Mark Graban is hosting the Management Improvement Carnival #40. Mark recently authored a new book, Lean Hospitals. Health care highlights from this carnival include:

• Hospital Error - Heparin in the news again (The Lean Thinker Blog): “I am reasonably certain that the two workers who went on “voluntary leave” (yeah, right) will absorb more than their share of blame as the system solves the problem by asking the “Five Who?” questions.”
• Management 101, 201, 301, and 401 (Paul Levy - Running a Hospital): “The only role of management is to create an environment where people left to their own devices and unsupervised are most likely to engage in behavior that advances the goals of the organization.”
• Why I Work In Healthcare (Lee Fried - Daily Kaizen): “Great people that were trying to work in a broken system.”
• Competing Podcast Interview with Mark Graban (Dwight Bowen - Lean Thinking Network): “Most everyone has been aware of the increasing costs of healthcare - the general public is recently becoming more aware of the patient safety and quality risks they face in a hospital. And these are all problems that can be addressed with Lean.”
• 5S, Poka-Yoke, and Visual Controls (Bryan Lund - TWI Blog): “I need a visual control to tell me if the standard is met, in order to avoid mistakes or failure.”

Related: previous management carnivals - Curious Cat health care article library - Curious Cat Management Improvement blog Health Care posts - improving health care links

• “Certifications” - Buying Credibility? by Mark Rosenthal - “if you are looking for your own professional development, and look at a program for what it is: An academic education, and possibly an opportunity to establish professional network, then go for it. Just don’t go in believing that ‘being certified’ means a whole lot else.”
• Toyota Invests In Workers Instead of Laying Them Off by Mark Graban - “You can treat people as expendable costs or an asset to train and invest in. Even as Toyota’s truck sales have plummeted, are they resorting to layoffs? Nope!!”
• Quality, Productivity and Competitive Position by John Dowd - “I can still clearly hear his words, “There is no substitute for knowledge.” The knowledge is there in the pages of his book. It needs only to be extracted and acted on.”
• Deer Poka Yokes by Mike Gardner - “if the deer would just follow the operation standard and flow with the traffic instead of attempting to flow at right angles to it, all of this could be avoided”
• Too Bad, So Sad by Kevin Meyer - “Like most companies that try to implement lean, it appears that the second pillar, respect for people, was forgotten. Therefore most of the potential benefit was lost.”
• Projects vs. Process Improvement - “By taking a project as opposed to process improvement approach it is very hard to make performance visible and understand the effect improvement interventions are having or will have.”
• We Do Not Make What We Do Not Sell by Jon Miller - “Production control is a comprehensive activity of planning, organizing production and related activities including purchasing, managing inventory and production cost controls”
• Age and the Entrepreneur by Paul Kedrosky - “People founding tech companies over the last ten years had an average and median age of 39-years, nowhere near the age that makes for good stories about dorm room entrepreneurs”
• Queue Management by Mark - “the measurement of ‘on time’ is ‘pull away from the gate’ not “leave the ground” so in order to get an ‘on time’ departure, they will load the plane as scheduled, then go sit on the tarmac rather than delaying the passenger load. A great example of ‘management by measurement’ not getting exactly the intended results.”
• Free Download - Chapter 1 of “Lean Hospitals” by Mark Graban
• Better Meetings by John Hunter - Document decisions on a flip chart that everyone can see in the meeting and then email everyone the decisions.

Please submit your favorite management posts to the carnival. Read the previous management carnivals.

