Month: April 2013

Turn Our Waiting Room Into Just… A Room. How’s That For A Hoshin?

Ikitt‘ve enjoyed many of the commercials GE has put out over the last few years.  They seem to have struck a nice balance between informing about technology and entertaining the audience.  I mean, how many times do you find a new way to use KITT in today’s advertising world?  One of the first I remember was “Healthcare Re-Imagined – Love Story” which showed how improved technology can help patient care.  And who can forget the little kid capturing the power of wind?

geimaginationatwork

The most recent agent smithbrings in Agent Smith from the Matrix to explain to us how GE technology in hospitals is improving patient care and reducing waiting time.  And at the end, I think I heard a pretty good hoshin!  Here’s some of the dialogue from the video, Agent of Good:

GE has wired their medical hardware with innovative software to be in many places at the same time…  Using data to connect patients, to software, to nurses, to the right people, and machines.  Helping hospitals treat people even better while dramatically reducing waiting time.  Now a waiting room… is just a room.

There are some additional videos from the GE website connected with this video, including aventura-hospitala visit to Aventura hospital in Florida where we hear snippets from the hospital staff on how they believe the technology is helping them improve the quality of care.  In an earlier video one statistic they throw out is that the system has helped reduce the waiting time for patients by 68%.  Not bad!

If you spend a little extra time, you can find little coded spots (I’m not sure why they made it so hard and repetitive) using the time bar in the first extra video that give additional facts, such as:

  • A typical hospital can expect nurses to get an hour per shift back to spend on patient care, up to 250 hours annually
  • Can help increase equipment disinfection compliance up to 90% at a typical hospital so equipment is there and ready to go faster.

Now, I’m not always an advocate of a complex, capital-intensive electronic system being a countermeasure.  In the first year, or even months, you usually find so many things you wish you had known about when you designed the system, but to change now would mean costly rewrites to software or changes to hardware that you’ve already sunk a lot of money into.  Before developing such a system, first I’d ask, is there a simpler, more manual way to get the same job done?  In fact, many times someone develops a new shiny system just hoping to find a problem to attach it to.  But, if you develop a system to solve a problem, if you take time to define the problem and study your potential countermeasures,  and then design an electronic system to implement the solution and sustain it… well, then there’s not much to argue about!

From the additional videos, I heard several comments from the hospital workers that were really focused on how they use the system to improve patient care:

  • Everything is tagged and is specific to that equipment, and I can go into the system and see exactly where it is in the hospital and see that.  And since my area is critical, it’s a matter of life or death.
  • The GE software helps me provide better care because I’m able to get to the equipment sooner that is often vital to that patient
  • When a patient comes in to a hospital, they expect to be treated efficiently, effectively, and returned to their home.  The GE software is the catalyst that has helped us improve the bed management system.
  • It wasn’t until the GE software was implemented, that we were able to significantly reduce the amount of time a patient waits.
  • For that nurse to have that extra 5 or 10 minutes to spend with a patient, it makes a world of difference.
  • What if, we were able to see that a nurse only got to spend 2.7 minutes with a patient?

Hoshin kanri is usually associated with setting strategy.  I’ve always associated it with the image of a compass pointing you in the direction you want to go, towards your ideal state, or what I’ve heard called an organizacompassnorthtion’s “True North”.  Many times a slogan, or a short set of phrases, are associated to help bring imagery and meaning to the purpose of your organization.  A simple (and Toyota) example would be Lexus with “The relentless pursuit of perfection”.

A hoshin helps focus your organization’s improvement efforts by outlining a vision of where you want to be someday, even if you may never get there.  As you implement lean, you may create a great kaizen process, hold many improvement events, reduce changeover times, 5S the heck out of your maintenance area, create wonderful management systems with visual controls…  but at some point you may sit back and reflect from a distant vantage point and ask yourself, do we know why we did all of this improvement work?  If you are operating with a hoshin in mind, you should be able to connect most of your work towards the achievement of that ideal.

“Turning waiting rooms into rooms” may be a smaller hoshin, for one area of patient care, so it isn’t likely a rallying cry for the entire healthcare industry.  But it is connected to improving the patient experience, and is something just about anyone can relate to.

