I scheduled a meeting this week and a room for our meeting.  During the course of our conversation, we began to discuss process and other items related to the their work.  Gratefully, I had enough awareness to stop the conversation and we, as a team, walked out to the Gemba and continued our discussion there.

Where we ended-up was not comfortable or warm, but we were in their natural environment – where they do work everyday.  In this environment, they were able to show and share, not just talk about it.  Then, something really magical happened.

What proceeded was a very productive and energetic discussion that turned into a mini Kaizen.  I guarantee that it would not have turned out so well if we had continued our discussion in the meeting room.

Go to the Gemba.  In the Gemba, we begin to empathize with people – we not only see their pain, but we feel it – and that has tremendous power to change hearts and minds.

A spreadsheet or report doesn’t invoke emotion, but experiencing the facts can.  That is the power of being in the Gemba.

The two pillars in Lean Thinking are Continuous Improvement and Respect for People.  What is not well understood is that most of what we know as The Toyota Production System comes from these two pillars.  The Lean sub-culture tends to over-emphasize the “tools” of Kaizen, but miss the point altogether, since the tools stem or originate from one of the pillars above.  The relationship between the 2 Pillars and Waste is subtle, but important.

For example, let’s take the Andon Cord, a tool in the Toyota Production System.

An Andon is a cord that hangs on both sides of a production line. It is to be ‘pulled’ when a problem happens on the line and, when pulled, production stops on the line, loud irritating Japanese music blasts through the speakers, bringing attention to everybody that there is a problem.  The team gathers together, conducts root cause analysis (5-why’s), implements countermeasures (solutions on the spot), then the production line start again and the Japanese music stops.

Now, suppose your organization breeds fear in its people and that questioning the status quo or speaking-up when there is a problem is viewed as bad. In this type of environment, implementing the ‘tool’ of an Andon Cord will not work.  Why?  An Andon Cord is just a tool, but it represents an organizational tenet of “if there’s a problem, please speak your mind and be not afraid.”  If that tenet doesn’t exist, then it makes sense that nobody will pull the Andon Cord.

Changing Worldview, Changing Behaviors

Lean Thinking is more about changing worldview and behaviors:

when you change a person’s worldview, a change in their behavior will follow, then they begin to improve their world

In this specific example, an Andon Cord did not work because the fundamental worldview of the company is that they do not want to know if there are problems, or that they do not value the employees’ opinions or input — THAT is a bigger problem than the cumulative effect of all defects in the company (more precisely, that is the root cause of waste as well as issues in organizational effectiveness).

For this example, here is what is at play:

1. Speak-up if you see a problem
2. Don’t pass problems up or down the value chain
3. Improve the way you work, the service, and the product
4. There is an end-customer, but the person upstream and downstream from you is also your customer

If an organization doesn’t subscribe to these basic principles, then no matter how many Andon Cords are available at your company — nobody will pull them.

Underutilized People

Switching gears now.  A related tenet to the Respect for People Pillar, is the idea of Underutilized People.  While not officially one of the 7 Wastes in Lean, Underutilized People clearly sits in the Respect for People Pillar.

Barry Schwartz, in an inspiring TED talk on Practical Wisdom, explains the impact on the organization and customers when the company structure and values creates underutilized people:

In this talk, Schwartz tells us about a hospital janitor, showing the responsibilities associated with the job in their job description.  Of all the Janitor job descriptions, not a single one involves interacting with other people.  When Schwartz interviewed hospital janitors about the challenges of their jobs, all the problems they listed dealt with other people.

For example, good janitors knew not to vacuum the floor when guests were napping, or not to mop the floor when a patient was walking the hallways and restoring his strength.  Being a hospital janitor involves interactions that require kindness, care and empathic thought that’s not in the job description.

To test Barry Schwartz’s findings, I went to Monster.com (NYSE: MWW) and search for “Hospital Janitor”.  The job description is one I found for an Elderly Care Facility:

Cleans and maintains entry lobby, including cleaning of windows, doors, mopping floors, vacuuming carpets, etc., at least daily, and more if necessary to maintain excellent entrance appeal.

Cleans laundry room, community room, conference room, and management offices on a daily basis.

Vacuums hallways on a daily basis.

Cleans community bathrooms on a daily basis, more if necessary to maintain in a sanitary manner.

Cleans stairways and elevators on a regularly scheduled basis.

Does cleaning of units, including stoves, refrigerators, bathrooms, floors, windows, etc.

Reports all maintenance repairs needed to Maintenance Supervisor.

Sweeps and cleans parking lot on daily basis.

Waters flower box on a daily basis (seasonal).

Picks up trash from grounds.

Uses hose to clean front entry walks.

Changes all light bulbs in hallways and common areas.

Does minor work orders for residents and/or management as assigned by Maintenance Supervisor.

Reliable…Must be able to work a flexible work schedule

Not one of the requirements deals with elderly patients, listening to them tell war stories, smiling at them, or any other small nice-ities that can make the day for an elderly person.  This job description reflects the values of the company.

A Long-Winded, Jagged Post

Yes, a lot of inter-related ideas in this post.  Here’s the point:

Worldview and Values matter – those dictate the behaviors of everybody in the company.  When “tools” don’t work, that is because the values don’t support the “tools”.  Focus on Worldview and Behavior — then the rest will follow.

