Tuesday, March 22, 2016

Ohno's Circle and Gemba Walks

While Mark Graban and I were at the recent TVMA Convention and Expo presenting our Lean lecture a couple of weeks ago, a veterinarian came up to us and said that he routinely schedules each of his staff to spend 30 minutes several times each week to just observe procedures and flows around the hospital. In Lean terms, these are called a “gemba walks.” We, of course, think this is a great idea, and it reminded me of the story of Taiichi Ohno and his chalk circle (Ohno’s circle).

Taiichi Ohno was an engineer at Toyota in the 50s. He is considered to be one of “The Fathers of TPS” (Toyota Production System). The story says that when a new engineer was assigned to him for mentoring, he would take the individual to the shop floor (gemba), draw a four foot circle on the floor, near one of the processes of the production line, and “ask” him to stand inside the circle and observe for any improvements he could find. With no other instructions, Mr. Ohno would leave. 

After several hours, he would return and ask the young engineer what he had observed. If Ohno was not satisfied with the response, he would again “ask” that the trainee remain in the circle and continue to observe, and, again, leave for several hours. Evidently, some of these “students” spent as much as an entire eight hour shift standing in Ohno’s circle and considered it an honor to do so; to learn from the master. The improvement they suggested could be as small as moving the pneumatic wrench two inches to the right, so it would be easier, and faster, for the worker to do his job. Now, you know there have already been several hundred (or thousand!) iterations of kaizen when moving a tool two inch is the only improvement you can find!

What Ohno was trying to demonstrate to these young managers is quintessential Lean. It is not enough to just “look.” One must truly “see”; to deeply understand the process and how it affects the value stream, the greater systems, the customer and the worker at the gemba. Even more importantly, he was trying to instill into their “being” the process of how to think, to analyze, to pursue perfection through continuous improvement (kaizen).

Now, I think most of us here in the west would consider Ohno’s circle to border on the “cruel and unusual,” but I celebrate the veterinarian I talked to for his vision, understanding and the investment in the long term effects of assigning “gemba walks.” I hope he is also carving out time for himself and the other doctors to observe the work that occurs around them. I think we, as doctors, owners and practice managers, act like we know everything that is going on in our hospitals (our gembas), yet we know that isn't true. We just put off dealing with it, and the problems keep recurring. When was the last time we went into our “waiting room” and just observed what was really happening? Might we be surprised at what we saw?

The other thing that I hope is happening at this vet’s practice during these “walks” is that everyone is stretching their comfort zones. In other words, the surgery tech should spend some observation time at the exam room gemba, the receptionist should go to the surgery gemba, the kennel tech should go to the reception gemba, etc. 

After a few “walks”, I think it is important to schedule an additional period of group reflection (hansei). Did you discover something you weren't expecting? How did your idea(s) of how processes were occurring compare with reality? Did you find some opportunities for improvement (kaizen)? Were you able to see your value stream from your client’s point of view? How would your staff change things? Why? Use the Socratic method of teaching by asking questions, so everyone deeply understands, learns to think and create ideas for solutions.

“Gemba walks” are an easy, inexpensive, enlightening experiment into the Lean culture.  Schedule them at your gemba, and then be sure to share your experiences with the rest of us by adding a comment to this post.

Wednesday, March 16, 2016


Toyota has long been very generous in allowing other organizations serious about beginning a Lean initiative (even competitors!) access to their Toyota Production System, even to the point of mentoring these companies as they attempt to implement a Lean initiative. See how their TSSC group does this with suppliers and non-profit organizations.

However, Toyota has been very forthright in stressing that the TPS that works for them may not be the form of TPS that is right for others. They are very careful to help these companies find the particular form of TPS that will work best in that industry, organization and culture. The tools can be extrapolated, but the goals, processes and outcomes will be unique.

This brought to mind the use of industry benchmarks, especially for a practice that is embarking on the unique journey of Lean. Are they useful?  Should the performance of others set  the goals for a Lean veterinary initiative?  Should they represent the future state aims and goals? Could those benchmarks actually set limits to our own progress?

Every practice is different, with unique visions, talents, clientele, resources, floorplans, etc.  The tools and specific methods that work for one might not be right for another (but the philosophy is very transferrable). The goal to a Lean thinker is to be better tomorrow than you are today; to get closer and closer to perfection or your ideal state, not just an industry benchmark. Besides, with a culture and mindset of kaizen, a Lean practice will probably leave these benchmarks “in the dust.”

So, in my mind, it is more important to focus on your particular practice processes. Concentrate on closing the gap between your current state and future state using the PDCA / PDSA cycle (blog on PDCA/PDSA), kaizen and continuous improvement (blog on Kaizen).

Also, a Lean practice will come up with Key Performance Indicators (KPIs) and benchmarks that are unique to this mindset, such as Door-to-Doc time, Doc-to-Discharge time, # of kaizens submitted per staff member per month, # of kaizens completed, etc.

The competition (or the goal!) is not the hospital down the street, it is yourself. Strive not to emulate, but to innovate and experiment...and learn!  This takes effort, creativity, and persistence. If you can find that... the rest will take care of itself. 

Tuesday, March 8, 2016

Introducing Lean to the Texas Veterinary Medical Association Conference 2016

Mark Graban and I had the pleasure of presenting a two and a half hour lecture introduction to the Toyota Production System, Lean, entitled "What Veterinary Medicine Can (and Should) Learn From Toyota," at the 2016 TVMA Convention and Expo, held March 3-6 in San Marcos, Texas.

Although the convention was small, compared to regional and national conventions, and primarily a working meeting for the different TVMA committees, we had about 40-45 attendees. Everyone appeared truly interested and engaged. In fact, everyone returned to the lecture after the break, which was very good sign.

As mentioned, the lecture only lasted two and a half hours, which was a real task,  as the material to cover, even for a basic introduction to Lean, could have easily filled four hours or more. But, we got through all of the material with time left at the end for a short Q and A session.

Responses and feedback after the lecture were very positive, such as, "I wish my practice manager could have been here" and  "I wish I had this information years ago."  One practice owner caught me in the exhibits hall and said the information was "an epiphany. " Really, an epiphany?  Well, who am I to argue!  I felt the same way when I first discovered Lean, so I definitely understand.

The material presented included topics such as value, value streams, "pull" systems, kanban, Just in Time philosophy,  flow, visual management, and problem solving. The written notes published in the Proceedings totaled 16 pages and, in fact, form most of this blog's posts to date.

All and all, Mark and I were extremely pleased with this "experiment" of working together and introducing the Toyota Production System to veterinary medicine. Both of us have strong feelings concerning the positive effect Lean could have on our profession, and are ready, willing and able to teach more veterinarians and staff in the future.

Here is Mark's post about this at www.LeanBlog.org.