New operational excellence program at Fisher makes big debut

Excitement is high this week at the Fisher College of Business as we launch the first cohort of our MBOE Healthcare Program. MBOE, by the way, stands for Master of Business Operational Excellence, a program we introduced three years ago with a group of students mostly from the manufacturing and service industries. In the last cohort, however, we noticed nearly half of the students were from the health-care sector – and what we did about it is this very program.

Dean Poon
Dean Poon speaking to the MBOE class

MBOE Healthcare is a one-year program focused on achieving operational excellence using lean and Six Sigma, combined with effective leadership skills and team engagement techniques. The program aims to develop each student – a manager, leader or other professional with a passion for operational excellence and change –  while improving the systems and processes in his or her organization. 

This MBOE program isn’t just in a classroom. Students will head to hospitals to visit the gembaand observe successful changes. They’ll also take part in online learning and a combination of on-site and distance coaching by industry experts. The students apply this knowledge to a strategic capstone project carefully selected with the active involvement of the student’s supervisor or sponsor. They also work closely with the original industry cohort in the four weeks they’re together on campus to learn from each other.

MBOE Students

Each of the eight weeks on campus involves four full days of intense learning from Wednesday to Saturday. Past students have called these weeks “exhausting and exhilarating” as experienced faculty members and guests teach using their own experiences working in organizations all over the country.

A student of class 2011, Susan Moffatt-Bruce, Assistant Professor of Surgery and Chief Quality and Patient Safety Officer at the Ohio State University Medical Center, told me the program “has provided me the tools to implement change through shared understanding and team engagement.”

Stay tuned for a daily update on the first week of the MBOE program.

Want some value-stream mapping tips from the pros?

Our good friends at the Cambridge, Mass.-based Lean Enterprise Institute are giving operational excellence junkies a chance this week to learn from a few masters this week – without leaving the office.

Tuesday Nov. 29 at 2 p.m. EST, the institute is hosting a free webinar titled “Learning to See the Whole Value Stream: The Power of Extended Value-Stream Mapping.” It’s set to last one hour and will be led by Jim Womack and Dan Jones. Those of you brushed up on your lean reading might notice they’re the gents who quite literally wrote the book on some hallmarks of lean thinking including, well, Lean Thinking, Lean Solutions and Seeing the Whole Value Stream.

recent value-stream mapping session
COE Executive Director Peg Pennington hosted employees from Grange and Huntington for a recent value-stream mapping session

The cost? Your time, an hour of it to be exact. Click here to register for the webinar.

The concept of value-stream mapping will be fresh in the minds of a few of our member companies: Grange Insurance and Huntington National Bank. A group of employees from each company came to Fisher earlier this month for a day-long session on VSM led by COE Executive Director Peg Pennington. They’re part of a growing contingent of transactional companies in COE – and they’re making great strides in apply operational excellence strategies to new realms of the corporate world.

Amy Tomaszewski, Grange’s assistant vice president of operational excellence, told me the event was a great success for her company and “provided quite a few ‘Ah-ha!’ moments.”

“The instruction was excellent and tailored to the service transaction environment, which is often overlooked in lean training,” Tomaszewski said. “Through the real-life computer simulation of the movement of electronic work and the team exercises around value-stream mapping and a simulated Kaizen event, we were able to see the result of both positive and negative changes that can occur when a company looks for and acts upon improvement opportunities in a value stream.”

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.

When opportunity knocks

Any time I see a great lean process at a company or in real life, it looks so natural I’m shocked it wasn’t always that way. That’s probably why I had to read a recent Akron Beacon Journal article featuring Center for Operational Excellence member Akron Children’s Hospital twice before I saw the lean thinking behind the innovation.

Akron Children's Hospital

The Oct. 30 piece by medical writer Cheryl Powell focuses on the growing importance of so-called advanced-practice providers – you know them as nurse practitioners and physician assistants – at Akron Children’s and other hospitals. This is taking place because of restrictions on resident work hours and growing demand for service. Akron Children’s, however, is using that situation to create a lean environment where ownership is shared and the blame game isn’t played. Think about that when you read the anecdotes that open the piece:

“When the medical staff executive committee helps chart the future of Akron Children’s Hospital, nurse practitioners sit side by side with doctors as peers. As the hospital’s pediatric neurosurgeon finishes a complex brain operation, he usually steps back and lets a physician assistant close the child’s head. And if a cancer patient has a problem in the middle of the night, an advanced-practice nurse or physician assistant often provides the care.”

