Notes from John Black

Instilling A Safety Culture

1/1/2018

When implementing Lean management, instilling a safety culture is the priority. This means creating a culture and structure in which safety is the priority for all staff and built into all operations.

While consulting in Saskatchewan, initially some leaders doubted their ability to reach zero defects. Patients are not the only people at risk of harm from defects—healthcare workers are additionally at risk. They may be injured from lifting, slips, and falls. In order to overcome the mindset that zero defects is impossible to achieve, you need to eliminate the idea that these defects are inevitable. Preventable injuries are just that: preventable. But you need to put the proper measures in place. Unless zero defects is the goal, how can any healthcare system truly put the patient first and pursue continuous improvement?

To my mind, the only acceptable rate of preventable injury and death is zero.

In Saskatchewan, Suann Laurent, CEO of the Sunrise Health Region, demonstrated that she believes in, practices, leads, and mandates the goal of zero defects. She notes:

“I believe in what we call ‘Mission: Zero’—that safety is at the core of everything we do for our patients and with our staff. The more our culture of safety improves, the better our health system is for everyone we serve. For us, Mission: Zero means being defect free. Getting to zero defects is our goal.”

My advice to best implement a holistic safety culture would be to mistake-proof all systems. Provide examples of successful safety cultures in other existing operations to your leaders. This will illustrate to your leaders that zero defects is an attainable goal. Focus on developing a better system for identifying and reporting adverse events. And finally, remember to continually stress the primacy of safety. If you constantly enforce the message of a zero defects mindset consistently, it will resonate and continue to be of importance.

Maintaining Momentum With Lean

11/27/2017

One of the greatest dangers when implementing Lean is a loss of momentum. There are times when healthcare workers express concern about being able to sustain the transformation. Achieving and publicizing early successes can help boost morale and enthusiasm, but, typically, people still must endure weeks, months, or longer doing the same amount of work the old way while also learning and implementing the new way. This transitional period means extra hours and, often, frustration. The critical metric for long-term sustainability of the transformation (and the toughest metric to ace) is establishing the organizational infrastructure. However, quality improvement happens not as intense bursts, but with consistent, daily management systems. Strong leaders ensure that the small systems are running efficiently to keep the entire Lean operation moving forward with momentum. An example of one of the important tools of infrastructure is the Healthcare Production Board where daily schedules and status provide visibility to all team members.

Kaizen Fellows Build Leadership Capacity

10/27/2017

The Evolution of the Kaizen Fellows Program

I first created this kind of leadership development program at Boeing. There, we trained a team of upwardly mobile employees and managers with executive potential, representing all major functional areas, to become experts both in Lean and leadership. These “expos” evolved into Boeing Production Systems Specialists (BPSS). The candidates were, among other things, required to work basically a 24/7 schedule for airline customers—an expectation similar to healthcare’s 24/7 work ethic to care for patients.

Hands-on learning

Over the course of two years, their education included about seven weeks in Japan, including a weeklong gemba kaizen seminar with hands-on work at Hitachi, Showa, Taiho, Hokushin, Yamatake, and Toyota. Candidates underwent intense training in time observations, cycle-time investigations, improvement implementation, standard work analysis, and documentation of results. Even more intense was a three week master sensei training seminar led by Sensei Nakao, president of Shingijutsu Global Consulting. I attended with our first BPSS team, whose members stood for hours to observe workers at various operations. Candidates were given grueling assignments to conduct “process at a glance” observations with minimal input from plant staff, and they provided detailed reports to Nakao. Other BPSS trips had them studying distribution kaizen, production preparation, supply-chain kanban, and the achievement of breakthrough changes and results. I later took this leadership development model, with refinements, to Virginia Mason Medical Center and Park Nicollet.

Building commitment and capacity

After beginning work with VMMC, I enlisted Dr. Gary Kaplan, CEO, and Mike Rona, president, to launch what I renamed the Kaizen Fellows program in 2004. Participants were nominated, with one cohort starting in 2004 and another the following year. We could not have asked for a more enthusiastic and committed group of leaders. Rona joined me in leading the first and second Kaizen Fellow study missions to Japan, and his final trip report described the group’s experience at Toyota—which Rona called the pièce de résistance of the trip. In his words,

“The complete and grand finale of TPS implemented synchronicity and harmony of man, machine, technology, and the customer, made possible through product innovation, focus on people, respect, community, society, and the world. . . . We have only a stronger commitment to the Virginia Mason Production System and the promises it holds for our patients and our staff. Even more importantly, it became even more apparent to us on this trip that the success of Virginia Mason in fully and successfully implementing VMPS is essential to changing healthcare in our country.”

