I got into the middle of this discussion on the Healthcare Management Engineers (HME) group on Yahoo.
A question was posed:
We're in the process of designing a new facility for a small group of family practice physicians. I'm primarily concerned with a layout that enables optimal workflow. Do you know of any articles/research that may help? Do you have or know of any specific layouts/blueprints that intentionally considered workflow design using Lean principles? Is that blueprint something you may share?
My response, which got a few “amen” emails from other readers:
Unfortunately, there are no short cuts to this process. Copying someone else's layout may end up being suboptimal for your needs.
When I take healthcare teams through layout exercises, you have to first observe and identify the waste in the current process:
Wasted walking and motion for staff and patients (due to room locations or supplies/equipment locations)
Can you design standardized and multifunctional rooms instead of separate specialized rooms?
Can you impact the process to improve flow so less waiting room space is needed?
You should look at the process before designing new space. There is an example of an E.D. going through this same process in my book.
Should the patient move multiple times or stay put in a single space, with all caregivers coming to them?
Does the layout give room for volume growth? What happens if business increases 30%?
You have to look at the flow of people, the flow of materials, and the flow of information — that will point your layout in the right direction.
You can learn from the layouts and lessons of others, but be careful about copying too closely.
The original poster accused me of endorsing “corporate amnesia.” Far from it, if you read the last sentence of what I wrote. I just see this far too often, someone writes a message that implies they want to copy instead of learn. Maybe I unfair implied the original author of the question was leaning that way. But after seeing umpteen questions like, “I'm looking for a West Virginia based manufacturer of plumbing supplies, revenue under $200M, one that also has plants in Malaysia, run by a left-handed COO, that I can benchmark.” To me, that reads “copy.”
I really do think there are no shortcuts. Maybe I should re-name this blog “No Shortcuts.” Nah.
Where do you find the proper balance in learning from others versus using Lean analysis methods to figure it out yourself?
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I honestly believe this gets at the heart of the success of the Toyota Production System. Taichii Ohno and Shigeo Shingo had visited Henry Ford’s operations and developed ways to integrate the best manufacturing practices they observed into the environment they faced in Japan at the time. Although this is an over-simplification of what Ohno and Shingo did, the principle here is they did not copy Ford’s production line. Today, anyone attempting to copy the Toyota Production System will fail, whereas, those who figure out how to integrate the underlying principles of TPS into their culture and environment will experience success.
The original poster you mentioned is likely still looking for a shortcut and probably does not have an appreciation for the tremendous benefits of drawing process maps or value-stream maps.
I agree.
I think alot of the issue at hand with copying is the variability. Lean processes should be learnt from experienced not from a fax machine.
I don’t think there is a balance between learning from others and figuring it out yourself, because they are both learning experiences.
I think that copying artifacts of a lean process such as layouts only works optimally if you copy the accompanying business processes. If you are prosperous enough to consider copying somebody else’s business process, it is because you probably have your own. Changing business processes is hard and much harder than it looks. The approach of Lean is to evolve business processes based on measurement of effectiveness. Each of these evolutions are straightforward and small, and continuously measuring intermediate results allows you to quickly reject inappropriate and/or untimely changes to the evolving business process. This is learning.
Learning from others’ business processes is a useful learning exercise as well. From analyzing others’ business processes, you may find redundancies or unnecessary steps in your own. You may find more efficient ways to execute the same process or similar processes.
There is no balance because both are useful learning experiences.
One way to avoid copying is to do the opposite of what many want to. Find organizations to learn from that are not like you. If you are an airline seeking to improve turnaround time and you learn from Nascar pit crews it isn’t easy to copy. You need to learn and then figure out how to apply it to your situation. Southwest Airlines did this, if my memory is right…