds me that I bought the book just over two years ago.
I meant to blog about it and never got around to it (I have a lot of ideas about posts and write a few). McChrystal, in connecting his lessons learned from helping reshape the military and, in particular, the special forces, to the business world ends up talking a lot about issues and history near and dear to those of us working with Lean as a methodology.
I'll come back to my thoughts on the book later, but I was thrilled to stumble across a podcast called "Boss Level Podcast," which is hosted by Sami Honkonen from Finland.
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Today at 3 PM, I'm doing a webinar at the invitation of the BC Patient Safety & Quality Council, as part of their "Quality Café" series. Thanks for the invitation!
It's open to the public and it's titled:
"Standardize What Makes Sense... Then Engage Everybody in Improving What You Standardized"
I hope you can join us...
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I enjoy "gemba visits" (of sorts) to wineries and vacations often focus on this walking, tasting, and learning.
I usually read the wine column that's in the Wall St. Journal each Saturday, and this one stood out to me:
"Do You Have What It Takes to Be a Sommelier?"
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Back in 2012, I blogged twice about aspects of Dr. Donald M. Berwick's 1989 article in the New England Journal of Medicine titled “Continuous Improvement as an Ideal in Health Care.” The full text is only available to subscribers.
As I posted on LinkedIn, another aspect of this article caught my eye when I was reviewing it the other day in advance of my talk at the Studer Group "What's Right in Healthcare" conference next week.
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I'm excited to be attending the annual Lean Coaching Summit today through Thursday in Austin. If you're there, please say hi! Today, I've registered to take a class on a topic that I've taken an interest in over the past few years: "Motivational Interviewing," or MI for short. I'm hoping to learn more about coaching people through their stages of "change talk," as related to Lean and organizational change... and that's what today's post is about.
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There are Dr. W. Edwards Deming quotes that get thrown around... one that sounds incredibly "pro-data" and others that say data and measures are not the only thing... which is it? How do you reconcile that?
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An article from this week in 2010... Today's New York Times has an outstanding article about Lean Healthcare and what Seattle Children's Hospital calls C.P.I. or Continuous Performance Improvement.
The article: "Factory Efficiency Comes to the Hospital"
I wish the headline had also addressed quality, waiting time, and staff engagement, but the article body does, at least. The article highlights Seattle Children's Hospital, as well as others, including members of the Healthcare Value Network (Park Nicollet, Akron Children's, and Paul Levy's Beth Israel Deaconess Medical Center), and Virginia Mason Medical Center. Yours truly is quoted in the article, as well.
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A few of you sent me this sad article from the Wall St. Journal:
"'People Are Dying Here': Federal Hospitals Fail Tribes."
I feel like I've some variation of this article and exposé many times over. Sometimes, it's some form of government medicine (active duty military medicine, the VA, or another country) or it's a similar sad story from the private healthcare sector (be it non-profit or for-profit).
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In this post, I write about a phrase that I heard many times when visiting Franciscan St. Francis Health in Indianapolis. How can this phrase help us challenge ourselves and to find positive solutions instead of barriers and obstacles?
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Does the Phrase "Lean Transformation" Jump to a Solution?
Another in the series of "do words matter?" posts... do phrases like "Lean Transformation" resonate as much as "Business Transformation?"
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Imitation as a Path to Innovation... If You Know What to Copy...
At the recent Lean Healthcare Transformation Summit, there were thought provoking presentations... and we had many discussions about the role of incremental improvement vs. redesign or transformation. And, lots of discussions about imitating vs. innovating... so I explore those themes in this post.
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If we're going to practice Kaizen (continuous improvement), do the words matter? Should we call it a Kaizen Card or something else? Do we start with a "problem" or something else? Are we writing down "ideas" or "countermeasures?" Does it matter?
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What if "easier" is less safe? Great question. It begs the question of why Safer isn't first in Shingo's list? Is it because safety is assumed to be such a fundamental pre-condition in the Toyota culture or the Lean approach? Safety is such a non-negotiable point that it doesn't need to be said?
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Does your healthcare organization struggle with keeping hand sanitizer dispensers full? Let me know what you think of this "two-bin kanban" system prototype from a vendor that might more forward on this...
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Thanks to Lean Frontiers for sharing a story from Mike Hoseus on LinkedIn. Mike is, of course, co-author of the excellent book Toyota Culture: The Heart and Soul of the Toyota Way (written with Jeff Liker, who I just learned is retiring from the University of Michigan... more on that soon).
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Here are three audience questions we didn't have time to address after a recent talk that I gave... questions about engaging people in improvement and about how to share and spread improvement ideas broadly.
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Today's reader question comes from somebody who has been put in the position of what I call "the lone wolf" in a health system. This happens a lot. A health system hires or designates one person to be "the Lean change agent." It doesn't matter how amazing and/or experienced this individual is... I'd very skeptical about the organization's Lean journey.
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What are the parallels between the mindsets and approach of a world-class university band director and our mindsets in Lean, Kaizen, and continuous improvement, in healthcare or beyond?
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It's good that United's CEO has taken responsibility for system problems. It's great that they are changing some policies. But why does he say they don't have a culture problem if employees aren't empowered? That sounds like "culture" and a "problem" to me.
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I'm excited to announce that Practicing Lean is now available as an audio book... or least the first half is, but you can buy today.
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The mistakes at The Oscars were trivial and unimportant in the grand scheme of things. What are some lessons learned that apply to improving healthcare supply chains?
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If you don't have 20 minutes for meditation, you should.... do what? Does this classic Zen quote apply to Kaizen and continuous improvement?
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A Lean-thinking physician from Canada asks how many people an organization or department should have in a dedicated Lean or continuous improvement function. How much time is needed from staff and managers?
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When did the term "concrete head" start getting thrown around in Lean circles? Do people still use this label today? Is it helpful? Should we agree that the term is disrespectful and counter productive?
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Last week, I received a few questions from somebody at a hospital system and I thought I'd address one of them here: "Can you suggest any "quick wins" to get staff engaged in a Lean culture?"
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I posted this on LinkedIn earlier today and am re-posting as a blog post to get your thoughts... and then, as I writing this, the news about the man being forcibly removed from a United Airlines flight went viral.
Full title: "The United Flight 3411 Mess, Holding Individuals Accountable vs. Fixing the System [Updates]"
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As part of my partnership with Cardinal Health, they have published an article that I wrote on their "Essential Insights" blog: "Changing how we think about change: How healthcare leaders can create a progressive culture"
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Can physician-led surgical centers provide lower out-of-pocket prices for patients, along with lower infection rates, and higher compensation for the surgeons? One surgical center in Oklahoma says so...
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Six Sigma and Lean Sigma has "belts." Some people in Lean call themselves a "sensei." Is that really appropriate? The term is supposed to be situational... it's a term of respect one chooses to use for another person...
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In this post, I look at the impact (or lack thereof) of targets, rankings, and incentives, when it comes to safe driving or PCI (angioplasty) procedures in a hospital cath lab. Are we improving? How do we know? How do we improve?
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It's time for another new, revised edition of my book! It was originally published in 2008 as Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction.
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A few of you sent me this article... and you were correct to think I would be interested:"Inside Alabama's Auto Jobs Boom: Cheap Wages, Little Training, Crushed Limbs
The South's manufacturing renaissance comes with a heavy price."
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It's been 10 years since I first wrote about my awkward acronym L.A.M.E. Is it helpful to distinguish between true Lean principles and "Lean As Misguidedly Explained?" Will we see more L.A.M.E. talk and behaviors in the future?
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Today, I'm happy to share a link to a white paper that I co-authored for Catalysis (formerly the ThedaCare Center for Healthcare Value).The paper is titled: "Lean for Doctors."
Appropriately, the co-authors are two physician leaders you might very well know: Dr. John Toussaint (founder of Catalysis) and Dr. Jack Billi (from the University of Michigan).
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Today's Post in&t;50 words: Lean thinkers don't blame individuals who in a bad system, whether that's a presenter at Oscars, a kicker in a football game, or a healthcare professional in a hospital.
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In today's post, I write about how Kaizen starts with you. I share some examples of "personal Kaizen," including the way I've streamlined my call scheduling process, for my benefit and for others.
http://leanblog.org/audio186
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While I'm writing here about Northwestern men's basketball learning from Duke (without copying everything), the same ideas apply if you're Ford learning from Toyota or a hospital learning from ThedaCare.
http://www.leanblog.org/audio185
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Thanks to GoLeanSixSigma.com for asking me some questions for a discussion that they've posted on their website.
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Today's Post in&t;50 Words: I get worked up about labeling a troubled surgical department as "a factory," but there are far more important issues of patient safety and hospital culture to be discussed related to a Seattle Times investigative piece.
http://www.leanblog.org/audio183
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Art Byrne's latest book, The Lean Turnaround Action Guide, has a lot of great tips that he's trying to share, CEO to CEO. How many CEOs are reading this book and heeding his advice, in manufacturing or in healthcare?
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Registration is now open for our "Kaizen Live!" event, where you can visit Franciscan St. Francis Health in Indianapolis to see what a "culture of continuous improvement" is like in a way that will help you in creating the same for your organization.
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Today's Post in&t;50 Words: I continue sharing documents from the Don Ephlin library archive. What did Ford and the UAW learn when they visited Japan in 1981? Many of the things that made Japanese industry successful are the same things that make organizations successful with Lean today, including in healthcare.
http://www.leanblog.org/audio180
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Today's post points to my guest blog post for the W. Edwards Deming Institute: Reflections on Dr. Deming's Hospital Notes - What Has Changed Since 1990? Why do the same problems that Dr. Deming experienced as a patient 30 years ago still happen so often today?
http://www.leanblog.org/audio179
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This post in&t;50 words: Are there parallels between medicine and organizations when we look at the tension between heroism and the sometimes boring work of preventing problems and improving things? I comment on an article...
http://www.leanblog.org/audio178
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Lean sometimes gets, I think, an unfair rap that it's only a method for incremental improvement. See this article, from the NEJM website, for example: "Limits of Lean -- Transformative Care Redesign Must Go Beyond Typical Lean-Based Improvements."
http://www.leanblog.org/audio177
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http://www.leanblog.org/audio176
I saw this article a few days ago in one of the larger healthcare industry trade publications:How One Woman Saved IU Health $54 Million
The headline is misleading, as addressed in the opening sentence / sub-headline of the story (via HealthLeaders):
"With a little help from about 10,000 of her friends and colleagues, the head of Indiana University Health's office of transformation leanedin to cut waste and encourage value, one project at a time."