Much of the article focuses on the promising salaries of those advanced-practitioner careers, but what struck me were anecdotes about the Cleveland Clinic, which is using those workers to help patients with less-serious problems, “which frees up doctors’ time to spend with people who have complex problems.” Sounds like standard work to me.

The results, by the way, are the true goal of any standard work implementation: Smooth flow and more time for innovation. The clinic also boasts of higher patient satisfaction and quality scores coupled with lower average stay length and readmissions.

As in any industry, sometimes a problem becomes an opportunity.

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.

‘People are the glue’

Hanging around operations professors for a few months has made me realize I think entirely too little about the small wonders in my everyday life. In short, I’m starting to feel like I should take a moment of awed silence with my iPod Nano before I shuffle to my running mix and hustle down the street. The supply chain for even the simplest product out there (a bottle of water, for one) is really anything but. On a global scale, it’s a tightrope walk of symphonic precision with a healthy dose of interpersonal diplomacy for good measure.

Professor Edward Anderson

It’s that diplomacy that slowly took center stage at the latest supply chain forum hosted by Fisher’s Center for Operational Excellence and featuring Prof. Edward Anderson of the University of Texas. On the surface, Anderson’s presentation to dozens of COE members on campus and streaming live was about the potential potholes that form in distributed product development (COE members can view the webcast here). As he illuminated ways for determining the best strategy to avoid potentially costly problems, a prominent theme emerged: This globe-spanning process doesn’t come down to widgets and machines. It comes down to living, breathing human beings.

And we’re a complicated and costly bunch, Anderson told the crowd.

“People are the glue,” he said. “The problem is, we’re expensive glue.”

This is Spinal Tap stonehenge
this-blog-goes-to-eleven.blogspot.com

Central to Anderson’s presentation was the idea that with the right people in place to manage risks from one boundary to another in product development, the lower the risk of lost money, drained value and public embarrassment.  And these crucial patches aren’t grand gestures – sometimes they’re as simple as hiring someone who knows how to tactfully ensure a supplier’s “i”s are dotted and “t”s are crossed.

A favorite example of mine: If only the titular rockers in the cult mockumentary This is Spinal Tap (pictured above) hired a designer who knew their Stonehenge replica should be 18 feet…not 18 inches.

How has your company used its work force to break down barriers in a supply chain? Have a “Stonehenge moment” you’d like to share?

Lets go hi-tech

A few years ago, I was working with nurses, pharmacists and physicians to understand the chemotherapy administration process at a cancer center. They all had a common problem: Too many screens Way too many. As I observed a nurse as she was walking me through the process of activating a chemo treatment, I noticed she went through 19 screens as she toggled through the multiple systems to access all the information she needed to do her work.

In the lean world, this is described as “overprocessing” waste.

Electronic Medical Record
Electronic medical record screenshot courtesy ophmanagement.com

I’ve been a part of a number of IT system implementations where organizations hold out hope that it will solve all the problems they face. Many hospitals, for example, implement new or upgrade old electronic medical record systems to reduce errors and speed up the documentation process. There’s logic here: With electronic records there’s easy access, no file cabinets, no scribbled notes, one centralized hub for information and a much weaker chance it will get lost or delayed. Clearly there are many advantages.

The problem here is the blind reliance on IT systems to solve the complexities of organizational processes. An IT system isn’t going to help if your chemo activation process requires 19 steps because it won’t solve a problem that arises from a complex process. First, we must simplify the processes and base our IT systems on that, not vice-versa.

A prime example: Toyota was among the early adopters of hybrid electric engines and other state-of-the-art technology, but the automaker thoroughly tests anything to make sure it’s reliable and serves its people and processes. If systems aren’t tested they could lead to additional work flow issues. As Dr. Jeff Liker writes in his book The Toyota Way, management should conduct pilot tests to determine if new technology is suitable for the organizations business (or clinical) processes, operations systems or products. Management, Liker writes, also should reject or modify any technology that might cause disruptions or unreliability.

Many organizations, unfortunately, don’t follow that advice.

What kind of issues do you come across using IT systems at your place of work? How do you address them? What would you do differently?

Kind of a big deal

We’re pretty proud of the successes we’ve seen in just three years running Fisher’s Master of Business Operational Excellence program. And the same can be said of the industry heavy-hitters we line up to give students top-notch wisdom in lean leadership. Among those big deals is John Shook, the CEO of the Lean Enterprise Institute in the Boston area. Modest and easy-going as Shook is, he wouldn’t tell you that, but having him spend a day with our students is like taking a film-school course on westerns with Clint Eastwood as the prof.