Does your company’s lean transformation have focus and purpose?  What’s your hoshin?

Hard-Wired for Lean?

Ever take part in a team-building event where you and your co-workers take a personality test to find out more about what makes each other tick?  I know that I’ve taken several over the years, and have seen a few used in our company that I haven’t taken.  Usually you get some kind of a “scorecard” that you can post on your door or your desk to show others what type, score, or color you were rated at.

myersbriggstypeI’m actually a big fan of personality tests from a personal reflection standpoint, ever since I took my first Myers-Briggs in college.  I’ve usually been amazed at how accurately they seem to describe me after only answering multiple choice questions, without any face to face discussion or direct observation of my behaviors.  Some test result descriptions speak in generalities, while others seem to have been sitting in the room with you over the past month!

Many of the tests you take at work as part of a business team event are meant to identify strengths and weaknesses, better methods of how to communicate with each other, and when used properly are supposed to turn you into a more effective team.  My experience has been that managers and team members rarely know how to “use” the results to actually improve and realize the full potential of the information you just learned.  But you nearly always learn new things about your co-workers, which can lead to increased communication, therefore meeting success criteria for a teambuilding event.

dilbert relocation

This past week I switched offices at work.  I won’t go into all the waste I observed while only moving to another location 30 yards away.  But moving tendsinsights-discovery-wheel to be a great time for cleaning out all those old files, papers, and accumulated “stuff” that you forgot you still had.  (Yes, I know, I should have a better 5S system!)  While leafing through some of these documents, I found a personality test my group took in 2010, and decided to take a few minutes to read through it.  It reminded me that when I originally read through the report, I thought it to be an accurate assessment that described me to a T.  (“Color/Insights Wheel” from Gatehouse Alliance)

Several statements in the personality assessment really stood out to me that I can connect to Lean thinking:

  • Usually weighs up all relevant factors before reaching decisions – I like to evaluate multiple alternatives, I want to know how a decision in one area affects work in another area, negatively or positively (how it affects the overall value stream), and want to make sure root cause has been identified and verified before implementing solutions.
  • Can look for flaws and errors in almost everything – This can go both ways, because if you focus on nothing but problems and don’t celebrate any progress or accomplishments, it can be very demotivating.  On the positConCive side though, if you are of the mindset that everything can be improved in pursuit of the ideal, then this is a great skill to have vs. just saying everything is fine, let’s keep things how they are today.
  • Sees the world…as in which he can develop a series of procedures and regulations that will take care of the situation in hand – Process-oriented thinking, I see that there is a lot of opportunity to eliminate waste and defects by operating with the current least waste practice (and improving it!), and that I focus on the process and not the people.
  • May tend to believe that the success of the team and its individuals are a measure of his own success – I think the correct concept here is “servant leadership”.  Typically leaders are not the ones who create value in an organization, the team members are.  I believe the purpose of a leader in a lean environment is to develop the next generation of leaders by ensuring they have the opportunity to build capability, to remove obstacles from their work and their mindsets, and to ensure the team is working on projects aligned with the organization’s needs.
  • Ideal environment is one in which unity and cohesion prevail, theories and ideas have been tried and tested, clear rules and procedures exist – Here I see respect for people through respect for standard work and testing hypotheses, the organization is set up and connected in order to be highly efficient at creating value, and pathways for products and services are simple and direct.

Reading through these statements, I got to thinking about lean transformation.  There is no question; adopting and building a lean culture is difficult for most companies, and it takes time.  There are about as many recommendations out there for how to begin to transform as there are lean practitioners.  One common option is to choose a test area, try to apply the thinking and tools, generate, celebrate, share the good results and use the story to generate traction in other areas.  But how do you choose the right area?  Who are the right people to choose to lead the transformation?  Who are the right people to choose to do the work and learn the thinking first?  What kind of skills should you look for?

By most measures, I’d be considered an “early-adopter” in our culture change.  Lean thinking simply connected with the way I thought, or wanted to think.  Was there a chance I heatmapwas “hard-wired” for lean even before I learned what it was all about?