That's more like it and more likely... Lean is a team effort that, ideally, engages everybody... so it's not surprising to hear about 10,000 participants and the need to share that credit.
Like almost every health system, IU Health faced financial pressures. I'll give their board credit for pushing for a method other than traditional layoff-based "cost cutting."
"IU Health had already tried some performance improvement projects, but they were scattershot and not based on a unified philosophy. In order to improve results and scalethe improvement process, the board challenged then-CEO Dan Evans to deploy a system-wide value-improvement tool that could enlist all employees."
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When I talk to organizations about Kaizen, or continuous improvement, there's far too much self-defeating talk, where people say things like:"We're not going to try this Kaizen process because our culture isn't ready yet."
That's not only self-defeating, it's self-fulfilling prophecy. If you don't work on continuous improvement, you'll never have a culture of continuous improvement.
http://www.leanblog.org/audio175
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Yesterday, the W. Edwards Deming Institute published the second in my series of three posts for them: "The Failure of "The Livonia Philosophy" at my GM Plant." Read more...
http://www.leanblog.org/audio174
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In my travels, I often meet people or visit organizations that say something like:"We're doing Lean... we just call it Process Improvement."
They have a "Process Improvement" (PI) department, or they call it "Continuous Process Improvement" (CPI). They have people in roles like "Process Improvement Facilitators."
While process improvement is great, in using a term like that,there's perhaps a risk that they miss the full and complete essence of Lean and, therefore, don't get the results that they might hope for.
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http://www.leanblog.org/audio172
StoreSMART is partnering with me on this contest where you can win one of four sets of books, along with a selection of sample supplies that can help you with 5S, visual management, and other Lean methods.By January 31, 2017, we'll select four winners who will each get a set that includes:
Lean Hospitals, 3rd Edition (signed by Mark Graban) Work That Makes Sense (signed by Gwendolyn Galsworth) The Batz Guide for Bedside Advocacy (a great patient safety guidebook) One winner's package will includethe book Visual Workplace Visual Thinking instead of Work That Makes Sense.
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It's a weight loss program called "Lean 13." It's the everyday use of the word "lean," as in thinner, that has nothing to do with the Lean methodology and the Toyota Production System. They're promising that you'll lose 13 pounds in the first month.As with the Lean methodology, in hospitals, factories, or wherever, your results might vary based on a number of factors. For example, Nutrisystem can't stop a customer from supplementing their food with Buffalo wings and chocolate milkshakes.
We have situations out there where people say, "We tried Lean and it didn't work." Maybe it was because they were cherry picking a few Lean tools or they just thought Lean was about cost cutting, instead of focusing on safety, quality, patient flow, and employee engagement.
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My favorite book, as I've written about before, is not a "Lean book" -- it's Understanding Variation: The Key to Managing Chaos by Donald J. Wheeler, PhD. It might look like a book about statistics...
http://www.leanblog.org/audio170
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I'm extremely honored that The W. Edwards Deming Institute published my first blog post in a series of three that I've written for them, to be published over the next month or so.The post is titled:
"Why Dr. Deming's Work is So Important to Me"
http://www.leanblog.org/audio169
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Before Christmas, I was listening to the Dan Le Batard Show and their guest for the day was former NFL player Domonique Foxworth, pictured at left. Foxworth earned an MBA from Harvard Business School after his playing days. He's the perfect participant in a smart show about sports and whatever.During one segment, they all talked about NFL offensive and defensive coordinators and how they often fail when promoted to a head coach position.... and the discussion seemed relevant to other types of organizations.
http://www.leanblog.org/audio168
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I had a chance to visit one of their community hospitals, Hillcrest Hospital, as well as the main campus. It was a very stimulating visit and it was great to see the progress they were making in building a "culture of improvement."
http://www.leanblog.org/audio167
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"Making mistakes is better than faking perfection."I saw this quote the other day and tweeted it. It seemed like food for thought and something to reflect on for a new year. A Google search doesn’t lead to a clear creator of this quote… it’s a common thought that has been around a long time, I guess.
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http://www.leanblog.org/audio165
I get annoyed by corporate euphemisms, such as referring to people as "resources," the term "right-sizing" for layoffs, and the type of jargon and babble parodied in the Weird Al song "Mission Statement."Using unclear language can intentionally mask and hide reality, or sometimes it's just another form of incompetence.
You might know about the recent Wells Fargo scandal (as I blogged about here).
The bank is trying to make amends for customers being harmed by unnecessary fees and the hit to their credit score that resulted from accounts being opened in their name without authorization (because employees were under pressure to hit unrealistic goals).
I can't find the commercial online, but Wells Fargo has been running ads that sort of apologize and promise to make things right (better latethan never).
The ad says something like:
"... customers who were impacted..."
They don't say WHAT the customers were impacted by. They make it sound like a tornado or some other natural disaster impacted those customers.
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It's a bit of a modern management cliché to say "Don't bring problems! Bring me solutions!"
I think what that means is "Don't just complain! Think about improving things!"
It's good to think about improvement, but sometimes (if not often!) that improvement process starts by identifying problems.
In a "Kaizen" process in a team, I encourage people to bring problems forward even if they do NOT have a solution or "countermeasure" in mind. When somebody points out a problem, that can prompt discussion or brainstorming (with the manager and colleagues) about what solutions could be tested.
Here's an article from Harvard Business Review that delves into this same topic:
"Don't Bring Me Problems--Bring Me Solutions!"
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I first blogged about this article back in 2009 and it's still online:"Keen to Be Lean"
The sub headline talks about hospitals being "desperate to cut costs." Has that changed?
I wish the motivation was more often about hospitals being "desperate to improve patient safety and quality." Lean can address that too and should be mentioned, even in a publication for CFOs.
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http://www.leanblog.org/audio162
Dr. W. Edwards Deming used to warn against replacing intrinsic motivation with extrinsic rewards and incentives.Brian Joiner (author of Fourth Generation Management), who worked with Deming, warned that setting targets and quotas can lead to three things: improving the system, distorting the system, or distorting the numbers.
It’s often easier to distort the system or the numbers than it is to actually improve. We’ve seen that happen (gaming the numbers) in situations ranging from the VA waiting time scandal and the recent Wells Fargo scandal.
It’s predictable human behavior for managers to try to entice people to perform better through promises of rewards or threats of punishment...
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I was happy to see an engineer (Chemical Engineering) and a General Motors leader, Alicia Boler Davis, on the cover of the Northwestern University alumni magazine.See this profile and story:
"DRIVING GM"
http://www.leanblog.org/audio161
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In the Lean approach, we don't call people idiots or dummies. We don't say, or shouldn't say, things like "idiot proofing" or "dummy proofing."There's an old Toyota story about how the term "fool proofing" upset an employee, they switched to using the equivalent of "mistake proofing" or "error proofing." Read more about the story in a comment on an old blog post of mine.
Terms like mistake proofing help us focus on the process and the system instead of blaming individuals. Instead of labeling people as idiots, we have to focus on improving the system so it's easier to do the right thing and harder for errors to occur.
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http://www.leanblog.org/audio159
I do a lot of work across the U.S., but I've also been very fortunate to work with hospitals, clinics, and health systems around the world over the past 11 years.It started with a few trips to Canada to conduct some hospital lab assessments and Lean leadership training when I worked for a J&hospital consulting group. Then, came an opportunity to spend about eight weeks working with a hospital north of London in 2008, a fascinating opportunity.In recent years, I've visited and/or coached hospitals in The Netherlands, Sweden, Finland, Japan, China, and Thailand.
These are very different countries in their national cultures, of course. Their high-level, big-picture healthcare systems are designed differently (including the level of universal coverage, or lack thereof, and who pays).
But, when you look at the details of how the work is done... how healthcare is delivered... how people manage... things are more the same than they are different. In England, they said, "Same problems, different accent."
The same has been true in my most recent stop here in Thailand - except it's same problems, different language.
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A few weeks ago, I saw this announcement about Dean Gruner, MD, the second CEO to lead ThedaCare during their Lean journey:Dr. Dean Gruner, ThedaCare President and CEO, Announces Retirement
"Dean Gruner, MD, president and CEO of ThedaCare since April 2008, today announced his plans to retire. Dr. Gruner began in healthcare 40 years ago, has served this community for 33 years, and has served as President and CEO of ThedaCare since April 2008."
Congratulations and best wishes to Dean on his retirement! He has been a great leader and advocate for healthcare improvement.
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I was happy to see this announcement the other day:UCSF to Train Residents in Lean Management and Process Improvement
From the announcement:
“UC San Francisco will train medical residents and fellows in Lean management principles, as part of a broader institutional commitment to continuous quality improvement. The effort is being supported inpart with a grant from the Accreditation Council for Graduate Medical Education (ACGME) through its Pursuing Excellence in Clinical Learning Environments initiative. UCSF was one of eight medical training sites nationally to receive the competitive grant.”
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You might remember the hubbub (a kerfuffle?) over the NEJM opinion piece written by Dr. Jerome Groopman and Dr. Pamela Hartzband. See my first post about their article. There are more links at the bottom of this postNow, the "Perspective" section of the New England Journal of Medicine has published a piece titled "The Hard Work of Health Care Transformation" by Dr. Richard Bohmer. Check it out.
Dr. Bohmer says "government and regulators influence" (or attempt to influence, I'd add) healthcare organizations through financial rewards and penalties, regulatory constraints, and attempts to encourage "performance-improvement activities through education, research, and measurement programs." These approaches might help, but aren't sufficient.
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More notes and discussion about my trip to China.
http://leanblog.org/audio155
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http://leanblog.org/audio154
Continuing from Part 1 of my post about my first day of my first China trip, I'd like to share more about the Lean healthcare conference and presentations that took place.In the next presentation from a Chinese hospital, the speaker started talking about the need to "improve [patient and employee] satisfaction through Lean management" and that "we have the same goals and purpose" as I expressed in my presentation... namely safety, quality, waiting times, cost, andemployee morale (SQDCM).
I had showed a "spaghetti diagram" in my talk, shown below, of a podiatrist running around an Illinois clinic searching for supplies (this was the walking required for ONE patient... 10 minutes of waste):
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Audio courtesy of Quality Digest Live -- see www.QualityDigest.com for more info and http://www.leanblog.org/audio153 for the link to the article referenced.