• Value in Value Stream Mapping by Mike Wroblewski - “value stream maps helped us all agree on our current state and what our future state vision looks like. With this shared vision, our team began to move forward as a team.”
• AgileVersusLean by Martin Fowler - “So as you can see, lean and agile are deeply intertwined in the software world. You can’t really talk about them being alternatives, if you are doing agile you are doing lean and vice-versa”
• Measuring customer satisfaction by Shaun Sayers - “Indirect measures are tricky, because indirect measures are derived from analysing customer behaviour and then making an interpretation about what that behaviour means”
• Anchoring a Problem Solving Culture by Mark Rosenthal - “When a problem occurs, the first response is to detect it, then to fix (or contain) it. That is jidoka. But at some point, someone has to investigate why it happened, get to the root cause, and establish a robust countermeasure.”
• Surgical Checklists in the News! by Mark Graban - “For all of the medical and clinical brilliance in our hospitals, they often have a great deal of opportunity for operational improvements.”
• Six Sigma: Some problems by John Dowd - “Finally the calculation of six-sigma itself is accomplished by dividing a denominator based on a subjective assumption (The number of opportunities over which a defect can occur) into a measure of the number of defects where defects have been so ill-defined as to produce no meaningful measurement”
• Genjitsu: The Only Reality by Jon Miller - “lean management gently boots these successful professionals back to the gemba to find the only reality.”

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Ron Pereira is hosting Management Improvement Carnival #37 on the LSS Academy blog, some of the highlights include:

• Are we Cowboys or Not? by Mark Graban - “Anyway, I’m not trying to start a Liker v Bodek battle, but it’s an interesting contrast in perspectives.”
• Numb3rs by Sue Kozlowski - “Now, part of the reason for this hyperbole is that exciting headlines get more people to buy the paper, and so you may think that the exaggeration is just a way to get people to read the accompanying story.”
• Necessary but Insufficient by Pete Abilla - “Motorola (MOT), the inventor of Six Sigma, is in big trouble. Even though it invented Six Sigma, this is a clear example that shows how Lean or Six Sigma are not a cure-all for corporate woes…”
• Eight Reasons Your Lean/Six Sigma Could Fail by Ron Pereira - “Programs, by definition, end. Conversely, the ancient origin of the word philosophy (philosophía) means ‘love of knowledge’ or ‘love of wisdom’. And true love, as the good book tells us, never ends.”

Please submit your favorite management posts to the carnival. Read the previous management carnivals.

• Adopting Agile Processes by Eric Engelmann - “So scrum is about fixing the system. If you don’t write code, it might not be apparent what’s different about this, so I’ll pull out what I love about it…”
• Generosity comes with international shipping by Andy - “I am the CEO at Timbuk2…and I wanted to say - thank you for the posting. and tell you I am very proud of the team here.

  1. They made this call on their own.
  2. They broke the rules that should be broken

• The gemba of poverty by Karen Wilhelm - “But the idea wasn’t to give these things to those in need. It was to keep designing and trying until you had something that could be manufactured at a profit to meet a price point poor people could afford.”
• Fire Fighting vs. Root Cause Problem Solving by Mark Graban - “The workaround does nothing to prevent the problem from occurring again — this ensures more wasted time and more potential problems in the future.”
• Coffee cup kanban by Corey Ladas - “the cup is the kanban. The cup-ban doubles as an order form that can encode most combinations that a barista should expect.”
• Teams and Improvement by John Dowd - “The lesson is that being aware of the existence of interactions and being attentive to their implications is a part of team management.”
• Conference Calls, Kids, and SMED by Ron Pereira - “Why wait until the machine is stopped to get all the tools and supplies needed? Collect all the tools while the machine is running so you don’t waste time once the machine has stopped.”

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Kevin Meyer is hosting Management Improvement Carnival #35 on the Evolving Excellence blog, some of the highlights include

• Hidden Problems from TPM Log.  "We must encourage people to speak up and identify problems. We must
  also develop avenues for people to do so in a comfortable manner."
• It’s the People, Not Just the Tools from Shmula.  “what most folks forget is that ‘Kaizen’ was truly build upon the philosophy that ‘Toyota builds people and then cars’ - that is, Kaizen came from the notion that the collective intelligence of your line workers is valuable and that people, if given the training and the
  chance, can truly do amazing things.”
• True Work, Apparent Work, and Busy Work from Gemba Panta Rei.  “True work is of course the small amount of work in any process which changes form, fit or function as the customer desires.”
• Innovation on the Edge from Edge Perspectives.  “Why bother about the edge when everyone knows that all the profit is in the core?”
• Why Do Employees Underperform? from the Lean Six Sigma Academy.  “Muri means to overburden equipment or operators.  In many cases, muri can be avoided by the implementation of some basic forms of standard work.”

Read past management carnivals.

