A team from Children’s is off to Japan to learn continuous performance improvement tools and techniques from the world’s experts. Representatives from the Cancer, Transplant and Pharmacy Departments are part of the eighth group to travel from the hospital.
Nagoya, Kyoto, Tokyo are stops on this 12 day learning trip spanning from Dec. 4 -16. Stay tuned for news and updates from overseas.
We are fortunate to be part of Children’s CPI trip to Japan and fourth journey as part of the Cancer program. We are joined by our colleagues from Transplant and Pharmacy and are enjoying spending time together.
We arrived in the bustling city of Nagoya on Friday evening after a day of travel and a day lost to crossing the international date line. The city is beautifully decorated for the holidays, giving us a sense of familiarity and reminding us of home. There are other familiar places - there is a Starbucks in our hotel and a McDonald’s right down the street!
We have been struck by the dense population of the area. In spite of the busyness of the streets, shops, and hotels, the service we have received throughout the city has been truly impressive. Customer service seems to be ingrained into the culture in a way which makes us feel very special and welcome.
Our first full day in Nagoya was spent touring Nagoya Castle and “learning to see” through sketching. At first, sketching seemed daunting to most of us but we all agreed it is helping us to see in a much more focused, detailed way than we are used to in our daily work. The castle is an impressive representation of flow and how beauty and function can be integrated.
Our second day in Nagoya was spent touring the Toyota Museum. We came away from this experience with a much deeper understanding of how continuous, small change over time leads to great successes - something we over-achievers are struggling to come to terms with! We recognize our instinct is to take on a big project in order to maximize potential benefit, but we have seen how small, frequent change leads to impressive results.
We then traveled by bullet train to the peaceful town of Odawara where we will begin to tour factories. Our Japanese senseis have spent the day reviewing CPI principles and preparing us for our learnings. Already, just a few days into our trip, we have many ideas for potential improvements in our work areas. We look forward to the remainder of our time to experience deeper understanding of these important tools and how we can apply them to make Children’s the BEST!
—Bonnie Fryzlewicz and Laura Winter
As our Japan trip progresses we continue to learn by sketching, sharing our observations with each other and discussing concepts with our sensei.
Our first manufacturer visit was to Yamatake’s Azbil Shonan factory. We observed their control valve manufacturing line. Like Children’s, Yamatake has tailored the Toyota Production System to their own environment. For example, as their foundation they modified 5S into 5S + 1S. The sixth S stands for ‘smile’. Another concept we saw was implementing simple, low cost solutions. We saw examples such as work benches that were made out of simple, modular components like an erector set allowing the fixture to be modified and moved when needed. We need to take advantage of our creative minds and develop our own simple solutions instead of spending money on expensive items in health care that may not fully meet our needs.
On Wednesday we visited two musical instrument manufacturers. The first, Suzuki, manufactures harmonicas and melodions among other instruments. We began our visit with a brief musical demonstration by workers playing a Hammond organ and harmonica. During the factory floor tour we were impressed because we were able to see that too much inventory hides waste.
The second factory we visited on Wednesday was Yahama. We saw craftsmanship being done to a takt time. The creative work involved in tuning a piano was
completed within time parameters using standard work. We had a few moments
at the end of the tour to play some of the instruments in the showroom.
Steve Wanaka even had the chance to jam on the electric upright bass!
Today we visited another factory, Aisin, where we toured their aluminum casting and mattress manufacturing lines. We learned many things about inventory control. The sensei helped us visualize inventory as money sitting on the shelf. If we worked with our suppliers to receive medications 7 days a week we could reduce our inventory buffer and therefore
put money in the bank. We also saw a bidirectional kanban that went back
and forth between factory and supplier. The team thought this might be a
good idea to apply to the IV fluids in the pharmacy. The bin itself would
serve as the kanban going back and forth between the pharmacy and supplier eliminating waste and providing fluids just in time.
During one of our debriefs we also discussed the idea of using a third type of kanban signaling the flow of the medication preparation in the pharmacy.
This would help the pharmacy identify and prioritize patients who are waiting for medication administration in a clinic. By getting the medication out quicker, the patient could leave the exam room sooner.
We have been very fortunate to participate in this experience and are humbled and inspired by achievements we’ve seen. It’s clear that we can and will succeed in our CPI journey if we are persistent and dedicate ourselves to the right work.
Anne Bournay, Barb Marquardt and The Pharmacy Team
We have just enjoyed a day of rest in Kyoto after many others of travel and visiting assembly plants, where the sheer pride and joy in “making things” is palpable. At first, some of us questioned how line operators remain engaged and focused in their work but we soon recognized why manufacturing is so valued in this culture. The Toyota spirit of being studious and creative is evident in each place we have visited. There is reciprocal respect between each worker and their commitment to improvement.
In these places it is so easy to see that when standard work and flow are in place the entire workplace is less chaotic. The workload is balanced and little needs to be said among the operators when one picks up where the other left off. Watching their teamwork is like watching a well choreographed ballet or a fantastic soccer game. We are in large factories but the environment is surprisingly serene. Similar to the airplane simulation, which many of us have experienced, people are not working harder or faster, just smarter. There is little chatter among the workers because there doesn’t need to be.
We have seen many innovative enhancements and realize that standard work and removing waste is the foundation for incremental improvement. Likewise, an organized environment is critical for flow. We have seen that having a space that is 5S’d does not necessarily guarantee flow, but it is clear that flow cannot be accomplished without it. This simple idea provides a starting place for all of us whether or not we are involved in RPIWs or focused program value streams.
Lastly, we have been struck by the impact of the economic crisis and the renewed emphasis on removing waste as the primary strategy for cost reduction. The scope of projects is kept small which allows the change to happen with little disruption to the line. We have seen examples where small improvement efforts occur in the moment through collaboration with members of their Kaizen Production Team (the equivalent of our CPI staff). We are challenged but optimistic about creating ways to expand CPI efforts and making CPI our daily work.
We are back on the bus and looking forward to the grand finale or the final minutes in overtime (choose your analogy) as we head towards Toyota City. I look around and see some tired faces but also a confirmation that this was worth every second…..
12 hours later… “Absolutely awesome” may be the only way to describe what we have seen at Toyota. Seeing the big picture, an example of true flow and the synchrony of assembly lines and materials has allowed us to envision what is really possible for our patients.
Mikhail Baryshnikov and the folks at the Federation International Football Association (FIFA) would be envious of what Toyota has accomplished. We also come away with a renewed commitment to make sure that our staff have all the resources they need (not more or less) at the right time and in the right place.
-Debra Gumbardo and The Transplant Team
