I’m posting Book Talk a day early this week, because of the holiday tomorrow. And in the spirit of Independence Day, I thought it might be appropriate to write about Freedom from Command and Control: Rethinking Management for Lean Serviceby John Seddon, a book originally published in 2005.
Why? Because the word “freedom” is in the title. Because this book talks about the importance of not being dictatorial, and having employees engaged and involved – maybe not to the point of being a democracy, but certainly in a collaborative way. Even the cover of the book is red, white and blue.
But seriously… Seddon demonstrates that decision-making based on purpose-related measures (such as putting customers first and improving services) can help managers reconnect with operations, see waste, and exploit opportunities for improvement.
This book is focused on service industries. Seddon argues that service is fundamentally different from manufacturing, and shows how Toyota production principles must be transformed for application in service organizations.
For those of you who work in service, this book can be a valuable addition to your library.
Happy 4th of July!
Do you have a question or comment about a book(s) that you would like addressed in Book Talk? Email me directly at Ralph.bernstein@taylorandfrancis.com.
I’ve taken some liberties with the headline on this posting. The report to which I refer is a new document from the Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare. And the report did not actually say lean should be on the curriculum of medical schools.
What it did say is that medical schools need to change their curriculums. And part of that change involves focusing on what sound to me like lean principles.
Reforms in payment policies need to be accompanied by reforms in medical education. This pairing is important to ensure that students and residents learn the skills they need to provide care and leadership in new delivery models under restructured payment and incentives.
These skills include quality measurement and practice improvement, care coordination, multidisciplinary teamwork, cost awareness, and interpersonal skills. Research on internal medicine residency programs found several gaps in formal instruction on many of these skills.
Coordination, teamwork and measurement of cost are all central to a lean strategy, just as interpersonal skills are part of the fundamental lean principle of respect for people.
And let’s not forget about the central goal of lean, process improvement.
A Commission-sponsored study, conducted by RAND researchers, found that, although most internal medicine residency programs provide at least some instruction and experience in topics associated with quality and efficiency improvements, their curricula fall short of recommendations from the Institute of Medicine (IOM) and other experts…
The IOM states that physicians must be able to assess the quality of care they provide and implement changes in their practice for improvement…
The RAND researchers found that, while many residency programs provide some exposure to quality assurance and system change, only a small share require residents to complete their own systematic data collection, analysis, and resulting system change. Fewer than half the programs (11 of 26 programs) have lectures or computer-based training on quality assurance, but more (18 programs) require that residents work on quality assessment at the hospital. Fewer than a third (seven programs) have established curricula in which residents collect and analyze data on their own patients. The same share of programs introduces residents to chronic disease registries and provides lectures or computer-based training on implementing system change. Fewer still (four programs) have residents work directly on projects to implement system changes.
The section on medical education is actually only one part of the wide-ranging, 299-page MedPAC report, which is entitled “Improving Incentives in the Medicare Program.” For those interested in healthcare reform, it makes for interesting reading.
And I’m glad to see that lean principles are part of it, even if the word lean is not mentioned.
While huge numbers of people have lost jobs in this recession, employers are having a hard time finding qualified people for certain types of skilled labor. And while this may be a bit of a stretch, I believe one factor contributing to the situation is the failure of many companies to understand lean principles.
Unnoticed in the government’s standard employment data, employers are begging for qualified applicants for certain occupations, even in hard times. Most of the jobs involve skills that take years to attain.
Welder is one, employers report. Critical care nurse is another. Electrical lineman is yet another, particularly those skilled in stringing high-voltage wires across the landscape. Special education teachers are in demand. So are geotechnical engineers, trained in geology as well as engineering, a combination sought for oil field work. Respiratory therapists, who help the ill breathe, are not easily found, at least not by the Permanente Medical Group, which employs more than 30,000 health professionals. And with infrastructure spending now on the rise, civil engineers are in demand to supervise the work.
Why are these types of professionals in short supply?
For these hard-to-fill jobs, there seems to be a common denominator. Employers are looking for people who have acquired an exacting skill, first through education — often just high school vocational training — and then by honing it on the job. That trajectory, requiring years, is no longer so easy in America, said Richard Sennett, a New YorkUniversity sociologist.
