What a wonderful World Café

As a journalist, I was taught to eschew jargon and cut to the heart of the matter, sending corporate buzzwords like “synergy” to the trash bin along with serial commas. I’m pre-emptively asking for forgiveness, then, as I describe the great things that went on in a recent Center for Operational Excellence-sponsored event. If our first attempt at a World Café wasn’t a textbook example of synergy, I don’t know what is.

If you’ve never heard of a World Café (or, like I did, immediately think of the NPR music program), here’s a crash course: A group of people assemble with the goal to tackle a topic in an actionable way. They’re split up into small groups, each at a table, and switch at regular periods with the exception of that table’s moderator. For the event we hosted with the Operations and Logistics Management Association last week, we put the spotlight on logistics and opened the doors of the Blackwell Hotel ballroom to Fisher faculty, students and industry players, some of whom were COE board members. Check out a slide show of the event here.

World Cafe
The World Café event allowed Fisher students and faculty to interact with logistics industry players.

Like any maiden voyage, nerves were on high alert and expectations were uncertain, but a healthy and enthusiastic turnout led to rounds of stimulating discussion. We design the COE experience for our members in ways that connect them with faculty, students and industry peers but it’s rare that this occurs, well, at the same table. Just strolling around taking photos, I could feel the energy, and the session-ending report-outs were rich with thought-provoking conclusions on a range of different facets of the logistics trade.

Tom Goldsby, a Fisher logistics professor and COE associate director, tells me “our students benefited from the viewpoints offered and the very interaction with business professionals. The business professionals, meanwhile, seemed to enjoy the interaction just as much and indicated that the students provided fresh insights on the table topics.”

A crucial sign things were going well: Goldsby says several participants wanted to linger at the tables longer.

“In sum, it seems this first-ever event was a great success – one that we will repeat soon,” Goldsby said.

MBOE HC Recap: Where’s your one second?

Students in Fisher’s Master of Business Operational Excellence Healthcare cohort spent four days last week at the Thedacare Healthcare System in Appleton, Wis., as part of the year-long program. Senior lecturer Mrinalini Gadkari was on the scene for daily recaps.

Ever think about how much time you spend, and often waste, in meetings? Let’s do the math: Let’s assume you’re in one hour-long meeting in an eight-hour workday. Five meetings a week, 20 meetings a month, 240 meetings/hours a year. That’s the equivalent of 30 workdays.

"Time is a valuable commodity, and one easily wasted, in many organizations."

I got to thinking of this as lean consultant Tracey Richardson discussed the importance of even a wasted second while teaching our MBOE students the A3 problem-solving method. When Richardson started working at Toyota Motor Corp., one of her trainers translated the cost of one second lost to the company. Saving one second per plant worker, she said, was the equivalent of adding eight more cars per shift! One second to Richardson meant job security.

“I started looking for seconds everywhere,” she said, urging students to look at their own processes. Seconds might not make sense but probably hours or days or weeks or months would. Any unit of time could be translated into a dollar amount or, in health care, someone’s life.

Back to that one-hour-meeting calculation: With that much time invested, you’re pulling away key people in meetings that go on for years without achieving much. How does that translate into dollars or productivity?

How about going to the gemba instead? How about huddling with your team for a few minutes in a day and tackling real problems?

MBOE recap: The blame game and the Challenger explosion

Students in Fisher’s Master of Business Operational Excellence cohort are back on campus for their second week together in the year-long program. Senior lecturer Mrinalini Gadkari is on the scene for daily recaps.

The 1986 Challenger disaster killed seven astronauts and consumed more than $5 billion as the shuttle broke apart less than two minutes into flight, sending fragments of the craft hurtling into the ocean and putting the nation’s space program on ice for nearly three years. But what caused it? Was it the O-ring failure or that the NASA operational officials’ ignored the warnings of the engineering experts? Was it the absence of clear goals for launching the shuttle? Or was it a problem in their policies? As COE Executive Director Peg Pennington and Senior Lecturer and Executive-in-Residence Gary Butlertold our MBOE students in their final session this weekend, there were multiple causes to the problem – just as there are with any. 

