Going to Gembatag:goingtogemba.org,2008://232008-12-16T19:12:09ZMovable Type 3.34A Starting Place for All of Ustag:goingtogemba.org,2008://23.23042008-12-16T18:51:56Z2008-12-16T19:12:09ZWe 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...Kim Davisehealth
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
Learning Simple, Low Cost Solutionstag:goingtogemba.org,2008://23.23032008-12-15T22:00:56Z2008-12-15T22:23:31ZAs 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....Kim Davisehealth
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Small, Frequent Change and Impressive Resultstag:goingtogemba.org,2008://23.23022008-12-09T18:31:15Z2008-12-09T19:58:30ZWe 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...Kim Davisehealth
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Children's Team Heads to Japantag:goingtogemba.org,2008://23.23012008-12-08T21:49:38Z2008-12-08T21:50:24ZA 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,...Kim Davisehealth
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.
Planning for Next Steps - Children's Future Facilitytag:goingtogemba.org,2008://23.22992008-10-27T17:44:27Z2008-10-27T18:07:48ZHello! It’s Saturday night in Japan and we’re in Tokyo, looking back on a very intense week of training, hands-on practice and reflection on the tools of the Toyota Production System. Yesterday our three teams presented the results of our...Kim Davisehealth
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Sandstorms, Glaciers and Improvement Measurestag:goingtogemba.org,2008://23.22982008-10-23T01:34:18Z2008-10-23T01:43:14ZHello 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...Kim Davisehealth
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
Focus on Building Design, Cultivating Innovation and Uncovering Wastetag:goingtogemba.org,2008://23.22972008-10-22T19:28:24Z2008-10-23T01:33:20ZGreetings from Nasu-Shiobara, Japan! Our Seattle Children’s Hospital team of ten, along with kaizen leaders from Virginia Mason, Park Nicollet Health Systems in Minneapolis, Boeing, and Sun Chemical (EU) arrived on Sunday. We travelled by train and bus to this...Todd Johnson
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Heading to Japan to Study Integrated Facility Designtag:goingtogemba.org,2008://23.22962008-10-17T18:53:02Z2008-10-22T19:58:55ZI’m off to Japan and my first trip with Seattle Children’s to study integrated facility design and planning methods from the Toyota Motor Company - one of the world’s experts. We will be focused on bringing back insights and learnings...Todd Johnson
I'm off to Japan and my first trip with Seattle Children's to study integrated facility design and planning methods from the Toyota Motor Company - one of the world's experts. We will be focused on bringing back insights and learnings that will help us plan Children's anticipated hospital expansion and facilities for the future.
Our first stop is Tokyo. We'll be building on our knowledge of continuous performance improvement methods. I'll write more in a few days to share insights during our trip!
---Todd Johnson
Vice President, Facilities
Robots remind us of ballets and waltzestag:goingtogemba.org,2008://23.22942008-06-06T23:40:26Z2008-10-22T19:58:55ZGreetings from the Operative Services team here in Japan. After two days in Nagoya, we traveled south, arriving in Fukuoka late Sunday evening, where the rain greeted us again. We spent all day Monday in classes learning about Kaizen from...David Perry
Greetings from the Operative Services team here in Japan. After two days in Nagoya, we traveled south, arriving in Fukuoka late Sunday evening, where the rain greeted us again. We spent all day Monday in classes learning about Kaizen from our four senseis. We studied just in time, standardized work, kanban systems and flow of materials and information.
"Although we have been working on many of these concepts already, we are learning that we have just scratched the surface of our leanings and the importance of constantly building "iterations" on the work we have already started," says Cheryl Tada.
Monday ended with a traditional Japanese dinner where some of us were found to be more adventuresome than others.
"The culture and people have made us feel very comfortable. We are learning the Japanese way and trying not to disturb the "wa" (harmony)," says Eli White.
Even with limited Japanese language skills, we have been able to find our way (mostly), order food and understand the flow of work in the factories. The use of visual cues is everywhere along with a service culture that is unmatched. We have seen airline workers and immigration officials running in the airport terminals to assist passengers. Hard to believe for those accustomed to air travel these day perhaps, but true!
Another example of service excellence was provided on our last night in Fukuoka when a group of us set out to find the famed street-side food stalls located downtown. We must have looked a little lost as we were spontaneously adopted by a local businessman who took time to detour from his trip home and escort us to our destination.
