Health care: Too much on the plate?

Earlier this month, Shingo Prize-winning author and Master of Business Operational Excellence instructor Beau Keyte wrote a fascinating article on the Huffington Post titled “The Silent Killer of Health Care Transformation: Being Overburdened by Too Many Choices.” This addresses a key concept in lean called “muri,” or overburdening.

Keyte defines overburden a phenomenon where equipment or people are pushed to run at a harder pace and with more effort than is appropriate.  Using the analogy of going to a Brazilian steakhouse faced with multiple choices, with an eager waiter waiting for a signal from you to bring more varieties of meat, Keyte makes the point of how health-care organizations are laden with a vast range of priorities. As a customer at the steakhouse you can choose what you want to have on your plate but leaders in health-care organizations do not have the choice. Multiple stakeholders, internal and external bombard the leadership with ideas that are important to them with a very restricted timeline. The executives take on the burden of execution of these great ideas to the employees in the organization that are already overburdened with a previous task list.

Similar to the customer in the steakhouse who leaves half-eaten good food on the plate to try the new kind of meat, the employees leave projects halfway to bite on the new initiatives. Due to lack of time and resources, the new initiatives do not get the kind of attention they need and this nips the possibility of transformation in the bud. How do you address this problem? Keyte emphasizes that it is the leaders in the organization who can LEAD the organization on a path that reduces the burden – but how?

The first thing is to focus on the real stakeholder, the patient. Think about how the initiatives suggested by the other stakeholders impact the patient. Would the initiative result in the right outcome for the right patient at the right time? Do the initiatives align with the strategic goals? Do you have the human resources to work on these initiatives? Do you need to do all the initiatives? What are the few things that you NEED to get done to meet the three to five most critical goals this year? Could you drop or delay some? By answering these questions, leaders can dedicate the available resources to only the critical projects. This way, employees can spend their time wisely while providing patient-centered care.

The second thing the leaders can do is to think long term instead of saying yes to all the projects and trying to instantly gratify the stakeholders.  However, it is important to think forward and pick three to five strategic initiatives to work on in future and plan on carving out capacity to take these on.

Keyte puts it well in the last paragraph: “Like all silent killers, overburden sneaks up on you and your organization. Learn to sense it, see it, analyze it, and deal with it to help your organization not only survive, but thrive.”

COE-sponsored research maps holistic look at lean supply chain

The numbers don’t lie, as the saying goes, but Ilaria Raniero knows some tell the truth better than others – and many more aren’t worth listening to.

An executive summary of Raniero’s COE-sponsored research can be downloaded here

Raniero (pictured, right), a visiting scholar to the Ohio State University Fisher College of Business from the Polytechnic Institute of Milan (Politecnico di Milano) in Italy, recently conducted a wide-ranging research project with several Center for Operational Excellence member companies as part of her graduate thesis. This sweeping look at a wide variety of industries uncovered some promising trends in how  lean evolves in organizations over time and sheds light on how the successful ones select the right metrics.

More importantly, Raniero – with the help of COE Associate Director Tom Goldsby – developed a new performance measurement framework for the lean supply chain. The final product is a road map of sorts that could help organizations move from implementing lean in a single silo to a more holistic approach, all while measuring what matters – and ignoring what doesn’t.

Redefining performance

Raniero’s research, “Applying Lean Principles in the Supply Chain: An Examination of Measurement System Adaptation,” is the product of more than 80 hours of face-to-face interviews conducted between October 2012 and February 2013 with 10 companies, though much of the research looked in-depth at Dublin-based COE member Cardinal Health.

The inspiration for the research, Raniero said, was rooted in a key observation she made about organizational behavior.

“The measurement system is something that drives the company’s behavior and drives employees’ behavior, too,” she said. “As companies adapt their strategy, they need to adapt their measurement systems accordingly.”

