Mr. Liker discusses the 14 principles of the Toyota Production System in his book “The Toyota Way”. The second principle says to create continuous process flow to bring problems to the surface. Many times employees are reluctant to surface problems for fear of being blamed or assigned a project to solve the problem. A major part of Kaizen Events and Lean support activities is to develop value stream maps to help:

  • Design work processes to achieve high value-added, continuous flow
  • Identify and eliminate idle time
  • Create flow to move information and materials fast
  • Link processes and people together to quickly reveal problems
  • Make flow evident throughout the culture.

In healthcare disciplines departments tend to work in silos and do not communicate enough and, therefore, do not realize the effect their actions have on other departments. Following this principle and associated actions are imperative for improvement in an organization.

We should use “Pull” systems to avoid overproduction. Give the downstream customers in the process what they want, when they want it, and in the amount they want. Old habits are hard to break but we should let consumption drive materials replenishment, minimize work-in-process and inventory by stocking small amounts of each product, and restock frequently. Change our systems to respond to day-by-day shifts in customer demand rather than relying on computer schedules to track inventory.

As much as possible we should try to level out the workload (heijunka). Take the required amount of time and do things right the first time being deliberate like the tortoise and not like the hare. Eliminating waste is only 1/3 of what is required to make Lean successful. We must try to eliminate overburden to people and equipment and unevenness in work scheduling. We want to level out the workload rather than the more common start/stop approach of working on projects in batches.

Principle five states that we should build a culture of stopping to fix problems and to get quality right the first time. Quality for the customer/patient drives our value proposition. We should use all the modern quality assurance methods available and build detection capability into equipment (Jidoka). Visual systems should be developed to alert team members to problems and support systems should be built in that help to quickly solve problems and implement countermeasures. An organization should build a philosophy into the culture of stopping or slowing down a process to get quality right the first time and enhance productivity in the long run. 

Standardized tasks are the foundation for continuous improvement and employee empowerment states the sixth principle. Stable, repeatable methods should be used everywhere to maintain the predictability, regular timing and regular output of processes. Standardize today’s best practices and then allow creative and individual expression to improve upon them. We then incorporate these improvements into the new standard so that when a person moves on you can hand off the learning to the next person.

Use of visual control can ensure no problem is hidden. Simple visual indicators can help people to determine immediately whether they are in a standard condition or deviating from standard. Design simple visual systems at the place where the work is. Reduce reports whenever possible.

The eight principle states: use only reliable, thoroughly tested technology that serves your people and processes. Use technology to support people, not replace them. Proven processes that work should take precedence over new and untested technology. Quickly implement a thoroughly considered technology if it has been proven in trials and it can improve the flow in the process.

These principles put us on the right pathway to continuous improvement. This never ending journey leads to success as well as employee and patient satisfaction. The Lean journey becomes a way of life and not a flavor of the month.

Don Bingham is a Sr. Associate with HPP and brings over twenty years of experience in automotive manufacturing to Lean Healthcare. This includes seventeen years with Nissan Motor Manufacturing where he made strides in industrial engineering, supervision, supplier development and Lean Manufacturing. Don was instrumental in Nissan’s Lean Manufacturing techniques where he taught Kaizen Methodology, utilizing tools such as 5S and Standardized Work. While at Nissan, Don spent time in Japan on new vehicle model projects, benchmarking Japanese vendors and training. Don was with General Motors for three years, where he helped to implement their Lean Global Manufacturing System at St. Catharine’s Engine plant in Ontario, Canada. Don holds a Bachelor of Science in Industrial Technology and Math from Middle Tennessee State University in Murfreesboro, TN and earned a Six Sigma Black Belt Certification in 2007.

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