The bigger question is, can a tool like a personality test be used to identify key traits of potential early adopters and get them involved at the outset?  Or perhaps, could a widely distributed test give you an output that could be used like an organizational “heatmap” showing where higher densities of “hard-wired lean thinkers” exist, to help you choose your starting point?  Would there be value in knowing where you might find the path of least resistance and where you might encounter tougher than expected obstacles?

Just like any subjective test, data like this should be used as one of many decision criteria, not the only criteria.  The test is only as effective and accurate as the effort and information that people feed into it.  And I think for an effective lean transformation there need to be people who learn and apply the thinking and tools well, but there must also be individuals who are skilled in promoting and selling the change story to your organization, and these two skillsets may not always overlap.

Do You Need Advanced Math Skills To Be A Scientist?

Today I was doing some quick surfing to catch up on some of the latest headlines.  I don’t quite remember how I got to the story, but I found myself reading a Harvardvery long and detailed article on a member of the Harvard Quiz Bowl team accused of cheating, subtitled “the biggest scandal in quiz bowl history.”  Reading through the article, I was surprised at how the story spilled on to three pages, and impressed by the level of research and detail put into an area that many across the country may dismiss as trivial and uninteresting.  Then, I reminded myself that I spend several hours a month writing about lean thinking…

The article was on Slate.com, and I found it to be written with much higher quality and deeper insight than say, the “Top 10 Grocery Store Traps” on the regular MSN homepage.  So I tried another one, entitled “E.O. Wilson is wrong about math and science“.  EO WilsonThis Slate article examines a recent WSJ article written by E.O. Wilson, an “eminent Harvard biologist and best-selling author”, and concludes that Wilson is telling aspiring scientists that they don’t necessarily need mathematics to survive – and takes issue with that message.  (It was a much shorter read than the aforementioned “scandal that brought down a powerhouse”)  The article itself didn’t strike a specific chord with me, but then I began to read over the comments by readers.  Most of the respondents appeared to be physicists, professors, scientists.  In general they argued against the Slate article’s conclusions about Wilson’s message, with several stating that although understanding of basic math is necessary, most advanced math concepts are not necessarily applied in many scientific fields, and that Wilson was saying that “discoveries can come from ideas, not always just number crunching”.

Now I’m certainly not here to argue one viewpoint or the other.  Reading through the comments and arguments, I felt woefully inadequate on the intellectual front.  However, the articles and comments made me think about principles of Lean, a little on how Six Sigma fits in, and what it means to have GEeveryone be problem solvers vs. a handful of experts.  I was trained in Six Sigma at G.E. back in 2000 (thanks Cindy!), and loved the tools, the logical thought process, and the focus on reducing defects.  It gave you a roadmap of how to analyze and solve problems, especially when dealing with multiple interactive variables.  Then in 2008 at my current company, I learned about lean, and saw how much more power it held for the entire workforce, the entire end-to-end system, the entire organization, than Six Sigma alone did.

Lean is about creating a community of scientists, from floor operators on up through senior leadership.  It teaches that you do not need experts to come in and solve all the problems, scientistbut that to truly be a continuously improving organization everyone needs to be able to solve problems everyday.  To enable this ideal world where everyone solves problems, we were not told to go teach everyone triple integrals, how to design a fold-over DOE, or how to complete a one-way ANOVA test.  We were told to teach everyone the scientific method, typically summed up in Lean teaching as Plan-Do-Study-Act/Adjust – hypothesis thinking.

“I understand my problem to be this.  I think the problem is caused by this.  Let’s check and see if that’s really the cause.  If we do this, then we expect this… Yes it is, ok let’s figure out how to block/eliminate that cause and make sure we never have that problem again.  If we do this, then we expect this… And let’s figure out how to make sure that our solution stays in place.”

I think just about everyone can understand that basic line of thinking.  If you assume 1-5% of all the work you do in your organization is waste in the eyes of the customer, and you want to strive to eliminate it all… well, that’s a lot of Six Sigma projects, if that’s your only improvement tool.  And you’re going to want an army of blackbelts.  But you don’t need to build that army!  I can’t remember exactly where I read it, but I liked someone’s recent description of using Six Sigma to solve all your problems – it was something along the lines of using six sigma for everything is like using a flamethrower to remove small stacks of hay in your yard.  So much of that waste could be removed with much simpler methods by so many more people if you train them in the fundamentals.

