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?

MBOE recap: The Weakest Link (…goodbye.)

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.

As lean guru Tracey Richardsontaught our MBOE students the problem-solving process at Toyota, the thing that amazed me the most was that she rarely used the word “car” or anything close to it. She spent a major part of her time talking about culture and people instead, asking: “Does your company have values?” More importantly, she said, is whether your people believe in them. That, Richardson said, is the weakest link in a company.  Most organizations boast having values, but do leaders have the discipline to live them and hold people accountable? Have they internalized the values to reflect in their character? That’s where most organizations lag.

Tracey Richardson
Tracey Richardson coaches Fisher’s MBOE cohort

An example of a good leader sticking to values, in this case safety, remains in my mind: This company’s CEO was walking with me down a hallway when he noticed a paper clip on the floor. Without a moment’s hesitation, he bent down to pick it up, threw it away and we kept walking. He didn’t have to say a word. That company’s core value was conveyed through that action. 

Culture begins with leaders. People internalize what they see and hear their leaders doing consistently. The “true north” goal at Toyota can be described in one line: Customer first, the highest quality product, lowest cost, shortest lead time, safest manner, while respecting people. At Toyota, to create the highest quality product, they hire the right people in a systematic manner, train them to continue to have standardized processes, encourage them to highlight and solve problems in a systematic manner and value their inputs. Once a month, Richardson said, the president of Toyota would go to the shop floor and spend two hours working on the line, letting front-line staff help the manager on other processes. What a commitment from the president!

Discuss: How do you see the core values of your organization play out in everyday ways?

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.

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.

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?

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.

MBOE recap: Graduation day

“Remember that you have the best knowledge, and you learned from the best.”

These words came from a student wrapping up her capstone project for Fisher’s industry MBOE program, which ended its third intense and exhilarating year Saturday. This group of doctors, nurses, plant managers and administrators learned and shared principles of lean and applied them at their workplace, changing the way that work is done.

And this weekend they made it, walking away with a degree that’s one-of-a-kind in the U.S. Many sacrifices were involved. Instead of taking their kids to the zoo or going out for dinner with spouses and family, they worked on their six-sigma modules. They gave more than 600 hours this year for their professional development, making a positive change at their workplaces. Their projects were aimed at making shop floors and hospital units safer and easier for employees to use, resulting in satisfied customers/patients and a positive bottom-line impact. That learning, guided by some of the best coaches in the country, spread to others that they, in turn, taught.

MBOE Graduation
Fisher’s industry MBOE cohort at commencement

Some snapshots of the final moments of the MBOE cohort:

The management team from the Evansville school system in Indiana raved about how they successfully made big and small changes. Speaking of the MBOE program, one leader suggested that companies should work “to get your whole team in the program and you will see the widespread improvements.” I have not seen such open-minded executives who are willing to change first before making changes to their organization.

Two students – Dale Scott, lean manager at GE Technology Infrastructure; and Michael Raisor, executive director of process improvement at the Evansville school system – spoke at the pre-commencement session in the evening, an emotional tribute to the camaraderie in the class and the support they received.  Helen Zak, president of the Healthcare Value Leaders Network, inspired students to make use of the knowledge and think about how they’ll use all the extra time now that school is over.

The students expressed their gratitude for the knowledge they acquired from the faculty and coaches by giving a gift and coffee mugs imprinted with one important takeaway: Without data, you’re just another person with an opinion.

With this cohort finished, the next wave revs up early next year. We’ve already written about the first on-campus week for our new health-care cohort. Check out a podcast from earlier this year where I chat with Mark Graban of LeanBlog.org for more details.