Hello again from Japan.

It’s Thursday morning and our team is heading into the third and final day of factory work.

We all know quite a bit more about gas meters than we did three days ago when we arrived in this large, modern factory. We’ve been impressed by the cleanliness and orderliness of the facility, and have enjoyed the hospitality of the plant’s staff. There are several of the company’s managers in our workshop and they’ve been very helpful in describing current processes, setting up demonstrations, and getting simulation materials.

After a brief familiarization on Tuesday morning, we headed for the factory floor to observe the operators, measure cycle times (which varied from a few seconds on one line to hours on another), and develop ideas for improvement. Each team member produced at least seven ideas, basing them on concepts from nature. For example, in an operation that involved removing paint from a casing, the team referred to sandstorms and the grinding movement of a glacier. With idea forms grouped conceptually, a ranking took placed based on established criteria such as cost, quality, improvements in safety, and capital required to implement the improvement measures. Then off we went to simulate.

The teams used prodigious amounts of cardboard, duct tape, used soft drink bottles, and a few items found in the factory to create a vision of new equipment and production methods. Standard work sheets were developed for the revised processes, which we will test tomorrow (Thursday) morning. Some of our colleagues from the plant stayed late last night producing prototypical carts and other equipment to assist us in this testing. After observing several cycles of the proposed new processes in the redesigned space, we’ll prepare implementation plans for each of the three lines. Our hosts tell us that they want to develop many of the good concepts that have come out of our work here.

Our 1-½ hour bus rides back to our hotel gave the Children’s team some time to reflect on what we’ve seen and how the concepts can be applied to creating a new facility that supports our mission to become the best children’s hospital. We applied some standard tools to the debriefing sessions and recorded some key observations, including:

• Having accurate data about our current processes is essential to improving them.

• Our work begins with process improvement. We can’t build a new facility based on bad processes.

• Even in standardized processes we find variation. We must go to the site of care and observe to get a deep understanding of the work.

• Time is the shadow of motion. Every movement adds time to a process; if it does not add value it should be reduced or eliminated.

• Sometimes simple tools are the best. It’s easy to leap to an IT solution or to buy an expensive piece of equipment but sometimes neither is necessary.

• Simulation, based on the real process, is very powerful in helping avoid problems with the future-state design.

• Building flexibility into the facility is essential because demand and process will change over time.

Tomorrow, our teams will formally present a summary of our work to our sensei and the factory managers. After celebratory lunch and ceremony, we’ll head back to Tokyo where the team from Seattle Children’s will draw together more of our learning and continue translating them to guide our improvement work and phase one project design. We’ll make one more blog entry before we head back to our families and Seattle Children’s on Sunday.

—Todd Johnson