‘Adversity is a part of life’

The arc of Gail Marsh’s personal and professional life is part success story and part cautionary tale – and she’d acknowledge that as much as anyone.

Gail was gracious enough to share that story as part of a regular series of women’s leadership breakfasts the Center for Operational Excellence hosts, sparking a discussion with nearly two-dozen women from our member companies and students at the Fisher College of Business (check out more photos here). The strategy chief for the gargantuan operation that is the Wexner Medical Center at Ohio State University, Gail also is actively involved in community efforts around town. Those garnered her the honor of being named one of six Women of Achievement by the YWCA of Columbus last year.

Gail Marsh Wexner Medical Center
Gail Marsh shared her story and offered insights at a COE women's leadership forum.

If that isn’t enough, she’s a mother to three children she raises with her husband, Dr. Clay Marsh, an OSU professor and vice dean for research in Health Sciences and the College of Medicine.

Listening to Gail speak last week, I was impressed with how her story contains not only great wisdom for women but for anyone who works hard for what he or she earns and takes a step back, wondering how to balance it all. An undergraduate and master’s degree-earner from OSU, Gail was the proud owner of post-graduate student loans as she worked her way up in the male-dominated world of health-care administration, found love and started a family. It was the loss her mother that prompted her to realize she was moving too fast, life was too short and she needed to hit the reset button. With that, she began to create a work-life balance she says she’s still working to perfect, even though it has the flexibility she needs.

Not that her flexible schedule came on a silver platter.

“You have to be stellar at what you do for people to give you flexibility,” she said. “Everybody is balancing things.”

Some other wisdom Gail imparted at our event:

On taking the plunge into community service: “If you wait until all your work is done, your laundry’s done and all your kids have straight As you’ll never do it.”

On the secret to her own life: “Understanding that adversity is a part of life is the secret to my life now. It’s just going to be that way.”

On career mobility: “I like to think my promotions in the medical center have been because I know how to solve problems.”

Check out more from Gail in a video tied to her Women of Achievement honor.

The 411 on 5S

and execution:

Select a team: Selecting the right team members makes a huge difference when planning a 5S event. If the frontline staff works in shifts, ensure you have representation from each shift. You can communicate the changes via email or in person but it doesn’t have the same impact. A staff member coming in the night, for example, might feel frustrated for not finding the items in their usual place. The items that you red-tagged in the ‘Sort’ phase to dispose of later could be something used in the night shift.

Communicate, Communicate, Communicate: Everyone involved should be able to get a straight answer from you when they ask these questions:

1.    What changes are you making?
2.    Why are you making the change? What’s in it for me?
3.    How long will it take?
4.    How will I be impacted by the change?
5.    What is my role in the change?

If this is 5 day-long event, make sure you communicate everyday at the end of the day via email or a visual board in the area.

Involve all relevant departments:  5S Kaizen involves a lot of real-time changes. A spaghetti diagram gives you an idea of the convoluted flow due to the wrong placement of equipment and supplies. When you plan to move the equipment around to a new location, make sure you have a representative from facilities involved to create a new electrical socket. If you are going to reduce the inventory or move it around, involve materials management. They might have great ideas to dispose of extra supplies either to other departments or send back to the vendors and get some credit.

5S Pictures
Using pictures of items in a 5S review can save confusion and problems

Ask why: Before you remove or move things around, ask why an item is on the shop floor/work area and in that particular location to the people who work there. If the answer is, “Oh that’s where it has always been,” don’t hesitate to organize it such that it enhances the workflow. However, you might find some really good reasons why things are where they are. At one of the hospitals where I facilitated a 5S event, our team found that the entire bar-coded supplies were organized in a way that matched the online ordering system. If we made any changes to the location or quantity of supplies it would have messed their ordering system.

Use the same language: It is very common in hospitals for nurses and materials handlers to have a different nomenclature for the same item. Water for Oxygen for a nurse could be prefilled humidifier for the material handler. Use pictures to ensure everyone is on the same page.

Post a Suggestion Board: Post a white board or flip chart in the area to capture suggestions, issues and/or compliments regarding the event. You will be surprised how quickly the board gets filled up. This is a good way of getting people involved and getting their buy-in by incorporating relevant suggestions.

