Sleeping with the enemy

While hosting a colleague and her husband for dinner last weekend, somehow the conversation drifted to the topic of strange pets people keep. My colleague’s spouse shared the hands-down winner, a story of an acquaintance – we’ll call her Kelly – who was so attached to her pet python that she slept in bed with it. Everything was going well until she noticed the snake had stopped eating. Concerned, she took the python to the vet, who told her why: Kelly’s bedfellow was starving itself for the big prey – her!

Mrinalini Gadkari Ground Zero, NYC
Author Mrinalini Gadkari in Manhattan

We might not know it, but we’re cuddled next to hungry snakes every day: The defects in our systems and processes lurking beneath the reworks we perform and roundabouts we take. Toyota Motor Corp. has a way to find those: An “Andon” cord, which flags a problem, prompts a hunt for its root cause and potentially pauses production if it can’t be solved immediately. When Lean Enterprise Institute CEO John Shook came to our Master of Business Operational Excellence program in October, he mentioned that the cord is pulled about 15,000 times a day at Toyota’s factory in Kentucky. “Better safe than sorry” seems to be their motto.

We rarely look at the process as a whole, instead we fix one incident and move on. We do root-cause analyses and fix problems, but do we really track if those changes have succeeded? Most root-cause analyses become a part of files and folders opened only when a regulatory agency visits the organization. In the meantime, how many times do we allow errors and defects to pass on to the customer?

Reworks are like enemies in disguise. Keep them out of bed.

Lean Principles: Are they really applicable to me?

Because lean principles have their roots in automobile manufacturing, people in the service industry are prone to bristle at the thought that their organization could benefit from them. Health care is a prime example and its workers sing a common refrain:

My patients aren’t cars. They are human beings.

I agree, but there’s a hidden distinction that’s key here. Health-care workers with this complaint mean to imply that humans not only are different but superior (though who hasn’t had a car more reliable than some people?). If that’s the case, patients must be given even better treatment than cars. A health-care setting, where potentially deadly errors lurk around every corner, should have:

  1. Safe customers
  2. Safe employees
  3. Reduced defects
  4. Standardized processes

The Catch

These are all pillars of lean thinking, embodied in the Toyota Production System. That process aims to create safe processes for employees and workers, turn out well-tested cars and produce them with as few defects as possible to reduce the potential for recalls. Their processes are standard and led by cross-trained employees in a way that someone from a different factory can step in and work without any problem. How is this anything but a win-win for health care?

We want our nurses, doctors and staff safe. We want our patients to be treated right and on the road to recovery. And we want them out the door for good when they’re discharged as readmissions are costly to the hospital and the patient’s quality of life. Strategies vary patient to patient but the core processes are the same, from check-in to admission to follow-ups. Yet every department has a different way of doing things and doctors even within the same discipline follow different processes. This results in staff and customer dissatisfaction and increased chances of errors, which lead to an unsafe environment for everyone.

The core process seems so simple, but we’ve managed to complicate it because we don’t understand the process and its defects – but some organizations are working to change that. Thedacare Health System, Seattle Childrens, Cleveland Clinic, Akron Childrens, GroupHealth and others have successfully experimented and implemented lean principles, proving they’re not just for cars. And these organizations are reaping the benefits.

What are some of the concerns that hold back service organizations from implementing lean? What are some ideas that could help them see differently?