Monthly Archives: March 2008

Funny Video for Lean and Project Managers

This funny embedded video length is 0:59.  I have always heard about herding cats but I have never seen it like this!

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Blog Update: Updated RSS Feeds

I have changed my RSS feeds to Feedburner.  I apologize for any inconvenience this may cause.

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Physician View Of Standard Discharge Time

How good are we at practicing nemawashi when we set out to create a standard hospital discharge time?

I applaud Bob Wachter’s candid post Average Time of Discharge: Why a Hospital is Not a Hilton.  Here is an excerpt that really stood out to me: 

I’m also prioritizing my work – though the hospital undoubtedly wants me to see potentially discharge-able patients first, that violates the first rule of triage: see my sickest patients first. Until the cloning thing gets a bit more advanced, I can’t do both.

Lean implementors can easily “side” with the management side of the house since a lot of our directives birth from value stream planning.  Work with your value stream managers and process owners to uncover needs before you are in the middle of a kaizen workshop!  Use feedback like Bob’s to create a solution that will meet patient needs first while complementing the business needs.

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Kant Go To Gemba

“It is beyond a doubt that all our knowledge that begins with experience.” “Experience without theory is blind, but theory without experience is mere intellectual play.”  Immanuel Kant, German Philosopher, 1724-1804

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Remember To Add-On The Andon

How important do you think andon is?  I think it is extremely important.

Kaizen workshop teams usually build great standard work or reliable methods.  I see them eliminate waste, create detailed implementation communication schedules, and ensure the auditing plan will give something to measure in PDCA.  Andon is not always added.

Andon must be built into a new or updated process to make it sustain.  If there is no mechanism to stop and fix errors before they are passed to the next step, quality will suffer.  Waiting for the error to show up in the audit or a visual management system may be too late.

Workshop teams usually have tons of confidence their new process will be flawless because they thought it out thoroughly.  Challenge and remind them the importance of andon. 

I would like to recommend two articles:  Fixed Position Stop Systemby Jon Miller at Gemba Panta Rei and Parenting Tips from Toyotaby Craig Woll at Evolving Excellence

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Weigh-In Report Week 4

I lost 1.8 pounds this week.  My total loss is 11.4 pounds.  I am at 22% of my 53 pound goal!

Things that went well:  I think I have a habit now!  During the week, I keep exactly on my points without ever dipping into my 35 flex points.  I knew I was going to have a low point dinner this week so I was able to eat a donut at a meeting!  Yumm! 🙂

Things I can do better next time:  OK, I didn’t need the donut.  At least I didn’t go over my points for the day.  I am slacking on the 5 fruits and veggies and will get back on that.  Weekends are still an issue for me since I never keep my eating plans (at least I am making them).  I get too relaxed on weekends and then always dip into my 35 flex points.  Yeah they are there to be used BUT I would prefer not too.

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Disgruntled Employees In A Lean Hospital

Management loves Lean transformations, why don’t workers on the line?

I just read Jon Miller ‘s great post Improving Healthcare Delivery by Studying Toyota where he discusses the Seattle PI article To build a better hospital, Virginia Mason takes lessons from Toyota plants.  His article is fascinating and informative.

I found a gem in the Reader Comments for the article on the P.I. website.  Check them out and come back and read the rest of my post.  See any commenters from Virginia Mason who seem burned by Lean?  I saw quite a few.

While accepting change is ultimately up to the individual, I think Lean practitioners should do everything possible to help them with the process.  Management and Lean facilitators can easily write off a person who doesn’t embrace Lean as not being a team player.  We need take the harder path and communicate to people on their level.

  • Train your workshop teams to have two way communication when they implement improvements. 
  • Ensure the team engages the staff to understand their needs before they design the process(es). 
  • Help the team avoid being so dogmatic about their change(s) that they do not believe the CHECK step is needed from the PDCA cycle.
  • Work with the managers of openly Lean-hostile employees to reach common ground.
  • Always communicate (and practice) your organization’s “respect for people” pillar.

Some people will resist change no matter what you try.  Just don’t fall into the trap of writing someone off before you exhasted everything to communicate to people.

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Lean Articles

** Updated the links ** 

I am in a workshop this week so I wanted to share some articles I have enjoyed recently.

101 Kaizen Templates: Kaizen Newspaper by Jon Miller

  • Lean Topic:  KAIZEN – A visual way to involve people in giving improvement ideas to areas other than their immediate work area or job scope
  • Excerpt:  The only responsibility of a non-manager or non-team leader is to identify the problem and write it down on the kaizen newspaper, number it, identify the type of problem (safety, category of waste, etc.) and take a stab at a cause or root cause. The kaizen newspaper frees people from bringing the solution along with the problem and in that sense it is very different from the kaizen idea suggestion system. … The kaizen newspaper is a daily management tool and should be read and acted upon each day.

