Time to change over

Understanding setup time in the manufacturing world is easy: A machine makes products with different specifications, and parts must be changed to meet those. The time you take to make those changes is setup time. The more setup time, the more wasted time and resources. Lean companies focus on reducing changeover times to make a range of products in a given period of time to meet customer demand.

How this applies to health-care is occasionally tough, so let’s start with the easiest example. In an operating room, the time needed to turn it over for the next surgery would be setup time. The quicker you clean, disinfect and stock the room with the relevant tools, the more surgeries can be done in a day.      

Setup time and its opportunities for greater efficiencies go far beyond an operating room, though. Take a blood draw for testing. Supplies are situated outside patient rooms for safety reasons and, once ordered, require a nurse to walk to a storage area. Then, depending on how a supply closet is organized, the nurse may need to spend time looking for the correct, unexpired tools before placing them on a tray and walking back into the patient room to do the draw – provided he or she hasn’t forgotten anything. Drawing the blood takes no more than a few minutes, but the time spent in preparation can create a great deal of waste, reducing the time a health-care provider can spend with patients. At its worse, these inefficiencies can result in delays in diagnosis and treatment, affecting the length of stay and patient satisfaction.

Just think of how much could be changed by just placing a phlebotomy cart right outside the patient room or spending some much-needed 5S time on the supply closet.

Blood Draw
A simple blood draw can become a nightmare of inefficiency for a health-care organization

That’s not the only waste-prone procedure in this setting. Just think about turning over patient rooms, adjusting diagnostic equipment or starting a new round of chemotherapy. Any sort of walking, waiting or looking around is waste and if a highly paid staff is spending a major chunk of its day doing it, those are resources down the drain.

Many employees aren’t even aware of the wastes that run rampant in settings like these. Instead, they consider it part of their work because that’s what they’re used to doing. All it takes is for someone to take a look at the process and separate truly value-adding activities from the waste.

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?

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.

Break out the bubbly

It’s a point of pride at the Center for Operational Excellence that we’re able to maintain a strong link between our industry members and the inner workings of the Fisher College of Business as an educational institution. That’s accomplished in part by staffing our center with Fisher faculty who work closely with our students and add to the value we work to create.

Nancy Lahmers

We’re very unsurprised, but very pleased nonetheless, to let you know that two of our COE team members not only have raked in awards for their dedication to Fisher students but are advancing in their journeys at the college.

Nancy Lahmers, in charge of COE’s women’s initiatives, was given the 2012 Mount Award, an honor handed to “the faculty or staff member who is selected as the most exceptional example of commitment to leadership, scholarship and service and the dedication to students.”

Andrea Prud'homme

Additionally, COE Associate Director Andrea Prud’homme on Monday was given the Undergraduate Programs Teaching Award, a student-nominated honor.

On the heels of those awards, Fisher leadership has announced that Lahmers will be serving as executive director of the college’s Graduate Programs Office starting spring quarter. Lahmers over the past eight years has served as the director of Fisher’s Honors Cohort program. Taking over for Lahmers is – you guessed it – Prud’homme, a favorite professor among students who also advises the Buckeye Operations Management Society.

Very wise choices we couldn’t be happier about. Congratulations, ladies.

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.

MBOE HC recap: A vision isn’t enough

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.

Any of our MBOE students wondering how the landmark Toyota Production System could apply in the health-care sector got their answer at the Thedacare Healthcare System in Appleton, Wis. Although John Toussaint, its former CEO, had a clear vision for an efficient system, the transformation wasn’t free of challenges. The key to meeting them, we found: Leadership.

Simply having a vision isn’t enough. It’s important that it translates into something meaningful and actionable. When developing their core strategies, the leaders at Thedacare repeatedly asked the questions: What is most important? How do we measure that? They had to let go of past goals based solely on numeric results and embrace the “True North” goals of customer satisfaction, people development, safety and quality and financial stewardship.

Board
This board is posted at Thedacare to guide its lean leaders

Thedacare used the powerful problem solving technique called A3 thinking, widely adopted within Toyota also referred to as PDSA. The PDSA cycle has four stages: 

  • Plan – Determine the problems with the gap between current and ideal conditions, goals, and the proposed changes.
  • Do – Try out the proposed changes
  • Study – Analyze the results of the trials and reflect on the findings
  • Act – Incorporate the findings (successful/not successful) into the new process and standardize the change.

In addition to changing how they came up with strategy, they did two other things: (1) They created standard work for leaders that involved going to the gemba and assessing the health of the organization by visiting visual board for leaders, and (2) they translated strategy to actionable items for the frontline staff. That group, in turn, was able to chime in on what was possible and describe roadblocks.

In short: The leaders had to change how they did work before they could bring a change to the organization.

There is a lot more where this came from. If you’re interested in learning more, here’s a video  where you can see the highlights of the Strategy Deployment DVD at Thedacare and also a blog by Toussaint.

 

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
"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?

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.

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: The secret sauce of standard work

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.

Short question, long answer: How did Toyota become lean?

As MBOE coach David Hoyte told students in a recent session, the automaker organizes all jobs around human motion and creates an efficient sequence with lowest possible waste. If that’s the philosophy, guess how your employees will start thinking and working? They note time they spend walking around, looking for things, bending or lifting when it isn’t necessary. They take more care in detecting errors and preventing them. They come up with a sequence that makes more sense of the process.

If your organization’s philosophy is cost reduction, you run the risk of employees seeking low-cost suppliers and abandoning quality. Instead of focusing on reducing waste in the process, individual productivity is under the microscope and blame reigns supreme.  

In most organizations people are used to doing work at their own pace with undocumented methods. Some work slowly and others work faster. Some have figured out the fastest method but they hide it from others. This makes the process variable and unpredictable. 

Work Flow
Toyota bases its work flow on a philosophy of waste reduction. Image courtesy MotorTrend.com

Take note of these three elements to achieve standard work:

  • Employees must know the pace at which they are supposed to produce/do work (the Takt time)
  • Employees are trained to follow a standard sequence and method such that everyone follows the same steps and sequence in the process
  • Have only just enough supplies when and where they are needed to produce/do work (work in process)

Quite simply, it’s a better use of employees’ time and talent if they spend it doing more value-added work rather than wasting their time in wandering or waiting.

Discuss: Do you see variation in how your employees do work?   How do you apply standardization to your work processes? What are some of the challenges and wins?