Zero Defects – again!

Interesting comment to this post:

We are Hyundai Translead a trailer manufacturer located in Tijuana Mexico. This year third quarter have been though for our business and that’s why our General Manager have requested QC department (I’m QC manager) to look a program to drive defects to “zero”. Reading your comments I wonder if you can give me some directions for the type of steps I should follow in order to implement such a program like “zero defects”.

My comments:

I refer you to this excellent page by John Hunter:

or this:

The latter article makes the point:

Since the slogan zero defects implies immediate compliance to a defect-free standard, it may not leave time for the continuous improvement process to occur. In fact, it may even slow down the continuous improvement process because of the massive resources that inspected-in quality entails.

Zero defects is a message that can carry with it confusion and misinterpretation, mixed with technical impracticality. It may be appropriate that the idea of zero defects be replaced with a policy of “zero escapes,” since the latter has limited interpretation. As a company is doing all it can to improve the product and business using continuous improvement techniques, it also needs to consider what it can do to prevent a random, low-level defect from reaching the final customer. In this regard, zero escapes of defects may be a complimentary activity to continuous improvement.

In other words forget zero defects, focus on improving continually!

The Truth about Lean Healthcare

Why we are the enemy when it comes to healthcare process improvement.

I originally posted this article as a comment here and it won me a copy of Lean Hospitals.

Healthcare organisations in Canada and the US have been the first to introduce lean thinking, and there is top management support for it in some of the major healthcare organisations in these countries such as the Mayo Clinic, in Rochester, Minnesota, and the University of Colorado. There is also a plethora of practical case studies from them that demonstrate lean thinking’s successes.

As a result, several NHS trusts such as Wirral Hospital NHS Trust, Merseyside, are currently introducing lean thinking in their efforts to streamline services.

In the book, “Lean Six Sigma for Service”, there is an outstanding case study from Stanford Hospital and Clinics in which they have seen a drop in the mortality rate of 48% as well as costs savings of 40% since using lean six sigma. Also Park Nicollet Health Services have begun using Lean and Kaizen within there CFO offices and have been seening great results from it.

Successful promotion of lean health care across the UK depends however on gaining both the support of government and the NHS at executive level. If this is won, implementation of lean thinking at organisational level can be achieved by the strategic training of relevant staff members. The potential benefits of lean thinking are:

• Shorter patient waiting times
• More patient admissions and diagnoses
• Faster bed turn arounds
• Improved workplace organisation, cleanliness and safety
• Less inventory used and better use of space
• Better and more streamlined administration processes
• More efficient patient record and appointment processes
• More timely and efficient delivery of care
• Better supply and storage management

As the cost of health care continues to rise, the NHS is put under increasing pressure to reduce costs while improving patient safety and care, and reducing errors and the resulting litigation.

New discoveries in medicines are being made, and new treatments are being developed, at a rapid pace, but these will be no more important to healthcare services in the future than the results of lean thinking.

Image via Wikipedia

The associate chief of staff of mental health services at the University of Arkansas for Medical Sciences Jeffrey Clothier offers a glimpse of this future when he comments on how services are commissioned and used:

‘Some systems already allow patients to go online and select their appointment time without ever speaking to a clerk. The services they pull will be those that have value for them. Lean will provide the basis for understanding the value-added activities that will compose personalised medicine.’

Applying lean thinking to the healthcare sector can provide significant cost and process efficiencies. However, to realise and sustain these benefits fully, there is an urgent requirement to educate and empower healthcare staff in the principles and methodologies involved. Education and training in lean thinking should be part of organisations’ competency frameworks to ensure consistency across all functions.

Relevant links:

http://www.childrensmn.org
http://www.vha.com

Read this storyand then follow up with this one

On December 30, the New York Times published a shocking op-ed by Dr. Atul Gawande revealing that the administration has brought a halt to the life-saving checklist program both in Michigan and at Johns Hopkins:

”this past month, the Office for Human Research Protections shut the program down,”

Gawande writes.

”The agency issued notice to the researchers and the Michigan Health and Hospital Association that, by introducing a checklist and tracking the results without written, informed consent from each patient and health-care provider, they had violated scientific ethics regulations. Johns Hopkins had to halt not only the program in Michigan but also its plans to extend it to hospitals in New Jersey and Rhode Island.

“The government’s decision was bizarre and dangerous,”

Gawande adds.