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We'll probably also talk about this article that was published yesterday on QualityDigest.com:"Lean Is About Quality, Not Just Speed or Efficiency... in Factories or in Hospitals"
It might ruffle some feathers, but oh well. I'll stand by what I say here as factual, not just opinion:
http://leanblog.org/audio152
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My first trip to China...
http://leanblog.org/audio151
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http://leanblog.org/audio150
Thanks to those of you who pre-ordered the 3rd edition of my book Lean Hospitals.Click below to read a free preview from the book, the start of the chapter on leading and engaging employees (arguably, it's all about leadership).
Improving the Way We Manage [Preview of "Lean Hospitals" 3rd Ed.]
And if you post a comment sharing some of your reflections on your Lean journey, you might receive a free copy of the the book. Also, you still have a chance for me to send your CEO a free copy.
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For decades, manufacturers have been tripped up by the simplistic idea that Lean is about "zero inventories." It probably didn't help that one of the earliest and most prominent books about what many used to call "Japanese manufacturing practices" had that exact title: Zero Inventories. It was published in 1983, well before "Lean" was a term used for this.Not even Toyota has zero inventories. They don't have zero raw materials. They have non-zero buffer inventories in between parts of their assembly lines. And it's not hard to see INVENTORY of unsold cars at Toyota dealers (realizing those are independent businesses and the inventory's not on Toyota's book, but still...)
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Thanks to this post by Bruce Hamilton (aka "Toast Guy" or "Old Lean Dude"), I was reminded of the old General Motors effort, spearheaded by then-CEO Roger Smith (of "Roger&Me" fame), to fully automate car factories. Their concept was the "lights-out factory" that could run without people (other than a security guard).GM invested $90 BILLION dollars over 10 years in this quixotic (if not foolhardy) quest. The robots often famously painted each other instead of painting cars, as described in this book:
http://leanblog.org/audio148
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The 1994 book Why TQM Fails And What to Do About It is a book that could be very relevant today, in the context of Lean. I'll give credit to Greg Jacobson, MD from KaiNexus who had a copy of this book on his shelf. I bought a copy and have recently been reading it because I was curious to see if there parallels to be found with Lean failures.
http://leanblog.org/audio147
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http://leanblog.org/audio146
Earlier this year, we had rantings from two doctors about Lean in the esteemed New England Journal of Medicine... except what they described didn't really sound like Lean (as I wrote about here and here - and also see Dr. John Toussaint's rebuttal).Now, there's a story written by an emergency medicine physician, Dr. Brad Cotton, that appears in a publication called "Emergency Medicine News" -- FIRST PERSON: 'We Fired Our Hospital'
What appears on the front page of their publication in the June 2016 edition isn't news -- it's a first-hand story and an opinion piece. This is the "most trusted" name in "news" for emergency medicine professionals? Good grief.
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Ah, whiskey. I like whiskey. I'm not afraid to say that. I've blogged about whiskey (or whisky) once before: Why Kaizen is an Important Differentiator for Japanese Whisky. I also have a personal Kaizen story that I need to write about from my day volunteering at a Texas bourbon distillery.On a recent flight, I was reminded of the need to follow standardized work, even in the context of something as simple as ordering a drink.
A passenger seated across from me (yes, it was another passenger, not me), responded to the flight attendant asking him if he wanted a drink.
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Previously on LinkedIn, I’ve written about Kaizen in a wine bar and the need for restaurants to not blame employees for problems.
Yesterday, I published my 50th post for their Influencers program:
This Restaurant Server Sadly Explains a Widespread Management Problem…
I hope it’s thought provoking about your own workplace.
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http://leanblog.org/audio143
I've written before about the subject of hospitals "flexing" nurses and employees. I've criticized flexing (or the practice of sending employees home early because patient census is low) and I've pointed out that it's not keeping with "Lean" principles to "save money" by sending people home early.See these posts:
Is This The One Question That Determines If You're Truly a Lean-Thinking Hospital?
"The Emperor's Sacred Cow's New Clothes - "Flexing" Hospital Staff"
Where Do Hospitals Get the Idea that Lean is Only About Cost Reduction?
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http://leanblog.org/audio142
You might remember the hubbub (and my earlier blog post) about this article that somehow appeared in the NEJM: "Medical Taylorism."It's sad and frustrating that people so often talk past each other in these different "debates" about Lean. Drs. Groopman and Hartzband seem unwilling to learn about Lean and TPS. They have just now doubled down on their assertion that Lean equals Taylorism and that it's not appropriate for healthcare. Sigh.
The NEJM just published two letters to the editor.
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As is often the case, I have too many open browser tabs full of articles that I was going to potentially blog about. This slows down my Mac (thanks, Chrome!).So, it's time for me to clear out my backlog and a little mental overhead... to share some articles I've been reading with some quick notes, instead of doing full blog posts. Well, I'll get my backlog down a little.
Why Giant Hospital Systems Might Be Getting it Wrong Resiliency Training - Important but Not Nearly Enough 'Lean Six Sigma' comes to the VA; Collins cheers Rotarians tour hospital to see improvement model
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I'm always happy to see success stories where healthcare organizations solve problems that matter through Lean concepts, practices, and principles. Today, I'm blogging about two articles I saw about this recently.One of the problems that needs to be solved in healthcare is long waiting times, whether that means waiting for care in the emergency department, waiting for an appointment, or waiting for test results.
http://leanblog.org/audio140
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http://leanblog.org/audio139
In the previous editions of my book Lean Hospitals, I've included case examples from Avera McKennan Hospital and Avera Health. Fred Slunecka is the former president of Avera McKennan and he is now chief operating officer for the Avera system.I talked with Fred again for the updated and revised third edition (available for pre-order now, shipping in June), with my highlights added for this post:
Reflecting further in 2015, Slunecka says:
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After the previous CEO of JC Penney, Ron Johnson, was fired (see my post "Lack of PDSA made JCP CEO SOL?"), it seems that new CEO Marvin Ellison might be taking a different approach.See this article from FORTUNE: "The CEO Who's Reinventing J.C. Penney."
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The revised, updated, and expanded third edition of my book Lean Hospitals has been sent to the printer and copies should start shipping by mid June.I'm happy to now be offering a free PDF of the revised first chapter.
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recently saw some updates and new details related to some topics I've covered here on the blog, so I'm combining them into this batch update.In this post, we cover everything from a hospital NICU, to baseball, to healthcare waiting times and a scandal there that won't die.
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As I guy who started his career in manufacturing before moving to healthcare in 2005, I don't get many opportunities to visit the "gemba" at a factory very often anymore. I get to occasionally visit a Toyota plant (in the U.S. or Japan). As I'm getting settled back into the Dallas / Fort Worth (DFW) area, I'm reconnecting with some of the people I know through our local "Lean DFW" network.foremanOne of those Lean DFW people is Rick Foreman, the VP of Lean Development at Federal Heath Sign Co. Federal Heath makes big signs for gas stations, restaurants, hotels, hospitals, and the like. There's metal being cut and bent, stuff being painted, structures being built, and lights being installed and assembled. Rick, pictured at left, is more of a khakis-and-polo-shirt guy (as he was dressed on Friday). Suits and ties exist daily in hospitals, but exist mostly in LinkedIn profile photos in manufacturing :-)
We had the chance to meet for a few hours on Friday morning to catch up andtalk about their Lean approach at Federal Health, across their different sites. Rick and the folks at Federal Heath have a very strong focus on developing people. As Rick says, "Doing Lean with people, instead of doing it TO them." They have mentoring and development programs tied to Lean, with leaders at different levels learning from each other in different ways. Their President / CEO is the chief advocate for Lean as a business strategy.
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I love stories of humility and customer focus in healthcare. Let me share two such stories with you today. Oh, and, I ended up sharing a story of mine that's related and might just recount a few screw ups on my part... but I think I eventually did the right thing.
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Today's post is an addendum from Saturday's post on the apparent death of a health system Lean program: "Why Would a New Healthcare CEO Kill a Lean Program?"If you read that post, there's an interesting comment from a Presence Health employee that doesn't shed too much more light on this:
"From the standpoint of a current Presence Health Employee~ my opinion is that the RIEs failed because they were aggressively site specific. At a time when PresenceHealth is "Becoming One" I do not believe the RIEs took the entire ministry into consideration when planning events. Decisions and "experiments" where being made and conducted through a site specific lens, and this was often in contradiction to the spirit of the new organization."
As I commented in response, I'm not sure why a goal of common processes or a health system that's actually a system would be a reason to stop with Lean. Unless hopefully they are really just re-booting the effort instead of killing it altogether.
As I alluded to in the post Saturday, there was a sad story about ahospital that I featured in the 2008 1st edition of Lean Hospitals that basically killed their promising program when a new CEO was hired from the outside. As Adam Zak, one of the top Lean-focused executive recruiters said, it's a shame that the board (apparently) didn't hire a CEO with Lean experience.
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Apparently, the Lean journey at Presence, regardless of what form it was taking in late 2015, has not survived a CEO transition at Presence Health. A new CEO, Michael Englehart, took over about six months ago (just after that Modern Healthcare story was published).Here is the latest Modern Healthcare piece by Sabriya Rice:
“Presence Health rethinks its Lean initiative”
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http://leanblog.org/audio131
Back in December, I wrote about a method called "Motivational Interviewing" (MI), something I learned about from a social worker who was also at the Lean Startup Conference. It's funny how these worlds intersect sometimes.I saw parallels between people being addicted to food, drugs, or what have you (the reason the MI method was created) and people being addicted to old behaviors in the workplace (such as blaming others, not planning, or jumping in to be the hero). I recently ran across Ron Oslin, who is an internal Lean coach at CapitalOne. He has been using the MI method and has trademarked the phrase "addicted to the status quo." It's apt.
I've chatted with Ron and will be doing a podcast with him soon.
Here is a video webinar of Ron giving a great overview of Motivational Interviewing:
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As Patient Safety Awareness Week continues, thanks to all of you who shared this PBS News Hour story with me via email or Twitter. If you ever see something you think might be of interest, please let me know.On March 9, this story aired on PBS: After tragic mistake, rural hospital transforms into model of success.
http://leanblog.org/audio130
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http://leanblog.org/audio129
I generally avoid politics here on the blog... In October, I broached the subject when I blogged about a company that uses Lean principles to make Donald Trump hats in New Jersey (and interviewed the owner of the company), but that was during a time when Trump seemed like a novelty or fringe candidate. It might be a "third rail" to even bring him up... but I'll limit my remarks to one particular context - his view of "leadership."As reported by FORTUNE and other publications, Trump said the following on March 3, when asked about his earlier comments about wanting the military to follow orders that violate international law and treaties:
"I've always been a leader. I've never had any problem leading people. If I say do it,they're going to do it. That's what leadership is all about."
