What Nukes – a little more clear.

I re-read my “What Nukes?” post and realized I was really rambling. I want to reiterate a key point more clearly because I think it is important.

In the “Bad Apple” theory there is an implied assumption that the cause of an accident or other problem was one person who, at that moment in time, was not following the documented rules or procedures.

Except in the most egregious cases, such as deliberate misconduct, that is likely not the case. Most organizations have a set of “norms” that operate at some level of violation of the written or established procedures. The reasons for this are many, but usually it is because good people are doing the best they can, in the conditions they are given, to get the job done.

Failure to follow the rules does not result in an accident or incident.

Have you every run a red light or a stop sign? It happens thousands of times every day. It almost never results in an accident. Only when other contributing conditions are ripe will an accident result. Running a stop sign AND a car coming through the intersection.

The same goes for quality checks, and the more reliable an “almost 100%” process becomes, the more vulnerable you are. If a defect is only rarely produced, it is unlikely that any kind of human-based inspection will catch it. The faster the work cycle, the more this is true. The mind numbs, it is impossible to always pay attention to the detail, and the mind sees what it expects. “Failure to pay attention” is never an adequate root cause. It is blaming an unlucky Team Member for an omission that everyone makes every day just going through life. It is just, in this case, “there was a car coming through the intersection.” It is bad luck. It is being blamed for red beads in Deming’s paddle experiment.

So attaching the failure of an individual, while it is easy, avoids the core issue:

People’s failure in critical processes is a SYSTEM PROBLEM. You must investigate from the viewpoint of the person at the pointy end. What did he see? What did he perceive? What did he believe was happening and why was that belief reasonable given his interpretation of the circumstances at the time.

The post about “sticky visual controls” got to this. Your mistake-alerts or problem signals must penetrate conciousness and demand attention if they do not actually shut down the process.

Waste

I guess four months into this, it kind of makes sense to talk about waste. But rather than repeat what everyone else says, maybe I can contribute to the dialog and toss out some things to think about.

Identifying / Seeing Waste.

Taiichi Ohno had 7 wastes, a few publications say 7+1. I have always disliked trying to put “types of waste” into buckets. I have seen long discussions, some of them fairly heated, about which list of wastes is “correct” and whether this waste or that waste should be included, or whether it is included in another one. None of this passes the “So What?” test. (A related military acronym is DILLIGAS, but I’ll leave it as an exercise for the reader to work out what it means.)

The problem, as I see it, with lists of categories isn’t the categories themselves. It is that we teach people using the categories. We make people memorize the categories. We create clever mnemonics like TIMWOOD and CLOSEDMITT. We send them on waste safari with cameras to collect “examples” of various types of waste. Well.. you can’t take a photo of overproduction because it is a verb. You can only photograph the result – excess inventory. So which is it? People end up in theological discussions that serve no purpose.

Like I mentioned in an earlier post, teach it by inverting the problem. The thing people need to understand is this: Anything that is not adding value is waste. If you understand what value is, then waste is easy to see. It is anything else. What category of waste is that? Who cares. That only matters when you are working on a countermeasure.

What about “necessary waste?” Even Ohno concedes there is some of that. OK – ask “does this work directly enable a task that does add value?” Then it is probably necessary – for now.

Let’s take a real-world example from my little corner of the world – welding. Welding is pretty easy. If there is an arc, it is very likely value is being added. Not always, but it is a good place to start. Now – watch a welder. What does he do when he is not “burning wire?” (the phrase “and producing a quality weld” has to be tacked onto the end of this because I can burn wire, but it doesn’t mean I am welding.)

What stops the welder from welding? When, and why, does he have to put down the gun and do something else? For that matter, what makes him let go of the trigger and stop the arc? Is he loading parts into the jig? Does he have to jiggle those parts into place? Does he have to adjust the jig?

Special Types of Waste

In spite of what I said above, there are two types of waste that merit special attention. Most everyone who can spell “J-I-T” knows that overproduction is one of them. I won’t go into it here – anyone who is reading this probably already gets that at some level. If I am wrong about that, leave a comment and I’ll expand.

The other is the “waste of waiting.” Of all of the categories, overproduction is clearly the worst, but the waste of waiting is the best. Why?

It is the only type of waste that can be translated directly into productivity. It is the waste you are creating as you are using kaizen to remove the others. That is because all of your kaizen is focused on saving time and time savings, in the short term, turn busy people into idle people.

