A C.O.W. Tale

Photo Source: http://www.flickr.com/photos/amosville/3165780788/

Does your hospital have a system to ensure nurses have working equipment or they know how to get them fixed?

I recently visited a hospital where the answer would be “NO”. 

Last week, a family member needed a day surgery procedure done at a local hospital.  There were signs in the prep/recovery room touting their move to electronic medical records and no longer needing paper charts.  The problem for the nurse was, the Computer On Wheels (C.O.W.) did not work.  The nurse was unable to access or update the electronic chart!

A second nurse came in during the morning before the procedure to try to troubleshoot the malfunctioning C.O.W.  It was decided to grab a C.O.W. from another room and use it instead.  I am not sure if other nurses had to search for the missing C.O.W. now that it has been moved into our room where it sat there for four hours.  A third nurse eventually pulled it away to put back where it belonged.

The first nurse came back in and tried to access the original C.O.W. in our room and commented “This still doesn’t work yet?”

I looked at the C.O.W. and there was no signage about how to troubleshoot or who to call.  I do not know if a nurse tried calling their helpdesk out of my view but it looked like nobody knew what to do with the broken computer.  It seemed like nobody knew who was to take charge in fixing it.  One can almost infer they expected it to magically fix itself!

Three nurses spent time reacting to faulty equipment that could have been better used providing care to patients.  Instead of spending their creativity solving patient issues, they use it creating workarounds.

Lean thinking can help hospitals put systems into place to ensure equipment always works.  Procedures can be created for what to do when something is broken and how to handle.  Make things visual so staff doesn’t have to rely on memory or look up procedures because instructions are attached to the item being used.

Helping remove waste and frustration from those giving care with make a better experience for those receiving care.

If you liked this post, then try:

• More Committed Than Ever
• Martyrs and Hidden Problems

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Lean Related Posts Roundup

Since my work banned access to twitter, it is not as easy to share great Lean related articles.  I will do this on my blog now!

• Failure vs. Mediocrity – Dan Pink has a great thought about the creeping disease of mediocrity.
• How To Scold Like A Kaizen Sensei – Jon Miller explains the heart of scolding, something that surprised me in the Birth Of Lean book.
• Lost In The Land Of Firefighting –  This short video shows how we can easily lose sight when putting out fires.  I think it also shows why gemba walks need to be done instead of those doing the work saying “I already know it because I do it everyday”.
• An Idea Is Not Always Enough – Jamie Flinchbaugh uses an Aesop fable to demonstrate the importance of taking action on an idea instead of just talking about it.
• Of 777s and Heart Rate Monitors – Mark Graban tells a story about a hospital death due to a heart monitor being turned off and illustrating the need for error-proofing.
• Who’s Most Responsible for KPO Development? The KPO! – Mark Hamel encourages KPO offices to have intellectual curiosity to the point of obsession to be able to develop itself.
• Mocking Boards – Mike Wroblewski’s post demonstrates the effects of making problem’s visible.
• What does it take to be a Lean Manager? – Tim McMahon gives some practical advice for what makes a Lean manager.
• Magical Street Graffiti – 35 Breathtaking Illusions!! – Not Lean but the artwork is amazing!

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Be Different

Youngme Moon is coming out with a book called DIFFERENT.  The attached 3 minute video (RSS readers may need to open post to view) gives a great visual overview of how businesses can be different.  The video was created by XPLANE, a company that I enjoy their visual communication.  The book looks like something the Lean community would enjoy.

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Presentation Secrets Of Steve Jobs

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more about “The Presentation Secrets Of Steve Jobs“, posted with vodpod

 

Steve Jobs has a reputation for being an outstanding presenter.  This slideshow from Carmine Gallo is inspired from the book of the same name which I have seen a lot of references to lately (RSS readers may need to open post to view). 

What tips do you have about presenting?

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Windows Of Frustration (part 1)

As someone who helps people improve their processes and quality for a living, being a consumer can sometimes drive me batty!  I think there will always be a need for the lean principles to be applied (although some companies do not recognize the need).  My wife and I recently purchased new windows for our whole house and have had cascading problems since. 

The sales person did a quote while we were at work and mailed it to us.  To understand what the windows he quoted were, we visited the showroom and the sales person showed us a double-hung window where both the top and bottom opened.  We advised we wanted the energy-efficient and gas-filled glass.  We pointed out the measurements on the quote weren’t correct so he was going to send someone out again and provide us with a more accurate quote. 

The updated quote came and the price was good so we agreed via telephone.

During the day of the first installation I stayed out of the way from the crew.  I popped out at one point to see one of the windows that was finished.  It was a single-hung window where the top did not open like I ordered! 