No. Leadership is not about telling people what to do. What Trump calls "leadership" is an outdated strategy, the "command-and-control" model. That's a model that many call "Taylorist" -- a system where the boss thinks and gives orders,the workers just keep quiet and follow orders. The FORTUNE writer writes that Trump's "retro style is not set up for today's complex world."
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Last Friday morning, I partnered with Chip Ponsford, DVM, a doctor of veterinary medicine, to give an introductory Lean continuing education presentation at the annual conference of the Texas Veterinary Medical Association.Our talk was titled: "What Veterinarians Can (and Should) �Learn From Toyota." That was Chip's suggested title... him talking to the vets, not me as the engineer telling them this.
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Dr. Gary Kaplan is the CEO of Seattle's Virginia Mason Medical Center, considered one of the world leaders in the adoption of Lean healthcare principles. He wrote the foreword for my book The Executive Guide to Healthcare Kaizen.He co-authored a recent editorial in the BMJ Quality&Safety journal:"Lean and the perfect patient experience"
http://leanblog.org/audio127
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Each Saturday, I get an email newsletter from the UK-based site "Nursing Times." They cover issues that are somewhat universal in healthcare, including patient safety, healthcare culture, nursing shortages, budget cuts, and the like.Last week, this article, caught my eye:
"Workplace principles revealed for NHS staff in Wales."
http://leanblog.org/audio126
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http://leanblog.org/audio125
The Spurs have had great players, but there's a culture of teamwork and unselfishness. The Spurs (after learning their lesson with Dennis Rodman) have learned to draft and sign players who FIT into their culture and system.Here's a recent interview with head coach Gregg Popovich:
"Gregg Popovich broke down what he looks for in players, and it was an inspiring life lesson"
"For us, it's easy. We're looking for character, but what the hell does that mean? We're looking for people -- and I've said it many times -- [who] have gotten over themselves, and you can tell that pretty quickly. You can talk to somebody for four or five minutes, and you can tell if it's about them, or if they understand that they're just a piece of the puzzle. So we look for that. A sense of humor is a huge thing with us. You've got to be able to laugh. You've got to be able to take a dig, give a dig -- that sort of thing."
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http://leanblog.org/audio124
I made a few tweaks to the content of the 3rd edition's "first pages" based on some input from Jamie Bonini, vice president of the TSSC group within Toyota. They are the ones that did the great work with UCLA Harbor Medical Center and others, as highlighted in "The Toyota Effect" videos and earlier work with the NYC Food Bank.Jamie talked with me and contributed a number of thoughts and ideas about the Toyota Production System and what we might describe elsewhere as "Lean Culture."
There's a triangle diagram on the TSSC webpage that describes an "integrated system" that consists of:
technical methods managerial methods philosophy
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This article posted anonymously on AllNurses.com has over one million views in the month since it first appeared:"Hospitals Firing Seasoned Nurses: Nurses FIGHT Back!"
It's an "Open Letter to Hospital Administrators."
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Engaging Staff in Improvement is Actually the Toyota Way, TooHere, I blogged about an article I read in Modern Healthcare that said, basically, Toyota isn't innovative and maybe therefore healthcare should look to Google as a management system and model of staff engagement and continuous improvement.
WHAT? Toyota doesn't engage staff in continuous improvement? That's, frankly, ignorant and it's a great example of L.A.M.E. -- Lean As Misguidedly Explained.
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I wrote a new piece for LinkedIn that I hope would be of interest to you even if you’re in healthcare. Why? It’s a story about what an organization does when you don’t have enough (or any) direct work for your front-line staff to do. Toyota would continue paying employees and would put them to...
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I get asked a lot, "How do you know if a hospital is truly 'Lean?'"Nobody is ever perfect or "fully Lean," but you could ask, "How do you know if somebody is on a legitimate Lean transformation journey?"
http://leanblog.org/audio120
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Last year, Joe Swartz and I hosted a workshop at his organization, Franciscan St. Francis Health in Indianapolis. We called it“Kaizen Live!” and it was designed as an opportunity to see a culture of continuous improvement – what does it look like? What do people say?We lay this out in our Healthcare Kaizen books...
http://leanblog.org/audio119
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Alternate title:“Lean is an Integrated System. Of Course Just Implementing Pieces Leads to Failure.” Throughout the 10 years that I’ve been involved with Lean healthcare efforts, I’ve heard multiple stories of organizations that ended their formal Lean initiatives. They do so, as I’ve been told, because they need to cut costs...
http://leanblog.org/audio118
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At KaiNexus, we've been fortunate to have a good relationship with Professor Ethan Burris, from the University of Texas McCombs School of Business. He has done a lot of research and publishing around employee engagement and idea systems, as I've mentioned here on the blog before: "Is Fear the Only Reason Employees Don't Speak Up?"Burris has a new article on the Harvard Business Review website:
"Employee Suggestion Schemes Don't Have to Be Exercises in Futility"
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In the article posted today, Pamela Hartzband, M.D., and Jerome Groopman, M.D. (the later the author of the popular book How Doctors Think), rant about all sorts of things… some of which have nothing to do with Lean...
http://leanblog.org/audio116
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http://leanblog.org/audio115
A hat tip goes to Brian Buck for sharing this quote via email recently. Samuel Clemens, aka Mark Twain, was a pithy and wise man.
I didn't remember this quote, but it is attributed to him. It's very appropriate for the type of work we do.
I shared it last Saturday in my "Key Tweets" post, but it's worth discussing here in a separate post, I think.
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I had a bit of a new year's resolution about being positive and not fretting about organizations that don't "get it" when it comes to Lean. But, resolutions are meant to be broken, I guess.It's very frustrating when I hear people in healthcare complain that their hospital or health system has equated Lean with cost savings -- only focusing on cost reduction or primarily focusing on it. Hospitals that say to their staff that Lean is just about cutting costs (or demonstrate that) willfail to engage their most important asset -- their employees.
http://leanblog.org/audio114
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http://leanblog.org/audio113
This article, from December, was floating around social media the other day (hat tip to Paul Levy):Don Berwick Offers Health Care 9 Steps to End Era of 'Complex Incentives' and 'Excessive Measurement'
Among the points that Berwick makes, here is the one most directly related to Deming, Lean, and continuous improvement:
- Recommit to improvement science: For improvement methods to work, you have to use them, and most of us are not. I'm trying to be polite, but I am stunned by the number of organizations I visit today in which no one has studied [W. Edwards] Deming's work, no one recognizes a process control chart, no one has mastered the power of testing PDSA (plan-do-study-act), Nathaniel's Method or the route to the top. You can see the proof of concept. This is beyond theory now.
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How is it that we have two realities out there in healthcare... in parallel, Lean is awesome and Lean is horrible. It depends on where you are, unfortunately. I had an amazing day yesterday with a major health system...
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Humility is an important part of the Lean management philosophy... it also means being willing to admit that there is a problem. Humility means "we don't really know so we must understand and then try many things to see if we have the right solution."
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When we see a simple error, even in something as silly as sports memorabilia, we would ask "why?" or "how?" instead of "who?" Blaming individuals doesn't help...
http://leanblog.org/audio110
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When I was at the recent Lean Startup Conference, somebody I know somewhat randomly introduced me to another attendee. As we chatted, I learned her background was social work and she was founder of a technology startup that solves a problem that was important to her and her work. I never met people like that when I worked in manufacturing... again, I've really grown to appreciate the perspectives and experiences of those who have different educational backgrounds than my own.We were talking about healthcare, continuous improvement, and such topics and she suggested that I look into a framework called "motivational interviewing" (MI) as something that might be helpful in my Lean coaching.
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How many times do we hear people say things like“We don’t have time for Lean” or “We don’t have time for Kaizen“? It happens a lot, right? As I’ve said before (and this video) a “lack of time” is a problem to solve... so how did I get hospitals to dedicate staff time for 12 to 16 weeks?
http://leanblog.org/audio108
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The "five" in the "five whys" methodology is not a magic number, be it Lean or Lean Startup approaches.
http://leanblog.org/audio107
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Why do we need to move beyond "The Five Whys" into a more robust problem solving model for Lean or Lean Startup settings?
http://leanblog.org/audio106
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In discussing Lean and working with people in different organizations, I so very often hear things like "we don't build cars" or "we're different." I know I'm not the only one who hears that. The implication is "Lean won't work here, because we're different" in some way. Different country, different industry, different hospital department, different patient or payer mix, etc.
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Lean healthcare really is a global movement. Last year, when I went to Japan, we had people in the group from all across Asia, Denmark, Canada, the U.S., and Saudi Arabia. Health systems all around the world need to improve quality and patient safety, reduce waste and create better work environments, reduce waiting times, and get costs under control. These are universal challenges.Thankfully, Lean is helping.
Here's a story from Malaysia that caught my eye: "How assembly lines inspired Asia's hospitals."
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http://leanblog.org/audio103
Through our practice of Lean, we're looking at processes and our management system, looking to identify waste and opportunities for improvement.Lean is about engaging people to have them ask why we do things a certain way or if things could be better (it's not about finding fault from on high and telling them what to do).
The answer to why we (frontline staff or leaders) do something a certain way is often:
"We've always done it that way."
The fact we've always done something that way doesn't automatically mean it's a bad practice. But, we should be willing to challenge things to figure out if we should reinvent that process or tweak it. The same question applies to management practices.
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http://leanblog.org/audio102
The world (especially the world wide web) is full of surveys. Tell us how we're doing! Your satisfaction is important to us! We see this so often, it's easy to become numb to it in our Yelp-ified world.It's definitely a "first world problem," but I've been shopping for a new car over the past few months and I finally bought something. I won't disclose what I bought, but it's replacing a 2004 Saab 9-3 that I've had for 11 years now.
The car shopping and buying experience has its frustrations - that's nothing new...