Sustain: Communicate changes and train staff not involved in the 5S event regarding their responsibilities. As a manager you should set up some time on your calendar, weekly in the beginning, to walk through the 5S areas and do a 5S score to see if the changes are maintained. Have people assigned to refill supplies, maintain location and quantities. Capture any issues that people face due to the changes. There will be a learning curve in the beginning, but if the changes are adversely affecting flow, discuss with the team and make changes accordingly. Make sure the new changes are communicated promptly to everyone involved. Gradually you can change the frequency of the walkthrough to monthly and quarterly.

Any other tips to add to the list?

Trust me, I’m a doctor

How do you define a good doctor? Is it one known to have never made mistakes or one who made them, learned from them and got better?

This came to mind as I was watching a video where Dr. Brian Goldman, an emergency room physician in Toronto and host of CBC Radio’s White Coat, Black Art, discusses the shame and embarrassment doctors feel when they make mistakes. They can’t share this with colleagues because it makes them uncomfortable and they can’t share it with patients over fear of getting axed or sued.

In the video, Goldman says a baseball player with a 400 batting average is a legend, but if you applied that 4-in-10 success rate to a surgeon, what would they be called? There are no statistics to denote a good surgeon or doctor.

While a problem-free health-care experience is an ideal for all of us, in the Toyota Production System whose principles are making their way into hospitals, no problem is a problem. With a problem at hand, you can find out the root cause(s), developing countermeasures and mistake-proof the process so it won’t occur again. This goes for living, breathing human beings, too. It’s even more important that we talk about mistakes without any guilt or shame. The more we talk about them, the more we’ll be able to understand the reason behind our mistakes and fix the problem by cutting to the root cause.

Surgical Errors
Surgical errors, while formally reported, remain a hush-hush matter in the medical profession

Many hospitals have started having nurses report any errors they make during their shifts anonymously or openly into a reporting system. The nurse manager then works with a risk manager to address the incidents. Medical and surgical errors are addressed to a certain extent in the peer review and morbidity and mortality forums, but this is still a hush-hush affair.

Doctors get their education in one medical school but eventually work in a new organization with completely new systems, equipment and culture. A resident might not want to wake up their consultant in the wee hours, instead dealing with it on his or her own, but if the right decision isn’t made, there’s fear nurses and other ancillary staff may be judgmental. Doctors are expected to be perfect – patients choose those they haven’t heard anything bad about. That’s likely the case, however, because no one has ever reported anything.

It’s about time that we accept that doctors are human beings and we can, like everyone else, make mistakes. Create an environment where we can openly speak about our mistakes so that it will help with the greater good, helping patients become healthy and lead a quality life.

A matter of life and death

Call it human nature, but there are few feelings in the world better than the relief of exoneration, in matters big (a courtroom comes to mind) or small (a fender-bender comes to mind). We all hope for it and that connecting of the dots, that sudden calming of a fast-beating heart is hard to beat.

Lean thinking, then, comes as a bit of a buzz-kill as it teaches us to avoid directing blame and take responsibility as a group instead. This concept came to mind in a recent Q&A I conducted with a pair of professors in the Fisher College of Business’ Management Sciences department. Drs. Aravind Chandrasekaran, pictured left, and Kenneth Boyer worked with graduate student Claire Senot to examine the relationship between the quality of hospital care and patient satisfaction as organizations work to reduce medical errors and keep in step with government regulations. What they found: Those efforts to “chase zero” might work, but that comes with a trade-off in the patient experience.

This is touchy ground. On the one hand, who cares if you’re not smiling and satisfied as long as you leave the hospital in one piece? On the other, as an insurance-toting “customer,” aren’t you entitled to top-notch, error-free care in and out of the operating room?

Boyer (pictured left) in the Q&A offered a fascinating take on how the overall patient experience has become a metric along with clinical quality, one that will be directly linked to federal reimbursements starting next year. In the culture of medicine, a natural defense mechanism is to – yep – seek exoneration in seeing a patient death as an unambiguous result of illness. Over the years, however, it’s been more recognized that while some patients will die even if they do get “perfect” treatment, preventable errors also exist. With this realization, health-care providers can’t just pretend clinical quality is near-perfect, so it’s harder to brush off other problems that lead to less-than-thrilled patients.

“Revealing that there are excellent opportunities for improving one dimension leads to a realization that the other can be too,” Boyer wrote.

