A Lean Reference List

These are most of the books that I have read over the last seven or so years and that I found most helpful. When I first started reading and learning about the Toyota Production System (Lean), one could probably fit all the available books on one shelf. Today, it would require one (or more) bookcases! More proof that Lean is real.

Books

Lean Thinking: Banish Waste and Create Wealth in Your Corporation by James Womack and Daniel Jones

Lean Hospitals: Improving Quality, Patient Safety and Employee Engagement, 3rd Ed. by Mark Graban

Healthcare Kaizen: Engaging Front-line Staff in Sustainable Continuous Improvements by Mark Graban and Joseph Swartz

The Executive Guide to Healthcare Kaizen: Leadership for a Continuously Learning and Improving Organization by Mark Graban and Joseph Swartz

Measures of Success: React Less, Lead Better, Improve More by Mark Graban

The Toyota Way: 14 Management Principles from the World's Greatest Manufacturer by Jeffrey Liker

Follow the Learner: The Role of a Leader in Creating a Lean Culture by Dr. Sami Bahri

Lean Lexicon: A Graphical Glossary for Lean Thinkers compiled by Lean Enterprise Institute, Edited by Chet Marchwinski

Understanding Variation: The Key to Managing Chaos by Donald Wheeler

Toyota Production System: Beyond Large-Scale Production by Taiichi Ohno

Taiichi Ohno's Workplace Management by Taiichi Ohno

The Toyota Way Fieldbook by Jeffrey Liker and David Meier

Learning to See: Value Stream Mapping to Add Value and Eliminate MUDA by Mike Rother

Value Stream Mapping for Healthcare Made Easy by Cindy Jimmerson

Lean Daily Management for Healthcare: A Strategic Guide to Implementing Lean for Hospital Leaders by Brad White

Toyota Kata: Managing People for Improvement, Adaptiveness and Superior Results by Mike Rother

The Toyota Kata Practice Guide by Mike Rother

Training Within Industries: The Foundation of Lean by Donald Dinero

Out of the Crisis by W. Edwards Deming

The New Economics for Industry, Government, Education by W. Edwards Deming

The Deming Management Method by Mary Walton

Dr. Deming: The American Who Taught the Japanese About Quality by Rafael Aguayo

The Toyota Way to Lean Leadership: Achieving and Sustaining Excellence Through Leadership Development by Jeffrey Liker and Gary Convis

Toyota Talent: Developing Your People the Toyota Way by Jeffrey Liker and David Meier
Developing Leaders at all Levels: A Practical Guide by Jeffrey Liker and George Trachilis

Toyota Culture: The Heart and Soul of the Toyota Way by Jeffrey Liker and Michael Hoseus

The Toyota Way to Continuous Improvement: Linking Strategy and Operational Excellence to Achieve Superior Performance by Jeffrey Liker and James Franz

The Toyota Way for Service Excellence: Lean Transformation in Service Organizations by Jeffrey Liker and Karyn Ross

Practicing Lean: Learning How to Learn How to Get Better…Better edited by Mark Graban

The Machine That Changed the World: The Story of Lean Production- Toyota’s Secret Weapon in the Global Car Wars That is Now Revolutionizing World Industry by James Womack, Daniel Jones and Daniel Roos

Lean Solutions: How Companies and Customers Can Create Value and Wealth Together by James Womack and Daniel Jones

Gemba Walks by James Womack

The Lean Turnaround: How Business Leaders Use Lean Principles to Create Value and Transform Their Company by Art Byrne

Lean for Dummies by Natalie Sayers and Bruce Williams

Creating a Lean Culture: Tools to Sustain Lean Conversions by David Mann

Managing to Learn: Using the A3 Management Process to Solve Problems, Gain Agreement, Mentor and Lead by John Shook

Beyond Heroes: A Lean Management System for Healthcare by Kim Barnes with Emily Adams

Transforming Health Care: Virginia Mason Medical Center's Pursuit of the Perfect Patient Experience by Charles Kenney

The Lean Guide to Transforming Healthcare: How to Implement Lean Principles in Hospitals, Medical Offices, Clinics and Other Healthcare Organizations by Thomas Zidel

Lean Doctors: A Bold and practical Guide to Using Lean Principles to Transform Healthcare Systems, One Doctor at a Time by Aneesh Suneja and Carolyn Suneja

On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry by John Toussaint

Value Stream Mapping: How to Visualize Work and Align Leadership for Organizations by Karen Martin and Mike Osterling

