Akron Children’s cardboard ward makes headlines

How many times have all of us gotten that bright idea, mapped it out in our minds or on paper and then watched in horror as its real-life execution goes terribly wrong?

When it’s a romantic dinner or a driving shortcut, all that’s lost in the process is a little dignity. When it’s an entire ward in a pediatric hospital, the stakes are higher and the cost could be lives. I’m entirely unashamed to brag, then, that some of our Master of Business Operational Excellence graduates demonstrated their panache for avoiding a situation like that with such innovative aplomb that it garnered them ink in the Akron Beacon Journal.

ACH LogoThe article details an effort by MBOE grad Sherry Valentine and others to revamp the NeuroDevelopmental Science Center at ACH to handle more workers and cut down on patient wait times. Instead of taking plans from the blueprint to the contractor, though, Valentine marshaled a cardboard recreation of the proposed overhaul to allow employees to try it out.

A key facet of the revamp was reducing travel time as samples were moved for testing. “When lab staff tried out their initial attempts to renovate the department,” according to the article, “they discovered the changes left too little space in their work areas.”

“Sometimes, the teams have found what looks good on paper doesn’t work in real life,” according to the article.

From a lean perspective, a couple of teachable moments are at work here. In its own creative way, this mock-up operation is a kind of gemba, where management and workers can immerse themselves on the ground floor instead of a bird’s-eye view. The article also mentions that the simulation “allows the team members who will be doing to the work to be involved with designing their workplace.” Is there a better example of a no-blame, shared-responsibility culture than that?

Valentine tells the paper it’s unusual in the health-care sector for an entire mock-up to be created before construction begins. With change agents like her applying what they’ve learned at Fisher, that might not be for long.

Bringing it all back home

It’s a common occurrence but a sad fact of life in the business world: Lured by cheaper wages and less red tape, a company uproots U.S. manufacturing operations and sends them to China or another country in an effort to cut costs.

Harry Moser has made a crusade out of asking those companies a simple question: “You sure about that?”

Harry Moser Reshoring Initiative manufacturing Fisher College of Business
Moser brought the message of his Reshoring Initiative to Fisher in January. Image courtesy Emily Tara.

In a recent visit to Fisher, the founder of the Reshoring Initiative outlined how he’s working to broaden companies’ understanding of all the costs of offshoring – and the benefits, in turn, of keeping or moving it stateside. Sure, the price tag initially might look cheaper on paper, but factor in a host of other risks and costs that escape that first glance and the U.S. is much more competitive, if not less costly altogether over the long term (run the numbers with Moser’s handy Total Cost of Ownership Estimator).

“We’re much more competitive competing here than we are competing there,” Moser said.

At the forum, sponsored by the Center for Operational Excellence, CIBER and the Ohio Manufacturing Institute, I was thrilled to see Moser talk about the costs of offshoring from an operational excellence perspective. Based on evidence Moser presented, a compelling case can be made that running an operation offshore can create waste that would make any lean thinker shudder.

Just think about the impact the big blue ocean between your offshore plant and your customer can create. Bringing product back makes the most financial sense with large batch shipments, but what happens when demand shifts your product mix? And what about defects discovered after a product has been shipped from half a world away? Research in the pharmaceutical manufacturing realm by our own John Gray indicates offshore production – even by U.S. drug-makers – carries a greater quality risk than its American-made counterpart.

Advocates for bringing it back home, take heed: It’s easy to make the case for reshoring not just with dollars and sense, but common sense.

Show me what you got

I got my first real taste of old-fashioned, machismo-fueled negotiation when I wrecked my car earlier this year. Thankfully, I wasn’t the driver to blame, wasn’t hurt and was driving a 15-year-old parental hand-me-down I secretly wished would suffer that fate. Nonetheless, one totaled vehicle meant finding another with a settlement check from an insurance company in tow – and both of those would put me face-to-face with people who assured me they were giving me the best deal they could but were clearly lying through their teeth.

In both scenarios, I (naturally) feel I came out on top in retrospect. Talking an insurance adjuster into a few hundred extra dollars is no small feat and my performance in the car salesman’s office would make Ryan Gosling jealous.