The past two days we spent going to "Gemba" at Showa Manufacturing. They specialize in various heating and air conditioning equipment and have been practicing Kaizen (lean) for over 20 years. Judy Dougherty "saw standard work in action that clearly allowed the worker time to be creative and to continually improve the process. Furthermore, intuitive layouts supported the training of new workers."
Sean Flack was "surprised by the craftsmanship and variety of custom work evident in a factory setting." Clearly, manufacturing environments have more in common with our workplace than we might intuitively expect.
As Ti Refvem commented "many ideas can be taken from the factory floor and used in our setting. The factory workers use a combination of manual techniques and high-tech machinery to service our customer. We also do this in health care".
Today we traveled an hour by bus to two car manufacturing plants. We first visited the Nissan plant in Kyushu where we were left speechless by the extensive use of robots to perform many tasks. Who would have thought that we would be reminded of ballets and waltzes while watching these machines perform their work?
Then we were privileged to travel into the hills outside town to the Toyota plant where Lexus and Highlander models are made. Again, we were awed by the synchronous work of man and machine. As Jeremy Guideschek observed, "it's all about the flow". Unlike Nissan however, Toyota has clearly chosen to rely less on robots, and with careful thought provides a safe and supportive environment that promotes worker excellence.
Thanks for reading our blog and we look forward to reporting to you all in person on our return to Seattle.
The Operative Services Team
"Always be studious and creative..."tag:goingtogemba.org,2008://23.22932008-06-04T17:58:38Z2008-10-22T19:58:55Z…striving to stay ahead of the times.” This was the core philosophy of Sakichi Toyoda, founder of what is today’s Toyota Motor Corporation. While in Nagoya, our first stop during the Japan CPI trip, the Radiology team had the opportunity...David Perry
The team sketched extensively throughout our time in the museum (see photo of Ray Ramoso hard at work). During our team debrief (an exercise every team participates in at the end of each day) we identified 3 key learnings from our museum visit: 1) The 3 Is of success - incremental, iterative improvement; 2) The power of the 7 design principles which include "flexibility in use" and "simple and intuitive"; and 3) start small with reliable methods - in other words don't hesitate too long before you jump in and begin a cpi project or pilot. Speaking of reliable methods, this is one of the implications for the Radiology team at Children's. We agreed that we need, as a pilot project, to pick a specific area in Radiology to begin focusing on reliable methods and to get on the road of incremental, iterative improvement. In addition, we resolved that we need to understand our current processes better by collecting and analyzing data and via first hand observation.
During our bus ride back from the museum our discussion always led us back to the core reason for Toyota's great achievements - an unwavering belief that they could be successful. This was clearly demonstrated by Sackichi Toyoda's son, Kiichiro, who in 1934 moved the company into car production when many said it could not be done by a Japanese company. What you realize when you go to Gemba and see Kaizen (continuous improvement) principles in action is that it requires a strong, long term commitment to continuous learning and improvement.
We look forward to learning about more ways to improve our Radiology value stream as our trip continues and sharing some of these learnings with you in our next blog entry.
The Radiology Team
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We can learn a lot from a 400 year old castletag:goingtogemba.org,2008://23.22912008-06-02T22:58:50Z2008-10-22T19:58:55ZThe ED team completed a great first day in Nagoya, Japan. After a perfect flight from Seattle to Tokyo, a connector flight to Nagoya and an informational bus ride to Nagoya Central, the team settled in and prepared for a...Dawn Cotter
It was amazing to perceive the same area and structures in different and unique ways. While some focused on macro-structure, others saw the intricate design elements as their primary observations. Others saw the surrounding environment, while several individuals concentrated on the people involved. It reminded us of how we look at things through eyes and minds with diverse training and backgrounds, and often see different aspects of the same process, or the same picture in different ways.
A few of the major take home points for us included the following. Some noted that the visible structure is built and predicated on the infrastructure, which is intricate, but clearly thoughtfully planned and implemented. The solid structure of the castle walls reminded us that although the load bearing walls might be solid and uniform, the structure of the remainder of the walls was variable and unique, not unlike the multidisciplinary and unique individuals who make our institution function on a daily basis.
As we intently looked and sketched our areas, we were also reminded that first looks are indeed just that. We missed several key observations on those short assessments, reminding us of the need to go to the source often to experience the environment and learn, rather than look once and assume.
