Wednesday's Words of Quality, Lesson #4: Waste Elimination, Less is More. Redesign Lessons from Lean

 Wednesday's Words of Quality, 

Lesson #4: Waste Elimination, Less is More. Redesign Lessons from Lean

Richard Zarbo, MD  © 2022 Wednesday’s Words of Quality

Lesson #4 of 13

Most work systems are fraught with process inefficiencies and wastes that dominate the total time of human effort compared to the actual fraction of time involved in creating value. The fact that even well-intentioned business systems are not “Lean” was well articulated 91 years ago by Henry Ford who recognized in his own operations that:

 

“We still waste more than we use. We waste men, we waste materials, we waste everything, and consequently we have to work too hard and too long to accomplish what in the end amounts to very little. But at least we are learning that we cannot get anywhere without the kind of management which extends from the smallest detail to the whole purpose of what you are about.”

 

This is especially true in the business of healthcare where process defects may readily escalate to medical errors that currently account for the number 3 cause of death in the US. The Joint Commission recognizes the culture of Lean as a component of “robust process improvement” that should be pursued for healthcare to be effective in achieving high reliability exhibited by consistent excellence in quality and safety.

 

We all desire more reliability, consistency, efficiency, productivity and better patient satisfaction! The answer is not more people. In fact, that’s highly unlikely in the current economic environment. 

 

One solution is to redesign the nature of the work so that it is more efficient, that is to say, less wasteful of human and consumable resources.

 

What does efficient work design look like?

 

For starters, consider these Opportunities in work redesign

 

• Standardized work activities, connections, pathways

• Posted Standard Work Checklists or Job Aides

• Continuous flow and pull

• Reduction of cycle times (throughput)

• Front loading work in the paths of workflow

• Elimination of loops and forks

• Reduction of steps

• Work simplification

• Maintenance of sequence

• Load leveling across hours and shifts

• Batch size reduction

• Mistake-proofing

• Visual workplace to surface defects that workers can address in real-time

• Color-coding and visual controls

• Agreed “Playbook” to trigger team cross-coverage to maintain flow and throughput

• Daily metrics of performance and deviations

 

Lessons from Lean manufacturing production also tell us that there are several cardinal sins to drum out of our current work and some goals to continually strive toward.

 

Variation is bad. Matched only by poor communication.

 

The remedy to these cardinal sins is adhering to 4 simple rules of work that promote standardization and continuous

improvements in how the work is done. The 'fixes' should be contributed by empowered workers who are engaged as the ‘experts’ in doing the actual work best and seek quality at the source. This approach creates engagement, accountability and ownership of the improvement process where the actual work takes place.

 

The Rules of Work (see Toyota's Rules in Use from "Decoding the DNA of the Toyota Production System" by Spear & Bowen)

 

This is essentially forcing you and your team to take the time to work though best practices resulting in standardization of activities, connections and pathways and your approach to data-driven continuous improvements.

 

Rule 1- STANDARD ACTIVITIES. Specifications document all work processes to include the content, sequence, timing, location & expected outcome (how do you do your work)

 

Rule 2- STANDARD CONNECTIONS. Connections with clear YES/NO signals (e.g. received, not received) directly link every customer & supplier (requests & responses)

 

Rule 3- STANDARD PATHWAYS. Every product & service travels a predefined, single, simple & direct flow path (no looping returning to sender or forking to 2 different places)

 

Rule 4- IMPROVEMENT & WORKER EMPOWERMENT. Workers at the level where work is done, guided by a teacher, improve their own work, using data (PDCA).

 

Rule 4 is also referred to as the Improvement Kata. One of the opportunities for a leader intent on work redesign is to include those who actually do the work in its redesign.

 

Work Rule #4 as defined by Steven Spear, states that any improvement must be made in accordance with the scientific method, that is to say using PDCA (plan, do, check, act), under the guidance of a teacher, at the lowest possible level in the organization. That is to say that changes or pilot “experiments” are suggested and carried out by those actually doing the work. This approach also facilitates worker buy-in (empowerment) to change and increases compliance with the new work standard.

