The waste in your walk

Hospital administrators do a lot of hang-wringing over long turnaround times for procedure and operation rooms. They not only can’t get enough procedures done, but they have surgeons waiting around, twiddling their thumbs while rooms are getting prepared for the next patient. If several procedures in a 12-hour shift are scheduled and each one takes 15 minutes to set up, hours are wasted each day. Such an organization might boast of patient-focused care, but metrics indicate quite the opposite. Not being in a position to meet customer needs can hurt all the way to the bottom line.

A spaghetti diagram can illuminate wasteful steps – actual steps – in process flow.

So how do you create the ideal flow? To start, I’ve written before about how it’s extremely important – this can’t be stressed enough – to go to the gemba and seek out the so-called motion waste. This can be done on an intricate level with what’s called a Spaghetti Diagram, a title that should be apparent by this picture.

A Spaghetti Diagram is a graphical tool that helps understand the activities involved in any process with details of the actual physical flow, or lack thereof, and the amount of traveling involved. It also highlights the flaws in the process, especially when you see how your staff is spending time in order to provide the best service or care to the customer. Unnecessary motion occurs when the operator doesn’t have everything he or she needs where needed and in the necessary amounts. This also occurs with poorly maintained equipment, a lack of standardized processes, the right metrics or no accountability. Many causes could exist, but the key is to use the diagram to work on those issues.

Here’s how to make one:

–          Before you do anything, explain to your staff why you’re there and what you’ll be doing. Address any apprehensions they might have.

–          Draw a layout of the work area you are trying study. Contact the facilities department if you want.

–          Note important landmarks where staff members move to retrieve materials or equipment and use numbers for each station or work area.

–          With a pencil, draw this movement as they go about their work from the start to the end of the process. Use different colors if more than one staff involved.

–          See patterns? Dig deeper, pull out a stopwatch and even get a measuring wheel from a hardware store to note the time and distance. Follow the worker around if need be.

–          Take those results and share your findings. Shared information helps with shared responsibility.

Now grab your pencils and get to work!

Make your mark with Fisher’s MBOE program

A friend of mine who’s a cardiothoracic surgeon at a renowned hospital in India emailed me with a problem. Here’s what he wrote: “The people at my hospital are motivated, hardworking and some are brilliant, too. But the processes are abysmal. It takes three days to discharge a patient after I actually decide to; an admission entails eight signatures across four buildings; and my wait list is 24 days to surgery after admission.”

Operation room hospital electrical wires
Systems in organizations – such as the wiring behind the scenes of an operating room pictured here – often are more complex than they need to be.

Digging into these problems and helping organizations eliminate “wastes” in their processes to improve efficiency happens to be what I do for work. A subsequent chat reminded me of how process inefficiency is pervasive globally in all occupations. If you’re looking to make lasting change in your organization, we have a one-of-a-kind program at the Fisher College of Business to get you there.

It’s called the Master of Business Operational Excellence, or MBOE, program, and it helps organizations address these inefficiencies and achieve operational excellence. Working with an industrial cohort and a health-care cohort, we are addressing the major challenge of working professionals of not having enough time outside of work to attend school. Some basics:

  • It’s a one-year degree program accredited by the Association to Advance Collegiate Schools of Business.
  • Students come on campus only eight times through the year, or every five to six weeks. When they are on campus, they spend four full days that week from Wednesday to Saturday.
  • Students work on a major capstone project, creating a positive impact on the organization where they work.
  • Each student’s supervisor is a “sponsor” who commits to support the student throughout the year and help remove any obstacles.
  • A coach, hand-picked by us and equipped with extensive experience, works with the student throughout the year

In short, it’s possible to get a master’s degree from THE Ohio State University and tackle a major work project all in one year!

Time’s ticking. Apply now.

The Ten Commandments of lean management

The folks over at the Lean Enterprise Institute have pointed out a new article circulating in lean academia from Management and Production Engineering Review that breaks down the basics of applying lean philosophy in a tried and true form: Ten Commandments-style.

Charlton Heston
Charlton Heston (or Moses, your choice), improving flow like a true lean leader (source: DallasVoice.com)

The stone tablets here are a PDF you can download, but the piece is a detailed breakdown of each “commandment” that links it to its originating Japanese terminology (often a problem in communication) and drives home its importance. The team of authors, led by researchers at the Wroclaw University of Technology’s Institute of Production Engineering and Automation in Poland, do a nice job of summing up leadership duties and how the rest of the team comes into play.

No parental dishonor, coveting or “thou shalt nots” here, but take a look at the first five:

1. Have a clear vision and improvement goals for the whole organization.

2. Be an engaged boss initiating changes.

3. Improve processes and the results will come as a consequence.

4. Create an Obeya-like management center.

5. Determine indicators and bonuses that show one direction to the managers.

Thou shalt read 6-10. Feel like bearing false witness and suggesting better commandments? Leave them in the comments.

Finding flow in daily life

If you haven’t followed my advice and moseyed on over to Slate.com to read the online newsmag’s operations series,  bookmark me and make haste. Writer Seth Stevenson over the past couple weeks has turned out a great batch of pieces on operations success stories that, while a bit elementary for your average ops vet, are a reminder that simplicity breeds success. His latest piece – the result of a call-out to readers – is the best yet, sharing process improvement success stories in our daily lives.