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http://leanblog.org/audio101
I'm going to be attending the Lean Startup Conference in San Francisco next month, as a "faculty member," a moderator for a session, TBD, and maybe serving as a mentor. The organizers asked me to write a post introducing myself to that audience.Eric Ries, author of the book The Lean Startup: How Today's Entrepreneurs Use Continuous Innovation to Create Radically Successful Businesses, makes it very clear that the Lean Startup methodology has its roots in the Toyota Production System and Lean manufacturing. Ries writes about factory settings and gives credit to giants like Taiichi Ohno (listen to our podcast talking about this).
There are some in the Lean Startup circles who seem pretty unaware of the industrial roots of Lean. This often causes confusion.
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Many of you don’t care about football, but you might find it interesting, as I did, to learn that Northwestern’s defensive coordinator Mike Hankwitz is apparently a fan of Kaizen...
http://leanblog.org/audio100
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These Donald Trump hats (and hats for other candidates including Hillary Clinton and Jeb Bush) are made by a Newark company, Unionwear. Lean is their strategy and their production system. That’s how they are competing against China.
http://leanblog.org/audio99
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http://leanblog.org/audio98
There's a really good article that was published by Modern Healthcare as a special report, written by Sabriya Rice. Sabriya spent a week observing a rapid improvement event (RIE) at the Sts. Mary and Elizabeth Medical Center in Illinois. It's an in depth article that, I think, very accurately reflects the reality that Lean is helpful, but the process isn't easy for a number of reasons.
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I have many experiences in healthcare that I haven't blogged about. I try not to write posts that say, "Hey, you won't believe what happened yesterday," for a number of reasons. But, sometimes, my memory gets jogged and a story comes back to me. That's what I'm sharing today as a Throwback Thursday.
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Having a model like this helps prevent errors, such as jumping to implement Lean tools before the organization understands WHY change is necessary. You have to engage and enroll people in change, not just force things on them.I am convinced that the ExperienceChange simulations, either Lakeview or GlobalTech, are a great way to learn and practice.
http://leanblog.org/audio96
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My two previous trips to Japan have been incredible experiences, both personally and professionally. I'm planning to go back in December with a tour group I'm helping organize with Kaizen Institute. When people go to Japan, I think they are expecting to see perfect Lean practices. But, no...
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I was very saddened earlier to receive an email from an employee of a great leader, Dr. Michel Tétreault, informing me that he had passed away. Michel was, since 2005, the CEO of St. Boniface General Hospital in Winnipeg.
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And the idea of knowing why... again that's an old desire. It's not just a recent discovery of Simon Sinek and the outstanding book Start with Why (my friends at Gemba Academy have a podcast interview with him coming soon). Why are we doing something? Why are we starting this company? That's an old tale... are you breaking rocks or building a cathedral?
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Visit http://www.leanblog.org/audio92 for more info on this post and http://www.leanblog.org/audio for information about how to subscribe through iTunes and other places.
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Today, I discuss two articles: The first article is: "The NFL's Best Practice: No Wasted Time." "If You Can't Hire Urban Meyer, Can You Clone Him?"
http://leanblog.org/audio91
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http://leanblog.org/audio90
It's far too common to see somebody with just a little bit of understanding about Lean do things that really shouldn't be described as Lean at all... in terms of the decisions they are making or the approaches they are taking.I saw an article about Lean in physician practices: "Lean Practice Management for Physicians." I cringed a bit when the author said:
"In lean management programs, there are levels of belts based upon the colors found in karate: white, yellow, green, black, and levels of black."
No. That's an example of "Lean As Mistakenly Explained."
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I stumbled across an article from the Inc. magazine archives from 1987, so it's today's "Throwback Thursday."In 1987, I was starting high school and that was probably right about the time when my dad, an engineer for General Motors, was able to attend one of Deming's famed four-day seminars. Hearing about that was my first exposure to Deming or anything vaguely related to Lean thinking.
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Mark Graban talks about the revised 3rd edition of "Lean Hospitals" and a new eBook project called "Practicing Lean."
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Stories like this have been in the news before, but this was circulating the past few days: "Why erratic schedules are one of the worst parts of low-wage work."The story refers to so-called "just-in-time" scheduling techniques that jerk employees around and disrupt lives.
It happens to share a term, "JIT" with "Lean manufacturing" or just "Lean," but it's either a coincidence or it's a bastardization of what Lean is really about. And I can prove it quite easily.
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http://leanblog.org/audio86
I saw this story when it originally appeared online as part of a local public radio station in California. It was now picked up nationally by NPR and a number of you emailed me about this Lean healthcare piece about UCLA Medical Center:Hospitals Turn To Toyota To Make Care Safer And Swifter
It's a generally positive story about a large hospital system working to improve... and turning to Toyota (directly to Toyota) for help. To be fair, they did far more than organize closets... but that was the main photo and lead story that started the piece.
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How do you MAKE time for continuous improvement?It's been a little while, but here's a new video about Kaizen and continuous improvement from our friends at Franciscan St. Francis Health in Indianapolis.
In this video, Hollynn Lobsiger, the manager of the endoscopy unit, talks about what Kaizen means to her and her team and she also shares some thoughts about how to make time for Kaizen.
Everybody (or nearly everybody) complains about not having enough time for improvement - that includes time for staff and time for managers. The challenge is how to go from "lack of time" being an excuse to being a problem that you solve (see my video about this).
Hollynn and her team are a great example of being proactive to make time for improvement (as you can see in this video with staff describing an improvement). See how Hollynn sets a tone for them and expects input from everybody? They're "Kaizen Crazy!" :-)
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The Problem With Underreporting Problems, When Warnings Aren’t Heeded in Aerospace, When Warnings Aren’t Heeded in Aerospace, When Warnings or Concerns Aren’t Shared in Healthcare
http://leanblog.org/audio84
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Allen Iverson was a legendary NBA point guard and scorer who played from 1996 to 2011.In a 2002 news conference that still appears regularly on ESPN, Iverson responded to criticism that he missed practice (due to injury) and he somewhat indignantly asked (over and over) some variation of:
"We're talking about practice?"
Iverson wasn't complaining about having to practice, but more about the media's insistence on asking questions about practice, which is a topic he apparently didn't think was too interesting to talk about.
Practice is certainly important. Maybe not when you're already as good as Iverson was.
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I guess this counts as a "Flashback Friday," as I was reminded of an old game show that I loved as a kid: Match Game. I was too young to fully appreciate the show, I guess, but I remember it fondly and love watching old reruns (you can find episodes on YouTube).Last week, I read this article: "A happy workforce is a productive one."
You'll certainly get no argument from me on that!
Well, I think "engagement" is more important than happiness, as happiness might possibly be superficial. But I've long said that an engaged workforce is the key to success in an organization.
I thought the article got off track when the author brought up suggestion boxes. Oh no. Suggestion boxes never work.
So I took a line from the article and posed it as a Match Game type question on Twitter:
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http://leanblog.org/audio81
Lean is not about banning bananas from people's desks or banning sweaters hanging on chairs.We should be solving problems that matter, for customers and employees, through Lean. We should be engaging people rather than throwing silly top-down mandates at them.
I tend to get on a soapbox and rant about the "bad office 5S" examples... but I got an email this week that made me smile, because it helped an organization avoid the L.A.M.E. office 5S trap.
The email, shared with permission:
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http://leanblog.org/audio80
Here's the Key to Visual Management:To me, the core of visual management is captured in this statement from Fujio Cho, now the honorary chairman of Toyota:
"Know normal from abnormal... right now!"
If the "visual" isn't helping accomplish that goal, it's probably not visual management. Visual management has two parts - the visual(something you see) and the management (the action you take based on the visual). Why do we have to manage the visual abnormality? To get better results.
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http://leanblog.org/audio79
I love the Texas-based grocery store chain "Central Market." It's like a local version of a Whole Foods, basically.One of their features is a sushi area that's run by a third-party company, Yummi Sushi.
Posted prominently is a letter that outlines their stated approach to quality and safety. Click the photo for a larger view.
Below, I'm going to basically transcribe the letter, but as if it were the policy of a hospital or health system.
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Here is my latest article for the LinkedIn“Influencers” series, written for a general audience that might not be as familiar with Lean:
How These Credit Card Websites Illustrate Lean Mistake Proofing
I hope you enjoy the article, even as a Lean thinker.
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http://leanblog.org/audio77
I did a similar post in 2012, but here's a post where I share some recent NPR stories that I've heard recently (through the NPR One app, which I absolutely love).This is similar to my "A Lean Guy Reads..." series, my "Cleaning Out the Backlog" series, and the "Stuff I'm Reading" posts.
Not All NICU Babies Should Get the Same Treatments
Shrinking and Cutting Isn't the Only Path for Hospitals
More Expensive Cancer Drugs Aren't Always Better
Getting Patients Involved in Choosing Better Care
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http://leanblog.org/audio76
The Kaizen approach to continuous improvement is important to me, of course. The Japanese hospitals we've visited have a strong tradition of practicing Total Quality Management. Some are now embracing Kaizen as "daily continuous improvement" in addition to their six month long TQM projects.We're again organizing a Lean Healthcare Study Trip to Japan, which will take place September 13 to 19 in Nagoya and Tokyo. Learn more via http://www.japanleantrip.com.
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There's another approach that goes underappreciated, I think -- the "model line" or "model cell" approach. It has nothing to do with fashion models. I don't like the term "cell" because it might make people think of a prison or a gulag. Then again, the word "line" might make people think of "assembly line medicine" in a negative way. Maybe "model area" is a better term? I'll think about that as I work on the updated 3rd edition of my book Lean Hospitals.
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http://leanblog.org/audio74
In this post, I'll be presenting a parody video of Keith Olbermann's "worst persons in the sports world" videos.I don't know how much overlap there is in people who read my blog and people who are fans of Olbermann. I've always been a big fan of Olbermann the sports guy... Olbermann the political commentator not so much. But, "the worst persons in the world" is a bit that he's done on MSNBC and ESPN.
In this video, I'm playing a character... a parody you might call Keith Olber-Lean. I'll be taking some shots at people... naming names as the tongue-in-cheek "worst persons in the Lean world."
This video might seem mean spirited. I'm not normally this mean spirited on my blog, although I've made comments about these issues and people before (worse, worser, and worst).
Olbermann often seems mean spirited. But, he's entertaining and usually makes a serious point through humor. I'll try to do the same here. The serious points I'm making are:
Lean leaders and consultants should be humble... that'sthe Toyota style Lean office initiatives should solve real problems that matter for customers and employees (not create situations like this) It's factually untrue to say that Lean is only about speed and that Six Sigma is the only method for Quality. Lean is about both quality and flow (read more)
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I'm sure anybody who has done any work with Lean has heard these words said in one form or another, often prefaced with a "You don't understand..."We're different.