Hoshin Kanri for the Lean Enterprise: Developing Competitive Capabilities and Managing Profit by Thomas L. Jackson

The Basics of Hoshin Kanri by Randy Kesterson

Gemba Kaizen: A Commonsense Approach to a Continuous Improvement Strategy, 2nd Ed. by Masaaki Imai

The Spirit of Kaizen: Creating Lasting Excellence One Small Step at a Time by Robert Maurer

A Study of the Toyota Production System: From an Industrial Engineering Viewpoint by Shigeo Shingo
Patient-Centered Strategy: A Learning Strategy for Better Care by Jeff Hunter

The Lean Startup: How Today's Entrepreneurs Use Continuous Innovation to Create Radically Successful Businesses by Eric Ries

Implementing TWI: Creating and Managing a Skills Based Culture by Patrick Graupp and Robert J. Wrona

The 7 Kata: Toyota Kata, TWI, and Lean Training by Conrad Soltero and Patrice Boutier

The TWI Facilitator’s Guide: How to Use the TWI Programs Successfully by Donald A. Dinero

A Lean Guide to Transforming Healthcare: How to Implement Lean Principles in Hospitals, Medical Offices, Clinic and Other Healthcare Organizations by Thomas G. Zidel

The Definitive Guide to Emergency Department Operational Improvement: Employing Lean Principles with Current ED Best Practices to Create the “No Wait” Department by Jody Crane and Chuck Noon

A3 Problem Solving: Applying Lean Thinking by Jamie Flinchbaugh

A Factory of One: Applying Lean Principles to Banish Waste and Improve Your Personal Performance by Daniel Markovitz

The Outstanding Organization by Karen Martin

Clarity First by Karen Martin

The Lean Strategy by Michael Belle, Daniel Jones, Jacques Chaize and Otest Fiume

Multipliers: How the Best Leaders Make Everyone Smarter by Liz Wiseman

Measure What Matters: How Google, Bono, and the Gates Foundation Rock the World with OKRs by John Doerr

The Five Dysfunctions of a Team: A Leadership Fable by Patrick Lencioni

Scrum: The Art of Doing Twice the Work in Half the Time by Jeff Sutherland, JJ Sutherland

The New Work by Aaron Dignon

On The Web

Lean Enterprise Institute www.lean.org

Dr. Ponsford's LeanVets blog www.leanvets.com

Mark Graban’s Leanblog www.leanblog.org

Shingo Institute www.shingoprize.org

The Deming Institute deming.org

TWI (Training Within Industry) Institute twi-institute.org

Catalysis (formally ThedaCare Center for Healthcare Value) createvalue.org

Kaizen Institute us.kaizen.com

Toyota TSSC tssc.com

Toyota's TPS Page www.toyota-global.com/company/vision_philosophy/
toyota_production_system/


Hope this helps.

Why Lean Is Important: From An Informed Client's Perspective

Today's post comes from Gerald Cronin of the Vivarium Operational Excellence (VOE) Network.

The VOE Network is a worldwide group of Lab Animal and Biomedical veterinarians and experts that have discovered and been successfully utilizing the Toyota Production System, or Lean,  to reduce valuable research costs while at the same time improve research quality and animal quality of life. 

From thier own website:

"Every modern industry and organization has been influenced by the operational advances of the Toyota Production System, the thinking that made Toyota the #1 auto manufacturer in the world.   Decades of research has proven that Toyota's systematic approach to improving operations has tangible long-term benefits to customer service, quality, productivity, adaptability and ultimately to reduce costs."

"The Biomedical Research community recognized these advances over a decade ago and thus began the adaptation of systematic continuous improvement techniques to the Lab Animal Industry.  Consistent with Toyota's philosophy of "sharing what they have learned from over 50 years of experimentation with the world", the Biomedical Research community understood that together, we could improve operations better, faster, cheaper if we shared our knowledge with each other." 

"With over a decade of experience, the VOE-Network was born to help the entire animal care community improve operations through members' experimentation, learning and sharing."

"The Vivarium Operational Excellence Network is a consortium of animal care institutions and companies committed to quality clinical and veterinary research driven by operational excellence.  We are a members-run organization that responds to the evolving learning needs of its members.  Learning spans the organizational spectrum from front-line technicians through Webinars, videos and Lean Belt certification to leadership skills gained from our Leadership Academy events and offerings.  We also look to industry for insights into the best ways to improve operations as well as ways to build a problem-solving culture."