Lean Leadership In Healthcare White Paper by Richard Doss and Cameron Orr

  • Lean Topic:  GROW LEADERS – This 9-page paper suggests a focus on the leadership behaviors that are crucial for Lean to progress beyond limited pilot studies and get sustainable results.
  • Excerpt:  Take note of the statement there is “no such thing as organizational change, only personal change” (source unattributed). Lean Leadership in healthcare, as in any other industry, is dependent on the transformation and behavior of individuals. Training courses, culture change initiatives, rapid improvement teams, etc., will have only limited impact unless Lean leadership is developed on a one-to-one basis. The good news, however, is that behavior can change very quickly. Given the right support, the rest of the stakeholders will begin to mimic the Lean leadership behavior.

The Physician Culture and Resistance to Change, Part I by Richard L. Reece, MD

  • Lean Topic:  DEVELOP EXCEPTIONAL PEOPLE – Tips for understanding why physicians resist change and suggestions for handling them.
  • Excerpt from Part I:  To understand why physicians have resisted, you have to get inside their minds and skins. … These cultural characteristics may reflect a self-centered, narrow-minded, and shortsighted worldview. But these traits dominate many physicians’ minds and can’t be dismissed.
  • Excerpt from Part II: Certain specialists, including heart surgeons, cardiologists, orthopedic surgeons, general surgeons, neurosurgeons, and oncologists – the economic lifeblood of most hospitals – are accustomed to acting decisively in clinical matters. This decisiveness carries over into business affairs. … Physicians ask to be trusted to do the right thing, to be considered professionals, to be paid for productivity, and seek information systems that provide relevant information and speed patient flow.
  • Excerpt from Part IIIIn The Effective Executive (Harpers, 1956), Peter F. Drucker state leaders igniting fundamental change share these traits: They rely on courage rather than analysis to dictate their priorities.  They pick the future rather than the past. They focus on opportunity rather than problems.  They chose their own direction, rather than climbing on someone else’s bandwagon.  They aim high, for something that will make a difference, rather than something that is “safe” and easy to do.  They seek fundamental contributions to improve society.

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Weigh-In Report Week 3

I lost 2.4 pounds this week.  My total loss is 9.6 pounds.Things that went well:  I focused on eating 5 fruits and/or vegetables every day.  I didn’t get it done every day but I definitely increased my fruit and vegetable intake! 

Things I can do better next time:  I made a plan for the weekend, but I got caught up in the moment and went out to eat anyways.  I am thinking I shouldn’t plan on using my 35 flex points all in one day!  I also have a cold so I didn’t exercise as much as I wanted to.

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Celebrate John 3:16 This Palm Sunday!

I received an email update from Max Lucado reminding all of us to celebrate John 3:16 this Palm Sunday (3/16).  I am now passing on this reminder to all of my readers!

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Does Technology Pay For Itself?

I recently read Promises of Productivity Are Often BS by John C. Dvorak.  Many organizations turn to technology thinking they will save a lot of money.  I think he makes a lot of great points. 

I disagree with “No matter what the experts like to think, the office environment is not like the assembly line, where you can make genuine tweaks to productivity.”  As Lean practitioners, we can always find waste (Toyota still does!) and make improvements. 

I think technology can pay for itself after a Lean transformation.  Don’t Automate Bad Processes by Ralph Bernstein points out how important it is to standardize before adding technology. 

Ensure quality and error-proofing are designed into the process(s) prior to implementing automation to increase ROI.  Work with the technology designers to put in autonomation.  Maximize the technology investment by only using reliable and thoroughly tested automation.

Tell me what do you think?  Does technology pay for itself or should organizations only use minds and not money?

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How To Become Happier

I want to share one of my favorite passages as an inspiration for the week.  Our minds can go in many directions but the Bible does tell us how to think.  If we focus on these things, our happiness will grow.

Philippians 4:8-9 (MSG):  “Summing it all up, friends, I’d say you’ll do best by filling your minds and meditating on things

  • true
  • noble
  • reputable
  • authentic
  • compelling
  • gracious
  • the best, not the worst
  • the beautiful, not the ugly
  • things to praise, not things to curse  

Put into practice what you learned from me, what you heard and saw and realized. Do that, and God, who makes everything work together, will work you into his most excellent harmonies.”

Karthik Gurumurthy posted Law of Sowing and Reaping which has great advice for directing your mind in the way you want it.

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MMMM….TWIX

 Two for me by Soubrause

I am not too far into Weight Watchers yet where Paul’s picture here doesn’t entice me! Just one of these is 1/3 of what I am allowed!

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Weigh-In Report Week 2

I lost 1.8 pounds this week.  My total loss is 7.2 pounds.

Things that went well:  I ordered Girl Scout Thin Mint cookies before I started WW.  I looked at the box and 4 cookies are only 3 points!  Every day, I remove my 4 and break them up into smaller pieces so it feels like more.  I have been very good and stopping at the right time.  Just a couple months ago, I could have mindlessly eaten a whole tube of those cookies!

Things I can do better next time:  I love going out to eat on weekends.  During the workweek, I can manage easily since my desk and briefcase are stocked with all I need.  Open schedules and driving around to fun places on a weekend means I am not be as prepared for success as I could be.

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LEAN Online Resource

I have discovered a great blog that I recommend to all Lean practitioners. 

The blog is Gemba Panta Rei and I always find gems of information, insight, and inspiration.  Go and add this link to your Google Reader immediately!!  Here are some articles from Jon Miller to give you a taste of what you will find on this blog:

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