You need to "See" to make change . . .

Someone asked me the other day would I hire someone with a TPS background who had worked in a Japanese owned company for 12 years, or would I pick someone with Lean or Six Sigma certification.  My quick response: I would hire a person with a TPS background and only 5 years experience working at a Japanese owned company over anybody.

Now, I am not knocking certification.  I have several degrees myself that I obtained late in life, and this person has an MBA I believe.  A formal education combined with TPS experience should put you at the top of the list in my book.  However when you are out job hunting or looking to change career paths, it is very challenging trying to understand all the why’s and what fore’s a potential employer may look down on someone that is not certified in Lean or Six Sigma.

For me the basic traits to hire a Lean engineering type person (and this may count for other professions as well):

• Communication
• Problem Solving with any PDSA format
• Understanding Value
• Being a Change Agent never accepting status quo
• Seeing with “New Eyes”
• And understanding the closer a person is to the customer, meaning the people touching the product creating the value, the more they are your true internal customer, and that the further you are away from the customer, the more you are there to serve.

People from a TPS environment, whether absorbed through osmoses or hands on application, learn to see waste in the value stream.  Bottlenecks jump out at them.  They treat Kanban as a necessary evil because one-piece-flow has not yet been figured out.  They see a problem from the visual factory and resolve it.

The dissatisfaction I have with Lean/Six Sigma is the project time.  TPS is incremental improvements, looking for and eliminating waste.  People in TPS are not fearful of pilot studying what might happen if you remove one level in the Kanban (with predicted outcome - not tampering) in a moments notice, so you can observe interruptions to the flow, the process, the value stream, and either correct them on the spot, or put the Kanban level back until you have a fix.  Value added is still value added.  It does not add up any other way.  You add to the bottom line when you focus on eliminating waste and leaving the value.  Consider it a law of nature.  Or can I call this the "Law of Wes"?

This is not to take away from a Lean or Six Sigma certification.  I am an ASQ Certified Six Sigma Green Belt and want to become proficient as a Master Black Belt.  I find many of the tools beneficial.  However, I find TPS gets the job done quicker and with, in my opinion, greater customer satisfaction and bottom line return.  “I’ll gladly pay you Tuesday for a hamburger today”, as Wimpy would say.  People holding the money do not want to wait for tomorrow.  Nor does TPS.

Case in point:  A heart failure hospital had asked me to help them with their outpatient department. This facility embraces Six Sigma, as they should.  I have to step back for the moment and say there is a push to reduce the number of patients readmitting within 30 days of discharge.  The medical insurance industry is driving this.  Think of this as the insurance industry looking for a warranty. If it breaks within 30 days, you fix it for free.  So the hospital had a Six Sigma team that included a Black Belt heading the project as to why patients were readmitting for heart failure within 30 days after discharge.

Here was the interesting part.  The Six Sigma team consisted of all the department heads or head nurses.  They were all on a mission to collect all the data on patients to look for a correlation to the re-admittance within 30 days.  Let us just keep this short in that they were following the DMAIC process and it was taking time.  I was invited to one of their meetings several weeks after I had made some observations of the outpatient department.  After hearing all this discussion I had to ask, “Are you telling me the patient symptoms were not managed at the time of discharge?”  Something to that affect anyway.  I knew this was not the case however I wanted them to stop and listen to what they were saying and how it related to the problem they were trying to solve. Nobody got the hint.  There focus should have not been on their process with respect to managing symptoms if they truly believed the patient was being discharged correctly.  It should have been what was taking place between discharge and readmitting within 30 days.

After those few weeks, before I attended the Six Sigma meeting, I realized there was a huge lack of customer focus.  Everyone in the system was satisfying the system, but doing nothing to change the patient’s outcome or experience after discharge.  When the patient was readmitted, the patient was just put back through the process again.  The bottom line was the patient not being compliant with their own healthcare after discharge.  A lot of it being enablers you and I would tend to surround ourselves with when we are not feeling well, meaning family, friends, perhaps a different doctor.

This sort of gets back to my “Poka-Yoke or Not to Poka-Yoke” blog.  We see so many ads on television for medication, weight loss, and whatever else is out there relating to personal health, that we tend to not believe the information because it never seems to work.  We believe we know better.  So we ignore the information given to us and move on.  (Obviously much of the ads on television we do need to ignore.)

The biggest example was the outpatients who kept coming in after having a high sodium meal, drinking lots of water in the belief it would flush out the sodium.  Not true.  The actual result is much more stress on your heart because of fluid retention caused by the sodium, hence the requirement for heart failure for a low sodium diet and restricted fluid intake.  For the normal public this is against what we believe we know.  Hence the patient does not follow it, and with the support of their enablers.

Trying to make a long story short, the department and I developed a patient quiz.  This quiz asked the questions that would be asked during the outpatient visit.  It was also what they need to be doing at home for themselves.  It gave the patient time to reflect on the truth and the nurse to understand what the patient was not doing.  The focus was put back on the patient, not the system, with the intent to change the patient’s outcome and experience.  As we tracked the grades on the white board for all to see, the grades improved along with the patient’s outcome of managed health.  The patients that would typically readmit seemed to reduce. (The department closed so I could not collect the data to give you a percent change.)

The Six Sigma team was still doing their thing, evaluating their internal process, not making a connection to our findings in outpatient, and when they heard we developed and started a quiz they were a bit upset because they wanted us to hold off on all of our improvements for a roll out later, when their Six Sigma project was ready.  Hmm, what was wrong with that picture?

So, yes I would hire a TPS person that has at least breathed the air even in a 5 year period, over most of the certified people out there.  If for nothing else, a TPS experience allows them to “see” and make immediate change.