It was also obvious to us that although the surroundings were extensive and beautiful, they were somewhat overwhelming to us, even as tourists. We projected that feeling to how our patients and families might feel in our large and expansive facility. Although it is comforting to us as employees to work in a superb institution, it can be overwhelming and stressful for our patients and families, who not only have to contend with a new environment, but also manage the actualities of the illness, injury or other issue that has brought them to us.
It is our people who make the facility what it is and we are the ones who can make the building friendly and patient/family centric, as well as manage the medical concerns in a consistent, standard and quality fashion. As we viewed a facsimile model of several workers, connected by a rope and working in unison, who were tasked with moving a huge square building rock, it reminded us that the impossible and the unbelievable can be accomplished by teams that work together to provide safety, design a process and monitor results.
Together, working on the small as well as the large opportunities, we too can accomplish what might be thought of as impossible. Results might include service on demand with no waiting for care or interventions regardless of the time or day and medical processes without waste.
This has been a great first day of lean immersion and we are excited to continue our journey as CPI students and teachers. We look forward to sharing more information with you as we continue in Japan and upon our return.
May 31, 2008
The ED Team,
Dawn Cotter, Russ Migita, Kendra Powell, Amanda Mogg, Mark Del Beccaro, Cara Bailey, Connie Whillock and Tony Woodward
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A New Group Goes to Gembatag:goingtogemba.org,2008://23.22922008-06-02T18:51:12Z2008-10-22T19:58:56ZAnother group of excited Children’s team members has gone to Japan! They left on May 29 for two weeks of intense learning about continuous performance improvement methods and work. The group will visit many companies that use Toyota’s lean methods...Kimberly Arthur
Emergency Department Team
* Tony Woodward
* Dawn Cotter
* Russ Migita
* Amanda Mogg
* Kendra Powell
* Cara Bailey
* Connie Whillock
* Mark Del Beccaro
Radiology Team
* Ed Weinberger
* Chuck Fritz
* Ray Ramoso
* Randy Otto
* Lisa Brandenburg
* Barb Bouche
* Emily Camm
* David Perry
Operative Services Team
* Cheryl Tada
* Jeremy Geiduschek
* Tony Avellino
* Pat Hagan
* Judy Dougherty
* Sean Flack
* Ti Refvem
* Loan Lam
Wishing them safe travels. Check back here for real-time reports from across the planet.
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Lessons learnedtag:goingtogemba.org,2008://23.22892008-03-08T06:53:45Z2008-10-22T19:58:56ZToday was a day of reflection from this week of Kanban immersion training. While there are many information nuggets (such as using flexible PVC pipe to construct inventory racks) some of our most significant learnings are listed below: There must...Charles Hodge
Today was a day of reflection from this week of Kanban immersion training. While there are many information nuggets (such as using flexible PVC pipe to construct inventory racks) some of our most significant learnings are listed below:
There must be a stable process to have an effective Kanban system. If processes are highly variable/unpredictable a pure visual signal such as kanban is not effective. This is because the kanban is set on one cycle. The cycle works in a loop, so the loop must be in the same rotation over and over.
The role of the water strider (materials handler moving from station to station). This position allows the operator to focus on their core role/activites, while a resource dedicated to distributing supplies and equipment works around the operator to ensure they have what they need, when they need it.
Kanban at its core is visual. Everything about the kanban system is visually triggered. From the simple information on the card, to the limited flow pattern, everything about the process is easy to follow. The simplier the better.
A kanban should have a single purpose. The kanban triggers resources from point A to point B. It then returns to A for redeployment. It should be considered a round trip non-stop ticket.
Do not start work until a kanban is received and only produce what is requested. Kanban is a vehicle for standard work. If you start work prior to the signal, or work beyond what is required, you are contributing to the waste of overproduction (mira).
Placement of supermarket is key. Systems need supermarkets (inventory hold locations) to maintain flow between supplier and production points. It is critical to understand where the supermarkets are, what they hold, how resources flow through them, and how they are maintained.
Kanbans require continuous refinement. After implementation, assessments of performance become key. It is critical to ensure kanbans flow is controlled. Kanban replenishments should never be too "hot" (requiring many replenishments ) or "stale", but should always be in synch with customer demand.
Establishing Buffer (safety) stock requires diligent study. Levels of buffer stock accommodate processes variability. However buffer stock should be defined with quantitative tools, reviewed with frequency, and established with purpose recognizing criticality and severity of the item.