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What did I learn about learning to eat sushi and incremental Kaizen (change for the better) during my 2014 Lean Healthcare Study Trip to Japan? Listen to find out... and learn more about our upcoming Japan trip at http://www.japanleantrip.com.
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http://leanblog.org/audio71
Episode #403 of the public radio program "This American Life" originally aired in 2010, telling the story of the NUMMI plant that was a joint venture between GM and Toyota (it's now where they build Teslas). As a joint venture, that meant the closed-down GM Fremont plant was re-opened to be managed under the Toyota Production System.The This American Life story asks why GM didn't learn more of the lessons from NUMMI. Well, GM did learn many lessons, but it wasn't enough to save the company from bankruptcy (going from 50% market share to just over 20% will do that, regardless of how Lean your factories are, when you have moreretirees than active employees).
The story re-aired on NPR stations last weekend, which I learned of when many of you emailed me or tweeted at me about the program... and even some of my personal Facebook friends who don't share my passion for Lean shared the link with me.
What makes it a throwback, in a way, is that I first blogged about the episode in 2010 in this post: NPR on the "End of the Line" at NUMMI and My Story About an Interviewee.
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http://leanblog.org/audio70
How did a few episodes of HBO's "Silicon Valley" make Mark Graban think about continuous improvement and the need to avoid a "culture of fear" in an organization?
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How can the NHS reduce waiting times without throwing money at the problem? Are they using Lean to increase capacity and throughput in a way that also improves quality? The recipe is "reduce waste."There's usually the need to improve three things in any industry:
Quality Cost Speed
Traditionally, people would say you can get it "good and cheap but not fast" or some combination of just two of those things. Lean healthcare helps show that we can improve in all three dimensions simultaneously. We need "better, faster, cheaper" healthcare around the world and we need to go about it right way - improving systems rather than just cutting costs in a way that slows care or hurts quality.
Big challenges, global challenges.
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http://leanblog.org/audio68
Before I head out on vacation, here is a reader question that I am sharing for your input.I'm sharing this with permission and I'm obscuring a few details at their request.Please read and leave a comment below the post. My approval of comments might be a bit slow after Tuesday evening as I start to travel.
The Question:
I thought I'd get in touch. I have genuinely listened to every podcast you have on your site. They're brilliant, and I'm very grateful for the time you put into making them.
I'm getting in touch because I'm faced with a question I've never heard tackled anywhere. As the most accessible lean expert I know of, I thought I'd come to you.
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http://leanblog.org/audio67
My wife and I are getting ready to leave tomorrow night for a two week vacation, so it jogged my memory about this story I saw back in December in the WSJ: Airlines Try to Make Coach Classier. Anything that makes long flights more bearable is good news to me.One detail that caught my attention in the WSJ article was this:
"Etihad is rolling out new economy features taken from business and first class. There's nighttime turndown service--flight attendants put the window shade down, put a blanket over the passenger and offer hot chocolate or camomile tea.
There's a new coach amenity kit coming, with a sleep mask that's green on one side if you want someone to wake you up for breakfast and red on the other if you want to sleep as long as possible. The amenity kit doubles as a storage pouch for eyeglasses and stray pocket items you don't want to sleep on."
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http://leanblog.org/audio66
I'm a big nerd in that I love reading newspapers basically cover to cover. I'm a nerd in many ways, I guess. You don't have to be a survey nerd to take my short reader survey (and you might win a book!).I was a pretty unusual child, reading the entire Detroit Free Press every morning before school. I was a news nerd then. I wanted to be a sportswriter, since the father of one of my best friends from elementary school got to travel with the Detroit Tigers as a "beat writer." I am still a pretty big consumer of newspapers, often in print form (although I read the WSJ on my iPad).
Recently, I was perusing the San Antonio paper (cover to cover) and even glanced at the "Hints from Heloise" column that was traditionally aimed at housewives (that seems like an outdated sexist way of saying it, but that's the history of the column).
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http://leanblog.org/audio65
The Wall St Journal loves writing about how "Just In Time" (JIT) is a risky inventory strategy. See my past posts about how the WSJ is so often wrong on this.The WSJ seem to only understand Lean as JIT, as opposed to seeing Lean as a broader methodology and management system. JIT is just one component of the Toyota Production System (built-in quality being the other). See Toyota's website for info straight from the source.
Whenever there is a highly unusual event, like the Japanese earthquake and tsunami, the WSJ will say "see, just in time doesn't work." Well, keeping a lot of inventory stored in a warehouse isn't a good strategy if an earthquake or tornado hits the warehouse.
The Stanley Cup Was Late!
Even though I'm a Detroit Red Wings fan,I can say congrats to the Chicago Blackhawks for winning the Stanley Cup Finals in the NHL. Chicago was ahead in the series meaning they were in a position to put the series away last Monday night, playing at home.
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http://leanblog.org/audio64
When I teach about Kaizen and continuous improvement, I try to use scenarios and cases to help people think through how they would respond to, coach, and collaborate on employee ideas.One key point is that leaders have to thank employees for pointing out problems or opportunities for improvement. They need to do so even if they think the idea or proposed solution isn't ideal or might not work.
Here is a "Kaizen card" that I usually show in my training and coaching sessions, areal scenario:
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http://leanblog.org/audio63
I've been intrigued by the "Lean Startup" movement since I first saw Eric Ries speak at MIT back in late 2009. I've read his book The Lean Startup, have attended a bunch of the conferences (speaking at two of them - see video of one). I've interviewed Eric on my podcast series (listen here and here).There's a lot to learn and apply in life and at KaiNexus. I'm by no means an expert in Lean Startup approaches... but at the core, Lean is Lean. Eric gives credit to Taiichi Ohno in his book (and listen to us discuss that here).
I'm excited to have been named a "faculty member" to help plan thisyear's Lean Startup Conference, to be held in San Francisco this November. My role is to help identify and recruit speakers to talk about "traditional Lean" -- the universal Lean philosophies and management practices that apply in factories, healthcare, startups, etc. Sort of like what John Shook talked about last year. So, I hope to see you there!
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http://leanblog.org/audio62
Last week was an amazing week of learning and networking. I was in Dallas for the Lean Healthcare Transformation Summit (as I wrote about). As I mentioned yesterday, it was also my wife's five year reunion from her MIT master's program. As I also mentioned, I nerded out and sat in on a number of lectures that were part of the weekend.I'll also blog later about Steve Spear's lecture (you likely know him from the Lean community), but I also really enjoyed a lecture by MIT professor Zeynep Ton, from the Sloan School of Management (she's formerly of HBS... and also an industrial engineer, like me).
Prof. Ton gave an engaging lecture on her book The Good Jobs Strategy: How the Smartest Companies Invest in Employees to Lower Costs and Boost Profits. I had heard of the book but hadn't yet gotten to the Kindle sample that I downloaded, yet alone the full book. The Kindle version is only $5.99, by the way, or it's free if you have a "Kindle Unlimited" membership.
I've finally read the book and I highly recommend it.
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http://leanblog.org/audio61
My wife and I were in Boston over the weekend, as it was her fifth reunion from her MIT master’s program. I’m also an alum, but was considered a “guest” since I graduated 16 years ago from my program and you don’t have to have an MIT degree to know 16 divided by 5 is not an integer.
Being MIT, the reunion wasn’t just about parties (and it’s not a homecoming weekend with a football game, as my Northwestern 20th reunion will be this fall). The reunion was also full of lectures by alumni and notable faculty. I’ll be blogging soon about lectures by MIT Sloan professors Steve Spear (check out my podcasts with him) and Zeynep Ton (I’m reading her book The Good Jobs Strategy now and hope she’ll be a podcast guest too).
A few things caught my eye on the Boston Herald and Boston Globe on Saturday.
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At this year's Lean Healthcare Transformation Summit (see my summary here) Dr. John Toussaint talked about and introduced his newly released book Management on the Mend, a follow up to 2010's On the Mend. Summit attendees received a copy of the book, so they're the first to have a chance to read this important work.
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In American healthcare, there's a growing gap between hospitals and clinics that are being innovative and those who are stuck in the "way it's always been done" mode. For example, innovative primary care clinics are using a combination of better processes and better technology to deliver a patient experience that I wish I could experience.
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Jack Dorsey is well known among tech circles, as a co-founder of Twitter (he's @Jack) and, now, as the CEO of Square. I'm a frequent Twitter user (I'm @MarkGraban) and I also utilize the Square reader occasionally to sell a book to somebody. I appreciate being able to easily and inexpensively accept a credit card here and there.This interview on the public radio program Marketplace caught my eye (I mean, ear):
Jack Dorsey: Twitter co-founder, Square CEO, punk
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Don Davis, former CEO of Stanley Works, passed away in 2010 and left an unfinished book in progress. One of my friends (and former colleagues from Dell in the late '90s), Steve Cook and a number of other alumni completed the book, working with Don's daughter Ruthie Davis (of the eponymous shoe company).The book is Do the Right Thing: Real Life Stories of Leaders Facing Tough Choices.
Do the Right Thing highlights Don's "leadership mantras" and real-life stories from alumni who leaned upon these mantras to make tough decisions in their careers.
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It's not uncommon to hear statements thrown around about Lean that are more of a myth than anything resembling reality.I remember the time a professor told a group that if Toyota ran a health clinic, a buzzer would go off at the end of the planned appointment time and the patient would be kicked out of the room. That's ridiculous. That's a myth (and it's not one of the widely spoken myths).
A Lean myth might be an example of L.A.M.E. or "Lean As Mistakenly Explained."
This post addresses other myths, including the idea that "Lean is not patient centered."
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I love to cook and I"m the primary chef in my home. I often get asked a question - sometimes it’s serious and sometimes it’s smart-alecky - “Do you 5S your kitchen?” If by that, they mean, “Do you label the outside of your cabinets and put tape outlines around everything?” then the answer is no. And I’m not sure why anybody would want to… but if doing so makes your life easier, then great - that’s what Lean is all about, solving problems and being more effective.
I do, however, try to apply Lean principles in our kitchen. I can’t help it....