”But there was a certain blinkered logic to it, which went like this: A checklist is an alteration in medical care no less than an experimental drug is. Studying an experimental drug in people without federal monitoring and explicit written permission from each patient is unethical and illegal. Therefore it is no less unethical and illegal to do the same with a checklist. Indeed, a checklist may require even more stringent oversight, the administration ruled, because the data gathered in testing it could put not only the patients but also the doctors at risk — by exposing how poorly some of them follow basic infection-prevention procedures.

In summary: we are the enemy when it comes to process improvement.

What do you think? Leave your comments below:

Related articles

• Lean Healthcare from The Lean Enterprise Academy
• The Lean Healthcare Academy
• Lean thinking the NHS
• The Lean Healthcare Exchange
• Healthcare Transformation
• A powerful message on lean and healthcare

Six Sigma doesn't work?

There’s a rumour going around, and I’ve heard it from lots of people. Believe it or not, some people are claiming that Six Sigma doesn’t work, and Lean is the only approach you should take to effect continuous improvement.

Image via Wikipedia

Any unsupported process improvement initiative is destined to fail, no matter what moniker is assigned to it. Over the past few years, I have seen Six Sigma approaches drift further and further away from what General Electric Co., Motorola and Allied Signal (now Honeywell) designed them to be. If you have studied your quality history, you will know that the Six Sigma approaches employed by these companies and other forerunners worked because they included design features that were not part of the quality circle movement of the 1980s. Real Six Sigma worked for two key reasons:

1. increased support
2. increased focus

Ironically, we have reached a point in time when many people are buying Six Sigma packages that closely mirror those approaches that caused most quality circle programs to fail. If you are not familiar with this approach, here it is:

1. collect ideas from all of your people
2. provide a few days of training
3. form some teams to work on what appear to be the high-leverage projects

Quality circles failed because:

• Top-Management: Top management involvement and management have been suggested as key factors related to the success of QC programs. Top management involvement is essential in setting up the policy and guidelines and helps to promote more funding, participation, guidance, and cooperation throughout the company. QCs‘ participative problem solving and upward communication can open boundaries between management and worker that have traditionally been closed. Thus, communication channels to top-management are very important.
• Inadequate funding: Lack of financial support, or management’s unwillingness to invest a large amount of money to support the programs may also cause QCs to drop a project. The lack of recognition of circle accomplishments is also very critical.
• Middle-Management (Supporting Staff): QCs with a high level of middle-management support have worked on more projects and have a higher amount of cost savings than those with a low level of support. Resistance by staff groups and middle management and prohibitive costs are threats to the programs’ survival.
• QC Members: QC members’ motivation, commitment, cooperation, and effort in solving their problems may also influence the success or failure of the programs. Further, the lack of members’ problem-solving skills and training and the lack of knowledge of operations are threats to programs’ survival. Interestingly, About 37% of Toyotas assemblers participate in Toyota‘s global “Quality Circles” competition that pits worker against worker in a friendly competition to develop more efficient manufacturing methods. Twice a year, Toyota holds a competition to identify the best ideas. A Silver Circle award is presented for the best idea from one of every four quality circles. One of every four Silver Circles wins a Golden Circle award. The winners of the Golden Circle then face off against each other in the Global Quality Circle competition, often held in Japan.
• Low volunteer rate and the stability o.f the QC membership: may also influence QCs’ problem-solving process. Thus, turnover in an organization is an important factor related to the success and failure of these programs.
• The Nature of The Task: The nature of the project and the timing of the project seem important. First, the complexity and difficulty of the project may also have some impacts on the success of QCs. Sometimes, the project may be too complex and difficult for members to identify the solutions. As mentioned earlier, participants have limited power and are limited to the types of problems they are allowed to work on.
• Data and Time: Finally, the availability of necessary data, information, and time to solve the problems is very critical. Besides on-time delivery, Japanese supervisors display a strong management commitment to quality, yet U.S. supervisors expressed far less concerns on quality but placed a heavy emphasis on meeting production schedules. Therefore, it is plausible that management personnel in the U.S. may have a higher priority on meeting production schedules than on spending time to collect data and information for QC activities. This concern again is closely related to management commitment.

Do you know many green belts an organization of 250 people should have?

What percent of their work time should be devoted to Six Sigma projects?

According to Mikel Harry’s book, Six Sigma, the answers are:

“one per 20 employees”

and

“it depends.”

