Day 41: Our second day of the Jacksonville Lean Tour

Today we had two tour stops planned, both in the medical field. Stop number one: The Mayo Clinic

It's a big campus with a hospital, education centre, and outpatient clinics. They have been in operation for 150(!) years as a not-for-profit organization, and it is truly an impressive operation. They have only really been at lean management in the last few years at this facility (they have two other clinics in the US), and started with focusing on teamwork, internal communication, and training.

They branded their lean initiative "The Culture of Safety" which I thought was very clever... Don't necessarily use the terms "lean" or "continuous improvement" or six sigma" or other words which may make people nervous... However in the healthcare field, employees care very deeply about their patients and really just want to give them the best care possible. So to use the Safety card to get employees engaged - extremely clever :-) The focus on safety was a good way to encourage everyone to feel safe to speak out about what could be done to improve patient care, without feeling pressured or afraid. 

This is a common theme, it seems, regardless of industry. People fear raising their hand to ask for help or to point out a problem. 

Why is that? 

Is it culturally-isolated to North America? I don't think so, I have seen it in Europe, China and Japan. 

Is it only front line workers? I don't think so either, I have seen many a c-level employee exhibit this behaviour.

I suspect that it is inherent in everyone to want to please others, and this, coupled with fear of public shame, is what drives this behaviour. Can we learn to manage this response? You bet. But how many employees, supervisors and managers are actually taught anything useful about human behaviour in order to do just that? If they are, it's often only later in their careers. A long time ago, a very good manager of mine (one of my first) told me that "people are messy". She didn't mean it in a bad way but in an honest, let's-face-reality, kind of way. It was her way of saying sometimes people's lives get messy and it's in no ones best interest to make it worse. I have found that showing true respect for people means that you actually have to respect people's lives including what lies beyond the work day.

Mayo also had an impressive simulator lab - a dojo - for learning and testing new tools and technologies. It included this amazing digital anatomy table, where you could take real CT scans and spin, slice, add or remove layers. Absolutely fascinating, but imagine what they could use this for in the future? Pre-planning surgeries. Creating custom joint replacement parts (3D printing anyone?). I have to imagine that in my lifetime, everyone will receive regular full body CT scans as part of preventive medicine.

For the afternoon, we visited Medtronics, a manufacturer of medical devices and consumables. they had aligned their teams into Value Streams, something we are attempting at Alpha. Medtronics had gone further than us (to date) and created a Value Stream Manager position. I have a feeling we will gave to evaluate the need for this type of role - I am curious to see where we end up - but it was great to see a real-life example.

Medtronics had decoupled most of their manufacturing processes from their ERP system, and simply replenished what was purchased by customers. They had a small amount of inventory as safety stock, set into a two-bin kanban system, such that as soon as the first bin was picked and shipped, a trigger was sent to production to replenish the safety stock. When raw materials for production ran low (similar two-bin system), a trigger was sent to purchasing to buy more. So simple. They used heijunka to redirect excess staff to improvement activities, or to overburdened areas. If pick to ship was slow but production was hopping, staff could be moved to where the need was greatest. They also used a simple red card/yellow card for issues - at the line, in each functional area, and cascading up to the value stream level. Red: needs action. Yellow: actioned with a due date. Daily 12min huddle only focused on the red cards or overdue yellow cards. 

The thing I like about this approach - as you can see by the picture above - is that the supporting functions realize that if they want to be part of the process (managing and resolving issues that is) they need to actually participate.

In university, I had a chemistry prof who used to joke: "if you aren't part of the solution, you're part of the precipitate" (insert groans here). 

But if you don't participate, you aren't part of the solution. Even if it is messy at times.

AMac