Lean Summer Reading

In the last year or two we have learnt more and more about what makes Toyota’s lean management system so successful. The emerging literature grows by the day and it is hard to keep up with it all. Someone asked me the other day what are the best books to read on lean management this summer. This is my list.

Thankfully many years ago Koichi Shimokawa and Takahiro Fujimoto, two leading Japanese academic experts on lean, conducted a series of unique interviews with Taiichi Ohno and his colleagues about the original experiments that led to the Toyota Production System. They are finally available in English in The Birth of Lean. Toshiro Norusawa and John Shook have collected some of the original training material used by Toyota in the original Japanese and English translation in Kaizen Express. It would be very good to compare this with the lean training material being used in your organisation.

Jeff Liker has done us all a great service by writing down the current Toyota management practice in his most recent book, Toyota Culture. And Satoshi Hino, a very astute Toyota watcher who worked for many years at Mazda, gives a really interesting view of what lies Inside the Mind of Toyota. Particularly fascinating are his observations on how Toyota brought together the lean knowledge developed by Ohno and others and the knowledge about quality they learnt from Deming. Toyota’s synthesis of the two still makes them the reference model for both lean and quality.

Learning about Toyota is one thing — working out what it all means for our own management systems is another. When John Shook worked for Toyota he discovered that Ohno based his training material on the Training Within Industry material developed for the US government during World War lito teach newcomers, often women, to replace factory workers who had gone off to fight. Jeff Liker tells the story on Toyota Talent, but it is really worth reading the original material. This is now available in Donald A Dinero, Training within Industry, and the accompanying TWI Workbook by Patrick Graupp and Robert] Wrona. Ohno saw how this combination of learning and doing in bite sized chunks was the most effective way for people to learn how to do lean. Ironically most US firms ignored this material after the war, which lay hidden for many years.

Probably the most insightful building block of lean management is the use of the A3 process to teach managers how to think about the right things in the right way. Durwood Sobek and Art Smalley’s describe this tool in detail in Understanding A3 Thinking. While John Shook’s Managing to Learn walks through the use of this process from both the teacher and the pupils’ perspective. As you read this tale you begin to understand how powerful and transformative this tool is for changing the way we manage. This tool is taught to every manager joining Toyota and forms the framework for every planning and problem solving activity.

One of the biggest challenges at the top of any organisation is to prioritise the vital few things the organisation needs to focus on and then to engage in a dialogue down the organisation to translate these plans into actions. Two excellent books describe how you can use policy or strategy deployment in your organisation are Thomas L Jackson’s Hoshin Kanri for the Lean Enterprise and Pascal Dennis’s Getting the Right Things Done.

If all this is a bit heavy going and your team learns best from telling stories then I still think The Gold Mine is the best lean novel around. Michael Salle’s sequel called The Lean Manager ought to be on everybody’s reading list this summer. Give it to your team to read on holiday and then use it for your study group when you get back.

Finally healthcare is one of the most active areas of lean at the moment. Follow the early steps of one of the pioneering lean hospitals in David Fillingham’s Lean
Healthcare and follow how a top management team transforms their hospital in our own new lean workbook by Marc Baker and Ian Taylor called Making Hospitals Work. That should keep you busy for a while. Happy reading.

Yours sincerely
Professor Daniel TJones

Making Hospitals Work

Two years ago we organised the first Global Lean Healthcare Summit in Stratford. This was both an inspiring and sobering event. We all glimpsed the huge potential of lean to improve the working of healthcare and also began to realise how much hard work it would take to make this a reality.

For our part we quickly concluded we would have to roll up our sleeves and conduct our own experiments to learn what it would take to create a truly lean hospital. Two years later after deep involvement in two hospital transformation projects in the UK we have produced our own progress report in the form of a new lean workbook called Making Hospitals Work: How to improve patient care while saving everyone’s time and hospitals’ resources. We hope this will set the scene for the next phase of the lean healthcare journey.

Experience in other sectors tells us that the power of engaging staff in rapid improvement events has to be seen within the context of the end-to-end patient journey through the hospital and beyond, and by looking at the work done by the many shared resources used by each clinical pathway. Our action research led us to focus on two important value streams followed by patients admitted to most general hospitals, the emergency medical and elective surgical value streams from admission to discharge, plus the key enabling support activities.

It also became clear that an end-to-end perspective has to be led from the top, in a way that complements and focuses bottom-up improvement activities. This workbook outlines the A3 method our fictional top management team uses to define the core problems facing the hospital, to learn to see these value streams and analyse where and why they are broken, to come up with the possible countermeasures and create an overall action plan for realizing a future state for these value streams. It also introduces the role of the value stream manager in gaining agreement from each of the departments on the right actions to take.

The A3 planning process used in the workbook follows Deming’s ‘Plan, Do, Check, Adjust’ cycle that is used by Toyota for planning and problem solving at every level in the organisation. This is the same scientific method applied to management problems that doctors use to diagnose and treat medical problems. Think of it as evidence based management to complement evidence based medicine.

This book draws on practice rather than theory. We have tried and tested all the building blocks described in this workbook ¡n isolation and in combination and we know they all work. It also describes how lean tools have to be modified for a situation where the patient is at the same time the ‘product’ being diagnosed and treated and the customer experiencing the process.

Over time it is quite possible to eliminate unnecessary waiting time for patients, remove the overburden on clinical staff so they can spend more time caring for patients, while freeing up the capacity to treat more patients by significantly reducing length of stay. It confirms that lean is the most promising way for healthcare systems to meet growing demand without escalating costs.

John Toussaint from Thedacare described the book as ‘entertaining, sobering and inspiring” while Jack Billi from the University of Michigan and David Fillingham from Bolton said ¡t is a “must read for healthcare leaders”. We will bring together the team to launch this new workbook at the one day Lean Healthcare Transformation Summit on 10 July at the QEII Conference Centre in central London. Please take a look at the Summit agenda and details of the contents of the book on our web site at www.leanuk.org (or ring LEA at +44 1600 890590) and bring it to the attention of your colleagues and senior management team. I hope you enjoy the book and can join us at the Summit.
 

Yours sincerely
Professor Daniel T Jones