Today's post:

I took my dog to a large Veterinary practice about a year ago and needed to use the restroom.  The restroom was tucked inside the clinical staff area, so I needed to navigate through some hallways to get to where I needed to be.  Along the way, I was able to see “behind the curtain” of this operation.  I was disturbed to see rooms full of medical supplies in random areas, cardboard boxes both opened and unopened piled on top of each other, medical devices stacked on top of unfolded towels and on top of unopened boxes, there was almost zero floorspace for staff to move around.  Random bottles that looked to contain some sort of medication were in random locations.  Then there was the office with piles of paperwork, computer terminals were poking through the mess, almost as if they were struggling for air.
The staff was walking from room to room and asking each other “have you seen the (X clinical item)?”  “Did you call Mrs McGillicuddy or was I supposed to”? “Sorry for the wait, Mr. Cronin, we’re really busy today” and “We will need to schedule your next appointment, we were hoping the machine would be ready today, but it’s in need of maintenance”.

I made it to the restroom and got to see more of the same on the way back. The trip made me pause, as I now questioned the quality of care my dog was about to receive.  I’m also thinking about what I was going to get billed for and why I need to come back. Piles of inventory and random clutter, medications that didn’t seem to belong there, medical devices mixed with cardboard boxes filled with supplies 3-boxes deep.  Machines that should be operational but are not. The red flags were popping up everywhere.  What am I paying for?  Can I trust this clinic?  Who can I trust here? Do they know what they are doing?

You can tell a lot from what you see in a clinic. Maybe some of the judgements are assumptions, but often they are pretty accurate. The telltale signs of disorganization, the questions staff ask each other, the delays, the missed information, the clusters of inventory that often contains expired materials; all give me the chills, no matter if I’m going for my annual physical or if I’m taking my dog to the Vet.   To me, the paying customer, they all tell a story of wasteful processes that I know are built into my bill.

I’ve been a Lean practitioner in healthcare for a few years, watching and helping clinical teams improve their care to the patient in the bed. If they can do more for the patient in a better, easier way, they are all over it.  I now work in the Veterinary world, and I have seen amazing transformations of quality of animal care and improvements to the Veterinary staff quality-of-life by focusing on improving small (sometimes tiny) process that support their daily work.  It’s so exciting to see folks enjoy the teeny challenges of improving their own work. Lousy processes are like “pebbles in your shoe”; workers agonize through the customs and clutter; given the chance, they would stop and remove the pebble to make life better.  Lean thinking does just that for workers, and the animals and their owners benefit exponentially. 

If you ever feel frustrated, rushed, frazzled, buried by complaints, or workers constantly asking questions looking for “common sense’ answers, the prescription may not be buried in a store room or office, but right here, sitting out in the open at no charge to you.  The world of Lean thinking is liberating, and Lean thinkers are eager to share their learnings and experiences with you.  We are here to help you; we’ve all been through the same frustrations and we found the prescription.  Take one small dose daily; you will be amazed at how your quality of life will improve. (My dog is OK by the way).

Gerry Cronin
gmcronin@mgh.harvard.edu
Vivarium Operational Excellence Network
www.voenetwork.com

R-E-S-P-E-C-T

“Respect for people” is a fundamental principle of Lean and a major difference between Lean and the Western, more Taylor-esque, concept of management. The Western tradition, which is still a part of educating MBAs, is that management knows best and makes all decisions. Workers are to do as they are told.

There is a quotation by Henry Ford to the effect that the problem with workers is that, not only do they come with two hands, but also, unfortunately, a brain. Workers are not hired to think! Lean is much less of a top-down style of management, and much more of a bottom-up, inclusive, transparent style. This is not to say, however, that the asylum is completely handed over to the patients.

This core belief influences the relationship Toyota managers and supervisors have with their workers. For Toyota, management’s primary function is more of teacher and less of an organizational police officer. We now understand, more than before, that the focus for Toyota is not just on building quality automobiles, it is primarily focused on the building of problem solving, innovative, respected employees who, then, build quality, innovative automobiles.

Dealing with people from a basis of respect permeates every aspect of Lean.

Systems thinking:

Have you ever had the feeling that, at some point at work, you were damned if you do and damned if you don't? Or, that you are in the the middle of a Catch-22 situation? If so, you have probably been the victim of poor systems or systems colliding with each other. That feeling of not being in control or at the mercy of things bigger than you.