Based on the theme of the piece, the grocery store appears to be a major problem – sorry: opportunity – for many of us. Like many processes, the chances for variation between that initial opening of the automatic doors and the final bag during check-out are myriad. As a writer with little to no exposure to the ops world before joining the Center for Operational Excellence, I’ve found myself making changes in that process. Coupons are organized in the order of where I’ll see the product on my route, and the shopping list itself gets the same treatment. 

Grocery shopping
Grocery shopping can provide plenty of stress but provides plenty of opportunities to go lean

Some grocery shopping frustrations remain: The deli counter still takes forever, a sign I should follow one Slate reader’s advice to drop off the order and pick it up at the end of the trip.

Opportunities like these in daily life are everywhere, and I’d like to hear yours. Where have you gone lean outside of the office in an effort to find a few more precious minutes to spend while off the clock?

Online series takes a look at operations

Leisure reading and work are typically two things I like to keep separate, but our operations readers might want to mix the two and check out an interesting new series at online news mag Slate.

A new series on the website, crafted by author Seth Stevenson, is taking a look at key tenets of operations over the next few weeks. You can get started by reading his first article here, one entitled “What You Hate Most About Waiting In Line.” This is solid, sprucely written material, though anyone with a years-long background in operations management might find it a bit basic. He’s already waxed poetic on Eli Goldratt’s The Goal and viewed operations through the prism of Southwest Airlines’ successful string of profits.

None of this might be new, or news, to you. What’s at play here, though, is a spotlight being shined on operations at a well-read website that spends much of its time on current events and pop culture. If even a few enterprising, undecided college students feel a light bulb going off reading this, that’s a few steps forward for a field that needs all the bright minds it can get.

Stop playing dodgeball

Growing up, one of the many games I played with my friends was dodgeball. It’s also a sport many of us haven’t given up – particularly in the workplace.

Reactions to organizational change can at times resemble a game of dodgeball. (Photo courtesy HeraldTimesOnline.com)

On each side of the “gym” are functional teams that represent different departments and work on departmental goals and priorities. If a new initiative is launched, they try to dodge the responsibilities because they don’t align with priorities or most of the time they don’t know how they align. One fine day they hear from the CEO the new change needed to be implemented. People do everything to resist the change – think bullet-dodging a la The Matrix. This resistance sometimes comes in the form of excuses wrapped in the plausible explanation of having too much on the plate or not having enough resources to take on the new challenge.

Why do people resist? One thing we all know is that change is difficult. How many times have you made New Year’s resolutions? Another reason is there is not enough emphasis on why the change is being made and how it aligns with the mission and vision of the organization.

One other key reason that leaders forget is the need to have a candid discussion with people who will need to implement the change. In a game of catch-ball, you have to look at the person to whom you are throwing the ball and strategize such that he/she does not drop it. The catcher has to pay attention as well. The Toyota leadership style involves the catch-ball process for communication. The leader shares the vision with his/her team. The team converts the vision in actionable items and presents the challenges of implementing the vision to the leader. The leader may stick to the vision but he/she listens, empathizes and proposes how the hurdles can be overcome. Based on the feedback from the team the leader might also adjust the vision to make it more realistic and practicable. The team and the leader agree on what’s possible and what’s not and how it can be implemented. They check in with each other from time to time to ensure progress.  It’s win-win situation.

If you have been playing dodgeball, now is time to switch. Play catch ball. Get your team on board. Make them want the change.

Fisher class tours COE member Huntington

One of the Center for Operational Excellence’s many partnerships within the Fisher College of Business is its financial support of the Operations in Action class. This course launched in the 2010-11 academic year and is aimed at encouraging sophomore female students to consider operations management as a major and a career choice.

Now in its second year, the course got out in the field recently with a tour of COE member Huntington National Bank hosted by Jeannie Raymond and John Largent (click here for more photos of the student group). This was no normal walk-through. COE Associate Director Andrea Prud’homme tells me a team of students did research on Huntington and gave a presentation to the rest of the class on the morning of the visit. They then took the lead in engaging with Huntington managers and prepared questions in advance to fuel a Q&A session.

Andrea Prud'homme
COE Associate Director Andrea Prud’homme, far left, poses with Fisher students and Huntington executives at the bank’s headquarters

 

Raymond told us the bank greatly enjoyed hosting the students and said management was “very impressed by the students’ questions and their overall level of engagement and interest throughout the day.”

Huntington is one of a number of member companies that support this important course, and we’re always looking for female mentors to step up. Think that could be you? E-mail Andrea Prud’homme at prudhomme.3@osu.edu and we’ll make it happen.

You’re listening to WII-FM

Have you ever heard the WII-FM Station when driving change at your organization?

Not familiar with the station? You’ve probably heard many people resisting that change saying it: “What’s In It For Me?”

It’s easy for pilots to answer that question. They refer to a checklist before flying to ensure the safety of the plane and the passengers. Why? It’s part of their job, and their own life is involved.