I thought about both of those negotiations last week, when the Center for Operational Excellence hosted a forum for our member companies’ administrative assistants. The brave souls that trekked through an unusually blustery and snowy Columbus day got a hands-on crash course in negotiation from Maggie Lewis, a lecturer in the Fisher College of Business. Unfortunately, that thinking led me to realize the kind of negotiating I did wasn’t that tricky. I cared nothing for the results or the feelings on the other end of the table, a classic “win-lose scenario.”

Maggie Lewis
Maggie Lewis, presenting at COE’s administrative assistants forum

The kind of negotiating we do in our lives as lean thinkers is much tougher than balking at a sticker price. In a realm where responsibility is shared, blame is avoided at all cost and flow requires buy-in and cooperation from everyone involved, negotiation is a tightrope walk. On one end is the current state, riddled with problems and inefficiencies, and on the other is the future state your pursuit of operational excellence will take you. The last thing you need is a disgruntled colleague with a good pair of garden shears.

Lewis during her presentation made a few comments that struck me for their deep relationship to lean principles, chief among them: “Negotiation is just problem solving.” Any manager could tell you that sentence works in both directions.

Tell me where it hurts

Fair warning: This is one of those articles you read that makes you think twice about checking into an emergency room.

I’m still reeling from a recent New York Times article on a Department of Health and Human Services study that found hospital employees note and report only one in seven errors and other incidents of harm to hospitalized Medicare patients. One in seven: That’s an F in a classroom and includes instances that range from bedsores, acquired infections and other mishaps that could even result in death.

Medical error
This x-ray, courtesy BigHealthReport.com, illustrates a much-feared medical error.

The point here isn’t to encourage you to hit the Advil next time you fall off a roof. Read deeper and the lean alarm bells start sounding. According to the article, federal researchers say it isn’t shame or embarrassment that’s keeping these instances from being reported. Rather, it’s hospital employees not recognizing what constitutes patient harm or realizing a procedure has harmed a patient. In lean-speak, researchers hint the root cause lies deep within the procedures and training that line the backbone of hospitals’ operations.

The most staggering sentence in the article comes later: “In some cases … employees assumed someone else would report the episode, or they thought it was so common that it not need to be reported, or ‘suspected that the events were isolated incidents unlikely to recur.’”

This is a shining example of how a finger-pointing, siloed approach to daily work and problem-solving can infect an organization. On a shop floor, this could mean a malfunctioning widget. In a hospital, this could mean one less vacancy in the basement morgue.

The report is mostly, but not all, bad news. Medicare officials told the Times they’ll develop a list of “reportable events” to clear up confusion, a sure sign of progress. But much work remains to be done – a major problem in the system these days, the report states, is that once problems are recognized they very rarely lead to changes in policy or procedure. It’s a good start, though, to define what a problem is, design processes so they expose problems and then have a process in place to address them.

Reading the article, I’m reminded of a chat I had with lean guru Steven Spear when he visited Fisher to coach our Master of Business Operational Excellence cohort in November. Spear has loudly advocated that health-care providers should focus less on problems in the market and more on reforms in specific processes to effect meaningful change.

“I’m not sure that’s caught on in health care in a broad-based way,” he told me.

Unfortunately, he’s right.

Practicing what we preach

Even if many of the speakers who come before COE members have lean-transformation success stories to share, all of those tales have to start with some gory details about problems at their organizations. In the spirit of quid pro quo, I’d like to share one of ours and fill you in on what we’re doing to make it better. Think of it as the Fisher College version of US Weekly’s “Stars: They’re Just Like Us!”

Our Dec. 2 seminar featured fantastic and well-received presentations from Cardinal Health Inc. and Starbucks Corp. (don’t believe me? Check out these pics). If you logged in to watch either of these events via a live webcast, however, you got a front-row seat to some technical problems we had in the morning and afternoon. Live audience members in the afternoon were privy to an audio glitch at the start of the Starbucks presentation as well.

Fisher College COE cause mapping
COE joined with the audio and visual teams that helped with the Dec. 2 seminar to dissect some of its glitches.

In a world without lean thinking, we’d hoist the blame on the shoulders of the good folks at Fisher and the Blackwell Hotel who handle audio and video for us and be done with it. Easy? Sure. Fair? Not at all. So in the spirit of lean thinking, we spent a half-day this week creating cause maps with the audio and visual teams that revealed a number of issues that fueled the fire. And like the dutiful lean thinkers we are, we emerged with some proposed changes to our event planning and execution next year that should boost the quality of COE members’ experience and lower our blood pressure readings.

