tag:blogger.com,1999:blog-32053362.post6056127084936352737..comments2024-03-18T06:27:51.599-04:00Comments on Not Running a Hospital: Lean: Tortoise not HarePaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger11125tag:blogger.com,1999:blog-32053362.post-3988275271007876522009-07-29T10:54:34.329-04:002009-07-29T10:54:34.329-04:00Mr. Levy,
I have been following your blog since m...Mr. Levy,<br /><br />I have been following your blog since my time in graduate school and it has only become more helpful as I've moved into the 'real world'. As an individual who has been trained as a Lean leader in a large, academic medical center, I've been especially interested in your posts on performance improvement. I'm glad to see the "Tortoise, not Hare" analogy being used, as I struggled at first with the pace of a performance improvement culture change. While individual efforts may reap immediate rewards, the establishment of a culture that truly understands and leverages the tools of Lean and Six Sigma takes years of executive sponsorship and communication. I've shared your work with many of my colleagues and I look forward to seeing progress at both institutions. <br /><br />Thanks for the sharing the great work at BI.Unknownhttps://www.blogger.com/profile/06033975359577278110noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-15941532252104292962009-07-24T16:13:35.246-04:002009-07-24T16:13:35.246-04:00Thanks for the ping.
When I first started study...Thanks for the ping. <br /><br />When I first started studying Toyota in 1995, I asked a simple question: ten years into the lean manufacturing movement, why was Toyota still outrunning its rivals? I expected to a missing production control tool--a variation on value stream maps, an extra version of kanban cards. <br /><br />I was completely wrong in those expectations. It wasn't another standard work chart or shikumi diagram.<br /><br />What I did discover that Toyota was designing all its work--from the repeatable work of individuals to the one off project work of large teams, so as the work was being done, it was obvious when and where problems were occurring. In short, for all the attention standardization had gotten as a way to create stability where chaos previously existed, I saw a second purpose. <br /><br />Yes, by developing clear recipes, scripts, protocols, plays, whatever, Toyota was ensuring that when work was performed, it was being done with the best known methods brought to bear.<br /><br />Also, and critical, as work was being done, the work itself was saying where its design was inadequate and where additional effort had to be applied to create deeper understanding.<br /><br />That triggered incredibly rapid, highly disciplined problem solving that quickly and relentless created new useful knowledge that could be brought to bear. <br /><br />The result? An ability to be ever more effective and ever more efficient.<br /><br />The gist of my comment was a reaction to the incessant repeating that "lean" is about removing waste. No. That's a negative. <br /><br />The key is to create value and to discover when creating value is being impeded so you can learn to create more value more effortlessly. That's a positive framing, and much much more consistent with what Toyota actually practices and preaches than how many in the lean manufacturing movement have distilled and distorted the message.<br /><br />For more, please visit my blog: http://chasingtherabbitbook.com<br /><br />Regards,<br />Steve SpearSteve Spearhttps://www.blogger.com/profile/05721240360737568418noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-85089355491307188822009-07-23T05:01:32.394-04:002009-07-23T05:01:32.394-04:00I've asked Steve to reply.I've asked Steve to reply.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-29492818261456338702009-07-23T01:08:47.695-04:002009-07-23T01:08:47.695-04:00Sorry, my concrete brain doesn't understand St...Sorry, my concrete brain doesn't understand Steve Spear's comment, specifically #2 and the last paragraph. Can you give a specific example based on a hospital process?<br />Of interest, the WSJ recently had an article in which the new CEO of Toyota North America said that Toyota NA had "lost its way" and needed to return to Toyota's original principles. Just goes to show how hard it is to sustain these initiatives.<br /><br />Sorry for the comment blizzard; gotta take a sleeping pill.... (:<br /><br />nonlocalAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-72021482644463128412009-07-22T21:22:21.753-04:002009-07-22T21:22:21.753-04:00Let me offer an alternative framing for 'stand...Let me offer an alternative framing for 'standardization' or 'specification' in advance of doing work. <br /><br />(1) Creating a script, choreography, 'play,' recipe maximizes the chance that you'll succeed by bringing to bear the best of what you already know. <br /><br />(2) Missed in the blog's explanation is that making explicit what you'll do with what intended outcome makes problems jump out. Then, you discover what you don't know, so you know where to target your kaizen. <br /><br />The previous formulation, on the blog, misses the role of standardization in prompting the improvement and innovation dynamic on which Toyota and other 'high velocity organizations' depend.Steve Spearhttps://www.blogger.com/profile/05721240360737568418noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-46832679109386757902009-07-22T16:31:55.711-04:002009-07-22T16:31:55.711-04:00As an airline captain, whenever my flight is late ...As an airline captain, whenever my flight is late I always tell my crew that "we're going to hurry slowly." This is my way of saying let's not rush anything, but simply not waste any time. <br /><br />People seem to get it when I use this expression when I'm teaching a teamwork class at a healthcare organization too.<br /><br />Great stuff Mr. Levy. Thank you.Steven Montaguehttp://www.saferpatients.comnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-73372043816764210972009-07-22T10:50:54.119-04:002009-07-22T10:50:54.119-04:00There’s a time for the tortoise and a time for the...There’s a time for the tortoise and a time for the hare.<br /><br />For the tortoise - When major rapid changes take place outside the organization (such as shifts in the marketplace or advances by competitors, regulatory changes, and technological innovations), incremental improvement efforts in some existing processes are simply insufficient (not transformational enough and too slow). A more fundamental and rapid redesign of how work gets done is required. <br /><br />For the hare – no process should be allowed to slip backwards, but especially a newly redesigned process. Incremental improvements are essential to help reach and sustain the full benefits and potential of any process, and especially after being redesigned and newly implemented. <br /><br />The relationship between radical or discontinuous improvement and incremental improvement is complementary … and the use of both is essential.Kelvin Crosshttp://cross-rhodes.comnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-1027406651756687462009-07-22T05:20:50.758-04:002009-07-22T05:20:50.758-04:00After some thought, I've removed several comme...After some thought, I've removed several comments that arrived after these. They were making me uncomfortable, in terms of tone, and in my judgment were not consistent with the usual standards of people who read and write on this blog. Sorry to have to do that, but it also felt like that had little to do with the subject at hand.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-38738120928964302382009-07-21T16:05:01.435-04:002009-07-21T16:05:01.435-04:00Completley right, slow and steady wins the race.Completley right, slow and steady wins the race.pburrell254https://www.blogger.com/profile/10876683862282199877noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-75622133068899659882009-07-21T09:08:25.508-04:002009-07-21T09:08:25.508-04:00Oh and one other thought... I've also learned ...Oh and one other thought... I've also learned the "tortoise and hare" analogy from Toyota and have shared it with many hospitals. The idea of "go slow to go fast" is very counterintuitive.<br /><br />I had a nurse at a hospital ask once, "isn't there an animal we can use that's sort of medium fast????" :-)Mark Grabanhttps://www.blogger.com/profile/07953086531083611251noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-13486804668496378952009-07-21T09:06:12.166-04:002009-07-21T09:06:12.166-04:00Great stuff Paul, it's wonderful that you woul...Great stuff Paul, it's wonderful that you would share this online.<br /><br />Lots of progress being made in healthcare organizations - including BIDMC.<br /><br />I heard another hospital CEO say last week, "The only real healthcare reform is eliminating waste". Lean certainly gives a method for eliminating waste and providing better value to patients, and I applaud your work (and Alice's and your team's) in this area.Mark Grabanhttps://www.blogger.com/profile/07953086531083611251noreply@blogger.com