Let me cite some examples:

  • The Team Member is overproducing. You put in a control mechanism to stop it. Now the team member must wait for the signal or work cycle to start again before resuming work.
  • You remove excess conveyance by moving operations closer together. The person doing the conveyance now has less to do. He is idle part of the time where he was busy.
  • Defects and rework – eliminate those and there is less to do. More idle people.
  • Overprocessing – eliminate that, less to do.
  • Materials – somebody has to bring those excess materials. Somebody has to count them, transport them, weigh them. Somebody has to dispose of the scrap.
  • Inconsistent work or disruptions: Eliminate those and people are done early more often than they were. More idle time.

If you look at a load chart, these are all things which push the cycle times down. You have converted the other wastes to the waste of waiting.

Now your challenge is how to convert that wait time to productivity. What you do depends on your circumstance. You can drop the takt time and increase output with the same people. Or you can to a major re-balance and free up people – do the same with fewer, and divert those resources to something productive elsewhere.

Does something stop you from doing that? Do you have two half-high bars that you can’t combine onto one person? Start asking “Why?” and you have your next kaizen project. Maybe you have to move those processes closer together, or untie a worker from a machine.

Summary:

  • Don’t worry too much about teaching categories of waste. Teach people to see what is truly value-adding, and to realize everything else is waste – something to streamline or eliminate.
  • In most cases your kaizen activity will result in more waste of waiting. This is good because wait-time is the only waste that converts directly to increased productivity.

Invert the Problem

One very good idea-creation tool is “inverting the problem” – developing ideas on how to cause the effect you are trying to prevent. This is a common approach for developing mistake-proofing, but I just saw a great use of the idea for general teaching.

Ask “How could we make this operation take as long as possible?” Then collect ideas from the team. Everything on the flip chart will be some form of waste that you are trying to avoid. In many cases, I think, even the most resistant minds would concede that nothing on this list is something we would do on purpose.

It follows, then, that if we see we are doing it that we ought to try to stop doing it. And that is what kaizen is all about.

Kaizen Events – Why and Why Not… continued

The other day I wrote about the situations where I felt a 5 day kaizen event was actually useful. I want to add one more.. sort of. Actually I want to elaborate on “education.”

Sometimes in the early stages of an implementation, there are influential people who need to be won over. Now for those who are cynical, there is not a lot of hope of that, at least not now. But for the people who are honest skeptics – meaning they will take in what information they have and assess it – those first few kaizen activities can have a high emotional impact.

Here is where you, the change agent, have an opportunity to make this “sticky.” Back in August I wrote a couple of posts that suggested that deliberately applying the elements of “stickiness” outlined in the excellent book “Made To Stick” would go a long way in building and sustaining an initial momentum. An initial kaizen event that is specifically structured to be high-impact can go a long way to do that.

In this special case you are producing a “reality show.” You are building a structure and a situation that will give your participants a specific experience. You want to create the six elements of “stickiness” that are covered in the book.

Simple. You want to send a simple and direct core message, a take-away, that everyone involved will be able to relate to. They have to understand experience just how much waste (and therefore opportunity) exists in the operation. They have to experience for themselves the power of engaging the people who do the work, of seeing for themselves, living in the conditions that exist in the work area every day. They need to experience the drag that is put on effective operations by all of the short-sighted decisions that are made every day.

Unexpected. You want to structure this kaizen event so that there is a big change in the performance of the operation, preferably in a way that was thought to be impossible. The highest-impact thing you can do is to create flow across several previously isolated process islands. This will typically crash inventory levels by one, and sometimes two, orders of magnitude, with a relative increase in velocity.

Concreteness. Same as above, actually. By participating directly in something that produces tangible, and real, results they immediately begin to learn application vs. academic theory.

Credibility. Again – direct participation in seeing the problems, clearing and solving those problems, brings credibility to the message – that a dramatic performance improvement is something we can do if we just pay attention to the right things.

Emotions. The purpose of the report-out at the end of these events is to allow the team that did the work to get.. and take.. credit for what they did. The report-out also emotionally engages the team in their work and their results.

Stories. If it is done well, the experience starts to be shared. People inevitably talk about the improvements they made, and how they solved this or that problem. People love to solve problems, and they like to talk about what they have done and what they learned in the process. When the General Manager starts telling these stories from her personal experience, people tend to pay attention. Hopefully they begin to say: “I’ll have what she’s having.”

Training – Critical Questions To Ask

There is lots of “Lean Training” out there, and the quality ranges across the board.

“Lean training” is a megabucks business, and anyone who can assemble a pack of PowerPoint slides and a web site is offering “lean training” out there. It is certainly a case for buyer-beware. So how do you evaluate all of the alternatives, especially if you are just learning and might not be in a position to judge? (Irony: If you are in a position to critically judge these training programs, you probably don’t need them.)

