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The best way to understand the blue yarn is to follow it. That’s exactly what Dr. Gary Kaplan did. In 1998, he was CEO of Virginia Mason Medical Center, which was losing money. As he searched for a better system to manage the hospital, he ‘wound up’ at a Toyota factory in Japan where he spoke to a sensei familiar with the Toyota Production System.
What he found was something very simple that, at the time, had been around for nearly 100 years. Sakichi Toyoda developed a self-correcting loom that could stop when thread was broken or defective. They ultimately automated the process and made it mistake-proof. This process is called Jidoka, or autonomation, and means automation with human intelligence.
Jidoka is important because it stops a process immediately when a problem first occurs. Not only does it fix the condition, but it ultimately eliminates the root cause of the problem or defect. In an automated Jidoka process, equipment monitors its output (products) independently from operators, thereby enabling operators to operate multiple pieces of equipment and improve productivity.
Back to the hospital. The sensei used the blue yarn to map the path a patient would follow in a visit through cancer treatment. What they found was a mess. Cancer patients were already low on time and energy, but this ‘process’ had them winding all over the building in a seemingly needless pattern: a waste of time and energy.
When they ‘re-mapped’ the process, the savings from insurance expense alone were 37% and they were able to increase the number of patients without additional staff. Ultimately, they reduced patient receive treatment time by 50%. Dozens of hospitals have since adopted the Virginia Mason Production System. Based on a recent study of US hospitals, for two years Virginia Mason has placed in the top one percent in safety and efficiency.
Clearly, the flow of the process is one piece of the puzzle. Of equal importance is the decision to enable employees to: monitor a process, identify defects, stop the process, fix the problem, identify the root cause, and, ultimately, help eliminate the root cause of defects.
Imagine following a blue yarn through every step of one of your processes, including mistakes, corrections, delays, handoffs, miscommunications, etc. Recurring mistakes building on other recurring mistakes will create a big mess. Now imagine every person in that process having the ability to address those gaps and improve the process. Addressing the root cause will build a mistake-free and efficient process that is much cleaner and direct.
Clarity around your dream or whatever it is you want from your business (i.e., ultimate business outcome and whatever ‘freedom’ means to you)
Here is an interesting story I want to share. Back in my past as CEO of an injector manufacturing plant there was a phenomenon for several weeks. Every Friday at 3:00 pm we were in crisis mode. At that time, we were working seven days, three shifts and at 3:00 pm on Friday, the assembly manager indicated that we need to shut down the assembly line on the weekend due to inadequate parts supply. The logistics manager struggled to get the parts from the fabrication department or outside suppliers, which had to produce the parts by working overtime and expedited shipping cost.
Shutting down the assembly line would have had a dramatic impact on the supply to our customer as we were one of their just-in-time suppliers. We would have shut down their production line with a huge financial penalty. We were in crisis mode every Friday for a couple of months.
Finally, I called all managers involved in the supply and production process into a meeting to discuss the constant crisis mode on Fridays. After lengthy discussions and analyzing the root cause of the shortages, we agreed to meeting on Thursday mornings, everyone providing information about demand and supplies for the weekend production. We were now able to prioritize and adjust production where needed. Within two weeks there was no crisis meeting on Fridays any more. Problem solved. We were able to reliably provide the necessary quantity to the customer.
Conclusion: Unless you find the root cause of the problem using six sigma methodology and eliminate the issues in the process, you will not see improvements in your processes and production output.
We all know the phrase: “You learn from your mistakes” or “Learning by Doing”. Most of the time mistakes happen as a deviation from an established or defined process for several reasons.
This is just a small example why mistakes occur, and the correction depends on the type of mistake that happened.
Mistakes that can have life threatening impact on the person or other employees e.g. not following a “lock out” procedure doing maintenance work on a machine, oil spills that can create a hazardous environment like slipping, etc. need to follow immediately a corrective action procedure like the 8-D process, a method for root cause analysis to prevent any future mistakes
Mistakes that impact the quality of a product or service should follow the same procedure as described in 1.
Create an environment of trust, so people are not afraid to admit to a mistake and come forward immediately when they recognize the mistake
Reduce the fear of being punished if they voluntarily admitted the mistake as soon as they became aware of it.
Allow them to become part of the solution, if they are willing to share their experience with others, learn from the mistakes and prevent future mistakes.
As I have led or been involved with dozens of business changes, I get asked often, “What makes you so successful?” I might offer up a different perspective, “What can stop a business transformation in its tracks?” In my experience it boils down to four things:
Most of us in most of our firms are experts in our small little space in the universe, and we focus all of our energies on understanding and mastering the rules of the game in that space. Those fancy terms, dominant logic and market myopia are our real adversaries here.
They keep us from seeing the impending systemic disruption. And our own biases and experiences keep us falsely optimistic in the face of big changes in our arena.
Marshall Goldsmith famously suggested in business, “What brought you here won’t take you there.” Proverbs more famously suggested, “Pride goeth before destruction and a haughty spirit before a fall.”