 

From our own experiences with Lean management in the laboratories of HFHS, we know that when a lab employee

contributes to the change, they are more likely to experience ownership. Change then, is not made by, but facilitated by the teacher who is defined as an internal expert, knowledgeable and experienced in the area taught. This also promotes worker accountability.

 

In this approach, empowered workers see their daily work in the context of continually making effective process improvement changes that are designed and tested by the scientific method. To convert to and foster this latter culture, it is important to acknowledge that your workers are the ‘experts’ and hold the knowledge that can result in continually improving the work toward the agreed goal.

 

This approach is a paradigm shift meant to optimize the overall system of work, across usual silos of control, rather than local optimization. Success in Lean therefore is promoted by the management systems and culture that facilitates trained, empowered employees and leaders to work in team structures with defined work rules and applying strategies and ‘tools’ to reduce 3 forms of work inefficiencies.

 

3 Types of Waste Inefficiencies to Address

 

I depart here from our convention of describing all things in English and use several Japanese terms in italics because each word is invested with much meaning and this is where these concepts are derived from. These 3 types of wastes contribute to Work Inefficiencies described in this fashion:

 

Muda describes 7 types of waste identified retrospectively within existing processes under the present work conditions. This is the non-value-added work of employees that the “customer” doesn’t care about. (see below)

 

Mura relates to work design implementation, scheduling and operations inefficiencies. This creates unevenness (lack of flow or smoothness) of workflow and gums up throughput.

 

Muri is derived from poor proactive preparation and planning for the new work design resulting in overburden of work imposed by management because of this poor preparation or planning.

 

The 3 define the opportunities within the system of work that members of the workforce at all levels have a hand in

coordinating and continually improving.

 

These wastes are sources of variation and inefficiency that if identified and eliminated will allow the system of work to be more efficient and productive, in effect doing more with less.

 

The 7 Types of Waste in the Work

 

1. Overproduction, in excess of what's required

2. Waiting, downstream process inactivity

3. Transport, material & work-in-progress

4. Extra Processing, due to defects, overproduction or excess inventory

5. Inventory, excess requires additional handling and space

6. Motion, personnel & equipment

7. Defects, don't conform to specification or customer's expectation

 

Weaving Lean Thinking into Your Management

 

We have found that a focus on the ‘rules of work’ as described by Spear and Bowen (attached), sensitizes the workforce in recognizing gaps they experience in light of the 3 forms of wasteful work inefficiencies- 1) within existing work processes, 2) how processes relate to each other in the flow of connected work and 3) in the subsequent design proposals of new work processes. These ‘rules of work’ define the expectation and key characteristics that the standardized, redesigned work should have.

 

Problem Resolution by Team Members in a Lean Management System

 

Continuous problem resolution is dependent on a worker-driven 'bottom up' approach rather than the conventional management driven 'top down' approach to problem solving. By leveraging the quality improvement organizational structure defined in a manner that aligns team members with their team leader by “workstations” into small teams, we can foster worker identification of the nature and scope of defects and wasteful work, and stimulate and guide the discussion of possible solutions that can be tested.

 

This cooperative approach is predicated on a 'no blame but all accountable' sense of process ownership. Through an empowering structure that continually informs the workforce about the quality of their work product and charges them with improving it, workers more readily assimilate the mantra- "never pass a defect, never accept a defect".

 

Transforming the culture of work, or more correctly the employees’ incentive to relate to each other and work differently, must occur to obtain success in a Lean enterprise. The role of leadership is to establish the shift in work expectations, structures and realignment of incentives so that workers can relate to and interact with each other horizontally across the path of workflow and contribute collaboratively toward work process redesign across historical silos of control.

 

To be effective in fostering change from the bottom-up, so to speak, the people-focused strengths of a Lean culture must be reproduced- namely:

• Employees in charge of the successful outcomes of their own jobs

• Employees contributing to the design of the standardized work procedures

• Employees working to continually improve the work, piloting changes and effectiveness assessed by the customer focused PDCA cycle

 

I leave you with the thought that engagement of the work team is most important in work redesign, broadened to include those within and external to the process in question (internal and external customers) in order for change to be successfully sustained. In a Lean culture the further expectation would apply that the work would be continuously improved by those who own and are accountable for that work.

