Medical Taylorism, Lean, and Toyota | P.Hartzband and J. Groopman | New England Journal of Medicine

Seen today in the New England Journal of Medicine, under the signature of Harvard Medical School professors Pamela Hartzband and Jerome Groopman:

“The TPS is a set of principles designed for the manufacture of inanimate objects in a factory. We accurately depict two essential elements of this system that are directly derived from Taylorism: standardization and time efficiency. In his classic study of the application of Toyota principles to the manufacture of cars in the United States, Paul Adler describes how ‘Each job was analyzed down to its constituent gestures, and the sequence of movements was refined and optimized for maximum performance. Every task was planned in great detail, and each worker was expected to perform that task in the prescribed manner.’ Adler refers to ‘the intelligent interpretation and application of Taylor’s time and motion studies’ as key to its success. He states, ‘The reference to Taylor may be jarring, but it fits.’

[…] Other medical professionals who, like us, have experienced the toxic effects of obsessive standardization and time efficiency in the care of patients have expressed concerns similar to ours. In an era of accountability, we believe that those who advocate the application of Lean principles to medical care must take responsibility for the unintended consequences resulting from these elements shared by Taylorism and Toyota practices.”

Michel Baudin‘s comments:

The authors base their claim that the Toyota Production System (TPS) is “derived from Taylorism” from the writings of Paul Adler, a business school professor at USC who has written many papers over the past 40 years, a few of which touched on TPS and NUMMI, the first plant to apply this system in the US and now operated by Tesla. I met Paul Adler at Stanford in the late 1980s, and found his insights on NUMMI quite valuable. It was also clear to me that Paul Adler was not an engineer, that TPS, to him was one interest out of many, and that his knowledge of the subject was only at the business school level, as reflected, for example in an expression like “Taylor’s time and motion studies.” Taylor did time studies; Frank and Lilian Gilbreth, motion studies with, as stated in other posts, very different objectives.

This distinction, perhaps too subtle for business schools, is of paramount importance to anyone who wants to understand TPS, which owes much more to the Gilbreth’s work than to Taylor’s. Taylor wanted to prevent workers from slacking off; the Gilbreths, to observe the way work was being done and make it easier. And the medical profession has a good reason to remember Frank and Lilian Gilbreth: the way operating rooms function today is based on the analysis and recommendations they made 100 years ago.

5S at Google?

In How Google Works, on p. 38, executives Eric Schmidt and Jonathan Rosenberg wrote:

“When offices get crowded, they tend to get messy too. Let them. When Eric [Schmidt] first arrived at Google in 2001, he asked the head of facilities, George Salah, to clean up the place. George did, and was rewarded with a note the next day from Larry Page, saying, ‘Where did all my stuff go?’ That random collection of stuff was an icon of a busy, stimulated workforce. […] It’s OK to let your office be one hot mess.”

So the company whose mission is to organize the world’s information and make it universally accessible and useful” has no use for 5S in its offices. The explanation they give is that Google employees are “smart creatives” who do their best work in a messy environment, like Pablo Picasso in his studio. But I can think of another reason: the information that matters to the googlers’ work is the stuff behind their screens, not on their desks. It’s in Google’s data centers, and they work on it with Google’s software.

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Sales, Marketing, and Manufacturing Improvement

The following reader question popped up in another blog:

“Does Lean apply to sales? We’re trying to introduce Lean thinking throughout the company and have found very little on how to lean the sales department.”

The response was a set of tactical recommendations on the behavior of sales reps with customers. Strategically, however, you need to think about the role of Sales within the business. It is not just to provide a flow of orders every day. Marketing is often mentioned in the same breath as Sales, with good reason, because sales are the business’s best source of market intelligence. Continue reading

Shmoozing About Lean Leadership with Beau Keyte

Last week, Beau Keyte sent me a copy of Chapter 10 of his book The Complete Lean Enterprise, entitled Leading in the Future State, and we have been exchanging thoughts about it by email since. Many of my words below are already in my account of the Central Coast Lean Summit, where this conversation started; what is new here is the back-and-forth.

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Is Choosing a Consultant Truly The Second Step in ERP Implementation?