The pressure to earn a bachelor’s degree draws young people away from occupational training, particularly occupations that do not require college, Mr. Sennett said, and he cited two other factors. Outsourcing interrupts employment before a skill is fully developed, and layoffs undermine dedication to a single occupation. “People are told they can’t get back to work unless they retrain for a new skill,” he said.
Two of those factors – outsourcing and layoffs – are the techniques employed by many companies when times get tough.
But not lean companies. Lean employers understand that outsourcing can create problems of logistics and quality, and that its cost benefits can often be matched by improving processes and keeping work in-house. And lean employers view employees as assets, providing them with additional training and responsibility for improvement when business is slow (rather than laying them off) so the company will be better able to compete when conditions improve.
Maybe if more companies understood and embraced a lean strategy, these shortages of workers wouldn’t be as severe.
With global operations, our military forces face daunting supply chain challenges. One result is that some of their people become experienced supply chain leaders.
The book details those qualities that can serve as benchmarks for measuring leadership success. It also provides a historical look at leadership in supply chain management, with original interviews of leaders in industry and government across three continents.
Over 29 years, Walden served in a variety of military supply chain positions that included designing and establishing a multi-million square foot distribution center in Kuwait to support Operation Iraqi Freedom and serving as the director of the US Army’s senior leadership school.Since retiring from the Army, he has led the Supply Chain Leadership Institute, served as a consultant to FORTUNE 500 companies and provided leadership programs for colleges and professional organizations.
His expertise makes this a valuable book for any supply chain professional.
Do you have a question or comment about a book(s) that you would like addressed in Book Talk? Email me directly at Ralph.bernstein@taylorandfrancis.com.
So-called “mystery shoppers” are a growing trend in hospitals, according to an article from HealthLeaders Media, and I have mixed feelings about it.
A mystery shopper is a person, usually a hospital staff member, who secretly observes the behavior of other employees – primarily to see whether they are regularly washing their hands.
No one disputes the importance of clean hands in a hospital in reducing the spread of germs, and pretty much everyone agrees that more needs to be done to get employees to wash their hands more often.
But is this the way to go about it? My concern is that this approach may end up focusing more on what individual employees are doing, rather than on flaws that may exist in hospital processes.
The article tries to put things in a positive light, describing a program at InovaLoudounHospital in Leesburg, VA.
The hospital uses these hand hygiene figures to spot trends and see where problem areas exist. For example, if a particular unit has a high incidence of noncompliance, Gayle Lovato, MS, RN, an infection preventionist, looks for opportunities to perform staff education or to improve systems issues, such as making alcohol-based hand sanitizer more readily available.
But sometimes, hospital employees are not thrilled by the idea.
There are a number of barriers to overcome before starting a mystery shopper program, says Brian Hudson, MT (ASCP), CIC, an infection preventionist at Cleveland Regional Medical Center in Shelby, NC.
Cleveland Regional also users secret shoppers to monitor handwashing. His biggest challenge has been recruiting people to take the job. "Nobody wants to be thought of as a rat," he says. "It's viewed as tattling."
What are you views? Is this a good or a bad approach? Share your thoughts below.
You don’t hear much about lean in education. Only a few early adopters are starting to embrace lean to improve the operations of their institutions.
One I came across recently is the University of St. Andrews, located in Scotland. Three people there are part of a team involved in lean initiatives.
Their projects range from redesigning how undergraduates travel through the recruitment/admissions process to standardizing absence reporting procedures across all schools.
Among their achievements so far:
In the library, cataloguing and processing of books lead time reduced from 50 days to 2 days
In reception and registry, production of Student Status Letters lead time reduced from 7-10 days to 2 minutes
Also in registry, large reduction in staff time needed to process student self-certifications while increasing availability of reporting
It is a pleasure to hear about successful efforts in an industry where lean is in such a nascent stage. I’m sure we will be hearing about more such examples in the future.
By the way, we have a book in this area scheduled for publication next year: Lean Higher Educationby William Balzer of Bowling GreenStateUniversity.
Lean can be used to address many types of problems in hospitals. One of the more heartbreaking areas is highlighted in a new report from the Agency for Healthcare Research and Quality. Its title: “Potentially Avoidable Injuries to Mothers and Newborns During Childbirth.”
The report, which is based on data from 2006, actually contains good news: The rates of these types of injuries in the U.S. actually fell significantly from 2000 to 2006. But the numbers are still disturbing, even if the rate isn’t that high. Out of 4.3 million births in 2006, there were nearly 157,700 injuries that may have been avoidable.