 

The Main Lesson of Lean for Managers

 

Lean, then, is not the ‘tools’, which are work-arounds employed by the workers for specific situations, but the continuous focus on these aspects of waste reduction as the work is continuously redesigned to be more efficient by those who do it.

 

 

Next WWQ: Lesson #5 – Standard Work

 

Wednesday's Words of Quality, Lesson #3: Role of the Manager/Supervisor in a Continuous Improvement Culture

 Wednesday's Words of Quality, 

Lesson #3: Role of the Manager/Supervisor in a Continuous Improvement Culture 

 Richard Zarbo, MD  © 2022 Wednesday’s Words of Quality

Lesson #3 of 13

Everyone desires Continuous Improvement. Who doesn’t want things to be ever better? Especially when we are talking about a human life. But things don’t get better permanently by wishing or sporadically placing a bandaid on a problem.

Our experience informs us that Continuous improvement is about eliminating the problem in a disciplined and scientific manner, based on trained observation, knowledge of common failure points in processes and data that tells us about the root

cause and demonstrates success from changes made. Continuous improvement is about testing changes rapidly, again and again until the desired outcome is sustained. This is the scientific basis of Plan-Do-Check-Act (PDCA).

 

Desire the outcome of Continuous Improvement but don’t know what or how to do this?

 

Well, as the manager or supervisor you are the key. Your functional role and support in a continuous improvement environment are the basis of success or failure in this new system of work that expects “quality to be everyone’s responsibility” as Dr. Deming stated. As the designated leader you have always been expected to assure quality in the people and the work you oversee.

 

But when this responsibility is owned by just a few people, success in improvement is often sporadic, slow, frustrating, uncoordinated and often with a wrong or unsustained fix. So a better system is needed to achieve continuous improvement.

 

Enter Lean systems of management that we discussed previously in WWQ and the Silver Certification Training that get you well beyond wielding an isolated improvement tool at a persistent problem. This is your new focus to obtain improvement of the work by those whom you oversee as this is ultimately your responsibility as manager or supervisor.

 

Dr. Deming’s prescription for a cure of poor quality identifies the manager and supervisor’s key job to work on the system of work to achieve continuous process improvement in product and services delivered.

 

In summary, the Deming-style manager must incorporate the following into their leadership routine:

 

1. Ensure a work system’s consistency and reliability

You need metrics that define success in your work system and outcomes. More often than not you will need to create this.

 

2. Bring level of variation in your operations within predictable limits

Achieve this from tracking and sharing your metrics with deeper knowledge of failures from root cause analysis as team opportunities to redesign how the work is done. Daily Management is the system you need to implement for the critical failing metrics.

 

3. Identify opportunities for improvement

Engage your people in identification and capture of work deviations or non conformances so that all can see, track, trend and measure what is failing the customer expectation. Deviation Management is the system to identify all that does not meet the expectation from the work.

 

4. Enlist the participation of every employee in improvement

Educate, train and expect participation from your employees to help improve the work as well as do the work. Use Daily Management as a huddle focus with delegated ownership for each metric followed and group participation in suggesting countermeasures.

 

5. Give those you lead the practical benefit of your experience

Continually share your learnings, new expectations and understanding of improvement and methods with your team. If it’s not important to you, it won’t be a priority for them.

 

6. Help them chart improvement strategies that define success and spread new knowledge

Consider visual means of actually charting improvement project progress to engage, educate, recognize and reward your team as you adopt the expectation of “we are here to the work and to improve the work”.

 

 

What does your success as Lean Manager look like?

 

Here is my Lean manager’s checklist for you to consider and self-assess your effectiveness.

 

• Move from Rote Workplace to Educated Improving Workforce

 

• Move from Reactive Crisis Management to Proactive Problem Solving Prioritized by Metrics

 

• Move from Snap Executive Solutions to Thoughtful Team Ownership for Problem Solving

 

• Move from Guessing at Solutions to Data Driven Solution Testing

 

• Move from Sporadic Leader-led Improvement Projects to Continuous Improvements by Workforce

 

• Move from No Team Knowledge to Deep Root Cause Understanding of the Work and Opportunities to Improve

 

 

How does this relate to High Reliability?

