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.

What Is This Takt Time You Speak About?

When I first started learning about Lean, one of the terms I seemed to have difficulty wrapping my brain around was "takt time."

Or, maybe it was getting straight the difference between takt time, cycle time, lead time, process time, value creating time, non-value creating time and all of the other “times.”

At any rate, if you read much about Lean, you will come across the term. So, I thought I would explain.

According to Lean Lexicon-5th Ed by the Lean Enterprise Institute:

Takt Time is the available production time divided by customer demand. For example, if a widget factory operates 480 minutes per day and customers demand 240 widgets per day, takt time is two minutes. Similarly, if customers want two new products per month, takt time is two weeks. The purpose of takt time is to precisely match production with demand. It provides the heartbeat of a lean production system. Takt time first was used as a production management tool in the German aircraft industry in the 1930s. (Takt is German for a precise interval of time such as a musical meter.) It was the interval at which aircraft were moved ahead to the next production station. The concept was widely utilized within Toyota in the 1950s and was in widespread use throughout the Toyota supply base by the late 1960s. Toyota typically reviews the takt time for a process every month, with a tweaking review every 10 days.

And:

Cycle Time is the time required to produce a part or complete a process, as timed by actual measurement.

For example, if you have 90 clients wanting routine annual exams and vaccinations performed on their pets each week and you have 30 planned hours available Monday through Saturday (40 hours/week/doctor, less surgery time, less in-patient treatment time, less new sick pet time), then your takt time is 30 hours/90 visits or or 1800 minutes/90 visits or 20 minutes per appointment.

Takt time is a time that represents the pace at which you need to work in order to meet current demand. To meet demand within the allotted time, a routine annual exam would need to be completed, on average, every 20 minutes.

In order to find the cycle time, an actual measured time, you would measure several appointments and calculate the the average time required to actually complete them. If you have a lot of variation, you might measure ten appointments, which is a good Industrial Engineering guideline (thanks to Mark Graban for that tip).

If the actual cycle time is less than or equal to takt time (meaning you can work faster than the demand rate), then you can meet demand within the available time restraints and everything should be good.

But, if cycle time is greater than takt time, then you definitely have a problem, because you cann not meet demand as performed within the time requirements. This scenario will necessitate a kaizen project and/or A3 thinking to work out some countermeasures. These might include finding more time for these exams sometime during the week (expanding your working hours), or eliminating waste and improving flow so the cycle time falls within takt time. We'd want to reduce the time it takes to complete the appointment, but without rushing or impacting quality or client satisfaction.

In manufacturing, it is sometimes a little less complicated because product is often moving through the production line at a much more precise interval and the time for each step has very little or no variation. So, cycle times in manufacturing are much more consistent. Manufacturers also have the opportunity to level their production rate by using inventory as a buffer against variation in demand. In a vet clinic, we might be able to somewhat level our workload through appointment schedule, but if we're taking walk ins, we have to be able to react and adjust to that variation in demand.

But, again in veterinary medicine, we have more variation. There is variability in how long an annual exam actually requires. Are there issues that need to be addressed? Will a fecal exam be required? How about a heartworm test? How many vaccinations are due? Do medicines needed to be filled and dispensed? In addition, there is variability in the arrival times of clients, even with appointments. This results in variance squared (variance X variance), and that = chaos.

There are two points that should be made here. The first is that variability is a form of waste and should be reduced as much as possible using the Lean mindset and methodologies. Meeting takt time is a first goal. The second point is that this is the reason you probably should not schedule more than 85% of your available appointment times. This allows you some "wiggle"room. I have heard some advocate high density scheduling, i.e. close to or at 100% booked.  But, even with a highly trained staff in a Lean environment, you just can't escape variation. The first time an appointment goes long or a client shows up late, you are behind schedule which means each subsequent appointment will have to wait. Waiting is muda. High density appointments are not value for the client, from the client's point of view.

In a later blog, I hope to write about queueing theory, exponential statistical distribution, and Poisson distributions. These concepts produce more realistic models that take into account the variabilities of arrivals and cycle times.