In other professions, such as health care, that answer is less clear. We place a lot of importance on patient centeredness. This is a great concept, any many hospitals work hard at this with patient-satisfaction surveys and process improvement programs aimed at improving operations and ensuring patient safety. But medication errors, patient falls, lab report mishaps and other problems still happen, so why don’t process improvement efforts bear fruit all the time?

This question has many possible answers: Leadership isn’t committed, training is lax, quality improvement programs are seen as “flavor of the month” deals, other priorities take precedence… The list is endless.

In my experience, one other key problem keeping our changes from truly taking hold is not answering that first question, not making it clear to the people making the change what’s in it for them.  Improving processes means changing how employees have been doing work, sometimes for years. Now you step in and tell them it’s because of our patients or customers? Sure, no one goes to work with the idea to give the wrong medication or make a defective product, but customer-centeredness is still not enough of a change motivator. What also is important is what employees get in return.

To answer that, here’s a sample:

  1. The complexity in your work is gone
  2. Your productivity is improved
  3. Overtime is gone and your work-life balance returns
  4. No more waiting for help or for others to finish work
  5. Better communication with your colleagues
  6. More time to do what you enjoy and less time spent on useless activities such as walking or searching for documentation 

Last but certainly not least: It doesn’t hurt to tell employees there are consequences if they don’t buy in, and this isn’t communicated enough. Not much is done to celebrate successful adapters. Not much is done, either, to address those who don’t adapt due political or financial reasons.

Remember this next time you need your team to tune in.

 

The lean secret of … Indian bread?

I never fail to be reminded that lean thinking makes sense anywhere – and everywhere. The latest occasion was at a friend’s house a few weekends ago making an Indian bread called paratha. I had made them in the past, but this was the first time it really registered to me as a process. Just watch how lean thinking takes over in the kitchen.

My friend began the setup by making a large dough ball, kneading wheat flour,salt and water. The process steps entailed

bread making
The Indian bread paratha takes teamwork – and some lean principles – to make a successful meal.

her making a small ball from the dough, rolling it flat and placing it on a pan where I cooked it. I then removed it from the pan, placed it in a casserole to keep it warm.

Here’s where it gets tricky – just like any process a few steps away from its future state. Initially, we weren’t synchronized to create one-piece flow. If she slowed down, my pan sat empty and overheated, creating waste in the form of time and human potential and winding up the pitch for a defect. If I slowed down, she already would have rolled the bread, standing there and waiting for my pan to be empty. As a countermeasure, my friend kept a plate between the pan and her rolling unit where the rolled bread  began to stack up. With the pressure on, I pushed to cook the parathas faster, turning up the heat and burning the bread. When I turned the gas down, the bread would be undercooked. More defects. If you’re still with me, you see her countermeasure covered up a symptom of the problem but didn’t get at the root cause.

It took us time to get things under control, but we “stopped the line,” huddled and came up with the most efficient way of cooking the bread. This involved using the correct amount of heat so I wouldn’t burn or undercook the bread. We paced our share of work so we produced at the same rate, or takt time. We decided the empty pan would be the kanban for my friend to start rolling the next bread. If the pan was filled, she would use that time to undertake some standard work: Making the ball for the next bread.

Voila! The lean recipe worked for our recipe: Warm parathas with delicious egg curry. Take a stab at it yourself – and learn from our mistakes.

 

Problem-solving starts with a look in the mirror

It’s not uncommon to blame other departments or people for the inefficiencies in your own processes. While working on process improvement projects, I’ve heard it all: “It’s the doctors who are the problem,” “Finance just gets paid to make things difficult for us,” “It’s the emergency department’s fault.”

The sterile processing department at OhioHealth Corp. has tackled that culture by focusing inwardly. They’ve accepted the fact that they can’t control how surgeons or ORs function. What they care about is how they can modify and standardize their own processes to meet the variation in demand from the ORs.

Gary Butler
“Fisher Executive-In-Residence Gary Butler with the OhioHealth team.”

And have they.

“Five hours, that’s our turnaround time,” Nikki Ross, sterile processing’s systems director, announced proudly as I toured the process with my colleague Gary Butler. That’s the time from when the trays arrive at the decontamination area to when they are ready to be sent to the OR. The national average: 12 to 24 hours!  

So how did they do it? Ross focused on the elimination of waste, first pinpointing what exactly waste is and then going to gembato observe the process, empathizing and asking questions along the way. Armed with the knowledge and training of an OhioHealth process improvement specialist she was able to figure out not just the wastes in the process but also the value of just-in-time production and one-piece flow. Just as Rome wasn’t built in a day, it took Ross a few years to create a smooth and efficient process equipped with the ability to process faster with fewer errors.

Instruments
“OhioHealth’s processing rates in sterile supply are much faster than the national average.”

In health care, it’s common for some to say the processes in the system are too complex for a lean transformation, but surgical kits are no different than a car assembly line. OhioHealth has proven this. As I walked through Ross’ department, I noticed evidence of standard work, visuals for setting up trays, and very little inventory.  As a result, they are able to process the kits and track errors faster while continuing to improve.

Discuss: Any success stories at your organization?