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.

Stepping outside the COE box

Attendees of last Friday’s professional development meeting hosted by the Center for Operational Excellence can thank the executives from Cardinal Health Inc. and Starbucks Corp. for the insights they carried into the office Monday. Those of us at COE owe them gratitude for a pair of touches outside the norm for our programming that proved wildly successful.

T-shirt folding activity led by Starbucks
Seminar attendees participated in a T-shirt folding activity led by Starbucks

In the morning session, at the suggestion of lead speaker and Cardinal executive Whitney Mantonya, we devoted the entire second half of her time to a panel discussion featuring her colleagues who have helped with the Dublin company’s lean transformation. A panel on a topic featuring all employees from the same company? It isn’t something we’ve tried before and it’s not even the traditional form of a panel.  What transpired, however, was a detailed dissection of the bird’s-eye view Mantonya provided in the first half, the exact kind of sleeves-rolled-up scrutiny our knowledge-hungry members want. It seems the group’s favorite part of the morning session was the very section we didn’t originally plan.

Sometimes it doesn’t hurt to step outside the box.

That’s exactly what we did in the second half of our afternoon session as well, when we escorted the entire crowd of attendees from Pfahl Hall to the Blackwell Hotel for a hands-on T-shirt folding activity suggested and led by Starbucks that taught the basics of standard work. We’ve been hands-off with hands-on activities at our seminars before, but the overwhelmingly positive feedback (and happy faces on our Flickr page) indicate it was exactly what the doctor – err, barista ordered.

MBOE recap: The fine art of stocking shelves

When I walk into a Giant Eagle, I know exactly where I can find my favorite multigrain Cheerios. I also know a box will be waiting for me when I want it. The logistical engineering behind making that happen never occurred to me until a recent presentation by Prof. Thomas Goldsby for our MBOE industry cohort on lean logistics.

Tom Goldsby
Tom Goldsby speaks to Fisher’s MBOE industry cohort

Lean logistics and a supply chain make many processes seem like magic. Think, for example, about a company like DeBeers, exploring unknown lands, discovering diamonds, cutting and polishing them and then supplying them all over the world. Or a hospital, well-stocked with syringes, needles and oxygen cylinders. Logistics account for $1.2 trillion of the U.S. economy, or about 8 percent, meaning that for every $1 spent, nearly a dime of it goes to logistics. Of that cost, 63 percent is transportation.

So what is a supply chain? It’s the network of companies that work together to provide a product or service for the end-use market. Simply put, an apple grown in an orchard doesn’t come to grocery stores in baskets. Logistics facilitates the flow of materials and products into and beyond a facility. Lean logistics facilitates the flow by minimizing wastes.

Back to those apples: If a store stocks up on a ton because a farmer had a good season, those take up not only too much space but likely will result in waste. On the other hand, if demand spikes that doesn’t mean retailers, distribution centers and farmers should go into overdrive. Supply chain and logistics is about balancing demand, inventory and the number of trips needed. The question: Are you going to manage your supply chain, or is it going to manage you?

Next time I visit my grocery store for those Cheerios, I’ll have a completely different perspective.

How do logistics and supply chain management affect what happens in your organization?