 

Chassin and Loeb of The Joint Commission recognize the culture of Lean as a component of “robust process improvement” that should be pursued for health care to be effective in achieving high reliability exhibited by consistent excellence in quality

and safety. Inferior quality and inconsistent or unsafe work practices are well addressed by the philosophy, principles, quality systems, methods and accountability for continuous process improvement that we share here.

 

 

Next WWQ: Lesson #4 – Waste Elimination, Less is More. Redesign Lessons from Lean

 

Wednesday's Words of Quality, Lesson #2: Manager’s Lean Journey

 Wednesday's Words of Quality, 

Lesson #2: Manager's Lean Journey 

 Richard Zarbo, MD  © 2022 Wednesday’s Words of Quality

Lesson #2 of 13

The Ford Models A, B, C……..and then came T

 

We all readily recognize the successful Ford Model T car that afforded common man entry to the new world of automobile transportation. However, the T was preceded by an alphabet of precursors including the very successful Model N. Never heard of that one, right? You can see the entire collection of pre-Model T Fords, the so-called alphabet cars, from the Larry Porter Alphabet Ford collection at the birthplace of the Ford Model T, the Ford Piquette Avenue Plant in Detroit.

Lean Models for Continuous Improvement

 

There are many parallels of the Lean method of step-wise improvements toward the target condition using data (Plan-Do-Check-Act) and constancy of purpose resulting in the Model T. Henry Ford’s approach of iterative improvements to a sound design beginning with the 1903 Model A and culminating in eventual success of the Model T is very similar to our own continuous improvement approach to “relentlessly pursing perfection” by using knowledge of sound work principles and Lean skills and “tools” to redesign our processes. The Lean journey takes investment of your time in education and creating the Lean systems to support the new way of working toward continuous improvement. Your understanding and successes will be iterative as well. You will learn from your failures. Continuous improvement is our constancy of purpose so never quit. Every day, do something.

4 Key Lean Management SubSystems for Effective Implementation 

Numerous work and management systems have been created over the past 15 years to sustain our Lean culture of continuous improvement in in order to “relentlessly pursue perfection.” These include 4 key management subsystems that create

structure for consistent behaviors that enable continuous improvement and create process stability at the level of the work.

These are diagrammed in the figure below as 1) Team Leader System; 2) Deviation Management System; 3) Improvement Management System (PDCA); and 4) Daily Management System. Each is integral to a highly functioning Lean system.

 

Note, the Tool Kit is only consistently functional in the hands of trained carpenters who follow the Lean discipline defined by the systems to solve problems. In any organization, progress toward goal achievement can come from above through major

executive directed change initiatives and technologic innovations.

 

But progress toward daily goal achievement must come from below at the level of the actual work (gemba) by managers and teams who are empowered and accountable to understand and improve the quality of their work product or service.

Culture of Continuous Improvement

 

A successful Lean culture of continuous improvement is a work environment in which the leader can walk away and empowered employees can sustain themselves in pursuing higher quality targets by implementing continuous process improvements. As Henry Ford once said, “Quality is doing it right when no one is looking.” Sounds like a manager’s dream, doesn’t it?

 

If culture is the key, getting started shows good intent but it is said that culture change takes about a decade to establish. Do not be frustrated. Lean success takes time, so to consider Lean as a short-term solution to an acute management crisis would be misguided.

 

As we shared in the Lean Silver certification training, there are 3 foundational pillars you must establish and support in order to create a functional Lean system that empowers employees to own the quality of their work.

 

The 1st pillar is Lean education of yourself and your team in what defines good work and what redesign approaches (Lean tools) can be applied to improve the quality and the flow of the work.

 

The 2nd pillar is adopting the Lean philosophy of aligning your work with knowledge of what the customer wants and needs (and does not want), creating a blameless culture, developing, recognizing and trusting those that do the work as expert and engaging them in work improvements at the level of the actual work.

 

The 3rd pillar is creating and implementing quality management subsystems that support expected employee behaviors for continuous improvement and managerial consistency of execution.