What is being taught and how?
In my experience, most people will readily agree that the tools and artifacts usually associated with the Toyota Production System or Lean Manufacturing are not the system itself. Rather, it is critical for people (and especially leaders at all levels) to understand the thinking behind the tools and artifacts.

The way Toyota teaches the thinking in their new plants is through structured experience. Key leaders are assigned coordinators as mentors. Leaders are taken to established plants to immerse into the system itself. The mentoring continues as the new plant is brought on-line. The process is long, resource intense and expensive. As a result the people who were trained this way are highly sought after in industry. (Another story for the future sometime.) Steven Spear’s article, “Learning to Lead at Toyota” does a great job giving the reader a feel for how this is done. The learning process is entirely experiential.

On the other hand, “talking head lecture” and PowerPoint slides are probably the least effective way to teach this stuff. Even with a couple of simulations with toy trucks or Legos, a classroom-only exercise is only going to get the general concepts across.

If you accept that the real learning comes from guided experience, then it follows to ask if the time spent in the classroom reduces the time required for experiential learning by at least as much. If a week in the classroom (plus the travel time, etc. away from the job) does not return at least two weeks of reduction in the hands-on learning, then it isn’t worth it… no matter how “feel good” it is.

What is the emphasis on direct observation of actual problems? One of the core skills for leaders to learn is how to see problems. If you ask “How much time is spent to watch and understand the work?” the answer you get will tell you a great deal about how well the trainer actually understands the TPS. A high-pressure “kaizen event” especially one which emphasizes just-do-something over first understanding the actual situation – is going to teach exactly the wrong things. Action without understanding results in chaos.

How much of the training involves making actual improvements to actual work? The more the better, but only in the context above.

The classic 5 day kaizen event was originally an educational exercise, and it works very well for this if it is planned and led with learning in mind.

What is the reputation of the teachers? Disregard client testimonials. Ask to speak to some long-term customers. I say long-term because in the initial stages of lean implementation things are pretty easy. A typical medium-sized factory, for example, can get most of the mechanics into place over a few months with aggressive leadership. But if the teachers do not understand (or understand and do not teach) the leadership how to detect, escalate and solve the thousands of problems that will inevitably be flushed to the surface, the implementation cannot sustain for long.

Recognize Reality: The only way to really lean this stuff is to through experience. And not just any experience. Just being told how to implement kanban, fill out the standard work forms, take cycle times, etc. is not learning the things you must know to sustain your gains and build on the initial momentum.

The critical skill – the one that (so far) is only learned through mentored experience – is how to direct actions through guidance and teaching vs. just telling people what to do or how to do it.

What Is Your Takt Time?

If you are the “lean manufacturing expert” you probably know. But what answer do you get if you ask the question in the work area?

Here is a quick diagnostic for you: Go to the shop floor and ask a supervisor, “What is your takt time?”

A reply of “Huh?” is pretty self-explanatory. Either the entire concept hasn’t reached this area yet, or if it has, the day to day variation and disruption renders the concept moot. A couple of follow-up questions can quickly discriminate.

A common reply is the daily output number (e.g. “14 units a day”). Although this shows understanding of a daily production requirement, “14 units a day” does not necessarily translate to “7 units before lunch” much less “a unit every 30 minutes.” This Team Member is still thinking in terms of total output, even if every unit has to be reworked in the last hour of the day. Obviously this is better than reworking every unit in the last week of the month though.

I have also had Team Members do the calculation in their head. They know how to calculate takt time, but don’t use it. This is pretty common when takt time is something that is only a factor during formal kaizen “events” that are run by someone other than the supervisor. I would imagine that standard work is also something that is a “kaizen event thing” rather than daily management as well.

Ideally though, anyone on your shop floor has the takt time embedded in their thinking. If the immediate reply is “28 minutes” then the follow-up question is “how are you doing?” At this point, you can begin exploring how well they use the takt time to manage variation and problems.

What is your takt time?

Getting A Plant Tour

A couple of days ago I wrote about how to host a tour. Here are some thoughts on how to get one. As always, I’d love to hear your comments and experiences.

Don’t expect your hosts to change your “cement heads.” I have had requests from groups who wanted to send their “resistant managers” to our factory so we can show them things that will change their minds. Doesn’t work. Sorry, that is your job. My experience is that people who don’t want to see the benefits will always find all of the things that are “unique” about their circumstance, and special case reasons why the other place is doing so much better.

Go to learn, not to look. In my last post I made reference to “industrial tourists.” Those are groups that are more interested in the layout and clever gizmos than in the thinking behind them. They are, at best, looking for ideas and technical solutions to their problems. Copying others’ solutions is not thinking.