This kind of intense educational (and psychological) conversion has been so effective at forging outstanding leaders, with immense commitment to Lean, that a Kaizen Fellows program continues as a key JBA consulting recommendation everywhere we go. We implemented the same process in Canada at Saskatchewan Province which included a very focused and intensive program beginning with the development of three senior managers in Saskatoon Region. Their initial training included week long sessions on the factory floor in the USA at fortune 500 companies.

Leading from the factory floor

10/13/2017

Most CEOs spend their time in an air-conditioned office, with no idea about the realities of the factory floor. Lean flips the script. Lean forces leaders to see firsthand what day-to-day operations look like. Sometimes, the first look isn’t pretty.

I remember Mike Rona’s shock when I worked with him on developing the Virginia Mason Production System. The first RPIW in which Rona participated focused on the emergency department. He was shocked. He said to me, “I didn’t realize how bad things were.” I told him that his shock is typical of high-level leaders in organizations:

You’ve spent most of your time leading from the comfort of your office, and now you are seeing the muda—the waste and confusion—your hard-working people deal with every day. Your patients are subjects of a disservice when the leaders are not involved at the grassroots level of ferreting out the waste and leading from the hospital floor instead of from the comfort of the executive suite.

This kind of reaction is exactly why I require leadership team members to make sketches of the hospital floor. At Virginia Mason, I sent leaders out into the medical center to sketch the seven flows of medicine. They were then required to present examples of their sketches. I then told them how a study of Leonardo da Vinci’s sketches had helped Toyota’s consultants and engineers better understand the concept of flow.

Lean Pioneers: Joanne Poggetti and Sister Monica Heeran

7/21/2017

Lean transitioned from manufacturing to healthcare through the vision of two pioneering women: Sister Monica Heeran and Joanne Poggetti.

Sister Monica Heeran, the CEO of PeaceHealth, had heard me speak in Chicago at a Juran Institute symposium on managing for quality in research and development. She asked for more information, because she wanted to improve PeaceHealth’s not-for-profit healthcare system in the Pacific Northwest. Probably the first US healthcare CEO to embrace Lean, she signed a two-year contract with Poggetti and me to lead a Lean implementation.

Back then implementing Lean in healthcare was a dream

Joanne Pogetti, far left Sister Monica Heeran, far right

Before Sister Monica signed the contract, I asked Joanne Poggetti, then president of Poggetti & Associates, what she thought. Without hesitation, Poggetti said yes, Lean could be done in healthcare. She had first-hand experience of inefficiencies and mistakes in healthcare. She had the vision to see how Lean could eliminate those mistakes.

So in 1996, before it was fashionable, Sister Heeran had the courage to implement Lean in her hospital system. Poggetti took Sister Heeran and her CEO’s to Japan. Sister Heeran was the first healthcare CEO in the world to see Toyota in action in Japan.

Sister Monica Heeran at Hitatchi in Japan

Poggetti and Sister Heeran came back and implemented learnings. Early results were outstanding.

Lead times for billing cut from 28 to 3 days.
Home Health services redesigned in a few weeks
Saving $600k almost immediately

Sister Heeran later retired and Lean didn’t continue at PeaceHealth. But the ground was broken for Lean in healthcare. Now, hundreds of healthcare organizations have seen the transformational impact of Lean, all thanks to Joanne Poggetti’s vision and Sister Monica Heeran’s courage.

Later after joining Boeing, Poggetti became a protégé of Dr. Deming & traveled with him.

The best part? I was lucky enough to marry Joanne and we’ve continue the work she started.

Lean History: John’s Journey

7/7/2017

From Vietnam to Boeing

I arrived at Boeing in 1978, at a time when the aerospace industry was doing well, and I brought with me some perspectives I had developed during my service in the US Army, including two tours in Vietnam. With the Army, I had conducted my own research into waste—specifically, waste in war—and I soon discovered that many of the same concepts applied to the corporate realm. Not long after I started my Boeing career, the company began examining—and attempting to apply—the “total quality” teachings of Dr. W. Edwards Deming and Dr. Joseph Juran, which had played such an important role in making Japanese industry competitive.

Captain John Black in the South Vietnam Mekong Delta, 1967.

Boeing leaders were making speeches about our 60 percent market share, our number-one position in the world, and the fact that rival Airbus could never catch us. When I looked at our performance metrics, however, I found the figures mediocre. I believed that, to move Boeing to the next level of performance, we needed to go to Japan to study world-class companies and then create a new vision for Boeing.