I called the salesperson who was very rude stating it was on the quote I agreed to.  I advised it was not the window my wife and I saw in the showroom.  He said that was just a demo of the window brand and we were not clear to him we wanted double-hung.  I asked where it said on the quote that it was single hung to alert me as a customer that I might not be getting what I expected.  He said next to each measurement is the code “SH” for single hung.  I advised him that as the window expert, I would have expected him to explain technical codes to me the consumer and asked why he would not have tried to up-sell me on the more expensive window anyways.  We eventually came to agreement to get the correct custom windows installed.  This was truly a test of my respect for people principle!

Besides the obvious upset customer (me!), there was a lot of waste for the sales/installation company and the manufacturer: 

• The installers have to send their crew out twice (you will find out it will be three times in part 2!). 
• The single-hung custom windows are now scrap cost to  the installer and/or manufacturer. 
• The time the salesperson spent fixing our problem took time away from him to generate new business for the installation company.

Potential counter-measures: 1) Train salespeople to ask customer’s the right kind of questions to ensure their needs are met prior to ordering.  2) Make quotes visual with descriptions with explicit explanations with no code so the customer can understand what they are agreeing to.  3) Don’t blame the customer when problems happen but own the issue.

I will share part 2 next week.  Any other wastes or counter-measures you see in this story?

My 2009 Hansei: Scarcity inspires creativity and innovation.  How can I help harness that inspiration?

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Brain Rules for Presenters (and Lean)

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I have not read John Medina’s book “Brain Rules” yet but this presentation from Garr Reynolds makes the book look fascinating (RSS readers may need to open post to view presentation).  If there is any trouble with the embedded video (sometimes SlideShare loads forever when I embed it), the original source is here.

Some elements really fit in with Lean thinking:

• The comments about instruction space sucking the brain power out of people is quite apt to consider if you are trying to create a learning organization. 
• The focus to minimize interruptions to gain quality is a form of waste to remove. 
• I love the phrase “going analog” because it does not have to rely on technology.
• Noticing where there is force feeding but little digestion makes me think of how respect for people is being practiced.
• “Pictures beat text” is a great clarion call to make the workplace more visual.

My 2009 Hansei: Scarcity inspires creativity and innovation.  How can I help harness that inspiration?

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more about “Brain Rules for Presenters“, posted with vodpod

Book Review: Kaizen Express

Kaizen Express: Fundamentals for Your Lean Journey by Toshiko Narusawa
My rating: 3 of 5 stars

Kaizen Express from the Lean Enterprise Institute is an interesting book. The book focuses on the basic fundamentals of Lean and should be interesting to anybody wanting to reflect more on the principles.

I really like the book’s drawings and its focus on how to implement things like standardized work, visual management, jidoka, flow, and others. I want to emphasize a strength of this book is these concepts are not just defined like a glossary or a single paragraph but have a few pages dedicated to exploring the thinking and practicalities to operationalizing them.

Some lessons that stand out are the definition of three kinds of muda, the idea of islands, auto-eject devices, “A type pull” and “B type pull”, visual management, and zone control. The forms at the back of the book were interesting to see how similar or different to what my organization uses.

I do have some criticisms of the book. The biggest issue I have about this book is the lack of PDCA mentioned. While I learned TPS and TQC were developed separately by Toyota, PDCA is usually bundled into all Lean materials at this point. For a book about the basic fundamentals, this seems like a glaring omission to me.

I also need to discuss that this book is written in Japanese on the left side of the page and English on the right. I do not have major problems with this but found it to be slightly distracting – especially when some of the page layouts are in the middle of the page. It is quaint to see the Japanese writing but I do not see this as value added to me.

Overall, this book has a lot of gems in it and I would recommend it. I see this as a very handy quick reference book.

Conflict of interest disclosure: I received this book from the publisher for review purposes.

If you liked this post, then try:

• My Past Book Reviews 

My 2009 Hansei: Scarcity inspires creativity and innovation.  How can I help harness that inspiration?

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Fun With Post-Its

We use Post Its a lot for teaching people how to improve processes and understand the current state.  I thought this 1.5 minute video was fun and creative (RSS viewers will need to open post to view video).  Thanks to the Visual Management Blog for alerting me about this video!

My 2009 Hansei: Scarcity inspires creativity and innovation.  How can I help harness that inspiration?

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Making Costs Visual For Customers

This weekend I went out for fish and chips and saw this fantastic sign.  The restaurant is very nicely helping their customers recognize the costs associated with taking excess inventoryof straws, tartar sauce, napkins, and other condiments.  I am not sure how much savings they have seen since posting this sign, but as a customer I was more aware of how much I was taking (I happen to be a ketsup maniac). 

Do you think this is a good way to help lower waste or is a sign like this is too much to ask customers?

If you liked this post, then try:

• Connect Actions To Cost 

My 2009 Hansei: Scarcity inspires creativity and innovation.  How can I help harness that inspiration?