The 1986 Challenger
The 1986 Challenger explosion, captured in this National Geographic photo, killed seven crew members and launched a massive investigation

In a previous blog, I mentioned the importance of defining what your problem really is, whether it’s an exploded space shuttle or a missing file. In hunting the causes, most of us simply go after that root cause that led to the problem. But there’s never just one cause. Problems occur because of multiple causes that underlie the entire system.

Cause mapping, which you’ve read about here before, is a retrospective tool that helps you find out why something happened. This weekend Gary Butler introduced students to a new one – Failure Mode Effects Analysis, or FMEA – that helps you proactively look for when and how things can go wrong before they go wrong. 

How much time do organizations spend on assessing their processes with an FMEA or other tools? If they install new information systems, do they go beyond the cost-benefit analysis? Do they think about the impact they will have on staff, customers or suppliers?  Many organizations have a very narrow-minded outlook and forget to plan for the catastrophes that could be avoided with detailed analysis.

Discuss: Have an incident to share that led to extensive root-cause analysis? Any FMEA stories of your own?

MBOE recap: Mr. Potato Head teaches lean

Students in Fisher’s Master of Business Operational Excellence cohort are back on campus for their second week together in the year-long program. Senior lecturer Mrinalini Gadkari is on the scene for daily recaps.

In my last MBOE recap, I stressed the importance of “shine” in 5S. Yesterday, Senior lecturer and COE Executive Director Peg Pennington demonstrated how 5S and visual management apply to the workplace with a little help from Mr. Potato Head.

Who knew Mr. Potato Head could be so educational? Organizing limbs, mustaches and hats, it got me thinking about how in hospitals it isn’t uncommon for nurses and doctors to hoard supplies so they can have them when they need them and won’t be scrambling at the last moment. If the workplace isn’t organized it’s easy to misplace or even lose things. If you can’t find them, you spend valuable time searching, hoard product or order more. 5S removes that waste, eliminates unnecessary items, creates a safer work area with more space – and, of course, saves you time. 

Mr. Potato Head
“This iconic, bespectacled lecturer led students through a look at workplace visual management.”

Once your workplace is organized and all items have a standard place, what work remains to be done on your processes? Each one of us has ordered something online and gotten the wrong product. Heard of wrong-side surgery? It’s easy to see opportunities for improvement in someone else’s processes. Our MBOE students, for example, took a trip to the Ohio State University Medical Center to view Central Sterile Supply and Nutrition Services. Some students say their “Aha! moment” came by watching technicians and nutrition aides.

In his lecture on training within industry on standardized work, Fisher Executive in Residence Gary Butler drove it home, telling students that a combination of standardized work and visual management stabilizes working condition, flags the abnormal from the normal and keeps staff on task toward reaching daily goals.

Discuss: Do you have an “Aha! moment” for your own organization, on the shop floor or in the service area? How did that lead you to standardize processes?

5S: More to ‘shine’ than the surface

Regardless of where you are in your lean journey, it’s likely you’ve heard of 5S, the set of five words that serves as a methodology for organizing the workplace. In English, they’re Sort, Set in order, Shine, Standardize and Sustain. That’s derived from the Japanese origin of Seiri, Seiton, Seiso, Seiketsu and Shitsuke.

Detractors might say 5S is simply a “spring cleaning” activity where trash is discarded to make room for more, but it’s a great deal more than that. When you sort, you separate and eventually throw away items that are unneeded. You set in order items according to the frequency and sequence of use. You get rid of dirt, dust and any leakages and shine the workplace. Once you organize the items, you standardize their location and level of use. To sustain that organization, you create paperwork that operators or managers can use to reach that goal. 

If it all works so well, then, why do some still consider shine a dusting and cleaning activity? Some say it’s played a part in saving lives. Ever heard of the controversial “Broken Windows Theory? It posits that simple disorder can increase the tendency for crime in urban areas – if more trash isn’t removed, more will pile up. The New York City Transit Authority in the 1990s applied this to stop an increasing graffiti problem on subways, scrubbing down trains each night before resuming service the next morning. Over time, they got rid of the problem as other initiatives were put in place around the city, contributing to a remarkable decrease in vandalism and the crime rate.

When you ‘shine’ the workplace it has a positive impact on the operators working there. A dirty workplace tends to cause distraction and reduce employee morale and doesn’t convey a positive message about the company. With items in ready-to-use condition, working is safer with dust and dirt gone along with slipping and tripping hazards.