Please submit your favorite management posts to the carnival. Read the previous management carnivals.

• Introduction to Factorial Designs by Jonathan Mendez - “I like the idea of velocity in marketing — test, learn, test, learn, test. Instead of one large test I prefer focusing attention on certain areas or elements to achieve deeper understanding.”
• MIT’s Message about Lean Enterprise Transformation by Mark Edmondson- “1. Market leaders are good at embracing enterprise change; 2. Enterprise change requires a holistic approach that engages all stakeholders. This includes employees, suppliers, customers, unions, and investors/owners”
• Two Types of Bottleneck by David J. Anderson - “I now teach that there are two types of bottleneck: capacity constrained resources CCRs; and non-instant availability resources”
• Oranges, Pebbles, and Sand by Ron Pereira - “In this video my daughters and I demonstrate how meeting an objective is just the beginning to improvement.”
• Why errorproof when you can double-check? - “If you are in the position to prevent the error in the first place, why wouldn’t you? And, I’d argue, if you can write a tool to detect the screw up - ie, it is possible to programmatically figure out that the template is wrong,”
• Systems and Improvement by John Dowd - “Thus did Deming, over sixty years ago, show a basic model about how to think about quality and improvement.”

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Shaun Sayers is hosting Management Improvement Carnival #33 on the Capable blog, some of the highlights include

• Lean and six sigma at Amazon (by Peter Abilla) a tiny peek inside the quality philosophy of this highly successful but intensely secretive corporate beast
• Thinking outside the wooden pallet (by Mark Wroblewski) a critical examination of the role traditional materials management methods on efficiency and work flow
• Lean six sigma for health care (by Sue Kozlowski) a short and timely guide to implementation of the methodology in the health care profession
• System design - make the right thing also the easiest thing (by Shaun Sayers) an examination of some key behavioural criteria for making system compliance much more likely

Read past management carnivals.

Please submit your favorite management posts to the carnival. Read the previous management carnivals.

• The Skipper & First Mate: A Pattern for Continual Progress by Jamie Dinkelacker - “An organization can only depend on individuals in critical chain processes when individuals are fungible — one can quickly take over for another with no interruption of the work flow. Moreover, it implies that there’s a pool of available developers, ready to step in, who themselves aren’t engaged in other priority activities. Software isn’t like that.”
• The evils of mass production by Kathleen Fasanella - “Really, I’d love to get feedback on what you think defines subassemblies and where you think batching is unavoidable. I don’t mean unavoidable in your particular situation, I mean over-all, assuming you had every resource at your disposal.”
• 10 Benefits of One Piece Flow by Ron Pereira - “we are better able to respond to last minutes changes from the customer. And everyone knows, no matter what industry you work in, customers love to change their mind.”
• Ask Why? - but How? by Mark Rosenthal - “Observe and gather information. Formulate possible hypotheses. For each reasonable possibility, determine what information would confirm or refute it… Observe, gather information, experiment. Get answers to those questions.”
• Improving Healthcare Delivery by Studying Toyota by Jon Miller - “As part of this they have taken hundreds of physicians and hospital administrators to Japan to learn kaizen on the shop floor. Their approach was radical surgery in the minds of some, but it has absolutely turned VMMC around in terms of profitability and speed of positive change.”
• If you can’t distort the data, just don’t look at it - “Just yesterday I ran into a baffling extension of distorting the data: if you have data which tells a bad story about your own organization, hide it!…I’m still seething that someone would turn a blind eye to a productivity problem for fear of how it might reflect on them.”

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Please submit your favorite management posts to the carnival. Read the previous management carnivals.