I walked the halls telling anyone who would listen that just because we had 60 percent market share for commercial airliners didn’t mean we had world-class metrics. It was a tough sell.

Bruce Gissing leads a meeting.

Eventually, Bruce Gissing listened. In early 1990, with Gissing’s insistence and leadership, a team of Boeing executives who were involved in the quality effort embarked on our first study mission to Japan. The trip itself lasted two weeks, and to put it mildly, participants’ eyes were opened. As one manager commented, “Thank God Toyota is not in the aerospace industry.”

Training for 100,000 employees and managers was completed in 24 months—a rate unheard of in a corporation the size of Boeing. From 1994 to 1996, defects in production were reduced 35 percent, and customer complaints dropped accordingly. Where applied, Lean reduced the typical floor space required for operations by 50 percent and cut the amount of inventory kept on hand by 30 to 70 percent (Boeing Company 1997).

Transition to Healthcare

Going outside Boeing, I recruited organizational development consultant Joanne Poggetti, who worked with Boeing statisticians and candidates representing all the company’s major functional organizations for an intensive, two-year learn/do experience. Everyone was sent to off-site seminars conducted personally by Dr. Deming, Dr. Juran, and Bill Conway of Conway Quality.
When the team members came back, Joanne had the assignment to design and launch 18 quality improvement courses and seminars that would be attended by more than 34,000 employees.

So, I wasn’t looking for business in healthcare when it came to me on that flight to Atlanta in the fall of 2000. But fate was already playing its hand. My wife, Joanne Poggetti, who had worked with Dr. W. Edwards Deming, had started her own consulting firm while I was still with Boeing. In 1996, she had signed a contract with a healthcare system and started them on the road to Lean, with consultation support from me, after the system’s CEO heard me speak. That October, Poggetti became the first person to take a group of healthcare CEOs to Japan to attend Shingijutsu’s gemba kaizen at Hitachi.

My years guiding Lean implementations in healthcare had begun, almost without me realizing it, just as a few leading healthcare organizations became ready for transformative change.

In 2000, Mike Rona, then president of Virginia Mason Medical Center, sat next to me on a plane. We started talking. I said, “Mike you have to see this pitch about Lean that I’m going to present to the Minister of Health in Spain.’ Rona listened patiently. When we got off the plane I handed him my first book, “A World Class Production System,” recently published by Boeing. He didn’t forget our conversation. He shared the information and the book with his boss, CEO Gary Kaplan. As a result, JBA spent 6 years helping Virginia Mason get started with Lean. VMMC is now an acknowledged world leader in healthcare.

Since then, I’ve helped other healthcare organizations, most recently the province of Saskatchewan in Canada.

Through my work with healthcare organizations, I’ve been able to apply my Lean learnings to a cause I’m passionate about: ending preventable deaths. My goal is to help organizations put systems in place that eliminate medical errors. Fewer errors means higher quality care, lower costs, and zero preventable deaths.

Just in Time Production: Survival and Victory Depended on It

6/9/2017

Back in the late 1500's, the Republic of Venice relied on rapid production techniques to survive. The Venice arsenal was produced by the largest industrial plant in the world at that time. The plant built warships. Because the Republic could not possibly afford to maintain a peacetime fleet large enough to repel attackers, it instead stood ready with the plant to literally build an entire fleet of ships on short notice--sometimes 100 ships in six weeks. It did this using techniques that were nothing short of enlightened, even by today's standards. The plant employed 1500 workers and covered 60 acres. It was the world's first large-scale assembly line. Necessity was the mother of invention. Reflect on that for a moment--better production techniques were used because survival--and victory--depended on it.

Two centuries later it was weapons again. Eli Whitney was awarded the contract to manufacture muskets for George Washington. A factory was built in New Haven, Connecticut. Some advanced production techniques were used: ordered integrated workflow; standardized, interchangeable parts; focused factory areas; dedicated machines; error-proofing mechanisms to reduce variations from personal craft. This example, too, is notable for the urgency that prompted innovation. America needed arms to protect itself in an era of international military conquest: better production techniques were used because survival--and victory--depended on it.

Still later, Henry Ford led a revolution of a different kind in this country. Ford can accurately be called "The Father of Cycle Time Management." Ford was a man who hated to waste time. In 1926 he wrote, "Time waste differs from material waste in that there can be no salvage. The easiest of all wastes, and the hardest to correct, is the waste of time, because wasted time does not litter the floor like wasted material." Between 1913 and 1914, Ford doubled production with no increase in the workforce. Between 1920 and 1926, cycle time was reduced by 90% from 21 days to 2 days.