Process improvement, when done right, is infectious – pun intended.

MBOE recap: What are you hiding?

It’s impossible to sum up all the great content we covered with our Master of Business Operational Excellence and MBOE Healthcare students on campus last week, so let’s settle on some worthwhile tidbits that could help you in your organization:

Share with the rest of the class. Drew Locher, Shingo Prize winning author, challenged the class by asking, “What do managers know that the employees don’t know? And why can’t you share this information with the employees so that they can make better decision using this information?”

Lean works anywhereTaking organizations in the service industry lean is a challenge (remember “Airplanes aren’t cars!”?), but Locher insists it’s not only possible but important because these companies deal directly with customers. Using visual management principles, such as a call-center signal light when an employee needs help, can increase productivity, communication and morale. Locher even helped a company that makes graphics for CDs, driving home the point that lean can work in creative processes as well.

In the MBOE program, Ellis New with his usual energetic and passionate style emphasized the importance of Total Preventive Maintenance. What point is there in waiting for the equipment to breakdown and then wait for the service people come fix it? Would you fight an 18 feet alligator or rather squish their eggs? In other words how long will you wait to fix the problem? The students were trying to find the answers to these questions while they were being a part of TPM at Tigerpoly, a supplier to major car companies and one of our of gemba learning sites.

…especially in health care. MBOE Healthcare students visited Akron Children’s Hospital to learn about visual management and its application in health-care settings. Anne Musitano, a process improvement expert at the hospital, MBOE grad and 2012 IQPCfinalist, organized an action-packed day for the students, having them observe daily huddles and visual management practices in several departments. Students also got to speak to area managers and understand the joys and pains of implementing changes in their departments.

Ann Musitano
MBOE grad Ann Musitano greets the latest health-care cohort at Akron Children’

Are you S.M.A.R.T.? File this acronym away, per coach Gary Butler: Metrics won’t work unless they’re Specific, Measurable, Achievable/actionable, Relevant/reliable and Timely. I also spent time with senior lecturer and COE Executive Director Peg Pennington discussing measurement systems, particularly the concept of Gage R&R. This helps you determine if your measurement system is repeatable (similar readings with the same operator) and reproducible (similar readings with two different operators).

Tune in for our students’ return to Fisher in early May.

A great idea without data = Whining

Matt Burns

The Center for Operational Excellence earlier this week hosted a kickoff event for the IT Leadership Network, a new subgroup of COE you’ll be hearing more a lot more about in the future. While turnout – for an offsite event at Nationwide Insurance – was great at nearly 200 people, I was equally impressed by our keynote speaker.

Mike Orzen, who quite literally wrote the book on lean and IT (it’s, uhh, called Lean IT), emerged as one of the most dynamic and engaging speakers I’ve had the pleasure to hear since joining the center several months ago. While the content of his presentation was tailored to an IT audience, the kernels of wisdom he shared about lean thinking and its place in an organization were universal and applicable to anyone at any point in their lean journey.

Speaker Mike Orzen
Speaker Mike Orzen

That’s why I’d like to share some of them with you right now.

“We’re really really good at describing what lean is. We don’t have a good track record of being lean and staying lean.” – This quote speaks to a topic of rising importance to our membership: Sustaining process improvements after the tools initially have been used. This is a challenge many of us face and is often tied to the level of engagement or buy-in at all levels of the organization.

“When everything’s a priority, nothing is a priority.” – Orzen was a wizard at getting to the heart of problem solving in a lean culture: Identifying what the problem truly is, not through the prism of our own work but in the prism of how it’s affecting the customer experience.

“Lean is invented by everybody in this room. It’s a growing body of knowledge.” – These are, I believe, the most important words Orzen spoke on Tuesday. Lean isn’t just a collection of scholarly articles and books. It’s a living, breathing way of doing and thinking that can take the shape of whatever problem is before you.

“The No. 1 value I see in many organizations: Self-preservation.” – No explanation needed here.

“We often see things from our paradigm. The hardest thing to do is to see reality.” – File this bit of wisdom under “Siloes,” what Orzen wisely describes as a necessary evil in organizations as they create and nurture specialization, but a factor that can complicate communication and efforts to see the whole value stream.

“A great idea without data – some people call that whining.” – Indeed.