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Lean Times Require Lean Thinking

Vodpod videos no longer available. Jason Yip & Paul Heaton created this outstanding SlideShare presentation “Lean Times Require Lean Thinking” (RSS readers might need to visit improvewithme.com to view).  I love the sketches throughout and really like the cartoon of 3 wastes.  The description of wastes are mostly hospital based which is nice to see.  The slide describing the difference between authority-based vs responsibility-based focus is a great reminder of the culture we are trying to create in Lean enterprises.

My 2009 Hansei: Scarcity inspires creativity and innovation.  How can I help harness that inspiration?

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more about “Lean Times Require Lean Thinking“, posted with vodpod

Free Visual Storytelling

I love comic books and they have played a huge part in helping me understand how to communicate visually.  This Saturday is Free Comic Book Day where you can explore this medium for free.  The comic book art form has evolved past superheros and many different kinds of stories will be available for you this weekend. Visit http://www.freecomicbookday.com/ to find your local store and to see what titles will be offered.

My 2009 Hansei: Scarcity inspires creativity and innovation.  How can I help harness that inspiration?

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Drawing: Treasure Map To Find Truth

Royce Willard said something via Twitter (@Rwilliard) a while ago that really stuck with me when I asked about executives at gemba.  He said “The truth is not in their office.”

I created this drawing to show places people try to find the treasure of truth instead of seeing where “X” marks the spot in gemba.

• Afar Land:  This is the office or conference room where people decide what the solution is without ever seeing the problem.  An Ivory Tower is too far removed from the reality.  Think of Hall ‘N Oats “You’re Out Of Touch”.
• Report Mountains: Taiichi Ohno states “Data is of course important in manufacturing, but I place the greatest emphasis on facts.”  Many people associate using the scientific method because they are driven by reports and graphs but miss out on the empirical aspect.  Reports only suggest facts/truths but they still need to be validated.
• Ear-ie Canal: When someone tells you about a problem, it is usually from a subjective perspective based on their interpretation of facts.  This method becomes increasingly unreliable the more it is passed around before it reaches you.  
• Past-Ville: Using “how it it used to be” as your basis for truth is dangerous because things may have changed since you last visited.
• Gemba Jungles: The truth is only found when you go and see the actual work being done.  Like a criminal investigator, gathering real-time evidence in the space of the crime will paint a more accurate picture of the situation.  The wild gemba jungles do not have the limitations of the other locations on the map.  The next time you need truth, take the direct route to the gemba jungles. 

If you liked this post, then try:

• Execs Need To Stop Solving Problems
• Debunking Myths Of Gemba
• Tips For Sketching

My 2009 Hansei: Scarcity inspires creativity and innovation.  How can I help harness that inspiration?

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A Song About Charts (really…seriously)

Dan Pink posted this 2 minute PBS Video aimed at kids to teach them about charts (RSS readers will need to open post to view).  Am I the only one who thinks this song is catchy?  Too bad they couldn’t think of something that rhymed with qualitative!

My 2009 Hansei: Scarcity inspires creativity and innovation.  How can I help harness that inspiration?

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Visual Thinking Tips – Basic Drawing, Nodes, and Storytelling

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An Introduction to Visual Thinking slideshare by Ryan Coleman offers great tips for communicating visually (RSS Readers will need to open post to view presentation).  It shows how to identify and label nodes in your drawing to make simple pictures more meaningful.  It also shows another visual way of explaining things using just shapes and words.

My 2009 Hansei: Scarcity inspires creativity and innovation.  How can I help harness that inspiration?

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more about “An Introduction to Visual Thinking“, posted with vodpod

What Is Great About This Guy’s Visuals?

Vodpod videos no longer available.Paddy Hirsch at Marketplace.org has a great video podcast where he uses a whiteboard to visually explain complex financial concepts.  I am sharing his latest about CRAMDOWNS (RSS viewers may need to open post to view).

more about “Cramdowns“, posted with vodpod

 

 

I have been diving in depth to learn and understand the power of communicating visually and firmly believe it is a key core competency for consulting.  Here are some things I think make Mr. Hirsch’s examples great:

1. He creates characters (subjects) to explain the concept.  It is not dry financial jargon, but you can see how things impact individuals and organizations.  This also clarifies the roles involved (the WHO).
2. He adds data and numbers to drawings.  The figures are not in another corner of the drawing but right next to the item/entity affected.  This adds relevant facts and helps the viewer understand the patterns better (the HOW MUCH/HOW MANY).
3. He creates common metaphors.  Linking an everyday item as an example of your concept is powerful and the viewers will remember for a long time.  People may forget the name of the concept but they will take away the understanding. 

What else do you think makes his presentation style great?

My 2009 Hansei: Scarcity inspires creativity and innovation.  How can I help harness that inspiration?

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more about “Cramdowns | Marketplace Whiteboard | …“, posted with vodpod