 

Culture in its most simplified definition is how people are incentivized to behave and the way people think, talk, work, and act every day. Like any corporate culture, Lean behavior is a culture based on a philosophy and supported by a management system and structures that allow the desired behaviors to take place consistently.

 

These are the philosophy and management principles of Deming that foster respect for people and human development, and allow for a culture of respected, empowered, and accountable employees who are recognized for their expertise and knowledge.

 

People development is extremely important as a differentiator of Lean success. This defines the desired culture of continuous improvement wherein employees (1) are in charge of their own jobs, (2) design their own standardized work, and (3) are authorized to make changes to improve the work.

In a Lean culture, quality is based on the pillars of respect for and development of people who are responsible for the continuous improvement. This is the basis for creating a culture of continuous improvement and change that sees quality as more than a desirable outcome but as the foundation of a business strategy to remain competitive. The success of this strategy is obvious when comparing organizations in which continuous quality improvement is at their core.

As manager, you are the chief carpenter, knowledgeable in proper use of tools and armed with the structural plans and systems to expertly build your customized house of continuous improvement while providing guidance and coordination to your team. 

Your trusting "customers" anxiously await your finished product with anticipation of a consistently great outcome.

 

 

Next WWQ: Lesson #3 - Role of the Manager/Supervisor in a Continuous Improvement Culture

Wednesday's Words of Quality, Lesson #1 of 10: Continuous Improvement and Lean

 Wednesday's Words of Quality, 

Lesson #1: Continuous Improvement and Lean 

 Richard Zarbo, MD  © 2022 Wednesday’s Words of Quality

Lesson #1 of 13

What is Lean?

What is Lean?

 

We have shared that Lean is a business management system designed to engage the entire workforce in continuous improvement of the work that we all are charged with doing. "Do the work and improve the work" requires a mindset that monthly, weekly and daily team meetings scheduled by design for this specific purpose. 

Metrics are devised to show the current condition to be improved and indicate improvement after countermeasures are implemented. Further, all actions are authorized and supported by leadership and quality management systems that have been designed and are routinely relied upon at all levels of the work to result in consistent execution of the defined business and improvement goals. (reference 1)

 

Improvement is a team sport and for continuous improvement to take place, you must schedule the time each week to focus the team's efforts on this goal. Otherwise, you will fail. So efficient meetings designed to improve the work with a defined purpose matter. Even if only 30 minutes each week.

 

In this manner, you are leading with your team through a focus on quality and metrics to ever improve the experience of the internal or external user of your service or product, the so-called customer. We are all customers and suppliers of each other. This is how you can focus on obtaining more efficient and highly reliable work that is ultimately experienced by the patient.

What does continuous improvement mean?

What does continuous improvement mean?

 

We start with the premise that everything can be better and that we are not performing a single task as well as it should be.... Those words are from Henry Ford himself in 1925. It was the case then and so it is today. This means that "how" we work evolves over time. Often in the current state, the "work outcomes" fail to meet the expectations of those for whom it is intended. In other words, the work is not perfect or it does not meet the customer expectation. It could be better. Therefore, how we do the work needs to be redesigned with knowledge of what good work looks like in order to satisfy the customer and achieve our any one of our business goals of better quality, efficiency, throughput, safety, consistency, reliability, productivity, satisfaction, and cost.

 

Continuous improvement is a daily goal, supported by an educated, trained workforce who understands what good work design is, and how it can be evaluated scientifically using data and then redesigned or modified to provide improved results. This is where education and training in the so-called tools of Lean are key to define how to assess and improve the current state of work.

 

People who do the actual work see and know what is not perfect and when educated and empowered can address quality issues at the source. This approach to improving the work continually must be supported by you who are leaders and managers by

relying on Lean management systems that engage people and structure their successful behaviors for continuous improvement.

 

How do I contribute to continuous improvement?

 

There are several basic roles in continuous improvement for each of us to contribute in some manner, whether leader, manager, staff.

 

Much of our improvement needs to occur from the level of the true work, where value is actually created. Therefore, the one who does the work is recognized as the subject expert as they are closest to the actual work. At a minimum, it is important that they involve themselves in 3 improvement related activities under the direction of their manager or supervisor.

