Tuesday, February 26, 2019

A Different Kind Of Rounds: Lean Daily Management

As doctors and veterinary staff, we are well acquainted with the daily ritual of morning or change of shift medical rounds. This is the gathering of hospital staff and doctors to be updated on the current status of all of the patients in the hospital for treatment, and for the dissemination of new treatment orders by the doctors in charge. This is a form of standardized work. It gets everyone on the same page in a routine and timely manner.

Lean Daily Management (LDM) serves the same purpose, but for the operations and management side of the practice.

Each morning, leadership and management go to the gemba to meet with staff of a particular area of the practice to go over that area's board. What numbers are up (and why?) and what numbers are down (and why?). Or, better yet, do the Process Behavior Charts (PBC) of the data show any "signals" or is it all just "noise?" (see also Mark Graban's book "Measures of Success") What countermeasures should be tried? Any new kaizen ideas? What, if anything, can management do to support the staff? Any evidence that standardized work is not being followed?

Sidebar: One of the two Process Behavior Charts above is showing two signals. Can you identify which chart it is and what the signals are?

LDM helps support our progress through that big PDSA cycle called hoshin kanri or strategy deployment. Remember, part of the Act (/Adjust) phase of a successful PDSA cycle is to sustain the results (for now), write new standardized work, scale up if appropriate, and start teaching to the new standard. This brings a new current state, and the next target condition is identified, initiating a new PDSA cycle of improvement.

In the figure above, the wheel has been moved up the ramp (improvement) through A3 thinking and kaizen. But, there are forces in any system that want to undo that which has been accomplished. Some call it entropy; I think of it as organizational gravity. The function of standardized work is to counter those evil forces by stabilizing and sustaining the new current state.

The role of LDM is to sustain and stabilize ("nail down") standardized work as it is currently written. LDM functions as a "checks and balance" for standardized work, which acts as a wedge to help prevent organizational backsliding. LDM is the setting aside of time on a daily basis to monitor for this potential.

So, to recap, standardized work sustains the current state, and LDM sustains the current standardized work.

Lean Daily Management meetings should take 10 to 20 minutes per day. They are typically done in the mornings, however, they need to be a scheduled, daily priority for all involved. Choose the time that’s best for your practice and team.

All extraneous interruptions should be put on hold for the entirety of the time. During the meeting, a staff member from the department or area of the practice, such as the Hospital Care team, quickly reviews the metrics, status of any countermeasures, new problems that have come up, any cross training efforts, new and ongoing kaizen, etc. with management. The staff member that leads the meeting should rotate from amongst the entire team, so that everyone gets the opportunity to lead the conversation and learn.

As is the Lean perspective, management takes on a teaching and mentoring capacity; asking questions to stimulate A3 thinking, encouraging all efforts and practicing servant leadership.

So, Lean Daily Management accomplishes several things:
1. Gets management to the places where work occurs (go to gemba)
2.  Facilitates conversation and consensus building with staff
3.  Demonstrates management's commitment to the staff
4.  Monitors the metrics that support the True North statement and KPIs
5.  Allows time to encourage and appreciate kaizen efforts
6.  Sustains and audits standardized work
7.  Creates increased engagement of the workers
8.  Show respect for workers

Thanks for stopping by. Comments, questions, and suggestions always welcome.

Also, to answer the sidebar questions, the bottom PBC is showing a signal that needs to be investigated. The first signal is the data point above the upper process limit.The second signal is three or four of the last four data being closer to one of the process limit lines than the average. In the case above, the last five data points are closer to the lower process limit line than the average. In fact, it appears that we may be trending around an entirely new, lower average, which indicates that the whole system has changed somehow. Both of these conditions should have been recognized earlier than now, if they weren't. The next step is root cause analysis and formation of countermeasures, i.e. PDSA problem solving.

Sunday, February 3, 2019

The Origins of Lean are Not All Japanese

Over the past few years, while discussing what Lean is with people, I have had one or two of them make comments to the effect that they weren’t interested in learning about anything coming from Japan (or any other foreign country!).

Now, while it is true that Lean did come from Toyota via the Toyota Production System (TPS) and Toyota developed this in Japan, much of what originally went into it came from the good ole' U.S. of A.

There were four primary entities from the United States that had an influence on and are responsible for a very large part of what came to be TPS. They are:

1. Henry Ford and Ford Motor Company
2. W. Edwards Deming 
3. Training Within Industry (TWI)
4. 1950s U.S. grocery stores

Henry Ford

The first influence came from Henry Ford's idea of the assembly line and mass production, allowing the increased manufacturing of identical products by several orders of magnitude. 

These concepts included highly standardized parts, which also allowed for the quick replacement of defective parts with identical replacements, which saved time. But, the mindset was still based on inspecting and repairing defects after the fact instead of preventing defects, as Toyota had already been focusing on. 