Kanban does not create standardization, but it does rely upon standardized processes. Customer orders can be diverse (ie: different models and accessories on cars coming down an assembly line) but the items delivered to support the assembly process should come the same way every time.
Kanban is not a universal tool or solution. It does not fit all applications. It is a vehicle for flow but not always applicable. Sensei Niwa asked the question "Do you need a kanban card to tell you that you are hungry?" You want to develop systems that automatically pull the right supplies. Until you reach the point of innate pull within the system, the kanban can be the right answer.
The Supply Chain team has discussed plans for piloting a simple kanban system based on these learnings that can be started within the hospital and rolled out to the outpatient clinics. The goal is to remove the clinical staff from the supply replenishment process. This can be an iterative improvement on some of the early kanban systems that have been established.
This spring we will be working with our Tauber Institute (industrial engineering graduate students) interns to apply kanban approaches to some supplies in the OR core area and to the case cart process. Included in this work is possibly changing from the notion of case carts to case "kits" meaning that the OR is provided with exactly what is needed, for a case as it is needed. This would be a true kanban application.
Advanced Kanbantag:goingtogemba.org,2008://23.22882008-03-07T09:23:42Z2008-10-22T19:58:56ZKanban - A system that ensures the required parts are received when they are needed in the volumes they are needed. At the end of this Kanban instructional journey are the Black Belts of Kanban, the Toyota plant and one...Charles Hodge
Kanban - A system that ensures the required parts are received when they are needed in the volumes they are needed.
At the end of this Kanban instructional journey are the Black Belts of Kanban, the Toyota plant and one of its primary suppliers, Toyota Boschoku. Toyota Boschoku started in 1914 as a spinning and weaving company. The production line of the Toyota Tsutsumi plant (making the Camry and Prius) communicates to the Boschoku via e-Kanban in a continuous fashion during the working day. This kanban notification to Bobuschoku set their paper Kanbans into motion. Boschoku is the supermarket for the Car assembly line and they have various production lines within their factory.
Boshoku make 610,000 pieces monthly, for 23 different customers. Boschoku has 180 inventory turns per year. This means that they deplete and replenish their inventory every 18 hours. In order to do this they must be completely in sync with their customers demand on a moment by moment basis. Kanban helps them make this connection. Each day they handle 20,000 kanbans.
One application of the kanban was in support of one of the assembly cells. This was a one person work cell. A kanban card was swiped by the operator and the materials were provided to him. The materials were perfectly positioned for his work and included the standard work instruction for the piece he was assembling, appearing on a monitor directly in front of him. To his right the correct tool tray was automatically unlocked for use to make sure he had the right tools (poke-yoke).
The plant has all the lean elements to perform significant manufacturing. They focused on flow, die turnover and making sure that they meet customer demand. A strange similarity is that the Toyota Boschoku plant building has a serrated roof line that looks exactly like the symbol for "supplier" in our Value Stream Maps.
The main event was shown in the Toyota Tsutsumi plant. Receiving shipments every hour during the workday, they quickly use and refill the 30,000 parts required to build a Prius or Camry. They build 34,000 cars per month at the plant in two shifts. The goal for the line we observed was 288 cars. They were running at 97% of this goal as we observed the process in the afternoon. The takt time for the line has a car finishing every 3.3 minutes. Their lead time is 20 hours.
Dollies holding parts and tools accompanied the body down the line. Just like in the one-person cell each station had an instruction sheet for the particular car at the station. Kanbans were so integrated in the flow of materials that it was hard to see any differentiation between the kanban and the arrival of the materials.
One place where they did not use kanban cards was in final door installation. Each door was perfectly matched to the main vehicle body. The doors were removed after painting to allow improved access for installation and to avoid cosmetic damages. The removed doors continued along at exactly the same rate as the body and they arrived in the precise order needed at exactly the right time. The kanbans are unnecessary.
Tomorrow we will be discussing lessons learned and steps for Kanban at Children's
From Theory to Practicetag:goingtogemba.org,2008://23.22862008-03-06T12:34:07Z2008-10-22T19:58:56ZTuesday was all theory. Lectures on the Kanban applications, simulations, and case studies. Kanban involves looking at demand looking at stable level loaded processes, establishing Takt time and making calculations on the number of Kanban cards and reorder points. We...Charles Hodge
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