 

1. 5S. “A work team that cannot do 5S, cannot do Lean”.

Good work comes from a visual, organized and standardized workplace. The management approach to achieving this state is called 5S, which stands for sort, set in order, shine, standardize, and sustain. This is a team-based endeavor. We have taught you various approaches to accountability in this discipline of daily work life.

 

2. Deviation Management. “No problem is a problem.” (reference 2)

Those who do the work must identify defects that are in countered in either receiving, doing or handing off the work. The management system that defines how this is captured is called deviation management. This is a sophisticated evolution of simple white boards, which is where most of you will start. Both approaches allows those who do the work to see and understand what to improve, how to document corrective actions taken and how to contribute to planned process changes that designed to eliminate the most common or the most severe deviations from expected work outcomes.

 

3. Daily Management. “QTIPS—Quality, Timeliness, Inventory, Productivity, Safety.” (reference 3)

Daily management refers to a formal problem-solving board to be used in brief team-based huddles to identify, track and resolve the most critical defective work processes. This daily focus begins the root cause analysis and assessment of

proposed interventions that will address the most important or prioritized deviations encountered within a 24-hour period. This mechanism accelerates problem solving today using data (PDCA).

 

So that's it.

 

1. Start with education of yourself and your team about the continuous improvement philosophy and the 3 expected activities that everyone will use, own and be accountable for.

 

2. Then, with your team create a visually managed workplace so that you as manager or supervisor are aware of the problems and the outcomes of your team-based interventions.

 

What to expect?

 

By doing improvement work continuously, work standardization is achieved by consensus of those who do the actual work.

Variation and deviation from expected work, otherwise known as waste or non-value added work, is continually reduced. 

Over time, incremental changes that improve the work result in improved levels of quality, efficiency, throughput, safety, consistency, reliability, productivity, satisfaction, and cost.

 

References

1. Zarbo RJ. Management systems to structure continuous quality improvement. Am J Clin Pathol 2022;157:159-170. DOI: 10.1093/AJCP/AQAB109

2. Zarbo RJ, Copeland JR, Varney RC: Deviation Management: Key management subsystem driver of knowledge-

based continuous improvement in the Henry Ford Production System. Am J Clin Pathol 2017;148:354-367. 

DOI: 10.1093/ajcp/aqx084

3. Zarbo RJ, Varney RC, Copeland JR, et al: Daily Management System of the Henry Ford Production System. QTIPS to focus continuous improvements at the level of the work. Am J Clin Pathol 2015;144:122-136. 

DOI:10.1309/AJCPLQYMOFWU31C

Next WWQ: Lesson #2 - Manager’s Lean Journey

 

"Share the Gain" for Sustaining the Improvement Culture

Spreading Learnings and Coaching Through "Share the Gain"

To showcase the numerous improvements performed by the empowered workers, and to allow them to understand their importance in the organization, it is important to design a reinforcing and sustaining venue for workers to share process improvement lessons with their peers.  

We hold monthly “Share the Gain” meetings as catalysts to set the pace of change that in 2009 after 4 years of Lean cultural transformation resulted in 536 documented process improvements accomplished. By not setting numeric goals, a 110% "improvement on improvement" was seen the following year resulting in an even more astonishing 1,128 process improvements performed in 2010 in the laboratories of Henry Ford Hospital alone. This "Share the Gain" public presentation with reinforcement of method and principle is a continual learning mechanism that has greatly assisted in establishing a change in the culture of work and worker involvement in that change.  

In year 2010, after 5 years of cultural transformation, more than half the "Share the Gain" presentations from Henry Ford Hospital laboratories were given by the workers themselves with the remainder contributed by the team leaders and managers. Two additional community hospital laboratories and an additional 29 outpatient clinic laboratories undertook the cultural Lean management transformation in 2010 resulting in 1392 total process improvements that year. The same pace of process improvements continues in 2011, with 900 accomplished by the 3rd quarter, signifying a stable culture of continuous improvements generated by an empowered workforce of 780 laboratory employees across the Laboratory Service Line.