Not to mention that most of these defects weren't caught until the whole auto had been built, so sometimes it was just as easy to scrap the car altogether. 

But, what the heck! America was victorious after the war and had plenty of returning workers and plentiful resources. What’s a few thousand defective products and the time and labor to fix the situation? Japan was a defeated country with a scarcity of resources, which required them to be more creative.

Toyota, as well as the rest of the world learned from Ford as he started the mass production assembly line. However, they would tweak it quite a bit in the years to come. And, others would learn that Lean applies in environments that are not moving assembly lines.

W. Edwards Deming 

In recent years, a Toyota executive said:

"There is not a day I don’t think about what Dr. Deming meant to us. Deming is the core of our management.”

W. Edwards Deming was an engineer, mathematical physicist, and statistician during the twentieth century, becoming one of the greatest quality gurus of all time. In 1947, Dr. Deming was asked by the United States to go to Japan to help with the census during the post war restoration efforts. While he was there in that capacity, he gave a series of lectures on quality and process control to the Japanese Union of Scientists and Engineers. They eagerly incorporated his material into their thinking. The Deming Prize is still given out in Japan for examples of the highest quality organizations.

The PDSA (or PDCA) cycle is also known as the Shewhart cycle (or the Deming cycle)

From Dr. Deming, Japan and Toyota learned about building quality into the product at the gemba, the PDCA cycle and systems thinking.

Training Within Industries (TWI)

When the United States decided to enter World War II, most all able bodied men were ushered into military service. This left a large deficit in the workforce population, especially at a time when the military industrial complex was gearing up. In order to replace this workforce, women were recruited to fill these positions. Think of “Rosie the Riveter.”

The problem, of course, was that these new hires had little to no training in industry. Because the need was so immediate, the war department started the Training Within Industry (TWI) program.

Training Within Industry was a predominately volunteer program to help get new workers up to speed as quickly as possible. Many of the TWI trainers were loaned to the project by manufacturers, which continued to pay their salaries.

No manufacturing company was forced to utilize the TWI program. They had to request TWI help, and many did. There were also cases where TWI was used in healthcare.

There were four training programs offered at different times called the Jobs programs. These included the Jobs Instruction (JI) course, the Jobs Methods (JM) course, the Jobs Relations (JR) and, later, the Jobs Safety (JS) course. 

The program was very successful and contributed greatly to the United States being among the victors. When the war was over and the United States was helping to rebuild Japan, the TWI programs were exported. Manufacturers, including Toyota, enthusiastically incorporated the concepts into their own cultures. There is still a copy of an original TWI manual in the Toyota company museum. 

Once the war was over, the War Department ended the TWI program, the men returned to their jobs, the industrial revolution was on its way, resources were plentiful, manufacturers didn't see the need of TWI in their companies and interest in TWI dwindled to almost nothing. In recent years, however, there has been a renewed excitement in the old programs and methods.

The TWI Job Instruction (JI) course
This course was designed to teach supervisors how to teach new workers. These people knew their jobs well and had a lot of experience, but many didn't understand how to teach someone else. This course showed them how to dissect the job into its individual steps and provided them with a standard way of instructing on a step-by-step basis. This was the nidus for TPS's standardized work.

Training cards (as shown above and below) for each of the “J" courses were given to students to constantly refer to when dealing with their workers at their jobsite. This was necessary to protect the uniformity and integrity of the material throughout the project.

The TWI Job Methods (JM) course 

Job Methods taught how to improve the work being done. It was the impetus for kaizen or continuous improvement.

The TWI Job Relations (JR) course

The Job Relations course instructed supervisors how the deal with interpersonal relationships and conflicts. Toyota's commitment to the respect of workers and people came from this information.

These early concepts eventually evolved into Toyota's Improvement Kata and the Coaching  Kata. These are the standardized work of how managers and supervisors teach and mentor their direct reports.

1950s United States Grocery Stores 

Toyota executives who had come to the United States to observe and learn were intrigued by the way our grocery stores replenished their shelves at night with only those items that had sold that day. By the next morning, when the store reopened, the shelves were full for customers to purchase and the cycle repeated. 

Very little inventory was kept in the back of the store which cut down on costs to warehouse a large inventory and the capital tied up in that merchandise. All of this appealed to a small company in a small, recovering country. Just-In-Time thinking was born from this U.S. grocery store concept

While there is definitely an Eastern philosophical hue to the Toyota Production System, the roots of much of the mindset, especially what we would consider the major concepts, originated from the United States. But, keep in mind that Toyota is not the same as every Japanese company. They've worked hard to create a special culture -- they've been willing to learn from other countries. How about you?

Thank you for stopping by. Comments always welcome.