It’s disheartening and even scary to dig beneath the surface and expose the frayed wires in our process but they remain a problem waiting to happen until you do.

Discuss: How has operational excellence influenced the way you or your organization dissects problems after they occur?

COE member Cardinal Health gets supply chain honors

Sometimes the scope of the machine can obscure the beauty in the little cogs that make it all work. Take Center for Operational Excellence member Cardinal Health Inc. for example: It’s a $100 billion-plus company, highly profitable, one of the largest employers in the Columbus area and manager of a network of distribution centers so vast its products can reach a staggering share of hospitals nationwide in no time flat.

It’s also an extraordinarily efficient and nimble enterprise, having navigated through the recession with few bruises, shed a piece of itself to create a new West Coast entity and plotted an ambitious expansion into Asia that could pay untold dividends in the future. It’s the efficiency and its translation into high-quality service to customers that has captured the attention of the number-crunchers at research firm Gartner, which recently named the Dublin-based company the No. 1 health-care supply chain in the nation.

To reach No. 1, Cardinal moved past last year’s holder of the top spot, Owens & Minor, which slipped to No. 5 this year. Nos. 2-4, in order, were Mercy, BD and the Mayo Clinic.

It’s reasons quantitative and qualitative that got Cardinal the honors. Gartner perused data on financials and inventory levels, combining that with other survey data and peer opinions (Cardinal’s top-notch there, in specific). The company in bestowing the honor called Cardinal “a complex combination of well-connected businesses … (that) combines the varied strengths of a medical-surgical distributor, a pharmaceutical wholesaler and a large manufacturer.”

So why all the hoopla over a health-care supply chain? Gartner gets at a key distinction that strikes at the heart of why operational excellence in the health-care realm is so important: “Losing sight of the customer, in most industries, results in frustrated tweets and blog posts about a product or service that may lead to lost sales opportunities. Losing sight of the patient, however, can reduce the quality of life for particular patients and, in the worst case, can lead to the loss of life.”

So congratulations to Cardinal, an all-star on COE’s roster that recently came to Fisher to share its lean story at our Dec. 2 quarterly seminar.

A congratulations by proxy goes to fellow COE member Abbott Nutrition, whose sister pharmaceutical operation made Gartner’s top 10.

Stepping outside the COE box

Attendees of last Friday’s professional development meeting hosted by the Center for Operational Excellence can thank the executives from Cardinal Health Inc. and Starbucks Corp. for the insights they carried into the office Monday. Those of us at COE owe them gratitude for a pair of touches outside the norm for our programming that proved wildly successful.

T-shirt folding activity led by Starbucks
Seminar attendees participated in a T-shirt folding activity led by Starbucks

In the morning session, at the suggestion of lead speaker and Cardinal executive Whitney Mantonya, we devoted the entire second half of her time to a panel discussion featuring her colleagues who have helped with the Dublin company’s lean transformation. A panel on a topic featuring all employees from the same company? It isn’t something we’ve tried before and it’s not even the traditional form of a panel.  What transpired, however, was a detailed dissection of the bird’s-eye view Mantonya provided in the first half, the exact kind of sleeves-rolled-up scrutiny our knowledge-hungry members want. It seems the group’s favorite part of the morning session was the very section we didn’t originally plan.

Sometimes it doesn’t hurt to step outside the box.

That’s exactly what we did in the second half of our afternoon session as well, when we escorted the entire crowd of attendees from Pfahl Hall to the Blackwell Hotel for a hands-on T-shirt folding activity suggested and led by Starbucks that taught the basics of standard work. We’ve been hands-off with hands-on activities at our seminars before, but the overwhelmingly positive feedback (and happy faces on our Flickr page) indicate it was exactly what the doctor – err, barista ordered.

COE adds staff amid growth spurt

Life brings bad problems and good problems, and the Center for Operational Excellence is happy to be right in the middle of a very, very good one.

Tom Goldsby
Tom Goldsby

To put it quite simply, we’ve grown our membership base at such a steady clip that a group once numbering four in 1992 has hit 34. This has translated not only to more people actively working with Fisher on their pursuit of operational excellence but more attendance at our quarterly professional development meetings. A lot more. Our Sept. 30 event that featured a retired Kodak executive and Harley-Davidson CEO Keith Wandell peaked at about 200 attendees, a record. This past Friday, when hosting executives from Cardinal Health Inc. and Starbucks Corp., we would have hit and potentially exceeded that record by opening the events to the public but invited members only because of space constraints. Once again, a very good problem.