Going to learn is a different attitude. When you look at a layout, or other technical solution, ask yourself this: “What problem does that solve?” How does it save time? How does it remove variation from the process? What did the operation look like before they did that? Force yourself to think in four dimensions. Not just what you see now, but what it would have looked like in the past. WHY did they do this?

Although many people think lean manufacturing is counter-intuitive, I think that with this line of thinking you will find it actually is just common-sense solutions to the problems that everyone has, every day.

Nobody is perfect. Even a Toyota plant has obvious issues. If you end up fault-finding, you will miss the good stuff. I was touring a Toyota plant with a group a couple of years ago and it had obviously slipped. This is old news, and one of the reasons for their internal back-to-basics approach. But two things came to light: The rich visual controls made it easy for total strangers on the 1 hour tour to SEE the difference between “what should be” and “what is.” Wow. Try that in YOUR factory. And, reading the news stories, it was a problem they were taking very seriously and doing something about it vs. not noticing the deterioration and just letting things go.

Every plant has issues. Some have great material flow and pull systems, but only average problem solving. Others have a great technical base for home-grown tools, fixtures and machines. A few have great problem solving (They seem to be doing better than others.) Take in what is working, and what is holding them back. What would be the next problem they are working on?

Pay attention to the people. People are the system. How do they interact with the physical artifacts (layout, machines, etc.) An operation that has their stuff together will have people who are obviously comfortable with the pace of work. It will be obvious they get support when there are problems.

Don’t ask too many questions. What? Aren’t you there to learn? Yes. But try to learn with your eyes first. Even if you are moving, “stand in the chalk circle” and see the problems and the solutions. Sharpen your observation skills before you take the tour. Practice in your own plant. When I am hosting visitors and we have the time, my response to a question is to show them where to look for their answer, then ask them what they saw.

If allowed, make sketches. Most operations will have a prohibition against photographs. Even if they allow photos, however, you will capture much more if you stand and sketch what you see. You don’t have to produce a work of art. The purpose is to force your eye to pay attention to the small details. You will see much more through the eyes of the artist than you will through a camera.

Remember they are in the business of production, not consulting.
“Be a good guest” and remember that everybody there has a real job.

Edit 5 Sept: And Jon Miller correctly pointed out something I missed:

Give Back. You will bring “fresh eyes” to their environment and see things they do not. Everyone suffers from a degree of blindness to the familiar. If you are really going to see and learn, you will gain insights that can help your hosts in their own improvements. Ask them the questions that will help them see what you see.

Giving A Plant Tour

When one of my operations at “a previous company” started to really show some results, they began to get a lot of requests for tours from other groups. Obviously they are not in the business of giving tours, and these requests were beginning to impact on their time. Here are some guidelines I gave them based on my experience at the previous, previous company. 😉

Separate the groups who are really interested in learning from the “industrial tourists.” This is easy to do. At the first email or phone contact simply ask them “What do you want to learn about?” People who are serious about learning will have something specific. If they say “Everything” you probably have industrial tourists – a group that wants to see, but not study.

Develop a standard 1 hour tour with a script and teach all of your supervisors to give it. When industrial tourists show up, give them the 1 hour tour send them on their way, and they will leave happy and excited.

What about the others? The ones who aren’t industrial tourists?

Turn them over to your very best kaizen leader. Spend as much time with them as you possibly can. Customize the time to meet their learning objectives. Confirm what you plan to do with them, and verify that is likely to work for them. While they are there, check continuously. Make sure all of their questions are answered, even the ones you had wished they didn’t ask. Better yet, show them what chalk circle to stand in so they can see the answers for themselves.

Why do all of this? Because these are people who are trying to learn, just like you. Your leaders have everything to gain through interacting with a truly curious group. They will ask questions you haven’t thought of. They will see things that, due to your daily familiarity, you have overlooked. And most importantly, you will work to build the community and extend the spirit of learning to one more organization.

Hopefully they will remember the experience and do the same thing when someone asks to come and study them.

Standards Protect the Team Members

One of my kaizen-specialists-in-training just came to me asking for help. The Team Members he is working with are not seeing the need to understand sources of work variation.

I hear that a lot, both in companies I have worked in and in the online forums. Everyone seems to think it is a problem in their company, their culture – that they are unique with this problem.

The idea of a unique problem is variation on the “our process / environment / product is different so ____ won’t work here.” Someday I will make a list of the standard management “reasons why not” but that isn’t the topic of this post.

I told him:

  1. This is not unique to China, or to this facility. The same resistance a always comes up, and nearly always comes up the same way once the Team Members begin to realize we are serious.
  2. There is no way to just change people’s minds all at once.