We have set the pace for change by setting the expectation of one process improvement presented per month per team. These need not be completed improvements but can include progress updates of interventions in-process or even process improvement attempts that failed. These one-hour, monthly meetings showcase 8-10 workstation team presentations. We encourage attendees to participate in question and answer sessions to reinforce the work principles, rules and tools applied. Presenters are ‘shop floor’ workers who are given individual artistic freedom in presentation.  This forum allows the workers to not only share their improvements but to receive praise from their peers and become recognized and rewarded by leadership who attend each meeting. 

In this era of dwindling ability for leaders to provide economic incentives, it should be noted that employees are greatly appreciative of this form of recognition of their ability to contribute to the group's success. As a leader, through this reinforcing mechanism, you are also developing your next generation of leadership and solidifying your new culture.  

A successful Lean culture is predicated on Deming's management style and the value placed on the worker. Through this cultural change mirroring Deming's principles, reinforcing and sustaining structures can effect continuous quality improvements leveraged at all levels by the empowered workforce. The "Share the Gain" process lives out Deming's principle #14, for management to push and sustain this method of work to insure that the pace of improvement is rapid and the processes of work are ever-evolving and optimizing toward a more perfect state.

The White Board in Identifying Opportunities for Change

"Even a mistake may turn out to be the one thing necessary to a worthwhile achievement."

-Henry Ford

The primary role of team members is to reveal in real-time, to each other, and to their managers what is not working as expected, that is, to identify in-process defects and waste.

To this end, we place white boards in the workplace so that defects can be made visible by the workers themselves, in a blameless fashion. A white board is a work communication tool for the worker and manager so that “no problem doesn't become a problem.”

Why write it down publicly?  Simply, to collect factual information about less than optimal work and because lack of effective communication begets poor quality. Should you walk into a workplace and see white boards, describing defects encountered, you will understand this tool to be a visual reminder that in a true Lean culture employees are empowered to work differently, invested in and accountable for the quality of the work they receive or produce.

White boards are a simple tool to help the individual worker and the team communicate within and between work stations, connect work stations horizontally across the path of work flow (or value stream) and make the workplace visual for both those doing the work and those managing the reliability, consistency and stability of the work. White boards are only fully functional as visual workplace tools when leaders have created the enlightened culture that encourages blameless identification of mistakes, provides an organizational structure and reporting relationships that incentivize empowered workers to contribute to daily defect resolution. This is the essence of Lean- a continual improvement loop with a 'shop floor' focus by employees who know the nature of their work best.

The elements that may be captured on white boards to clarify the defects that arise in your workstation and facilitate your team's subsequent resolution are the following:

•                Date

•                Problem

•                Who identified

•                Action- short term (our rapid fixes)

•                Action- long term (our A3 based improvements)

•                Responder/Comments

•                Estimate % complete  (visual using a circle with quadrants filled in)

See if this Issues List described above from a White Board adapted from the manufacturing world helps you think about how to best to use your own white boards.

Standardized White Board

Although we have been using white boards for some years now, we have only recently standardized our own approach in the laboratories.  Below is our current iteration of a white board. The header is meant to inform and educate the workforce. It contains regularly used references to the defect resolution process of the Henry Ford Production System:

• The 7 Types of Waste
• The 5 Why's of Root Cause Analysis using an Ishikawa Fishbone diagram of common causes
• The 4 Rules of Work from the Toyota Production System that are often in violation when a defect is encountered
• The process improvement procedure methodology of the Henry Ford Production System
• The leader's quality messages, here, the Wednesday's Words of Quality that I write weekly

The board is segmented to capture detail about:

• Daily defects encountered
• The defects immediately resolved on the spot or those queued for further development as an A3 based process improvement that often requires a 'Go and See' or a customer-supplier meeting
• Communications for and between shifts and ongoing quality education topics and learnings

So, should you as the manager on a "gemba walk" through the workplace see a blank white board, you now have a visual of either a perfect workday (doubtful) or a workforce disengaged from their responsibility of contributing to continuous improvement. The simple white board functions for all levels of work engagement. 
 