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Here's my latest post for LinkedIn through their "Influencers" series. It might be old hat to readers of this blog, but I hope what I shared is useful for a wider audience that I have there.10 Key Lean Mindsets for Factories, Hospitals, Startups, and More
http://leanblog.org/audio54
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http://leanblog.org/audio53
In my first post about the on-site Kaizen learning experience at Franciscan St. Francis Health, an event I came to call "Kaizen Live," I wrote about some of the initial presentations and discussions from Franciscan leaders. You can also see my tweets from the days.A big part of the 1.5-day event was the three "gemba visits" that took place. Each attendee had the chance to visit pharmacy, endoscopy, and the NICU. I had visited all three departments before (when we shot this series of videos last October) and I focused this time on the NICU, going there all three times. Why did I go three times? Some of it was logistics, as I was the person responsible for getting each group there and I don't know my way around the hospital that well. It was easier to learn one path - how to get to the NICU and back.
Since my last visit in October 2014, the NICU movedinto a new physical space (in November). The old unit was the traditional NICU of days past - a big open room with curtains that divided the space for each infant incubator, but didn't provide too much privacy. The new, modern NICU was built with private rooms with sliding glass doors - providing more quiet and privacy than before.
While the NICU team had implemented hundreds of Kaizens in previous years, the chance to design a brand new space was a rare opportunity for radical Kaizen, or what might be called "Kaikaku." Since it's difficult to continuously improve many elements of a physicallayout (such as the location of walls), the team experimented with full-size Styrofoam mockups of the space. Staff and parents were able to give input at a stage when you could still Adjust easily in the PDSA model of Plan, Do, Study, Adjust.
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http://leanblog.org/audio52
There's been a back and forth of views about the state of pediatric emergency medicine recently in the Wall St Journal.Let me start first, actually, with the more recent statement, a rebuttal from Michael Gerardi M.D., FACEP, President of the American College of Emergency Physicians, in the form of a letter to the editor.
He wrote:
"Emergency care of children in the U.S. is the best in the world. Emergency physicians treat more than 22 million sick and injured children under age 15 each year, and the vast majority of them have good outcomes. If a child has a medical emergency, parents should get that child to the nearest emergency room and have confidence that they are receiving top-quality care in the right place from the right physicians."
It's "the best in the world." Is that an opinion? Where is the data to back that up?
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Following up on yesterday's post on seemingly successful experiments with ACOs, here's another article, from HBR, on "safety huddles" in healthcare:"How Every Hospital Should Start the Day"
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You might be considered "wonky" for enjoying the topics discussed here at LeanBlog.org... but that's fine. This is a safe environment for being wonky about Lean and improvement.From Vox.com, Sarah Kliff normally does a great job covering healthcare topics, including this latest piece:
"This small, wonky Obamacare program saved $384 million over 2 years"
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http://leanblog.org/audio49
I was quoted in two articles that appeared in "Today's Hospitalist":"Discharging Mr. Wood: Time to get serious about waste" and "Standardized work: Improving quality by reducing practice variation." Reducing Waste
The author, David A. Frenz, MD, points out that it's a "collective delusion" that the U.S. spending so much more on healthcare leads to safer or higherquality care.
People are waking up to the fact that there is too much waste in healthcare. We have poorly designed systems and processes -- it's not the fault of individuals, nor is the waste due to a lack of clinical expertise or a lack of technology.
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http://leanblog.org/audio48
On April 22 and 23, I collaborated with Joe Swartz and a countless number of his colleagues to host 24 visitors from different health systems (and an Indiana state government organization) to learn about the "Kaizen" approach to continuous improvement first hand at Joe's health system - Franciscan St. Francis Health in Indianapolis.I tend to "take notes" these days via Twitter and you can read all of my tweets and quotes if you like. Here are a few highlights, incorporating some of these tweets, as appropriate....
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http://leanblog.org/audio47
One of the many things I admire about W. Edwards Deming is how hard he worked into his 90s. He must have had "pride and joy" in his own work.I learned from this IndustryWeek piece that Dr. Deming was teaching seminars up until two weeks before his death at age 93.
IndustryWeek was kind enough to share Dr. Deming's last interview, originally published in January 1994, on their website in three parts....
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Chris Van Gorder, CEO of Scripps Health in California, wrote this article in HBR back in January: "A No-Layoffs Policy Can Work, Even in an Unpredictable Economy."
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Forgive me for being a bit of an Industrial Engineering geek here in this post. After all, my bachelor's degree is in Industrial Engineering, even though I sometimes get called "a healthcare guy" after focusing on healthcare for just about ten years now.One of the things we learned about in our IE organizational psychology class was something called "the Hawthorne Effect."
In the past few months, I can recall maybe three different occasions where somebody referred to the Hawthorne Effect in a positive light, as in:
"We'll have to see if the data improves, maybe we'll get the Hawthorne Effect."
People have meant this in a positive light in the context of the flow of the conversations. I remember somebody almost bragging that the improvement in an area was due to the Hawthorne Effect.
I cringed... that's not really anything to hope for.
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Dr. W. Edwards Deming advised against relying on slogans and posters as a way of trying to improve quality.Point 10 of his famed 14 points said:
Eliminate slogans, exhortations, and targets for the work force asking for zero defects and new levels of productivity. Such exhortations only create adversarial relationships, as the bulk of the causes of low quality and low productivity belong to the systemand thus lie beyond the power of the work force.
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http://leanblog.org/audio43
You might know my friend Karl Wadensten, the president of VIBCO, a small manufacturer in Rhode Island. I've interviewed him for episode #84 of my podcast series (which was also episode #10 of my video podcast series).I've had a chance to visit his factory a few times (mostly in the 2009-2011 timeframe). Each time, I've been impressed with the visible employee enthusiasm for improvement and the way VIBCO has used Lean to meet business objectives of better customer service and performance. Then, and over time, I've been impressed with Karl's transformation into a Lean leader.
Beyond VIBCO, Karl has been a tireless proponent of Lean for the state of Rhode Island.
These efforts have led to Governor Gina M. Raimondo supporting Lean and signing an executive order that will mandate the use of Lean principlesand methods in state government.
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have been going through some old papers recently and I found two sheets of paper with hand-written thoughts or "truisms" that I had scribbled down in early 2002. The word truism, it turns out, doesn't mean "true" so much as it means "a statement that is obviously true and says nothing new or interesting." Oops.This was a list of things I had learned after two years at GM, two years at MIT, two years at Dell Computer, and just over a year at a startup.
These aren't all original thoughts, by any means, but I had written them down when I was in between jobs (the startup had a real cash crunch after 9/11).If Twitter had existed, I might have tweeted many of the thoughts on that paper. Not all of them are under 140 characters, but here some of the things on that sheet from 13 years ago.
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http://leanblog.org/audio41'
I hope you might have access to this interesting article from the Wall St. Journal: "Toyota Veteran Rises to Corporate Office From Factory Floor." I was able to access it while logged out from my WSJ account.Mitsuru Kawai, pictured, started working at Toyota in 1963, at age 15. After 52 years of employment, Kawai is going to be in the position of senior managing officer, "the highest position ever held by a blue-collar worker in Toyota's eight decades," per the WSJ.
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http://leanblog.org/audio40
Every time I am in a hospital or clinic setting, one of the first things I do is get a pump or squirt of gel or foam from a wall-mounted dispenser to clean my hands.Or, I should say try to get hand sanitizer. For one, it's important to practice proper hand hygiene when entering or leaving a unit, for my sake and the patients (and to practice what I preach, a secondary concern). Secondly, I'm testing to see if the hospital's support processes work well - isthe dispenser actually not empty?
It's usually not difficult at all to find an empty gel or foam dispenser on the wall. Sometimes, the first one I try is empty (as are others). Sometimes, I have to try a few... but there's almost always an empty one.
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http://leanblog.org/audio39
Joe Swartz and I have been planning the first-ever workshop (a conference of sorts) where people can come see what a Kaizen culture, or a culture of continuous improvement, looks like at his health system, Franciscan St. Francis Health in Indianapolis.It's designed to be a small event. We have ten people registered right now, with a few more committed, and we have space for up to 25 people total. You can still sign up and attend on April 22 (full day) and April 23 (half day). Learn more at http://leanblog.org/audio39.
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http://leanblog.org/audio38
When people ask me why I do what I do, my first answers are:improving patient safetycreating better workplaces for people It's as simple as that. Those are the important problems that I'm passionate about (and have been able to help fix, at least in some local situations). At a more global scale, too many patients are hurt or killed by preventable medicalerrors. Too many people end up hating their jobs or going home crying or exhausted at the end of the day. That needs to change.
In my 20-year career, in manufacturing and in healthcare, Lean has been a powerful and effective methodology for meeting those goals, along with improving quality, reducing waiting times (for products or for care), and reducing cost.
But, not always.
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Last Monday, I had the chance to attend a Lean Startup event in Austin where Eric Ries announced the launch of a Kickstarter project for a new book. 10 days ago isn't much of a "throwback," but bear with me.He was asked a question from the audience: "Do you wish you had used a different name than Lean Startup to resonate more broadly?"
Before we get to Eric's answer, I thought back to me asking Jim Womack that same question about the term "Lean." When I worked for LEI back in 2009, I asked Jim casually and he said basically, "It's just a word" or something like that.
But, I got a longer response to this question from Jim back in Podcast #118, in 2011 (which makes it more of a real throwback now).
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http://leanblog.org/audio36
When we introduce the idea of Lean to healthcare organizations, it's very common for somebody (often a senior physician) to say something like,"But we don't want assembly line medicine."
The implication is that assembly lines and factories are cold, rigid, uncaring places that focus on ruthless efficiency and making the numbers at the expense of safety and quality. Do a Google search for the term and the implications of "assembly line medicine" are very negative.
It's also a bit of a "red herring" (or is it a "straw man") for them to bring up assembly lines when we're in agreement (I hope) that our goals are to improve safety, quality, waiting times, cost, and staff morale.
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Today's Throwback Thursday is a look back at a 1993 book that I purchased in 2011 on somebody's recommendation. It was probably one of those used books you can buy for a penny on Amazon... Creating the New American Hospital: A Time for Greatness. It's indeed available for a penny today.I had flipped through the book at the time as it was interesting to me to get more context on how hospitals are not just suddenly in crisis (financial or otherwise) in recent years.
Book-NAHChapter 1 of the book is titled "Why Hospitals Fail." The author says, "Clearly, something isn't working."
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http://leanblog.org/audio34
OK, so it’s not the kind of scientific research that involves lab coats and microscopes, but I’m doing some research that I’d like your help with.