Harry states that there is no formula for how a green belt’s time should be used, but the ‘one green belt per 20 employees’ ratio is explicitly stated. In General Electric, becoming a green belt is a requirement for all exempt employees, and in most cases, you need a black belt certification to get promoted. We are regressing toward our ineffective quality past, and yet we have the nerve to blame the tools when the users use them wrong. It’s like saying a cordless drill doesn’t work because we failed to charge the battery first. We must build project-focused and continuous process improvement expectations into every employee’s job.

Many companies think lean works through reduced headcount, but they have yet to realize that short-term gains will most likely come back to haunt them as customer service slides and process failures increase. The reduced waste (fewer people and lower labor costs) looks polished on this quarter’s financial report, but what happens if we are also trimming away those skills and relationships that provide value to our customers? We are essentially watering down a powerful approach to process improvement on a day-by-day basis.

What’s the case in your organization? Are you properly supporting your Six Sigma efforts with well-trained, focused and effectively supported leaders, or are you repeating the mistakes that many of us made 20 years ago?

With each day that goes by, we are losing ground. If we don’t stop this erosion, where will we end up?

What do you think? Leave your comments below:

Related articles

• Joseph Juran, 103, Pioneer in Quality Control, Dies
• 3M: Six Sigma vs Innovation
• Motorola Insider Blame Game: Engineers Shoved Designers Aside [Motorola]
• Global Leader in LeanSigma Consulting and Training Selects Crossbow Group for Brand Development

How beer helps with lean

photo credit: josef.stuefer

We all love drinking beer, but did you know that is can be used to teach Lean principles?

When you invite the whole world to your party, inevitably someone pees in the beer

–  Xeni Jardin

From the ASQ forums: Are you familiar with the “Beer Game” simulation?

It was developed at the Massachusetts Institute of Technology (MIT) in the 1960s, so it pre-dates Lean (though, obviously, it does not pre-date beer!). Even so, it can be used to demonstrate several lean-related concepts.

It is used to demonstrate the advantages of taking an integrated approach to managing the supply chain, especially the value of sharing information across the various supply chain components.

It is useful for explaining several lean-related concepts, especially the “Bullwhip Effect” (aka the “Whiplash Effect“), Kanban, and the advantages of “Just-in-Time” (JIT).

The game is played on a board that represents the production and distribution of beer. Teams of students represent different parts of the supply chain. Players take on the following roles to simulate the supply chain for each brewery:

> the retailer sells cases of beer to a consumer and orders cases of beer from the wholesaler,

> the wholesaler sells cases of beer to the retailer and orders cases of beer from the distributor, and

> the distributor sells cases of beer to the wholesaler and orders beer from the factory.

> the factory brews the beer.

Image by qa.manager via Flickr

Pennies represent cases of beer and are moved between the positions on the board. The object of the game is to minimize two inventory related costs: holding cost ($0.50/case/period) and backordering cost ($1.00/case/period). Costs are assessed each period as the game is played.

During each period the players receive orders, evaluate their inventory position and decide orders and shipments for their echelon. Consumer demand for beer is simulated using a deck of cards according to a predetermined sequence and given to the retailer each period.

A fixed shipping delay of two periods simulates the time required to receive, process, ship and deliver orders. In the case of the factory, a lead time of two periods is required to produce a new beer order. The game starts in equilibrium with 12 cases of beer in inventory at each echelon and 4 cases in each of the delay positions.

Normally, the simulation begins with four weeks of steady demand (4 cases per week) and all the players are directed to order and ship four cases each period, to maintain the initial equilibrium. Following the four-period startup, players are then instructed to order any quantity they wish. At this point, there is an increase in customer demand to eight cases per week. This change in demand induces disequilibrium into the system to which the students must react.

The Beer Game can be a very useful addition to Lean classes (especially those in manufacturing environments that depend on a good supply chain):

Here is the quick Wikipedia explanation of the Beer Game:
http://en.wikipedia.org/wiki/Beer_Distribution_Game

Here is the MIT guide to the Beer Game:
http://beergame.mit.edu/guide.htm

Here is the On-line Beer Game simulator from MIT:
http://beergame.mit.edu/default.htm

Here is information you about supplies you will need if you do the Beer Game:
http://www.solonline.org/pra/tool/beer.html
http://www.solonline.org/pra/tool/bibl.html

And, here is a set of tips from a Professor at Arizona State University in the U.S. who has used the Beer Game for a while:
http://www.public.asu.edu/~kirkwood/sysdyn/BGame/BGame.htm

Here is some additional about the “Bullwhip Effect”:
http://en.wikipedia.org/wiki/Bullwhip_effect

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