While in Boston, I'm getting the chance to sit in on some sessions of an MIT Seminar in Healthcare Systems Innovation.
Today, the session that focused a lot of Lean as a means to improve quality and cost. Lean is the focus of a few class sessions, including guest lectures from MIT's Deborah Nightingale and Steve Spear. It's great that Lean is being given such attention.
The professor made a great point that no single solution, Lean or otherwise is a silver bullet. Complex systems require complex solutions. He's right. I agree that Lean is not the ONLY systemic change that's required in healthcare.
He brought up an interesting point — one reason that any organization struggles to “become Lean” is that they are often just copying Toyota too literally instead of thinking for themselves. Even Toyota does “un-Toyota-like” things when it makes sense — like adding buffers in the middle of a long assembly line so one andon-related stoppage does not stop the entire line.
The real key to TPS seems to be developing problem solvers — as some hospitals are aiming for, a culture of everybody solving problems and improving every day.
Will you get that by copying? Probably not.
The professor then placed blame on consultants for selling a cookbook-like Gospel According to Toyota. Easy answers and rules to blindly follow.
I spoke up and asked, “Doesn't the client take some responsibility for WANTING easy answers, silver bullets, and 90 day paths to ‘being Lean' without wanting to think?”
We agreed that the consultant (a good one) has an obligation to inform the client that they can't get Lean in 90 days, that there are no easy answers. But some consultants are happy to sell cookbooks and easy answers.
It's a chicken and egg problem — who is to blame? The consultant, or the client, or both? What is your experience with this, from either side of the equation?
p.s. Maybe this is a trick question, since this blog tries to be a “no blame culture”???
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Mark,
I believe Toyota having small buffers is not un-Toyota-like, it's very Toyota like, because it is understanding variation and managing that variation scientifically…but I'm already off-topic.
You should never copy Toyota. I've even written columns about that and the failed efforts of benchmarking. Whether Toyota or someone else, you should never copy. You should understand what problems you have and understand how (cause and effect) Toyota's and others solutions solve their problems. Even if you were making cars just like Toyota does, you shouldn't copy them.
I agree it is a trick question – I don't think it is about placing blame. As long as a client wants a quick solution, clients will give it to them. Even mighty McKinsey does 20-week lean transformations, and then the operation is left performing poorly because they didn't really fix anything, just ripped out some headcount. That's what you could sell to that particular client.
I think consultants and clients have some obligations in the relationship. First and foremost, the client still needs to lead themselves. Regardless of who the advice is from, they have to take it as counsel only, and then make their own damn decision.
And consultants have an obligation to give sound advice, even to the extend that now is not the right time for you to start a lean journey, which I've done several times.
Blame won't help us, but improving the code of the relationship can improve the current condition.
Jamie Flinchbaugh
jamieflinchbaugh.com
As a consultant, I'm conflicted when clients want a quick fix solution, that in my professional opinion wont be worth (to them) even the limited time and effort they propose to spend on it.
Looking more widely, is the world better-served by having consulting firms continuing in business, ready and able to help clients that really want to change fundamentally, at the cost of short-changing the palliative-seekers? Or would it be better to have these "exploiters" go to the wall and not be around to help the enlightened few?
Jamie – I hear what you're saying, that having buffers in strategic places is smart and probably not "un-Lean". But the conundrum is that when Toyota didn't have buffers (or didn't use kitting), then people would confuse "un-Toyota-like" with "un-Lean."
Toyota changing from long line to shorter segments with buffer zones is all "Toyota-like" because they were / are doing it. But is it in keeping with TPS principles or "lean?"
Too many people are copying Toyota instead of learning TPS or Lean.
I got an email from a guy at an automaker who wants to learn about kitting. Probably because he read that Toyota is now using kitting in their plants…
Hey Mark, I looked up the bios of the speakers and see that Ms. Nightingale is blessed to have been a Buckeye! So hey… Dr. Nightingale… O-H!
Also, I agree with Jamie… strategic buffers that the company carefully controls (instead of buffers that magically appear because of overproduction) is not un-lean… it's smart.
If people would just visit a Toyota plant they'd see that their efficiency target is 97% and not 100% since they know that their process is not infallible and that the line will stop from time to time.
Additionally, there is this misconception that for a company to "be lean" they cannot have any inventory or buffers. This is likely caused by text book practitioners (those that spend more time reading books and/or in 2 day workshops then on an actual shop floor managing a real business) not truly understanding what the waste of inventory really is.
Next, as long as the consultant is doing all they can to provide the value the client is asking and paying for how can they be faulted? Plus, if the consultant always tried to "upsell" their clients on a 50 year deployment plan people would likely accuse them of shady business practices… so really the consultant is in a tough spot.
Finally, if the client is sincerely doing their best to improve a broken process – even if they are not following the best road-map – well, I could think of worse things! At least they are trying to continuously improve… isn't that what it's all about in the real world?
Another reason for Toyota's 97% efficiency target over setting the target at 100% is to encourage making problems visible. If the target is 100%, there is a strong tendancy to hide problems. Even in a "no-blame" Toyota-like culture, who wants to be the first to pull the andon if the target is 100%.
All that tool training being done causing the wrong actions is an ongoing trend. TQM did for Deming what Lean has done for Ohno, they wanted us to think differently and instead got tools. Not surprise here.
Now if we can just get rid of those arbitray numerical goals (targets).
Mark, all I can say is amen. I grow weary of perspective clients wanting a 6 pack of Kaizen, a 5 day certification of some kind,and a "90 day path" for becoming Toyota like. Consultants worth their weight in salt should help clients understand that while these things may help the organization to get started, that Lean is a journey, its not the silver bullet they are seeking, and that there isn't a cookbook/one size fits all approach. There are too many folks out there advocating such craziness to make a sale, and many hospitals will fail, become frustrated, and feel it isn't what they expected, thus consider Lean as just another fad. It isn't. Thanks for asking this question as well. Sincerely, Charles Hagood
If the learner hasn't learned, then the teacher hasn't taught.
I suppose whether one is the client, student, teacher, consultant, etc. the useful thing is to consider what one can do rather than blame others.
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