Monday, March 25, 2019

Training Within Industry: A Closer Look At the Job Instruction Course

With this post, I take a closer look at the Training Within Industry's Job Instruction course that I introduced in the post "The Origins of Lean Are Not All Japanese." One of the reasons, from a systems viewpoint, staff may not be performing well is inadequate training.

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 Lean standardized work.


Have a Time Table--
   how much skill you expect him to have, by what date.

Break down the job—
   list important steps.
   pick out the key points. (Safety is always a key point.)

Have everything ready—
   the right equipment, materials and supplies.

Have the workplace properly arranged—
   just as the worker will be expected to keep it.


Step  1—Prepare the worker
   Put him at ease.
   State the job and find out what he already knows about it.
   Get him interested in learning job.
   Place in correct position.

Step 2—Present the operation
   Tell, show and demonstrate one IMPORTANT STEP at a time.
   Stress each KEY POINT.
   Instruct clearly, completely and patiently, but no more than he can master.

Step 3—Try out performance
   Have him do the job—correct errors.
   Have him explain each KEY POINT to you as he does the job again.
   Make sure he understands.
   Continue until YOU know HE knows.

Step 4—Follow up
   Put him on his own.
   Designate to whom he goes for help.
   Encourage questions.
   Taper off extra coaching and close follow-up.

If the Worker Hasn't Learned,
The Instructor Hasn't Taught.

Below is an example of the Job Instruction method of teaching a new student how to clean an endotracheal tube after it has been used following our standardized work for the activity.

At this point, you can have the student go through the process another time or, if you feel confident of his ability, allow him to work independently. Be sure to praise him for his attentiveness, and give him permission to reconnect with you at any time for any additional assistance he may need.

As explained in the earlier post referenced above, the three TWI J-courses had a major influence on several of key concepts of the Toyota Production System, namely Standardized Work, respect for workers and continuous Improvement. But, true to Toyota’s character, they took that information, put their own “flavoring" on it, and developed what Mike Rother calls Toyota Kata.

Kata comes from  the world of oriental, martial arts. It means “form.” There are two primary kata; Improvement Kata and Coaching Kata. I will look at Toyota Kata in the next post.

Thanks for stoping by. If you enjoy and learn from this blog, please tell a friend or colleague. And, as always, comments always appreciated.

Tuesday, March 19, 2019

Great Scores For Kaizen At 2019 AVMA Veterinary Leadership Conference

This past January, Mark Graban and I had the honor and pleasure of speaking at the 2019 American Veterinary Medical Association's Veterinary Leadership Conference in Chicago. The title of the 90-minute lecture was The Lean Concept of Kaizen: Taking Your Practice To the Next Level...And the Next! The attendance was good.

I started the session with a brief introduction to the history of Lean, starting with Lean manufacturing through Lean management and Lean healthcare to, now, Lean veterinary medicine. Mark, then, took over in his usual dynamic and enthusiastic style. He explained the literal and common definition of kaizen, why it is a better system than suggestion boxes, the PDSA cycle, and ending with a description of a simple kaizen system using Idea cards, Summary cards and a conspicuous Idea board. Along the way, he gave numerous examples from both human and multi-species (veterinary) healthcare.

Just a few days earlier I presented a one hour webinar entitled The Lean Methodology: Evolution of Veterinary Practice Management for the AVMA's Lead and Learn webinar series. For this webinar, I took the approach that the Lean mindset is very much akin to the scientific method of diagnosing and treating disease, which we as veterinarians are extremely familiar with. I tried to demonstrate that in both cases we have an ideal vision (Health and True North), we perform a physical exam (in Lean it is "go to gemba" and create a current Value Stream Map), we define our current state and, then, list the gaps between the two conditions (master problems list). At this point, both methodologies analyze the list for root causes (tentative diagnoses) and perform an experiment (treatment) with their respective tools and processes. At the end of the experiment, we assess our success, or lack thereof, and either sustain the new condition or experiment again with a different set of countermeasures. 

I haven't received any follow-up from the webinar, but attendee scores for the lecture were very satisfying.

As the results show, 91.2 percent either agreed or strongly agreed that the information presented was useful. In addition, 87.9 percent either agreed or strongly agreed that the material was presented effectively.

Lean is starting to make its way into veterinary practice management. Something that Mark and I have been advocating for the past three years. But, even more exciting is that others within our profession see it as valuable. That has always been the benchmark.

Lean is not a complete abandonment of all the concepts of traditional management; it is not a dogma. However, many of the older, traditional management concepts are challenged by this different mindset. Just as a computer language does not dictate what program or application is produced; it only supplies the means. Lean is, also, an infrastructure...for adaption and continuous improvement in practice management.

The AVMA Lead and Learn webinars (including mine) are available for viewing free of charge to members here.

Thanks for stopping by. Dialogue is always welcome.