Is there a place for Six Sigma?  Sure!  It is a great tool.  Like I said, I loved using it.  There are complex problems with multivariable interactions that need to be analyzed with statistics to help make the right problems visible and weed out the noise.  But it will still take hypothesis thinking to figure out what you’re going to do to solve those problems!

Think of your organization and all the work you execute as a Louisville Sluggerlarge, round, 4-foot diameter chunk of lumber.  Think of what your customer values within that chunk of lumber as only the shape of a baseball bat.  Lean thinking, tools, and principles, are what can help whittle away large chunks of wood and get it to the shape of that baseball bat.  Six Sigma might be a tool you can use to fine tune where the sweet spot is when you get to that point.

One question I don’t have any answer to yet is, when do you decide what you do everyday isn’t enough and call in the experts?  When is the proper time to pull that particular andon cord?  What defines a problem as “complex”?  I’m sure there are some simple decision rules, such as “We’ve tried four times and the problem keeps coming back” or ” we’ve tried 10 experiments and don’t have any more direct causes we can think of to check”.  But my hypothesis is that most organizations have a long way to go and a lot of benefits to realize after they begin their lean transformation before they even need to begin worrying about that final 5% of waste to eliminate.

So do you need advanced math skills to be a scientist in your organization?  I think you need the ability and discipline to form and study a hypothesis.  And I think anyone can be taught those skills, regardless of whether they took AP calc or not.

I Came, I Saw, I Problem Solved… I Only Got To A Temporary Countermeasure. Do I Still Feel Worthy Of Lean?

Problem solving to root cause is an important skill to build capability in.  The “why” behind problem solving to root cause is so that you prevent problems from ever recurring again, thus eliminating potential waste from your future PDCAactivities.  Along the way you grasp the situation, take steps to contain the problem so you are still able to provide the product or service to your customers, understand potential direct causes, test the connection from cause to the problem, develop and test a countermeasure (your hypothesis towards preventing the problem from ever coming back), and put measures in place to sustain and check that the countermeasure works and is still in place.  (Yes, this is simply a description of P-D-C(S)-A with a containment step thrown in!)  It doesn’t matter if you’re talking about 4-Step, 8-Step, x-Step or DMAIC problem solving, the fundamental principles are all the same.

Most organizations that begin a lean transformation are already very good at what they think of as problem solving.  A problem comes up, I work hard to understand what caused it, I fix what caused it, and we’re up and running again.  I add it to our troubleshooting guides and therefore if it happens again we will be able to get up and running even faster because we know how to fix it!  And the veteran problem solvers will be able to tell you war stories of all-nighters where hours of investigation finally yielded something they never thought of: a motor wired backwards and turning in the wrong direction, a bit set wrong in the control logic, or an incorrect part sent and installed that looked just like another part but had different guts.  They might call it “stuff that never should have happened if someone else had done their job right in the first place”, because they are still learning what it means to focus on the process and not the people.  And how if only they’d called the expert in the first place they could have avoided all those hours of downtime because he’d recognize the symptoms and connect it to a problem he solved 5 years ago and could have told them exactly what to check and fix.

“Haven’t we worked on this problem before?” and “Didn’t we fix this last year?” are common phrases you might hear that should trigger you to wonder if you really understood the root cause of the problem the first time.  It feels like problem solving deja vu!  You honestly shouldn’t feel bad about it though, especially if you are still at the outset (read: first several years or perhaps decades depending on point or systemic problems!) of your lean journey.  Solving to root cause, so the problem never occurs again anywhere in your organization, is hard.  It can be hard to identify the root cause, hard to rollout countermeasures across groups in multiple global locations, hard to not get distracted by all the other fires you need to fight this week that seem like a much higher priority.

I recently switched cable, internet, and phone service providers from Time Warner to att uverseAT&T, for a whole host of reasons that could be turned into another post on “thinking customer”.  I’m actually very happy so far in a short period of time with what I now have from AT&T Uverse.  It’s not all ice cream and puppy dogs through the switch however, I have had a couple of internet setup issues that have been frustrating, but they’ve actually been more due to lack of knowledge and added system complexity on my end vs. something that was the service provider’s responsibility.