King Pharmaceutical (NYSE: KG) recently had a drug approved by the Food and Drug Administration (FDA).  Their drug, Embeda, has an interesting property: If you take the medication as prescribed, it works fine; if you abuse the medication, it ceases to work.  This is Poka-Yoke (ポカヨケ) for Pharmaceutical drugs.

Poka-Yoke (ポカヨケ), translated, means mistake-proof, or fail-proof.  In it’s simplest form, it is a method that prevents failures.  Poka-Yoke is a critical piece in Lean Thinking, pioneered by Shigeo Shingo.  Examples of Poka-Yoke might include:

• Clocky, a clock that prevents you from sleeping-in
• A Key can enter a keyhole in only one way
• Needle cap, to prevent needle pin pricks
• A Microwave stops working, when the door is opened
• Aza Raskin explains Poka-Yoke for Humane Interfaces (Aza is a friend of shmula & his dad invented the Macintosh – Jef Raskin)

In their FDA approval press release:

We are focused on developing medicines that use novel technologies designed to reduce drug liking and make it more difficult to extract the active ingredient.  We anticipate a September 2009 launch for EMBEDA (TM).

Utilizing King’s proprietary technology, EMBEDA(TM) contains extended-release morphine pellets, each with an inner core of naltrexone hydrochloride, an opioid receptor antagonist. If taken as directed, the morphine relieves pain while the sequestered naltrexone hydrochloride passes through the body with no intended clinical effect. If EMBEDA(TM) is crushed or chewed, the naltrexone is released and absorbed with the morphine, reversing the morphine’s subjective and analgesic effects.

At the heart of Poka-Yoke is Prevention and an awareness of Human Frailty: we want to stop problems before they occur.  Indeed, preventing abuse, addiction, medication dependence, tragedy to the individual and families, or death, is a novel and innovative use for Poka-Yoke.

A Spaghetti Diagram is a simple visual tool to demonstrate the flow of material, flow of information, and flow of money in a process. The word “spaghetti” is descriptive because it describes flow that is not easily understood, can’t easily be followed, or if the flow is literally all over the place.  Indeed, a Spaghetti Diagram represents a point-of-departure: what does the current state look like and what are the exact improvements we need to make?

Put another way, a Spaghetti Diagram is a visual representation of how bad things really are and are used to expose Waste and Opportunity.

How Bad are Things, Really?

Sometimes, through poor thinking and poor choices, Spaghetti Diagrams aren’t just representations of how things are, but they can be representations of what we have created: sometimes, we turn our processes into Spaghetti Diagrams; this is precisely the case with the U.S. Government and the current Healthcare Debate.

The Democratic Party’s proposed Healthcare scheme is below ¹:

This map begs several questions:

• Where does it start?
• Where does it end?
• Are all motions equally important?
• What are the value-added steps?
• What are the steps we can do without?
• Can a 15 year old understand what is happening on this map?

It is safe to conclude that the map above is clearly bloated — complexity at its worst.

For me, I have a question that drives clarity and honesty in my thinking:

Can a 15 year old understand this?

If the answer is “No”, then I need to work harder to make my idea clearer and simpler.  Using that question as a litmus test for the Healthcare Scheme above, I believe the answer would be a clear “No.”  In other words, the Map above is a starting point, not an ending point: there is much to improve.

One area not exposed by either of the above maps is, perhaps, the most insidious of all: amidst all the confusion and motion are people that could potentially be harmed.  The patient is the true casualty in either of the above maps: she gets lost in it — indeed, we forget that at the center of Healthcare is the patient.  Broken processes enable our forgetfulness of people.

Broken process unfortunately helps us to forget people

Another map worthy of Spaghetti-like accolades is below ²:

Again, the presence of many squiggly lines means one thing: OPPORTUNITY for improvement.  This is clearly a starting point, not and ending point.  There is so much to improve.

To be fair, creating a future-state of the above is not trivial, underscoring the fact that Healthcare is clearly complex.  One thing is clear, if anything needs and begs improving, it is Healthcare where the biggest opportunities lie ³.

In Amazon’s 2008 letter to shareholders, Jeff Bezos shares about a Kaizen event he participated in:

At a fulfillment center recently, one of our Kaizen experts asked me, “I’m in favor of a clean fulfillment center, but why are you cleaning? Why don’t you eliminate the source of dirt?”

I’ve spoken numerous times about Bezos on Lean Thinking, some of which are here, here, here and here but there are many more — just browse shmula.

Here’s another citation from his 2008 letter to shareholders, which shows how he thinks and how every Amazonian is encouraged and taught to think regarding the customer experience, innovation, and waste:

The customer-experience path we’ve chosen requires us to have an efficient cost structure. The good news for shareowners is that we see much opportunity for improvement in that regard. Everywhere we look (and we all look), we find what experienced Japanese manufacturers would call “muda” or waste.  I find this incredibly energizing. I see it as potential – years and years of variable and fixed productivity gains and more efficient, higher velocity, more flexible capital expenditures.

What other CEO talks like this?  As a shareholder, I’m more confident that my shareholder value will increase with Bezos at the helm.  An example of Lean Thinking indeed.