A well-balanced introduction to Lean in hospitals


       ^ Cover Lean Hospitals & author Mark Graban

Do you want to know what lean working, thinking ánd managing in a hospital looks like, and what the results can be? The second edition of the book Lean hospitals of Mark Graban gives you a clear and well-balanced introduction! Almost all aspects pass in review, from standardizing and improving work, to creating flow and engaging employees. Also the need to create a problem-solving culture is addressed, be it on a basic level.

What I liked in particular is the practical line of approach. There are many inspiring examples, but Graban explains that you should experiment – of course without jeopardizing the quality of the care - to find out what works in your ward, laboratory etcetera. Typical Lean objectives like zero waste and creating a One Piece Flow should only serve as a direction for improvement, and the application of tools like 5S should not be exaggerated. It should always be kept in mind that the primary goal is more value for the patient. Lean tools are useful if these solve problems and reduce waste, with interfere with patient care.

There were only two things I missed in this well-written book: The concept of creating clinical pathways for patients with similar symptoms, and making a business case for Lean.

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The evolution and state-of-the-art regarding Lean


       ^ Early example of Lean. Moving assembly of
          the T-Ford in 1924   (source: Ford)

There are people who grasp each problem within Toyota, to state that Lean manufacturing now really is out of date. Others fight tooth and nail to defend the production system of the Japanese car manufacturer.

Both attitudes are rather peculiar. What we call Lean today, is no more or less then the state-of-the-art to deliver good quality products or services on time, and at the lowest possible cost. So, even if Toyota fails, this does not mean that Lean comes to an end. Regardless of how well Toyota is doing, our view on smart production will continue to evolve, like it did during the last century.

Nowadays, the attention for the organisational side of Lean increases. How can I make problem solvers of all my employees, is a question that many Lean researchers try to answer.   

Besides that it catches the eye that Lean turns out to be applicable in an increasing number of organization types. Even design to order production and administrative processes can be made Lean. This is also a matter of evolution, since Lean is adapted to match with these new environments.

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Combining Lean, Six Sigma and the TOC to achieve breakthrough performance


       ^ The authors of Velocity:  Jeff Cox (left),
          Suzan Bergland (middle) & Dee Jacob (right)

Gerritjan van der Ven, plant manager at Balchem in Italy, reviewed the book Velocity for us!

His findings:  "The authors recognize that only with a combination of the main logistic manufacturing theories you will get the breakthroughs you need in today’s competitive environment. This is a big plus, since the literature I studied so far kept especially Lean and the TOC strictly separated. Until now, it was like you had to choose between the Beatles and the Rolling Stones!

Lean, Six Sigma and the TOC all have their own strong points and weaknesses. As a plant manager I discovered myself how well a strategy based on TOC, can be filled in practically by applying Lean and Six Sigma tools. This approach I found justified in the very readable business novel Velocity.

The message in this book is twofold:

1. TOC should not only be used to maximally exploit a bottleneck machine, but should also be applied broader, to find business constraints on a strategic level.
2. When the TOC is applied that way, practical tools from the Lean and Six Sigma toolboxes can be used on the operational and tactical level, to relieve those business constraints.
   

In my opinion, this book about achieving breakthrough performance is also a breakthrough in manufacturing theory. However, there is also a minus: The examples of Lean and Six Sigma are weak and don’t show how these methods can really accelerate a TOC implementation. This is a missed opportunity"

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In memoriam Dr. Eliyahu M. Goldratt (1947-2011):   "Every conflict can be solved"


       ^ Eliyahu Goldratt

After an illness of several months, Eliyahu Goldratt, managementguru and founder of the Theory of Constraints (TOC) passed away. At the time he stayed in his house in Israel, surrounded by his family and friends. In the first place our thoughts are with them. Besides that, Goldratt’s death is a big loss to the process improvement community.

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Isn’t it obvious? Why even obvious solutions are not always accepted!


       ^ Eliyahu Goldratt and cover Isn't it Obvious

Due to the immense popularity of Eli Goldratt’s book The Goal, his Theory of Constraints (TOC) is often equated with maximally exploiting a resource of limited capacity (a bottleneck). However, it is much more than that, argues Goldratt at the end of his last book “Isn’t it obvious?”. I agree: The core of the TOC is mapping causes and effects, to find ground breaking business opportunities to focus on.