• Lean *is* About Quality, Folks by Mark Graban - “The two ideas are connected — improving flow (in itself) ends up improving quality and improving quality improves flow.”
• Statistical software is not six sigma by Rob Thompson - “With a good understanding of the process at hand, practitioners can solve many problems using statistical software. However, if there’s a lack of process knowledge, it’s hard to be sure of what’s going on in the process, or what the statistical analysis is revealing”
• Key Points for Managing Kaizen Idea Systems by Jon Miller - ” As a rule there should be 1) no suggestion box, 2) a simple suggestion form, and 3) team-based dialog to evaluate ideas.”
• Adjustment or Tampering? by John Dowd - “Deming called it tampering. It is the adjustment of of a stable process after each occurrence; treating every event as though it were special. It makes things worse.” (curious cat: tampering)
• The Importance of Heijunka by Mark Rosenthal - “Production leveling, however, is difficult, and the management has to have the fortitude to do it. Honestly, most don’t. They don’t like to deliberately set the necessary inventory and backlog buffers into place”
• Harmony and Toyota by Ron Pereira - “As we walked along the cat walk we were able to gain a birds eye view of the assembly operation. There was just so much to see… it was overwhelming.”
• A Good Layout is in the Details by Mike Wroblewski - “By focusing the majority of our effort on grasping the situation first, the action of moving was fairly uneventful. No firefighting, no frantic emergencies, no heroics and no customer disappointments.”

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Please submit your favorite management posts to the carnival. Read the previous management carnivals.

• How not to improve a process - “It is not enough to think you know what’s right for the process, if you don’t understand how the process works, then don’t play with it”
• A tour of a lean-inspired clinical laboratory by Ted Eytan - “In the design, which involved a labor-management partnership, the team elected to replace a million-dollar conveyer belt system with a $200 dollar cart to move specimens to the work area.”
• Should you hire specific experience, or the ability to learn and lead? by Kent Blumberg - “is the hiring process about what’s easy, or about making a great decision for the long term? I hope it’s about a great decision.”
• Toyota’s Value Innovation: The Art of Tension by Matthew May - “But the implied question for all of us to consider in light of the above is this: are resource constraints enabling or preventing innovation?”
• One Piece Flow versus Mass Production by Ron Pereira - webcast of the traditional “mass production” manufacturing technique square off against the lean “one piece flow” methodology
• Deming on leadership by Shaun Sayers - “We could therefore conclude that a system that is pock marked with such “work-arounds” is likely to be suffering from poor leadership. A tell tale symptom”
• Toyota’s Growth, Globalization, and Training by Mark Graban - “Toyota isn’t stuck in their own past, why should we be?”

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Mark Graban is hosting Management Improvement Carnival #29 on the Lean blog, some of the highlights include:

• Standard Work for Managers = Go to Gemba (Joe Ely, Learning About Lean) “Get to the workplace. Look. Listen.”
• Designing What’s Right for Customers (David Pogue, NY Times) “So what goes through the minds of executives who don’t sweat the small stuff?”
• Muda, Mura (and Muri) in Health Care (Mark Rosenthal, Lean Thinker Blog) “Key Point: Separate the routine from the non-routine. Separate normal from abnormal.”
• Explaining Lean at a Bar (Mark Graban, Lean Blog) “I asked [the bartender] how it would be if the ice were in the far corner of the bar, requiring lots of walking back and forth all day. She said that would be horrible.”
• JIT and Jidoka are Useless… (Ron Pereira, Lean Six Sigma Academy) “Yes, the two pillars of the Toyota Production System - JIT and Jidoka - are absolutely worthless… if you don’t respect people.”

Read the previous management carnivals.

Please submit your favorite management posts to the carnival. Read the previous management carnivals.

• Freedom = Success (And not the other way around) by Polly LaBarre - “we’re literally laboring under a myth (namely, time put in + physical presence + elbow grease = RESULTS). Our assumptions about how work works, where we work, and when we work are relics of the industrial age.”
• The Hidden Factory: Would the Customer Pay for That? by Peter Abilla - “most companies are glad that they do not have to reveal how their product or service is created, for fear of their inefficient processes and wasteful operations revealed to the customer.”
• We Need More Slogans! by Brian Tingley - “We used to have a slogan a year, sort of a focus on one issue. But now, we produce a new slogan every week. And what’s the result? We have a declining safety record.”
• Some Questions for Managers by Mark Graban - “Do you label those who speak up and identify problems (those asking for help) as trouble-makers?”
• Notes from the Book - Four Days with Dr Deming by Scott Hassler - “Special causes can be fixed by the people implementing the process via such things as training. Common causes need to be fixed by changing the process.”
• Data is like Art by Mike Wroblewski - “I just assumed once data is proven that the data becomes fact and everyone can move forward in agreement… Facts are facts, right? Not so fast, my friends. It is not that simple.”