Thinking in terms of systems means understanding that the systems at work within an organization are management and leadership designed. Systems are the responsibility of management. Workers have no authority to control or overhaul systems. They are at the mercy of the systems. Yet, many times, staff are blamed for what is, in actuality, a system design problem.

For example, if a job is not being performed well, systems thinking would first consider such things as does the worker know that job is their responsibility, has the worker been trained adequately, does the worker have the necessary tools, and does the worker have timely and correct information?

Systems thinking is more respectful. It recognizes that systems should be investigated when problems occur before blaming people.

Value:

The Lean definition of value is that which the client wants and is willing to pay for, and that improves the health status of the pet, without defects and waste along the way. Our clients get exactly what they want, when want it and in the amount wanted. They pay for only value adding services. The concept of defining value from the client’s point of view shows respect for them.

Variance and overburdening:

Lean understands that large variances in workload can be the source of difficulties and overburden our staff. Lean suggests work loads try to be leveled as much as possible. Being watchful for the overburdening of staff comes from respect.

Just-In-Time

The Just-In-Time (JIT) concept is the procurement and delivery of resources, (whether that be drugs, supplies, access to diagnostic equipment and information, or patients, doctors and staff) just exactly where it is needed, just exactly when it is needed, and just exactly in the amount needed. Nothing more and nothing less.

With respect to staff and personnel, the Just-In-Time idea is based, in part, on recognizing and respecting the unique value of everyone's time and skills; to only use them when, where and in the amount needed.

Standardized work

Standardized work is the mutually agreed upon method to do or handle a certain process or situation that helps insure quality, timeliness and safety, and gets everyone on the same page working in the same direction. It shows respect by involving staff in its definition and formal writing, and by eliminating ambiguity and the anxiety it causes to workers that come from policy and process chaos.

Kaizen

Kaizen is a Japanese word that can be translated to mean “good change,” “change for the better,” or “continuous improvement.”

While improvements can be large, time consuming and expensive major changes, the most common are the small, daily, quick, inexpensive ideas submitted by staff that improve quality, flow, safety, value to the client and make work life just a little easier. Staff are on the frontline of our practices every minute of every day. They know, better than anyone, where and what the problems are. And, they probably know better how to remedy them than we owners and managers do.

Kaizen shows respect by recognizing what an asset our staff is, and allowing them to partner with us in improving the practice; to be engaged and be part of the solutions, rather than always being blamed for the problems.

5S

5S projects are the physical cleaning and reorganization of a particular room or area of the practice. It helps the staff to work with less clutter, frustration and confusion on a daily basis. It creates better flow within the hospital which increase value to clients; all ways of showing respect.

Go to gemba

"Genchi Genbutsu" (go and see) means that whenever there is a problem found, all relevant stakeholders (management and staff) should go to where the problem occurs (the “gemba”) and solve it together. It shows respect by recognizing that staff have valuable input to the situation.  

The Andon cord

On the Toyota production line, workers are provided with a mechanism to sound an alarm and ask for help anytime they find it necessary. The line stops if the problem is not quickly resolved. Toyota trains and trusts its employees to use the Andon cord when an issue of quality or safety is in question. It shows respect by creating a culture of safety and trust for anyone to speak up, even if they think there might possibly be an inkling of a concern.

It is my humble opinion that if veterinary staffs knew about and understood the Lean mindset and its worker-centric (and client-centric) philosophy, there would be such a grassroots revolution within the profession that owners, managers and corporation leadership would have no choice but to start thinking Lean within their practices. Maybe, we could start now and circumvent all of the "bloodshed."

Thanks for stopping by. Please share this blog with your contacts! And, let me know if you have any questions, comments or post ideas.

Some Basic Concepts

 

As consumers, we all have had those epic experiences with call centers, auto repair shops, plumbers, etc. Why can they not see the consumer’s point of view? Yet, back in our practices, our “provider hats” go on, and we, too, fail to consider what our clients have to deal with. In Lean, the perspective of the consumer is the priority.

One of the goals of Lean is perfection. The book Lean Thinking talks about the “continuous pursuit of perfection” (and that also might remind you of a Lexus ad slogan). We know we will most likely never get to that point of absolute perfection, but we continually try, working toward an ideal state of safety, quality, waiting times, customer satisfaction, and other meaningful measures. Just as repeatedly dividing one in half will never get us to zero, it does get us darn close. If we can eliminate 50% of waste with each attempt, then after only 5 iterations, we have removed 96.875%. That’s not perfect, but really, really close (and more importantly, far better than our starting point). With just two more iterations, we get to 99.21875%. That's really, really, really close! The Lean mindset of continuous improvement drives us to solve problems that matter and to keep working at it. Think of how to do it, not why it cannot be done.