References:

Ford H. Today and Tomorrow. New York, NY: Doubleday; 1926

Ohno T. Toyota Production System: Beyond Large-Scale Production. Portland, OR: Productivity Press; 1988

Rother M. Toyota Kata. Managing People for Improvement, Adaptiveness and Superior Results. New York: McGraw-Hill, 2010.

Spear SJ, Bowen HK. Decoding the DNA of the Toyota Production System. Harvard Bus Rev. September 1, 1999:96-106.

Go and See

Go and See

The Deming approach to quality and the PDCA cycle attributed to him were appreciated by the Japanese in the early 1950s as a "way of thinking and managing rather than simply as techniques."

In this strategic basis for improvement (the Improvement Kata described by Mike Rother), "Toyota later added the words "Go and See" to the middle of the PDCA wheel."

This act of 'going and seeing' is critical to observe actual conditions for yourself and not to fall into the manager’s trap of jumping to conclusions. This must be the beginning of understanding a situation before suggestions for change can be made effectively.

The 4 key points of the Improvement Kata, founded in PDCA, deal with scientific experimentation, discovery and learning. This is how the culture changes for people from one of hiding and blame to one of openness and learning.  At its core, this approach to problem solving relies on development of people with insight and process repair closest to the level of the actual work. The 4 points of this problem solving routine defined by Rother are:


1. "Adaptive and evolutionary systems by their very nature involve experimentation." 


There is no one right answer, no one fix to a problem, just many tweaks on the way to a target condition whose path is largely unknown. Just try something. Let the data tell you if it is with accepting as a change in process. Given the right leadership and organizational structure, the workplace is your experimental playground to figure out how to do the work better. In the Henry Ford Production System, this is the basis of your empowerment.


2.  "Hypotheses can only be tested by experiment, not by intellectual discussion, opinion, or human judgement." 


Don't talk, test! What you believe or think is less important than what you try, usually on a small scale.


3. "In order for an experiment to be scientific it must be possible that the hypothesis will be refuted." 


Never assume that the change implemented will work as intended and should be accepted as originally designed. That assumption will stop improvement and adaptation in its tracks. The fluid nature of continuous improvement is an adjustment for most who adopt this approach to work and problem solving.


4. "When a hypothesis is refuted this is in particular when we can gain new insight and further develop our capability."

Dr. Rother elaborates further on these concepts:

"We learn from failures because they reveal boundaries in our current capability and horizons in our minds. This is why Toyota states that 'problems are jewels.' They show us the way forward to a target condition. You need to miss the target periodically (again, preferably on a small scale that does not affect the customer) in order to see the appropriate next step. 

...This is a fascinating point when you consider how much we as leaders, managers, and executives try to make it look like everything is going right as planned. The main reason for conducting an experiment is not to test if something will work, but to learn what will not work as expected, and thus what we need to do to keep moving forward."

"No Problem" = A Problem

Rother also observes that "If there is no problem, or it is made to seem that way, then our company would, in a sense, be standing still... The idea is to not stigmatize failures, but to learn from them."

"We hear about Toyota's success, but not about its thousands of small failures that occur daily, which provide a basis for that success. Toyota makes hay of problems every day, where we tend to hide little problems until they grow into big and complex problems that are then difficult to dissect. Toyota has mastered the art of recognizing problems as they occur, analyzing their nature, and using what it learns to adapt and keep moving toward its target condition."

To some, the writings of Mike Rother quoted above may be just an academic construct that cannot be realized. However, the philosophy and reality of this manner of working is supported by what we have accomplished in the laboratories of the Henry Ford Health System through the management structures and culture of an empowered workforce we have created and the principles, rules and tools we have adapted from manufacturing to our own healthcare environment. Our own Henry Ford said it better yet-

“There are no big problems, just a lot of little ones.”    -Henry Ford

This is a different way of thinking. Find the little problems proactively at the level of the work and empower the workforce to resolve them, continually.


But do encourage those you have empowered to "Go and See".  This is an important early step of problem solving in order to move from assumption or accusation to an understanding of root cause. 

References

Rother M. Toyota Kata. Managing People for Improvement, Adaptiveness and Superior Results. New York: McGraw-Hill, 2010.