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The Management Improvement Carnival #27 (Best of 2007) has been posted by Ron Pereira. Highlights include:

• 10 Common Misconceptions About Lean Manufacturing: 1. Lean production = volume production. In Taiichi Ohno’s Workplace Management he suggested that the Toyota system was ideally suited for low volume production, and not as well suited for the higher volume production…
• L.A.M.E. = Lean As Misguidedly Executed: We need a phrase that describes these “bad” or misguided attempts at Lean, things that give Lean a bad name. How about: LAME: “Lean” As Misguidedly Executed.
• Reacting to Visual Cues: The Toyota Production System makes effective use of visual cues to mark location in time and space, boundaries, and to answer the question “How am I doing” in a production setting.
• Dabbawallas, UPS, and FedEx: Mumbai residents rely on an intricately organized, labor-intensive operation that puts some automated high-tech systems to shame.

Please submit your favorite management posts to the carnival. Read the previous management carnivals.

• Lean and waiting by Aza Badurdeen - “Carefully mapping and identifying the value stream will make it possible to identify wastes in the office (or in your service). When these are identified we can remove these wastes from the system.”
• Happy Employees Create Value by Kevin Meyer - People have creativity, knowledge, experience, and ideas that can create value that doesn’t land on a traditional P&L. Hotelier Joie de Vivre does understand that oft-hidden but still real value.
• Everything You Will Ever Need To Know About Business - “Also included is a personal note: ‘I’ve included an additional FREE book by the same author. Thanks for your order.’ I smile.
• Womack on Respect for People by Mark Graban - “For anyone who thought ‘respect for people’ meant ‘being nice all the time,’ I hope Jim’s letter helps clarify the true difference.” (Curious Cat on respect for people circa 2006)
• Ten Things Our Sensei Told Us by Kiki Risyandi - “Lean is about managing the value that your deliver to your customers so that all the elements of delivering that value work together in a seamless, coordinated fashion and driving through the organization horizontally instead of vertically.”
• Sports ‘randomination’? by Mark J. Anderson - “From the knowledge gained from this experiment and other strategic moves, our team of techies went on to win our Class D league the following season.”

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Carnival of Human Resources #23 by Ann Bares:

Related: posts on performance appraisal - The Joy of Work - Hiring the Right Workers - Stop Demotivating Employees

Please submit your favorite management posts to the carnival. Read the previous management carnivals.

• Some theoretical thinking by John Dowd - “Deming was fond of saying, ‘management is prediction‘ and, in this, I think he was exactly right. Management never takes action or makes decision to affect what happened yesterday, but rather to bring about what is hoped to be a desirable outcome tomorrow.”
• TPM Excellence: Visual Equipment Management by Mike Gardner - Visual aids must be clear to be useful, but they do not have to be fancy. You can see this gauge was effectively marked with a red marker–effective and cheap.
• A3–Its about the Thinking by Lee Fried - “the A3 is a tool and without the process and thinking behind it nothing really changes.”
• Lean Enterprise Rules of Three by Jon Miller “Like any good system of continuous improvement, Lean should be used to nurture people, profit and the planet (let’s expand our thinking off-planet after we confirm that our impact beyond it is significant). This is sometimes called the ‘triple bottom line.’”
• Why Sham Employee Participation Is Worse Than No Participation at All by Bob Sutton - “Hire the least expensive and least disruptive consultant you can find; if you aren’t going to listen to them anyway, you might as well waste as little money and time as possible.”
• Meeting Rules by David Maister - “1) Do not call meetings when some other form of information sharing is possible. 2) Since most people can read ten times faster than a presenter can speak, send material ahead. 3) Meetings need to have concrete goals” (previous curiouscat post: Most Meetings are Muda)
• Poppendieck: Should Lean be top-down or bottom-up? by Peter Abilla - “At its heart, Lean is a management philosophy based on deep respect for people and relentless elimination of waste from the delivery of value to customers to return sustainable prosperity for the organization.”
• No Standards No Kaizen by Ron Pereira - “Once you have the steps documented ask someone who does the same or similar job to review the steps to see if they agree with them. If they don’t, and many times they won’t, discuss it with them and see if you can mutually agree on the best way to do this task.”