In short, a clean and safe workplace begets a safe and clean workplace.

What’s your problem?

I recently had to take a friend to an urgent care facility in town after she broke out in hives and itchy skin, likely an allergic reaction to a food item. After making it into the exam room, the medical technician very efficiently completed the vitals and reconciled medication and past illness history. Next in was a physician’s assistant, who performed a quick assessment and confirmed our suspicions about the food allergy.

But what food? We still weren’t sure, even as the hives were quickly spreading and my friend agreed to a Benadryl shot. Within 20 minutes, the itching was gone with the hives almost disappeared. One crisis averted, one very drowsy friend.

I have prescribed and given Benadryl shots to my patients in the past but this was the first time as a non-physician that I noticed how quickly the drug acts and makes the reaction disappear. It got me thinking about how a lot of the countermeasures many organizations implement to solve a problem act like Benadryl. Symptoms disappear but the root cause remains.

Cause Map
Cause map slide courtesy Peg Pennington

Most people, in fact, aren’t sure what problem they’re trying to solve. For example, if sales go down, marketing goes up. But what if your products are defective? What if customers are getting the wrong product or are waiting too long to receive it? What if a competitor is turning out a better, faster alternative?

You will only be treating the symptoms if you don’t know the:

–          actual problem you are trying to solve

–          root cause of the problem

There are many tools available to get to the root cause of the problem such as the 5Whys and Fishbone diagram.  I recently learned from a colleague a new method, causal mapping, which I prefer because it is visual and loose in structures, allowing for a free flow of ideas until you find the root cause.

My friend, by the way, is on her way to an allergist to nail down the real culprit.

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.

Don’t let the Zen garden fool you

I wish you a very happy 2012 as you make progress in your journey of operational excellence.

I am sure many of you must have traveled during the holiday week. On a recent trip I took to Orlando to attend the Annual Institute for Healthcare Improvement (IHI) conference, a very common occurrence got me thinking. We all know how first-class and business-class members get the preferential treatment of boarding the flight before economy class passengers. In terms of customer service, that makes sense. They pay more and get to board earlier. 

What I find extremely ridiculous is that they get to walk on a small piece of carpet when they board the plane, while economy class passengers are diverted to a separate passage that bypasses the carpet. But only one entrance leads to the plane. As you can see in the picture, the airline managed to create a fake sense of “specialness” for first- and business-class passengers.

We see the same thing in hospital waiting rooms and other service operations. Excellent customer service would be no wait at all but service industries use the band-aid approach for the problem. They build Zen gardens and embellish the walls with beautiful artwork in waiting rooms to distract customers. Instead of improving the processes to reduce redundancies and waste, they focus on the perception of customers regarding wait times. If wait times increase beyond a certain time because of “unavoidable” circumstances, customers are given freebies in the form of free parking passes or gift certificates.

The key is to attack inefficiencies in the processes and give customers what they came for. If you went to a grocery store looking for your favorite box of cereal and had to spend a half-hour hunting, guess where you’d go next time? A competitor.

Customers can’t be fooled by superficial embellishments. Give them what they want. Improve the process, not the ambience. That’s true customer service.

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?

Taking the pulse of your company

Having practiced as a physician, I can’t do my work on a chart or in a lab – I have to see my patients up close. With a thorough history and physical, I can examine signs of the illness and eventually reach a diagnostic conclusion. Simply taking a patient’s pulse gives me an idea of the condition of his or her heart. 

reading an EKG of your operation
Going to gemba is like reading an EKG of your operation

Going to gemba, the workplace, is like taking the pulse of an organization and how well it’s really doing. When you go to the shop floor, you know the conditions under which your staff is working – and seeing that can be a game-changer. Paul O’Neill, former CEO of aluminum maker Alcoa, went to the gemba and saw up close the unsafe conditions in which his staff was working, prompting a focus on his workers’ safety instead of profit margins. According to an article in Business Week, O’Neill took the company’s time lost because of employee injuries from one-third the national average to 1/20th.

If labor productivity is one of your concerns, leave the office and head to the shop floor or the clinic where your employees are working hard to do their best. You’ll see their challenges, their “firefighting” and you’ll start empathizing. Like Paul O’Neill, you’ll feel compelled to improve working conditions so your employees can focus on value-added work. Improvement in your financials will naturally follow.