According to the previously cited guide from ERP Focus, choosing an implementation consultant is the second step of ERP implementation, right after selecting a vendor. In the consulting business, being a certification as an implementer from a leading ERP vendor is known as a license to print money. Even vendors of ERP products acknowledge that their customers spend more to implement the software than to buy it, and that much of this cost goes into consulting fees. The following are a few thoughts about the process of ERP implementation and the roles played by consultants, contractors, and the in-house IT team. Continue reading

About Teams and Projects

In The Wisdom of Teams, Jon R. Katzenbach and Douglas K. Smith explained that, for a working group to coalesce as a team, it needs a common goal, complementary skills, and mutual accountability among members. It sounds simple, but it is in fact a tall order, and there is no evidence that it is sufficient.  The authors don’t claim it is, but they found these characteristics among successful teams in sports and business, and found them lacking in unsuccessful ones.

What Makes a Great Team

Let us explore the meaning of these three characteristics in more detail:

1. A common goal. It can be organizing a successful conference, or JFK’s “before this decade is out, landing a man on the moon and returning him safely to the earth,” or building a motorcycle that wins a race. Whatever it is, the goal must be clearly stated in few words, with obvious success criteria, for team members to sign up.

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The Lean Champion: Window-Dressing or Agent of Change?

Question seen in another blog:

I work as a deployment champion in a manufacturing company, but I don’t have the support of my managers because they don´t believe in the lean methodology. Which lean tools can be used to help them believe?

Image de Zacharie Gaudrillot-Roy

Image de Zacharie Gaudrillot-Roy

I have to assume you are not self-appointed. If you are “deployment champion” for Lean in a manufacturing company, it is because someone in  gave you the job, presumably because he or she believed in Lean and in you at the right person to champion it. But don’t presume it, find out what the motivation is. If it is that the company must be “Lean-certified” in order to continue doing business with its biggest customer, chances are that the whole effort is window-dressing, and your own job in particular. If this is the case, you need to decide whether you want to play along.

On the other hand, if the person who gave you the job is the CEO, the company must improve its performance to survive, and the CEO is convinced that going Lean is the only feasible way to do it, then it is a real job and you have the backing of the one manager who matters most.

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Cars Per Employee And Productivity At Volkswagen Versus Toyota

Seen this morning in a Lean consultant’s blog:

“Two decades later, VW has topped Toyota as the world’s number one automaker, but Toyota generally is considered to be […] far more productive. In 2015, VW employs 600,000 people to produce 10 million cars while Toyota employs 340,000 to produce just under 9 million cars…”

Is it really that simple? VW produces 10 million/600,000 = 16.67 cars/employee/year, and Toyota 9 million/340,000 = 26.47 cars/employee/year. Ergo, Toyota is 60% more productive than VW — that is, if you accept cars/employee/year as an appropriate metric of productivity.  Unfortunately, it is a bad metric that can easily be gamed by outsourcing.

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Principles About Principles

Abstracting underlying principles from practices is essential when you are trying to learn from the way an organization works, for the purpose of helping other organizations, engaged in different activities in different contexts. Unless you can do it, you are reduced to just copying practices without understanding what problems they were intended to address.

Unfortunately, articulating a set of principles is hard because they must be (1) understood, (2) actionable, and (3) memorable. Here are a few meta-principles on how to achieve these goals:

  1. Banish words like “thoroughly,” “rigorous,” “towering,” “powerful”, or “fully.” If the meaning is in the eye of the beholder, it doesn’t belong in a statement of principle.
  2. Express principles as an action verb followed by a single object. “Develop,” “create,” “cancel,” or “hire” are all appropriate action verbs in a statement of principle. If you have multiple objects, you need a statement of principle for each.
  3. Keep the number of principles down to a maximum of five. Otherwise, they won’t be remembered. Most Jews can’t recite the 613 commandments in the Torah; most Christians, their 1o commandments; most Americans, their bill of rights. If you want principles to be remembered, make a shorter list.

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About Obeyas (“Big Rooms”)

“Obeya” (大部屋) is Japanese for “Big room.” The term has been getting attention lately in the Lean community as a solution for service operations or project teams and is even conflated by some with production teams’ daily meetings on the shop floor, which don’t take place in a room other than the production shop itself.

On the other hand, the idea of bringing together in one room all the stakeholders in an issue, problem, or project to communicate face to face, find solutions and make decisions is not exactly new. It’s called a meeting, and those who wish to sound “Lean” without changing anything can call their meeting rooms “obeya.” Those who wish to dig deeper, however, find a more specific — and useful — concept, if not a panacea.

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