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Please submit your favorite management posts to the carnival. Read the previous management carnivals.

• Is it Scrum or Lean? by Jeff Sutherland - “A thoughtful analysis of the relationship between complex adaptive systems and Lean will show that both Scrum and Lean are instantiations of complex adaptive systems theory.”
• Deming’s Inconvenient Truth by Shaun Sayers - “Deming actually believed that a lot of important management information is not only unknown, but also unknowable.” (See Curious Cat on: “most important figures that one needs for management are unknown or unknowable”
• Clothing manufacturer Fit Couture trip reports by Susanna Tisa - “To envision that these multiple SKU, complex products were being made on demand from website orders with a quick turnaround was mind-boggling.”
• Five Questions to Ask When You Hear “We’re too busy for Lean” by Jon Miller - “If the manager is already in a constant fire-fighting mode, asking them to take on yet another project in the promise that it will make their life easier is like asking for spiritual enlightenment by reading a book.”
• How Often Must the Same Mistake Be Repeated? by Mark Graban - “Wow, that is one hell of a systemic problem. It’s not as simple as one nurse being careless one time if the Quaid twins were overdosed TWICE and it happened with other patients.”
• The Lean Approach to Email Management: It’s Not About Technology by Dan Markovitz - “To paraphrase Kevin Meyer, it doesn’t pay to worship the false god of the technological solution. Attack the problem at the root, rather than trying to apply some sort of electronic panacea to a fundamentally broken system. That’s lean thinking. And it works.”

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Please submit your favorite management posts to the carnival. Read the previous management carnivals.

• Assessing Results vs. Reflection by Mark Rosenthal - “Your plan for the year consisted of a designed experiment. ‘If we do these things, we expect this results.’ Then do that thing, and check that you actually did it. Compare your actual result with the expected result. Explain any difference. Learn.” - This process is key to improving, see my previous post: Predicting Improves Learning John
• Leadership and Systems Thinking by George Reed - “Success in the contemporary operating environment requires different ways of thinking about problems and organizations…It is insufficient and often counterproductive for leaders merely to act as good cogs in the machine.”
• “Heightened Vigilance” is Not Enough by Mark Graban - “Instead, we blame, we punish, and we say “be careful.” No wonder we have such problems. Being careful helps, but it is not enough.”
• Top 10 Problems with Problem Statements by Jon Miller - “1. Assign a cause 2. Contain the solution 3. Are based on conjecture or belief rather than fact 4. Are too long”
• Root Cause Customer Service by Kevin Meyer - “Why are customers calling? What is wrong with the design, quality, intuitiveness, or use of the product that creates problems? With few exceptions, having to answer a call from a customer is a band-aid on a problem.”

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Please submit your favorite management posts to the carnival. Read the previous management carnivals.

• How Many People Did You Cut? by Mike Wroblewski - “As lean thinkers, we should focus on our growth strategy. With a growth strategy, we reassign people from kaizen to perform other tasks that add value to our customer.” (this is so important - lean companies do not have layoffs, companies lead by poor mangers do- John)
• Do You Understand the System of Profound Knowledge? by Jon Miller - “People will perform as well or as poorly as the system will allow them to, and this is a major reason that why-based problem solving organizations will increasingly trump who-based problem solving organizations.”
• Deployment Strategy and Knowledge Exchange by Matt LeVeque - “The cultural benefit to applying a catchball mentality is that by keeping everyone on the team engaged in the process and the ideas flowing freely between online marketing channels, you begin to develop a learning organization”
• Lean Transport: Buses vs. Light Rail by Dan Markovitz - “30% fewer cars? Less traffic? Fast, cheap, mass transit? Public money freed up for other, more productive uses? Sounds lean to me.”
• “Packaging” is spelled M-U-D-A by Mark Rosenthal - “In other words, set up a barrier that contains the waste so that your value-adding operation sees the result of a perfect supplier.”

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