The injuries to newborns during birth include broken collarbones, infections and head injuries. The injuries to mothers include tears in tissue during delivery.
The report classifies births as vaginal, with and without instruments, and caesarian. It found a variety of correlations between injury rates and certain categories of mothers and infants.
For example, newborns covered by Medicaid had higher injury rates than newborns covered by private insurance. And rates of obstetrical trauma for mothers were highest among women living in the wealthiest communities, and women with private insurance had higher obstetrical trauma rates than those with Medicaid.
The report does not discuss why the rates vary. It may have something to do with the training and skill of doctors. But from a lean standpoint, it almost certainly has something to do with standard work.
I see this as a very difficult area to tackle, as each obstetrician works pretty much independently, which means the doctor, rather than the hospital, is in charge of the process of delivery.
However, the fact that injury rates have been declining offers hope that improvements are possible.
Green Intentions, by Brett Wills, is one of our first books focusing on the relationship between lean and green – which, as I and others have said, is almost certain to be a fast-growing area.
Wills, a senior consultant with High Performance Solutions and director of the Green Enterprise Movement, has solid experience in manufacturing, lean, and environmental issues.
He divides his book into two parts. The first explains what he calls the green value stream process and defines the seven green wastes. The second provides a step-by-step process for minimizing and eliminating each of those wastes.
The book also includes several resources: a green dictionary, web links and an environmental primer.
Do you have a question or comment about a book(s) that you would like addressed in Book Talk? Email me directly at Ralph.bernstein@taylorandfrancis.com.
Anyone even slightly familiar with lean knows the importance of eliminating silos and having departments work together. One area where this is valuable is product design. Engineers and product designers should work with production people when creating new products so they appreciate how their designs may make products easier or harder to manufacturer.
A recent article on CNN.com talked about an interesting variation on this approach: auto designers working not just with other departments in their own company, but also working with insurance companies so they design cars that are less expensive to repair.
Insurance companies are concerned that too many cars damaged in accidents have to be “totaled” because they are too costly to repair, even if only one part of the car is damaged.
Most major car companies are taking this collaborative approach, at least to some extent. The article talks about Ford’s new $650,000 Paint and BodyTechnologyCenter in Inkster, Michigan, which was opened partly as the result of design work on the 2009 F-150 pick-up truck.
During the vehicle's early development period, these engineers realized that new materials -- including ultra-high-strength steel and boron -- helped make the new truck safer, but also could make it more expensive to repair after a collision.
"The extensive use of advanced technologies and materials in the 2009 F-150 required us to develop new, specific procedures and repair recommendations," said Gerry Bonanni, Ford's collision repair senior engineer.
So, Ford engineers designed and developed new front and rear-frame-section kits -- which means one single section of the frame can now be repaired / replaced after a crash, instead of having to replace the entire frame.
"Partial-frame repairs cost at least $2,000 less than full-frame replacements," says Bonanni -- and will prevent some vehicles from being "totaled," which wouldhave previously been the case under repair laws in some states.
Has your company ever been involved in this kind of collaborative approach with outsiders? Share your experience by posting a comment.
Miscommunication is a form of waste, since it can drag out a process or lead to improper outcomes.
And in hospitals, apparently it is a significant form of waste, according to the Health Blog of The Wall Street Journal, which reported on a study in the Archives of Internal Medicine.
A review at two Canadian teaching hospitals reveals that in a two-month period, 14% of all pages were sent to the wrong physician—meaning to a resident who was scheduled to be off-duty or out of the hospital—and 47% of those were urgent messages. Extrapolating, that’s about 2,000 misdirected pages per year per hospital that require an immediate response, but don’t get one, the study found.
In one example cited in the study, an incorrect pager number was posted on a whiteboard.
The study did not look at how patients were ultimately affected by the delays caused by the paging mistakes. I hope someone does investigate that part of it.
From a lean standpoint, how can this problem be addressed? While I don’t usually push technology as a solution, that may help. There may be some kind of IT system that sends pages at the push of a button, with the numbers already programmed in.
But this probably is not just about incorrect numbers. There may also have been misinformation about which doctor was on duty.
Is it a question of standard work? Probably. Of eliminating handoffs? Perhaps. What are your suggestions?