In our member roster and the decision-makers who come to our programming, these aren’t just manufacturers with a shop floor. COE is embracing the notion of continuous improvement in the most inclusive way possible, paving the way for the entrance of Nationwide Mutual Insurance Co., Huntington National Bank, OSU Medical Center and others in the transactional and health-care spaces.

Not that we’re leaving our core constituency behind. We’ve come to recognize a growing contingent of members in the logistics and distribution sectors needs specialized attention. For that, we’ve brought on one of the brightest minds tackling logistics in academia today, and we didn’t have to look far. Prof. Tom Goldsby, PhD, of Fisher’s Department of Marketing and Logistics, has stepped in as an associate director for COE to work closely with several companies that will benefit greatly from his award-winning research.

Goldsby already has made his debut before our COE board. We expect you’ll see a lot more of him.

Want some value-stream mapping tips from the pros?

Our good friends at the Cambridge, Mass.-based Lean Enterprise Institute are giving operational excellence junkies a chance this week to learn from a few masters this week – without leaving the office.

Tuesday Nov. 29 at 2 p.m. EST, the institute is hosting a free webinar titled “Learning to See the Whole Value Stream: The Power of Extended Value-Stream Mapping.” It’s set to last one hour and will be led by Jim Womack and Dan Jones. Those of you brushed up on your lean reading might notice they’re the gents who quite literally wrote the book on some hallmarks of lean thinking including, well, Lean Thinking, Lean Solutions and Seeing the Whole Value Stream.

recent value-stream mapping session
COE Executive Director Peg Pennington hosted employees from Grange and Huntington for a recent value-stream mapping session

The cost? Your time, an hour of it to be exact. Click here to register for the webinar.

The concept of value-stream mapping will be fresh in the minds of a few of our member companies: Grange Insurance and Huntington National Bank. A group of employees from each company came to Fisher earlier this month for a day-long session on VSM led by COE Executive Director Peg Pennington. They’re part of a growing contingent of transactional companies in COE – and they’re making great strides in apply operational excellence strategies to new realms of the corporate world.

Amy Tomaszewski, Grange’s assistant vice president of operational excellence, told me the event was a great success for her company and “provided quite a few ‘Ah-ha!’ moments.”

“The instruction was excellent and tailored to the service transaction environment, which is often overlooked in lean training,” Tomaszewski said. “Through the real-life computer simulation of the movement of electronic work and the team exercises around value-stream mapping and a simulated Kaizen event, we were able to see the result of both positive and negative changes that can occur when a company looks for and acts upon improvement opportunities in a value stream.”

When opportunity knocks

Any time I see a great lean process at a company or in real life, it looks so natural I’m shocked it wasn’t always that way. That’s probably why I had to read a recent Akron Beacon Journal article featuring Center for Operational Excellence member Akron Children’s Hospital twice before I saw the lean thinking behind the innovation.

Akron Children's Hospital

The Oct. 30 piece by medical writer Cheryl Powell focuses on the growing importance of so-called advanced-practice providers – you know them as nurse practitioners and physician assistants – at Akron Children’s and other hospitals. This is taking place because of restrictions on resident work hours and growing demand for service. Akron Children’s, however, is using that situation to create a lean environment where ownership is shared and the blame game isn’t played. Think about that when you read the anecdotes that open the piece:

“When the medical staff executive committee helps chart the future of Akron Children’s Hospital, nurse practitioners sit side by side with doctors as peers. As the hospital’s pediatric neurosurgeon finishes a complex brain operation, he usually steps back and lets a physician assistant close the child’s head. And if a cancer patient has a problem in the middle of the night, an advanced-practice nurse or physician assistant often provides the care.”

Much of the article focuses on the promising salaries of those advanced-practitioner careers, but what struck me were anecdotes about the Cleveland Clinic, which is using those workers to help patients with less-serious problems, “which frees up doctors’ time to spend with people who have complex problems.” Sounds like standard work to me.

The results, by the way, are the true goal of any standard work implementation: Smooth flow and more time for innovation. The clinic also boasts of higher patient satisfaction and quality scores coupled with lower average stay length and readmissions.

As in any industry, sometimes a problem becomes an opportunity.