Sometimes, culture is the problem. There’s truth but not a foregone conclusion that culture eats strategy for lunch. (I push back in my article, Sometimes Strategy Must Eat Culture.)
In my travels, I’ve encountered more than a few organizations and the people in them predictably and proudly holding on to a past that was indeed glorious but is no longer relevant.
My friend mentioned above suggests this is the natural sequence of events for all businesses and those that have outlived their utility must pass.
Alternatively, sometimes culture can be disrupted as well. (More in the next post in this series on knocking down the obstacles.)
Know that the passion and emotion surrounding resistance to radical change in your organization may very well be the last thrashing of a dying business.
We all understand the importance of an accurate diagnosis for our health maladies. The same goes for business. Much like the organizational culture change issue described above, human biases, emotions, experiences deadly sins and failings all get in the way of cultivating and agreeing on the answer to the question, “What the hell is really going on here?”
Fail to answer that question properly, and the succeeding events move organizations down the path to decay and demise.
Transformation requires asymmetrical bets on new strategies, markets, technologies, and investments. Our management systems are set up to optimize in the short-term, and throwing sand in the gears of the management system requires leadership courage that many lack. (Young child to Mom, “Mommy, what are gears?”)
We might understand what we should do, but putting oneself on the line for a hard change and an asymmetrical bet is a commitment many will not make, and a risk most won’t take.
I debated throwing the present management system in as the fifth big obstacle to organizational change. Indeed, it is a factor. Nonetheless, I believe it is leadership’s responsibility to drive the changes needed in a system leading the firm down to the path of destruction. A management system is a tool of leadership, and as a tool, it can be changed or adapted to fit the situation. The fact that we often fail to adapt our management systems is a failure of leadership.
Walt Kelly, the illustrator of the famous and long retired comic strip, Pogo, once suggested (drawing upon a quote from the War of 1812), “We have met the enemy, and he is us.”
It’s always true. What’s not guaranteed is your organization’s failure in the face of existential threats. In my next post, we blow up these big obstacles. And remember, all it takes is courage.
Filed Under: 0.1a.(2) Mission, Vision, and Values, 1 Leadership, 1.1 Senior Leadership, 2 Strategy, 4.2a Organizational Knowledge, A.02 Visionary Leadership, A.06 Focus on Success
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The SFOL days will take place on Saturday, December 8, 2018 at the Marriott Hotel (75008 - Paris) The SFOL Days will take place on Saturday, December 8, 2018 at the Marriott Hotel (75008 - Paris).
We are expecting once again a beautiful and very rich day that will take place along two major axes: Class II and Class III.
It is with great joy and ambition that we invite you to participate in the next CEO Congress which will take place in Nantes from June 7 to 10, 2019 .
With Emmanuel Frerejouand, Scientific President, we propose to address the themes of quality and efficiency in orthodontics that represent the Grail and the future a qualified specialist in dentofacial orthopedics.
A paper published in the February issue of Health Affairs—discussed at length in an article in the New York Times —contains the sort of blunt, plain-spoken language you seldom read in academic journals. The authors, who include some of the most prominent neuroscientists and ethicists in the world, warn that manufacturers are misusing the FDA’s humanitarian device exemption to promote deep brain stimulation as a “treatment” for obsessive compulsive disorder (OCD).
In fact, they make clear that deep brain stimulation is very much an experimental procedure. Research is still at an early stage, and the risks to patients are not well defined. When suffering is severe and no other treatment has provided relief, there is value in making available an intervention like deep brain stimulation. But misleading or biased information, no matter where it comes from, certainly undermines patients’ ability to calculate benefits and risks.
To enable deep brain stimulation, a surgeon must first implant electrodes in the brain and connect them to a pair of small electrical generators underneath the collarbone. Deep brain stimulation uses electricity to affect how brain signals are transmitted in particular areas of the brain.
Among the concerns raised by the article in Health Affairs (and in our own article on this topic last year in the Harvard Mental Health Letter):
- Inadequate research. Although deep brain stimulation is sometimes described as a “pacemaker for the brain,” that is an oversimplification. Cardiac pacemakers monitor heart rhythm and trigger a heartbeat when necessary. While cardiac pacemakers have an established track record of success and clear guidelines for use, deep brain stimulation does not. (Among other things, when OCD symptoms do improve after deep brain stimulation, we still don’t know exactly how or why the electrical stimulation helps.) Only about 100 people in the world have undergone deep brain stimulation for OCD—only some of the results have been published—altogether too small a number to standardize the procedure.
- Safety. Implantation of a deep brain stimulation device involves boring small holes into the skull (for the electrodes) and surgery on the chest (for the battery). Possible complications—as for any surgery—are infection and bleeding. The wires may break. And the device’s batteries can run out, sometimes without warning—causing rapid mood deterioration or behavior changes.
Furthermore, many alternatives exist. Deep brain stimulation is only appropriate for people who suffer severe and incapacitating symptoms and have exhausted every other treatment alternative. Fortunately, most people with OCD have other—and more proven—options. These include behavioral treatments, drug treatment, or some combination of the two. You can read more about treatment options in an article in the March 2009 Harvard Mental Health Letter.