Shook was kind enough to sit down with me after a full day of breaking down A3s with the MBOE cohort for a wide-ranging chat on the future of lean and some of his personal experiences (read the full interview). If you don’t know much about him, he spent time in Japan at Toyota Motor Corp. about 30 years ago and, quite simply, is one of the reasons lean is alive and well in the U.S. today.

John Shook Lean Enterprise Institute Fisher MBOE
Photo by Peg Pennington

While our chat was full of insight, one thing Shook said near the end has stuck with me since, and it’s about why companies make mistakes in a lean transformation, and more specifically in using A3s to solve problems. “All lean tools and processes,” he told me, “are like an iceberg. There’s more underneath them that embody different ways of thinking and going about work, and if we just copy the tools it’s possible for us to miss that and be implementing the tool for the tool’s sake.” Shook then referenced an old saying about hammers in search of nails.

He’s not talking about carpentry here. This is the heart of the matter when it comes to lean, the idea that we shouldn’t just be putting out fires (hammering nails) but digging deep behind them to discover what caused that spark. Switching metaphors here: A layer beneath the tip of that iceberg is the crucial root cause.

So what does digging for that root cause, maybe with the help of an A3, do for your company? Shook says it best:

“It helps us solve problems and create a problem-solving culture all at the same time so it can help us choose the right hammer.”

What’s in a name?

In a recent session for Fisher’s Master of Business Operational Excellence class, we had the pleasure of hearing James Hereford, COO of the Palo Alto Medical foundation. While discussing lean deployment in the health-care sector, he touched on using Japanese terms for the tools and methodologies of the Toyota Production System. It’s Hereford’s preference to use the original terms. His succinct defense:

“When you go to a Japanese restaurant, do you order sushi or do you say something like, ‘Please get me raw fish rolled in a leaf and rice?’”

Photo by Mrinalini Gadkari

What is in a name, really? If we’re doing what the words mean, does it matter if they’re Japanese or English? For many words in lean there isn’t even an exact translation. The closest translation of a simple word like gemba, for example, would be “actual place where the value is created” (Google it for many others).

So is it necessary to expend energy inventing words that convey the meaning instead of using the original words, especially if the tools and methods will be used regardless? Many people tell me, however, that in process improvement they get better buy-in when not using Japanese terms. Whatever works!

Have you had to deal with a divide in using Japanese terms with lean?

 

Now I’m a Believer

Unlike my blog-posting colleague, I’m a relative newbie at lean, having spent my years out of college in the newspaper business and only recently making the jump to Fisher’s Center for Operational Excellence. I’ve pored over the Lean Enterprise Institute’s Lean Lexicon, scratched my head at A3s and learned very well how to nod politely at jargon as I scribble down mental notes for later. No amount of memorization, however, has taught me more about the transformative power of a lean approach than my first simulation.

Only weeks into my employment at COE, I joined a small group of my colleagues and employees from member companies for the three-part, day-long effort, hosted by Institute for Lean Systems Executive Director David Veech. My table’s task: To cobble together the hull and carry out final assembly of a Star Wars-inspired Lego aircraft with enough small pieces to strike fear into a playground full of toddlers’ parents.

lego naboo starfighter
An example of the final product in the lean simulation.

With a stack of directions, the first round seemed simple enough, mimicking a batch production system still used by many companies. But when game time came, the results were an unmitigated disaster, wasted pieces and frustrated “factory workers” everywhere. The second round, a simulation of a company partway through a lean transformation, wasn’t much better as purchase orders piled up and attempts at “milk runs” for Lego pieces floundered.

Round three, a simulation of a fully lean enterprise, was catharsis defined. Tasked with picking up a carefully chosen selection of Lego parts for the final product, I flew around the room and handed off deliveries with a smile. Completed Star Wars fighters began piling up and the collective morale – as grim as a Netflix boardroom at times – skyrocketed. Literally and figuratively, the pieces were locking into place. And the jargon made sense.

Only after the dust cleared did I realize it was necessary to feel the intense frustration of a wasteful production system before I could appreciate the logic of lean. The problem in many industries today, however, is that operations don’t realize they’re in round one because the status quo is so ingrained. Even once the “Aha!” moment comes, much work remains to be done, and change – even for the better – isn’t easy.

It’s the job of those of who have experienced round three to communicate its value. I’ll certainly never look at Legos the same way again.