Tom Goldsby
Tom Goldsby

Selecting the wrong metrics plays out in familiar fashion for many: A measurement that seemingly aligns with company goals – cost per unit, for example – ultimately can encourage very “un-lean” behavior. Aggressive bulk purchasing might lower a company’s cost per unit, but it could wreak havoc on inventory levels and other key measures. A company taking a broader look at the supply chain might instead choose to track total cost of ownership, a metric that would raise a red flag much sooner.

Raniero’s research, in fact, found that companies with a track record of success in lean implementation have taken such a journey: First, applying lean in operations, then spreading it across the entire enterprise. The final, and largest, leap came when companies began to bring this waste-zapping, value-focused strategy to their interactions with suppliers, customers, their own employee relations, and their sustainability initiatives.

In short, it ultimately becomes a question not of performing better in tried-and-true metrics, but broadening the very definition of performance, said Goldsby, a professor of logistics at Fisher.

“Companies are becoming aware of how operational excellence can impact customer retention, employee satisfaction, supplier relations, and sustainability concerns,” he said. “As a result, companies are introducing new measures that capture these dimensions of performance, which yields a more holistic perspective on the health and future prospects for an enterprise.”

This holistic perspective is captured in Raniero’s formal framework of five voices: Voice of Customers, Voice of Business, Voice of Employees, Voice of Suppliers, and Voice of Sustainability.

That final “voice” has taken on a much more important role in today’s business environment, but Raniero said companies wrestle with it nonetheless.

“Many companies struggle to find the right measures and don’t know how to tie sustainability into the profit-loss statement,” she said.

By making sustainability one part of a larger lean strategy, the report states, it’s possible to use tools such as value-stream mapping to identify environmental wastes and ultimately reduce cost.

Honing in

With five distinct “voices” and metrics for each one, how do successful lean organizations not wind up with too many dials on the dashboard? The answer, Raniero’s research found: They adapt metrics along with shifts in strategy, keeping an eye out for newly important ones and those that no longer guide lean behaviors.

John Matera, COO of COE member Willow Wood and one of Raniero’s interviewees, said his part in the research project has helped the company take a closer look at its “voice of business,” which includes key financial and operational measures. Where once Willow Wood was tracking as many as 15 business-related metrics, it’s now working down to half as many.

“(Fifteen) is a lot to keep track of on a regular basis,” Matera said. “Working with Ilaria has helped us focus on what’s important.”

This so-called “structured adaptation” in measurement systems is a defining mark of a company making progress in its lean journey. It also highlights another key feature of Raniero’s framework: Strategy influences each one of the five “voices” by guiding what’s measured, but the results themselves can play a role in strategy over time.

It’s this complex interplay that Alan Deutschendorf, vice president of operational excellence at Cardinal, says the company can evaluate with a renewed perspective after taking part in Raniero’s COE-sponsored research.

“This has really given us food for thought as we update our strategy and tactics and continue to develop a culture of operational excellence,” he said.

To view an executive summary of Raniero’s research, download the document here.

Toyota presentation highlights lasting impact of lean transformations


That’s the best way to describe how our Center for Operational Excellence members and guests left our seminar this past Friday following a rousing, inspiring presentation from Jamie Bonini, general manager of the Toyota Production System Support Center.

Bonini, speaking at the Sept. 13, 2013, seminar.

Bonini powerfully made the case to a crowd of nearly 150 that the guiding principles of operational excellence can make a lasting impact anywhere – and at COE, that’s what we’re all about.

Bonini illustrated the Toyota Production System implementation strategy TSSC has thus far used with more than 200 organizations, which range from manufacturing – a classic setting for lean implementation – to the more unusual nonprofit realm. Roughly 40 of these projects are under way in a normal year for TSSC, which has been around since 1992.

A deeply compelling case study that attracted attention earlier this year in the New York Times involves TSSC’s work with the Food Bank for New York City, where wait times for meals have plummeted and efficiency at the food pantry has skyrocketed. Check out a video of TSSC’s work with the food bank here.