The secret to Ford's success was a new process model for automobile manufacturing--Continuous Flow Assembly. And while his emergency was not a military one, remember that Ford was trying to build and dominate a brand new industry. He was quite literally trying to change the world. Like the other precursors of the JIT production system, better production techniques were used because survival--and victory--depended on it.

In 1949, Kiirchiro Toyoda sent his grandson to spend the summer at the Ford plant in Rouge. Soon thereafter, the Toyota system of manufacturing was born. To say that Toyota borrowed from Ford is not accurate. To say that Toyota copied Ford is not accurate. Toyota learned from Ford, especially from Ford's mistakes. The Toyota system was in some ways a revolution, just as Ford's had been. There were striking differences between how Toyota and Ford built cars. JIT was continuing to evolve.

One difference was that Ford relied on maximum lot sizes and minimum numbers of setups. Toyota, on the other hand, strove to reduce lot sizes to eventually produce each and every product uniquely.

Another big difference was in the control of production. Kanban was used as the major tool in Toyota's JIT production system.

A third key difference was in the rearrangement of equipment. Instead of grouping all machines together by type of machine--all of the lathes here, all of the milling machines over there, for example--Toyota arranged the machines in the order that they were used in the manufacturing process. This meant low inventories and small lot sizes.

These were revolutionary changes in automobile manufacturing. What prompted such innovation? Toyota was one of many Japanese manufacturers trying desperately to build something from what little was left of Japanese industry following World War II. Better production techniques were used because survival--and victory--depended on it.

We all know the result. Today, Toyota dominates the automobile market and is a model for manufacturing excellence. And Ford, the proverbial mentor, nearly failed before following the path of its protégé. The student became the teacher, and the teacher the student. In the school of hard knocks, Ford has learned a lot in the past decade, and better production techniques are being used because survival--and victory--depend on it.

Founding Fathers of Lean: Juran and Deming

5/26/2017

Dr. Deming and Dr. Juran transformed manufacturing in the United States. Each rose from poor beginnings to become cornerstone leaders of the quality control movement.

Dr. Joseph Juran

Joseph Juran, a child immigrant from Romania, worked his way up the ladder at the Western Electric Company, formerly a division of AT&T. Juran invented the Pareto principle, which states that 80 percent of waste comes from 20 percent of procedures.

For decades, Juran helped U.S. manufacturers cut waste and deliver better products. Now, we apply our learnings from Dr. Juran across all sectors of business. Here’s a video of Steve Jobs when he was president at Next, on working with Dr. Juran:

Dr. W. Edwards Deming

Dr. Deming spent most of his childhood on a barren farm in Cody, Wyoming. His family lived on the bare minimum to survive. He went on to study engineering and eventually earned his doctorate in physics.

Deming began his transformative work in Japan. He pioneered the use of applied statistics in the factories, and production soared. In 1960 he was awarded the Awarded the Second Order Medal of the Sacred Treasure by the Emperor of Japan for his service in saving the economy of the wore-torn nation from desolation.

After teaching all over the world, he returned to the United States. My wife, Joanne, was one of Dr. Deming’s protégés before we met. In addition to playing an instrumental role in Boeing’s Lean implementation during the late 1980s, she had the rare opportunity to shadow W. Edwards Deming during his consultations with Ford, General Motors, Chrysler, and Harvard. She also assisted him at some of his seminars.

Deming taught the world that systems are responsible for waste, and way get rid of waste is through continuous improvement. As Deming said, “The timid and the fainthearted, and the people who expect quick results, are doomed to disappointment.”

At JBA, Dr. Deming has taught us to look critically at every tiny part of the hospital care process. When we find problems, we then act step by step to reclaim wasted time and supplies.

When I was handed the responsibility to start a quality revolution at Boeing in the mid 1980s all Boeing senior leaders were required to attend the Juran and Deming seminars. In addition we formed a Quality Improvement Center that was staffed with the best and brightest executive potential candidates representing all Boeing functions. They also attended Juran and Deming and other specialized training.

Dr. Deming also taught us the importance of getting upper level management on board before a transformation. Ultimately, as Deming says, management is responsible for the system. To get sustainable results, management has to be committed to the long haul of continuous improvement.