I’m looking to do some research and some interviews for writing projects related to two different topics: Understanding Variation and Reducing Blame.
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Back in 2002, when I worked for a software startup called Factory Logic, I was able to sit in on some Lean training that was created and presented by a large electronics manufacturer that will remain unnamed (and it wasn't Dell). The class was for that company's suppliers, primarily...
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http://leanblog.org/audio32
This week is the annual Patient Safety Awareness Week, presented by the National Patient Safety Foundation, a non-profit that I like and support. As Lean thinkers, I hope we'd recognize that the amount of patient harm and death that's caused by preventable medical errors is a huge problem around the world.When we ask "why is there so much harm?" there are many answers - causes and root causes. There's no simple answer to the question of why so much harm occurs and why, sometimes, it seems like not enough progress is being made. One contributing factor, I think, is the lack of public awareness aboutthis problem and the scale of it...
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One of the two main pillars of the Toyota Way management system is "respect for people." I've blogged about that often over the past ten years, including this post.Lean provides a philosophy and a management model that should be nothing but good for staff and patients. The idea of "respect for people" might sound nice in principle, but what does it mean in a practical sense.
Respect for people can be illustrated in these ten ways, and more:
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As often happens, I have too many open browser tabs full of articles that I was going to potentially blog about. Too much WIP (a problem that Jim Benson will discuss in our upcoming Boston workshop).So, it’s time for me to clear out my backlog and to share some articles I’ve been reading with some quick notes, instead of full blog posts. Well, I got my backlog down by three. I’ll try again next week with some shorter blurbs about more articles, perhaps.
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http://leanblog.org/audio29
Some of you might know that I'm on the board of a Texas-based non profit, the Louise H. Batz Patient Safety Foundation. It's an important organization that helps patients, family members, and hospitals work together in the name of better care and safer care.One of the ways the Foundation helps is their publication "The Batz Guide for Bedside Advocacy." You can get a free PDF version or get a free iPad app version that does even more than a book can. Or, another option is to buy a paperback version via Amazon, which basically just covers costs and shipping.
The Foundation gives away a lot of Guides, but I think that the ROI of a hospital or employer purchasing Guides would be overwhelmingly positive (in addition to the core human benefits of protecting people and saving lives). More on that later in the post.
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This article caught my attention the other day, primarily because I like scotch, whisky (and whiskey and bourbon). The Japanese love scotch whisky and have long produced a product that's a variation of scotch -- Japanese whisky (the lack of a standardized spelling for whiskey is an endless debate). I'll settle on "whisky."The article: Japanese Whisky Got a Lot of Hype, But Can One Bottle Really Be the Best?
Now, you might not care about "the brownest of the brown liquors" (Simpsons reference), but there's an interesting detail in the article about the Kaizen mindset of continuous improvement.
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Here's another video in the series that Joe Swartz and I shot at Franciscan St. Francis Health back in October. See them all here or via a YouTube playlist.You might remember pharmacy manager Ronda Freije from two previous videos.
Here, she talks about a concept called "Seven Days' Grace." It's a concept that Joe Swartz and I wrote about in Healthcare Kaizen using stories from Franciscan (see excerpts via Google Books).
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Today's post is hosted over at LinkedIn, as part of my participation in the LinkedIn Influencers series.The post is titled: "The One Thing Google Should Show When You Search for a Hospital."
It's not about Lean per se, but it's about topics that I hope we'd agree are relevant:
Transparency of quality and patient safety data Making that data easily available and understandable by patients Using that data to hopefully make better decisions about where we get care Hoping that data, transparency, and choice puts positive pressure on every health system to get better.
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http://leanblog.org/audio25
In yesterday's blog post ("Safety is always our top priority" - From lip service to daily practice?"), I challenged hospital leaders to back up the "happy talk" with real action and stories about putting safety first. It's easier said than done.I wanted to share a story from Karen Kiel-Rosser, Vice President/Quality Improvement Officer, at Mary Greeley Medical Center in Iowa. MGMC is a KaiNexus customer, they've recently received the "Gold" level recognition in the state Baldrige process, and she's an upcoming podcast guest (to talk about Baldrige).
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http://leanblog.org/audio24
It's really easy to make statements like "patient safety is our top priority." That same statement can be applied to hospital staff, as well.Or, it should.
But the "happy talk" (as Pascal Dennis calls it) isn't always followed up by action.
When a hospital executive makes the "safety is always our top priority" statement, is it REALLY true? Is that statement backed up by action and integrity or does it just sound good?
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"Accountability" is a word that's easy to throw around in an organization. It's often pretty meaningless (or not well understood). What does it really mean?
http://leanblog.org/audio23
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Recently, I've seen many examples where businesses don't pay attention to little details. When you see little things going wrong, it makes you wonder about the more important stuff. One example from healthcare might be this story from the Cleveland Clinic, where patients told the CEO that there were dust balls under the beds in patient rooms. Why don't staff notice these things? Why don't they have better standardized work for cleaning the patient rooms?What are some of the other problems that I've seen just in the past two weeks?
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It's a pretty common facilitation technique to do a "plus / delta" discussion at the end of a meeting, exercise, etc.In the plus column go the things that went well, were enjoyable, were helpful, and should repeated.
The "deltas" (which is meant to seem more positive than saying "minuses," I guess) are the things that could be improved upon. A "delta" is a gap between where you are and where you want to be.
After being in the doctor's office for just over an hour, nobody said "let's plus / delta your visit before you go." That never happens in a clinic setting. At best, you might get some sort of survey after the fact. But, the point of a good constructive "plus / delta" discussion is to give immediate feedback to those who might be able to make some improvements.
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I'm planning two different workshops in the coming months:Boston 3/31: "Successful Lean Teams" - Personal Kanban (with Jim Benson) and Kaizen Indianapolis 4/22-23: On-site Kaizen Workshop at Franciscan St. Francis Health System
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http://leanblog.org/audio19 This article caught my attention the other day: "Philly VA employees ask for golf shirts in suggestion box for improving veteran care." I hesitate to throw stones, but there are some very predictable dynamics involved here... and I will provide some ideas about a better approach and not just criticize.
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It's easy to point fingers at others who don't do what they know they're supposed to do. It's sometimes helpful to be reflective and introspective instead of just trying to figure others out...
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What is the "productivity paradox" as coined by Erik Brynjolfsson of MIT and is there also a "Kaizen paradox?"
http://leanblog.org/audio17
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I recently re-watched parts of a DVD I helped produce a few years back for the ThedaCare Center for Healthcare Value -- Thinking Lean at ThedaCare DVD: Strategy Deployment, Alignment&Leadership.In the video, ThedaCare's CEO, Dr. Dean Gruner, is talking about their "True North" objectives. First and foremost in that list is safety. We can include patient safety and provider/employee safety in that discussion.
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http://leanblog.org/audio15
I have lived in Boston two different times, but I'm hardly a New England Patriots fan. I realize they have been accused of cheating (the previous "Spygate" controversy where they violated league rules by videotaping the hand signals of opposition defensive coaches and the recent "deflategate" controversy).For an organization to be truly admirable, integrity has to come first. Integrity is non-negotiable. There are many questions about the Patriots...
But, there were a few things that jumped out at me in a Saturday WSJ article on the Patriots and head coach Bill Belichick: "Deflategate Masks the Many Virtues of Belichick."
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My wife and I were late to the wildly popular podcast "Serial," but we listened to the first six episodes while traveling over the holidays. I ran hot and cold on the serialized non-fiction story about a murder... it was somewhat interesting, but a bit drawn out. The show requires a lot of patience (and at least eight hours of listening).I wonder how many of you were hooked on Serial, as many of my friends seemed to be?
Saturday Night Live did a Christmas/Santa-themed parody of the show. That, and some free time after the holidays, inspired me to create a short Lean parody (no, I'm not doing an entire series).
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Here's look back at a post from 2011 that talks about some of the misunderstandings that are thrown around about Lean and Six Sigma, with some new content and an audio clip from a speaker who gets this very wrong.
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A look back at my visit to a Toyota plant in Japan, with a group of global healthcare leaders, in November 2014 (part 2 of episode 11 of this series). Topics include andon cords, proper breaks, and 5s (or is it 4s?).
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A look back at my visit to a Toyota plant in Japan, with a group of global healthcare leaders, in November 2014.
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It's sad and unfortunate when leaders SAY they want a culture of continuous improvement, but don't walk the walk.
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Working with a personal fitness trainer has helped me see parallels to what I do with Lean... how my clients maybe see the world and things that I can do better as a coach, trainer, mentor, and consultant.I don't often get to be on the "coachee" side of the coaching equation. When I work with other consultants, like Karen Martin, that gives me a chance to get coached -- receiving positive feedback and being challenged to improve. When I've used a speaking coach, Kathryn Partan, it's very helpful because I try to improve and I see how somebody else approaches coaching and client work.
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Continuing the“Throwback Thursday” theme for the 10th anniversary of my blog, today’s post looks back at and builds upon one of my favorites from 2007. The post is a “GM War Story” from 1995 when I was just starting my career:
“GM Got Gamed (Or, How to Fudge Your Production Numbers)”
You can hearthat in episode 1 of this podcast - http://www.leanblog.org/audio1
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It seems to me that a strategy deployment process can be described as a series of hypotheses that are tested over time. Strategy deployment is a high-level annual PDSA cycle that contains embedded PDSA cycles of analysis, improvement, measurement, and adjustment.
http://leanblog.org/audio7
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A post from 1/13/15. Why are healthcare professionals afraid to speak up, in military medicine or other settings?
http://leanblog.org/audio6
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A post from 1/12/15, looking at how the two teams in the College Football Playoff championship game are doing some things differently than the way things have always been done.
http://leanblog.org/audio5
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A post from 2007... I was thinking back to some first-hand experience I had when I started my career at a GM engine plant, circa 1995. It’s the most blatant example of someone intentionally distorting data that I’ve ever seen… but it’s totally understandable. I blame the senior leaders, not the front-line supervisor in this case...,
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Looking back at two slides Mark used about 10 years when introducing Lean to healthcare executives
http://leanblog.org/audio3
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Mark describes some key points from the book "Four Days With Dr. Deming." Learn more at http://www.leanblog.org/audio2
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This post is about the small difference that led a nurse supervisor and her team to go from "no ideas" to having lots of ideas. Visit http://www.leanblog.org/audio1 to read the original article
http://www.leanblog.org/audio1
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