What resonates from this, and other videos from TSSC, is not only the success of the transformations but the passion that spreads like wildfire throughout the organizations they work with. My favorite part of the Food Bank video comes about 11 minutes in, when Teisha Diallo, program director Project Hospitality unguardedly voices the thrill of seeing the food pantry line running much more efficiently.

“When I come around that corner, the line is gone, and I’m like, ‘Yes!’” she exclaims.

Not that getting there is easy – and that’s where Bonini imparted some valuable takeaways on starting a transformation at the right time, in the right way, and with the right leaders on board. His most compelling advice came when he said it’s not a crime to reschedule a lean rollout if the time isn’t right. Often, Bonini said, the lack of an underlying drive to have a problem-solving culture can be a holdup – or a deal-breaker if it isn’t resolved.

“If you’re not willing to build an organizational problem-solving capability, then don’t bother (with an implementation),” Bonini said. “It’s often a very difficult missing element from what I see (with organizations).”

Check out more photos from Friday’s seminar here.

iPad rollout brings new operational efficiencies to Ohio State marching band

Ryan Barta hated to see dead trees wasted as much as anyone, but it was the waste of time and effort that got the wheels spinning.

Barta, during the media blitz surrounding the iPad initiative.

For years, Barta watched between 6,000 and 9,000 sheets of paper go out to the 225 members of the Ohio State University Marching Band in the form of 30- to 40-page drill and music packets for each show. If band leadership opted for a different version of a song, it was back to the printer for a new batch.

“I kept thinking about all that time spent waiting and passing out paper,” said Barta, a senior who plays trumpet and majors in operations management and aviation management. “The bottleneck was right there in that printer.”

For an organization with a more than century-long legacy of innovation, Barta knew there had to be a better way – and they found it in Apple’s ubiquitous iPad.

This spring, Barta and fellow band member Charlie King set out to make it happen, working with Ohio State and gaining buy-in from band leadership and higher-ups at the School of Music. Along the way, they also received advice from Aravind Chandrasekaran, an assistant professor of the Fisher College of Business’ Management Sciences department, and Andrea Prud’homme, an assistant clinical professor who also advises the Buckeye Operations Management Society. At BOMS, which our Center for Operational Excellence supports annually, Barta serves as CFO.

One of the apps used with the marching band iPads helps squad leaders digitally manage the drill book. (Source: Video screenshot)

Fast-forward to the onset of Buckeye football season and all staff and directors and the band’s 33 squad leaders in the band are equipped with iPads, thanks to a $25,000 grant Barta and King worked to secure from Ohio State’s Office of Sustainability. These 45 iPads are helping drive new efficiencies in everything from drill and music instruction to inventory checks.

The new initiative has made more than just band leadership take notice. Barta and King have been profiled by Fisher, an ABC Columbus news affiliate, Bloomberg Businessweek, and the Chronicle of Higher Education.

Barta said the ultimate goal is to get an iPad in the hands of every band member, which would virtually erase the $24,000 in printing costs the band shoulders each year. That’s roughly $100 per band member.

The paper- and cost-saving benefits are only part of the equation, though. The iPad is being deployed as a tool throughout the marching band using a mix of existing technology and a little DIY ingenuity. Designated apps are used for cloud storage, marching drill, and music. Each squad leader also has the leeway to use the video and image capture capabilities of the iPad to watch for individual errors and correct issues along the way.

“It’s instant feedback,” Barta said.

Improvements are taking place off the field as well. Inventory checks, once a tedious process, are much easier thanks to the roaming tablets. And instrument check-out has gone from an hours-long, paper-herding process to a much more efficient and paperless one.

There’s additional hope for improvement with schedule changes such as rehearsal arrival times, which often can be difficult to communicate flawlessly to hundreds of band members. Barta is hoping that will change by coordinating the use of Google Calendar.

The iPad initiative’s potential for other improvements in the future is enormous, but already, the innovation is proof that even the “Best Damn Band in the Land” can find ways to get better.