Try to keep an open mind. Lean is not particularly difficult to understand in concept, but it is different… and it can be difficult to change an organization of any size. Discard conventional thinking. It has proven itself over and over in every company and industry that has embraced it as a complete package and given it an honest trial, practicing Lean over time. We believe the same will occur in the veterinary medicine setting.

Nothing is written in stone. Lean is about experimenting in order to deeply understand and improve. But, if that doesn't happen, we can learn from it, adjust and try again. "Best medicine does not equal absolutely correct. In school, they told us that 80% of what we were learning would be proven wrong. We just didn't know which 80%. It's the same way with best management practices. Keep iterating.

Lean takes a systems approach to management. It tends to blame faulty systems rather than people. Systems are the responsibility of management, not the workers. Workers are at the mercy of systems, and systems can be very complicated with strange ramifications.

Lean is, foremost, concerned about quality. Toyota has been able to turn operational excellence into a successful business strategy. Facebook, Twitter and practice web sites have accelerated and amplified the effects of “word of mouth” advertising.  Before you promote, you better have “all of your ducks in a row” or all of your time and money may actually be counter-productive. Remember, prepare to promote and then promote!

Lean originated out of manufacturing; automobile manufacturing more specifically. And, although it has been successfully implemented in almost every industry, including human health care, it will require some adapting for use in veterinary medicine. This technology has only been experimented with very recently and only on a very small scale in veterinary medicine. This will be a new paradigm for us. We are the ones who will define Lean in our industry.

A New Paradigm For Veterinary Practice Management

 

There is a new paradigm, a new methodology, with proven results over many different industries including human health care. The new model is the Toyota Production System (TPS), better known in the West as Lean, for its consistent ability to deliver both quality and value without the waste and frustration that we see in so many organizations.

Over the course of 70 years, Toyota has grown from being a small, domestic, truck manufacturer in a devastated post-war Japan to being the largest auto maker in the world, for a time in 2012, even surpassing America’s industrial revolution icon, Ford Motor Company. Additionally, they have been profitable in every one of those years except three. How has Toyota been able to accomplish such milestones? By relentlessly pursuing a strategy of operational excellence, which includes a leadership style and organizational culture that is very different than most companies.

Lean is not just a set of tools. Toyota’s own website describes their production system as being a combination of:

1. Technical tools and methods
2.  Management methods
3. Philosophy and mindsets 

Practiced together, this results in an organizational culture that develops people in the organization and sets up the organization for long-term success. Toyota also emphasizes that the main goals are improving flow (in the case of healthcare, providing the right care at the right place at the right time) and ensuring quality at the source. There is a foundation of safety being a top priority (for patients and employees) instead of being a separate program or initiative. 

            Toyota also described their “Toyota Way” management system as having two key pillars:

• Kaizen (continuous improvement) (http://www.leanvets.com/2016/02/kaizen.html)
• Respect for People 

Being respectful in the workplace is not just a matter of being nice. It means challenging people in a constructive way so they can grow and perform to the best of their ability. “Respect for people” is a phrase that is also sometimes expressed as “respect for humanity.” This means not just showing respect for all stakeholders (such as customers, employees, suppliers and the partners, the community), but also respecting our human nature. For example, Lean leaders understand that we have human limitations, such as making more errors when we get distracted or are physically or mentally exhausted. This drives us to error proof systems to help prevent common human errors, rather than just asking people to be careful.

In the Lean framework, operational excellence is based concepts, such as the following:

1. Value (http://www.leanvets.com/2016/02/value.html) is defined from the customer’s point of view.
2. Work relentlessly to reduce or eliminate waste (http://www.leanvets.com/2016/01/in-japanese-word-for-waste-is-muda.html).
3. Build a culture of continuous improvement.
4. Standardize work to improve flow.
5. Make problems visible and react quickly.
6. Understand problems and solve them at their root cause(s).
7. Demonstrate deep respect for workers and all stakeholders. 

Successful practices realize that long-term success comes from satisfied clients. Clients should truly feel we have their best interests at heart. Hopefully, they would choose our practice not necessarily because we are less expensive than another practice, but that they received value for the hard-earned money they spend with us. We are responsive to their desires, and we value their time as much as we value ours. Satisfied clients help resurrect the idea of positive, direct ”word of mouth" advertising.