In his article Standing on the shoulders of Giants, Goldratt already positioned Lean manufacturing as a method with the same roots as the Theory of Constraints. In Isn’t it obvious he goes a step further. The way in which he analyses a retail chain, by mapping causes and effects, is still typically TOC. However, the solutions found – demand driven replenishment, mini-markets in warehouses, go see how your suppliers operate and find a win-win solution – all are typically Lean.

The cinematic book Isn’t it obvious not only shows what can be accomplished with the TOC in a retail chain, there is also a deeper message in it. Good solutions are often based on correcting wrong assumptions. Therefore they look embarrassingly simple, once you found them (remember Archimedes yelling Eureka?). However, this does not mean that everyone will accept these ‘obvious’ solutions at once! Hidden in the book, there is cause and effect logic to be used for change management. People can have a distorted picture of the gold, the pain, the crocodiles and/or the mermaids associated with change. If so, these wrong assumptions should be corrected.     

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   > see also: In memoriam Eliyahu Goldratt

Toyota Kata: A company full of problem-solvers and coaches!


       ^ Cover Toyota Kata & author Mike Rother

After six years of research in Toyota factories, Mike Rother describes in his book Toyota Kata how this car manufacturer manages their people.Toyota Kata is an excellent book, which really adds something new to the existing Lean literature!

The main message: Behavior routines, the so-called Improvement Kata and Coaching Kata, determine how everyone within Toyota strives iteratively to reach a Target Condition. This brings the company a step closer to a Vision, be it along a route that is a priori unclear and full of hidden obstacles. This is therefore something completely different then our management by quantitative and financial targets, in which not only what but also how things should be done is determined beforehand.  This results in ‘projects’ or ‘action-lists’, which often often fail due to unforeseen barriers.

This organizational difference explains why many Western companies until now often could become Lean, but failed to stay that way. Toyota turns out to be an organization in which everyone is a problem-solver, guided by a coach!  Can we learn to climb a mountain in the fog like Toyota does, and perhaps even become better than they are in developing new Lean tools?

Read what we learned from this book. In addition, author Mike Rother reacts extensively to our findings!

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Heineken's cascade of performance indicators for focused improvement


       ^ The TPM program of Heineken was
          implemented step by step

The Total Productive Maintenance Program (TPM) of Heineken started in 2003. Thanks to this program, all breweries produce increasingly more efficient and with fewer losses.

The factory in ‘s Hertogenbosch in the Netherlands is one of the best production sites, concerning TPM. Here, in recent years, the Overall Equipment Effectiveness of the packaging lines rose from 47 to 72%. In addition, productivity and quality are better then ever before! TPM-manager Age Posthuma explains this, by stressing three success factors: deployment, audits, and training. 

Of course, additional improvement is always possible. ‘This can be achieved by connecting our external processes better with the operations within the brewery’, says Posthuma. ‘Examples of those external activities are supply chain processes and the introduction of new machines and products.’

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> archived news

1. Lean Hospitals, by Mark Graban (jan '12)
2. Velocity, by Jeff Cox, Suzan Bergland & Dee Jacob (aug '11)
3. Isn't it obvious?, by Eli Goldratt (may '11)
4. Toyota Kata, by Mike Rother (april '11)
> more book reviews

Our mission is twofold:

1. Providing information about business improvement, to stimulate knowledge transfer.
Business-improvement.eu and its Dutch sister website procesverbeteren.nl both provide completely independent¹ and unbiased information about áll methods to improve the efficiency, quality and flexibility of production and business processes. Focus is on business-cases, of which most were also published in specialist journals about logistics, quality and maintenance. The idea is to transfer knowledge about best practises from one company to another, and also to transfer knowledge between different industry sectors, e.g. from manufacturing to hospitals.

Each company struggles with the same question: How can I provide – at lowest possible costs and with an acceptable delivery time – products or services that add maximum value for my customers? All methods on this site, Lean, Six Sigma, TPM etc, address this problem. Although it is often thought that implementations of these methods can be copied form one company to another (like a template), this is definitely not a good idea. The reason for this: Take for example the application of TPM within Unilever. Their approach evolved during the years to a company-specific improvement method, tailored to their specific needs, also including aspects of other methods like Lean and Six Sigma. Therefore the idea is not to copy approaches on this site, but to see these as suggestions, which might work in your own organization.

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