Yesterday I woke up to a new problem.  When I tried to open a web browser, I got an error message from my AT&T wireless router that popped up on the screen, saying “Excessive Sessions Detected.”  It explained that one of my computers had a whole lot of internet sessions going at once, and that it was likely the result of some form of a virus, or malware.  So, my head began doing problem solving.  Target = Able to access the web from all my devices.  Actual = Not able to from one PC.  Let’s continue to grasp the situation.  Check PC #2 – I get the same error.  Check IPhone – I get the same error.  Actual now equals “Not able to access web from any devices.”

Excessive Sessions Warning

Potential direct causes… 1) the error message tells me it may be a virus 2) the error message tells me I may have gaming software causing it 3) could be a problem with the router 4) a power problem or connection problem somewhere in the system 5) something is broken on AT&T’s end 6) my internet cache is full 7) just something weird that requires a restart.

Ok, so let’s try and work through the most likely causes – 2) I can eliminate this cause, don’t have any gaming software going on (sad, I know, I’m a long way from my college and single days!).  4) check to see I have power everywhere – all ok, eliminated.  1) the system error is telling me “virus” is the first place I should look.  So I run a check, and sure enough, it finds two items and eliminates them.  So as I restart my computer my mind is already jumping down the why chain to root causes like, inadequate standard for setting up my antivirus software, or inadequate process for selecting antivirus software.

Computer is restarted, and… nope, error message still pops up.  How about 7) – let’s restart the router and everything else.  Nope, error still there, can cross that one off.  Now it is about time for work, so I eat some breakfast, watch some TV, and off I go.  Midway through the day my wife tells me the TVs no longer work.  So now, new information surfaced that tells me that something in the system is degrading – the problem is getting worse!  So in my head I mapped out how the system worked and where problems could occur (see setup picture below), and couldn’t figure out what was changing to cause the new problems, because most of the TVs don’t run off the router.  Why did they work in the morning and then suddenly not work in the middle of the day?  Now I start leaning towards something on AT&T’s end as the direct cause.

ATT Setup Map

When I got home I hopped on the phone with AT&T, explained the situation and what I’d done so far, and then we went through their troubleshooting guides.  We do a reset from their end, restart computers and routers and DVRs, and the error still comes up. We cleared the internet cache and tried again.  Still have the error.  We’ve now eliminated 5) and 6), and AT&T is out of ideas on their end too.  Their only solution left is to send out a technician tomorrow, and maybe they’ll swap out a router to try and check 4) – the only direct cause we have left on the list.  This disappoints us, because we wanted to watch the new Modern Family!

As AT&T is finalizing the order for the technician, I decide to check one more thing.  On the error message there are two buttons – one says “Do Not Show” and the other says “Continue”.  I had tried “Continue” early on and didn’t get anywhere.  “Do Not Show” was labeled as something you should only click if you think the cause was gaming software 2) which we had already eliminated, and I didn’t want to ignore the error if I really had a problem or a virus.  So at this point I said what the heck and clicked “Do Not Show”.  It asked me to log in to my gateway, I did, and then it gave me a message – “The problem has been resolved.”

docmcstuffinsEureka!  We were now connected to the outside world again!  My three year old would not be without her Doc McStuffins in the morning!  We could watch Modern Family!  I could stream YouTube videos through my TV again!  I was the hero, I had “resolved the problem”!

My lean thinking was gnawing at me though.  I didn’t know what caused the problem in the first place.  I can’t recreate it.  I can’t develop any countermeasures to prevent it from happening again.  And I’m not sure the AT&T person really captured my “solution” in their knowledge database so that they try it with other customers in the future before deciding to send out a technician.  Yes, the problem is contained, and we are up and running again.  Is that good enough for this situation?  Or should I have done more?

Good organizations are very quick to recognize and contain problems, and to get up and running again to avoid customer service issues.  Great organizations have the discipline to spend time working towards truly understanding the root cause of the problem, developing adequate countermeasures, and ensuring waste never recurs.