Founding Fathers of Lean: Kiichiro Toyoda and Ohno

5/12/2017

When the Toyota Group (replacing the Toyoda family’s d with a t) set up an automobile-manufacturing operation in the 1930s, Sakichi’s son Kiichiro headed the new venture. He traveled to the United States to study Henry Ford’s system in operation, and he returned with a strong grasp of Ford’s conveyor system and an even stronger desire to adapt that system to the small volumes of the Japanese market (Toyota Manufacturing Kentucky 2015). Soon thereafter, the first Toyota system of manufacturing was born. To say that Toyota copied Ford is not accurate—Toyota learned from Ford, especially from Ford’s mistakes. This point demonstrates the driving power of the Toyota system: continuous improvement.

Taiichi Ohno, Toyota’s chief process engineer, added many of the tools and detailed production processes to Kiichiro Toyoda’s vision, and he understood that what would soon become TPS could be applied more broadly than just to manufacturing. In his book Toyota Production System: Beyond Large-Scale Production (1988, xv), he states:

"The Toyota production system, however, is not just a production system. I am confident it will reveal its strength as a management system adapted to today’s era of global markets and high level computerized information systems."

Ohno is best remembered for the implementation of the just-in-time strategy in the TPS. He went on to publish three books and mentor young managers at the Toyota Group.

Together, Ohno and Toyoda ushered the Toyota Group into an era of world-class production.

Ohno with his mentee Koshiki Iwata, who later became one of my mentors.

Founding Fathers of Lean: Sakichi Toyoda

4/28/2017

Sakichi Toyoda, founder of the Toyota Group, lived out the spirit of kaizen from childhood. As a teenager, Toyoda led study groups focused on self-improvement for other young people. He also wanted to find a way to improve society on a large scale, through the use of new machine technology.

In the 1890s Toyoda invented a loom that would stop automatically if any of the threads snapped. His invention reduced defects and raised yields, because the loom would not continue using up thread and producing imperfect fabric after a problem occurred. The new loom also enabled a single operator to handle dozens of looms, revolutionizing the textile industry.

The old loom, before Toyoda's improvements.

Toyoda's automatic loom.

The principle of designing equipment to stop automatically and to immediately call attention to problems is crucial to the Toyota Production System (TPS). The TPS was developed by Toyoda’s son, Kiichiro, and Toyota’s chief process engineer, Taiichi Ohno, who standardized the core of Sakichi’s learnings.

Throughout his time as an engineer at the Toyota Group, Sakichi Toyoda committed himself to rigorous study. Just as we take company tours today, Toyoda traveled to the U.S. and Europe to see how other textile factories organized their production, often after the Toyota Group suffered a setback. Each time a product failed, Toyoda looked for ways to fix the problem. He did not give up on his products. He did not cover up his mistakes. He sought continuous improvement.

The “Toyoda Precepts,” compiled by Toyota Industries management after Sakichi Toyoda’s death:

•Always be faithful to your duties, thereby contributing to the Company and to the overall good.
•Always be studious and creative, striving to stay ahead of the times.
•Always be practical and avoid frivolousness.
•Always strive to build a homelike atmosphere at work that is warm and friendly.
•Always have respect for God and remember to be grateful at all times.

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About the author

John Black, President and CEO of JBA, has implemented Lean improvements for four decades, first with the Boeing Company and later as a leading consultant in the healthcare industry.

Instilling A Safety Culture

Maintaining Momentum With Lean

Kaizen Fellows Build Leadership Capacity

The Evolution of the Kaizen Fellows Program

Hands-on learning

Building commitment and capacity

Leading from the factory floor

Lean Pioneers: Joanne Poggetti and Sister Monica Heeran

Lean History: John’s Journey

From Vietnam to Boeing

Transition to Healthcare

Just in Time Production: Survival and Victory Depended on It

Founding Fathers of Lean: Juran and Deming

Dr. Joseph Juran

Dr. W. Edwards Deming

Founding Fathers of Lean: Kiichiro Toyoda and Ohno

Founding Fathers of Lean: Sakichi Toyoda

About the author

John Black, President and CEO of JBA, has implemented Lean improvements for four decades, first with the Boeing Company and later as a leading consultant in the healthcare industry.

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Categories

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The Evolution of the Kaizen Fellows Program

Hands-on learning

Building commitment and capacity

From Vietnam to Boeing

Transition to Healthcare

Dr. Joseph Juran

Dr. W. Edwards Deming

About the author​John Black, President and CEO of JBA, has implemented Lean improvements for four decades, first with the Boeing Company and later as a leading consultant in the healthcare industry.

Get monthly blog updates in your inbox

Categories

Archives

About the author

John Black, President and CEO of JBA, has implemented Lean improvements for four decades, first with the Boeing Company and later as a leading consultant in the healthcare industry.