Monday, December 12, 2011

More on Lean from Michigan

I want to add a couple of more items to the post below about John Billi's MIT-sponsored webinar about Lean at the University of Michigan Health System.

When the Lean approach was first adopted at UMHS, there were some notable successes which I would term "projects."  For example, a rapid improvement event was held to redesign the carts used for blood draws, using the 5S approach that I have often referenced on this blog.  Here's the "before" view:

And here's the "after" view:

This is all good stuff, but it is not a full-fledged implementation of an organizational philosophy.  What UMHS found out  is that the cultural change inherent in Lean takes a long time to become embedded in the firm.  At BIDMC, we used to talk about "tortoise not hare" when we described that.  In essence, the process of adopting Lean becomes a Lean process itself.  It is one of modesty and constant learning.  Look, for example, at what John presented for the coming agenda for his institution.

The other point John made is when a map is constructed to enable all to all aspects of the value stream, "it's not the map that's valuable.  It the process of mapping, which produces a shared understanding of the value stream and which enables the front-line team to design improvement experiments together."


Anonymous said...

MIT has published a recording of this presentation at:

You can watch online or download to watch offline.

Keith said...


I think you missed your calling in life. Yuo should be running a closet orgainzation company!

Paul Levy said...

Excellent career advice! Thanks!

Susanne said...

From Facebook:

Exactly. Could it be the magic is not in the checklist but in the process of creating it, adapting it or even the process that leads us to recognize that we need it?

Mark Graban said...

Susanne - I think you're right. The process of creating the checklist (or in creating "standardized work" for lean) is a discovery process and an improvement process.

I have a friend who is an airline pilot who does consulting with hospitals, their team teaches people how to create checklists. He cringes (and I completely understand) at their competitors who will just sell the hospital a ready-made checklist.

Jack Billi said...

Thanks to Paul, Mark and the other commentators. At Michigan we were fortunate to have John Shook asking questions, urging us to reflect on what we learned, and to consider our our improvement efforts to be experiments. I agree with Susan and Mark that when the worker creates standard work, he/she takes ownership of the process and responsibility for changes - that is the key. As Shook told me often, some expert might suggest a more efficient way of doing a step, but that misses the point entirely. The point IS to empower the worker to make the changes. When a facilitator draws a map of a process and shows it to physicians or nurses, their eyes glaze over. It is the process of mapping, not just the map, that engages clinicians and other workers. They build consensus on problems, causes and experiments.