Here is something to explain to the concerned Team Members: The standard process is there to protect the team member. If there is a problem, and the standard process was followed, then the only focus for investigation can be where the process itself broke down. Countermeasures are focused on improving the strength of the process.

If, on the other hand, the process was not followed (or if there is no process), then the team member is vulnerable. Instead of the “Five Why’s” the investigation usually starts with the “Five Who’s” – who did it? Countermeasures focus on the individual who happened to be doing the work when the process failure occurred.

As you introduce the concept of standard work into an area that is not used to it, it is probably futile to try to tighten down everything at once. The good news is that you really don’t have to.

Start with the key things that must be done a certain way to preserve safety and quality. If they are explained well and mistake-proofed well, there is usually little disagreement that these things are important.

The next step is to make it clear that the above are totally mandatory. If anything gets in the way of doing those operations exactly as specified, then STOP. Do not just work around the problem, because doing so makes you (the Team Member) vulnerable to the Five Who’s inquisition.

If you focus here for a while, you will start to get more consistent execution leading to more consistent output, which is what you want anyway.

Then start looking at consistent delivery and all of a sudden the concept of variation in time comes into play. Why was this late? The welder ran out of wire, I had to go get some more, I couldn’t find the guy with the key to the locker…… Go work on that. At each step you must establish that the point of all of this is to build a system that responds to the needs of the people doing the work.

The 3 Elements of “Safety First”

When we talk about safety, most people consider the context of accidents and injuries. But if we are to achieve a true continuous improvement environment, where everyone fully participates, we have to consider more.

A good way to sum it up is with three elements that all start with ‘P.’

1) Physical Safety

This is what most people think of when we say “safety is the most important thing.” But, aside from the moral, legal and financial imperatives, what are some other reasons why physical safety is important?

Simple. We want our Team Members 100% engaged in performing their work and improving it. We do not want any of their precious mental bandwidth consumed by worrying about whether or not they will get hurt.

This is a far cry from the “blame the victim” approach I have seen. Root Cause of Accident: Team Member failed to pay attention. Countermeasure: Team Member given written warning.”

A few years ago I was painting my house. I will tell you right now that I am not fond of ladders. (Go figure, I spent three years in the 82nd Airborne, you’d think I would be over it.) There I was up near the top of an extension ladder painting the eaves of the roof. I can tell you that I was paying a lot more attention to staying on the ladder than to where the paint was going. The quality of the job suffered, for sure.

The truth is that a physically safe environment is more, not less, productive. Ergonomically bad motions take more time than good ones. Well designed fail-safe’s and guards prevent quality issues and rework. An even, sustainable pace of work reduces disruptions upstream and downstream. Good lighting lets people catch quality issues and mistakes sooner. Reduced noise levels foster communication. High noise isolates people in invisible bubbles.

2) Psychological Safety

Can your Team Members freely share problems and ideas free of concern for ridicule or rejection by their co-workers? Or is it safer for them to keep to themselves? Do you know who the natural leaders are? Do you know who the influencers are? Do you know who the bullies are? Do you know which line leaders people are afraid of? Which co-workers? Don’t kid yourself, it is only the truly exceptional team that does not have these issues. And most teams that move past these issues become truly exceptional. It is something called “trust” but that is just another way of saying “feeling safe being vulnerable.”

3) Professional Safety

This is a deceptively simple concept. The Team Member is not put in fear (real or implied) of losing his job for doing what is expected of him. That sounds so simple. The really obvious example is the Team Member being asked to contribute to saving cycle time (and therefore, labor) when he knows unnecessary people lose their jobs. But it goes further.

How often do we expect, by implication, people to short-cut The Rules in order to get something done more quickly? Sidney Dekker has authored a number of books and publications focusing on human error as the cause of accidents. One of his key points is that within any organization there are The Rules, and a slightly (sometimes greatly) lower standard of the norms – the way people routinely do things. The norms are established by the day-to-day interactions and the real and implied expectations placed on people to get the job done.

Well meaning Team Members, just trying to meet the real or perceived pressures of everyday work take shortcuts. They do it because they feel they must in order to avoid some kind of negative consequence.

At this point you can hopefully see that these three elements blur together. The work environment and culture play as much a part in a safe work place as the machine guards and safety glasses.

All of these things, together, set the tone for the other things you say are “important” such as following the quality checks (when there is no time built in to the work cycle to do so), and calling out problems (when halting the line means everybody has to work overtime).

One more point – everything that applies to safety also applies to quality. The causes of problems in both are the same, as are the preventions and countermeasures. Do you use the same problem solving approach in both contexts? More about simplifying your standards sometime in the future.