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Paying the Bills vs. Dealing with the Costs

House Dems want to tax the rich for health care – Yahoo! News

The health care debate in the USA is increasingly focused on how to pay (meaning who will pay) to operate a dysfunctional system with costs out of control.

I fully acknowledge that in government circles, this is about the only thing they can address.

But the real question is not “How do we pay?” but “Why does it cost so much?”

The care delivery system itself is error prone, dangerous for the patients (and psychologically dangerous for the providers). The net effect is much of the effort of the dedicated, but overworked, staff is siphoned off to deal with problems and chaos that shouldn’t be there in the first place. But there is no system in place, at least not in any operation I have ever see (including some claiming to be “lean”) that systematically detects, responds, corrects, and solves those thousands of little issues that occur every day. People seem too focused on the “big stuff” that creates lots of press.

The financial system is worse. The processing of payments and claims is inefficient (which is a kind word), error prone, chaotic, unresponsive to issues and problems, and treats the patients as though deciphering the “THIS IS NOT A BILL” statements is the only thing they have to do.

Honestly, I don’t have any ideas here. I just see that we are in a political quagmire debating how to pay for a system that shouldn’t be costing half of what it does… and it isn’t about controlling over payments or sharpening pencils on the billing.

What if one major HMO actually “got it” and became the Toyota of health care. Any takers?

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Dennis Goethals, Learning and Leading at DesignOnStock Furniture

During my visit to The Netherlands, I had the pleasure to spend a couple of hours with Dennis Goethals, Managing Director and CEO of DesignOnStock, a furniture manufacturer in Tilburg, The Netherlands. What I saw and heard were all of the critical elements I have seen in organizations that pull this off in a spectacular fashion.

It starts, as always, with leadership. DesignOnStock, like every other success story I have experienced, has a leader who dedicated to his personal learning and understanding – at a level way beyond the common, but hollow, statements of “committed.” He is down on his shop floor, exploring the flow, looking for the next problem, and working the organization through a solution.

The results? He can deliver a custom order in 1/10 the time of his competitors. In these hard times, his business is increasing because he can offer quick turn-arounds to his customers who don’t want to keep a lot of inventory in anticipation of sales. They can sell one, order one, and have the replacement in a few days.

Rather than trying to recall the details myself, I asked Dennis to share his story as an interview.

How did you first get into the furniture manufacturing business, and what was your experience there?

Dennis: I studied Economics at Erasmus University in Rotterdam. My father had a small upholstery company. When he got sick, we agreed I would come and we would work together. My experience was that the furniture making industry is very traditional. No real partnership between companies. Very small companies in the whole industry. (the biggest in Holland is 350 people, on average 10-20 people per company). As I am an entrepreneur I thought this is the perfect industry to work in. High prices, some volume and not so much really strong competition. We worked like crazy and in 4 years time we grew from 5 to 25 people and from 300.000 usd to 6.000.000 usd. Sales was not our problem, we had great difficulty organizing our production. So much difficulty that at some stage I decided to sell the company and move the factory to Turkey.

Ed. Note: To fill in a gap in the timeline here, Dennis formed a partnership and opened another factory in Tilburg which was being set up traditionally when he then encountered “lean manufacturing.”

When did you first encounter “lean manufacturing?”
What was your initial reaction?

Dennis: Steven Blom introduced Lean manufacturing to me on 6th of December 2006 at 11.30 in the morning. I thought it was the most brilliant thing I had ever seen in my life! I realized I knew nothing about production, only what I had seen at other companies. And I was amazed not everybody is doing this.

What kind of problems did you have to overcome as you tried to implement flow?
How did you go about solving those problems?

Dennis: We had 2 big problems implementing flow:

First, when you implement flow it becomes very clear what everybody in the production line is doing. We had to replace some operators who didn’t like the idea of the ‘flow’ of their work to be visible. We ended up replacing almost 1/3 of the workforce because they didn’t want to leave the idea of batch production. This was very hard to do, letting people go is always difficult. But for us this was the only way.

And second, when you implement flow you have to make sure that the supply of parts is well organized, otherwise your line is down most of the time. We started to use kanban to order our parts to solve this. In ordering materials for your production line, kanban is the most brilliant thing I have ever seen.

What has this done for your business and your competitiveness up to this point?
How have you been effected by the global economic conditions?

Dennis: It has been an amazing experience. We reduced our lead time from 30 days to 3 days. We reduced inventory 60%. Our product quality has increased, our profit has tripled. We are the only company in the Netherlands who can ship a custom build sofa within the week! Due to the economic crisis a lot of our customers have cash flow issues. We are the only player in the market who can generate cash within 2 weeks. A lot of customers focus on selling designonstock.com products to improve their cash position. We increased turnover by 10% and due to further cost reductions we increased revenue by 60%.

Where do you think you are now on the “lean journey?”
What are your next steps?

Dennis: We have just begun our lean journey. The first thing we did was to implement one piece flow. This was the big breakthrough. Now we are fine tuning the tools you need to do one piece flow. I think we can double the output without increasing our workforce. We will do a lot of work ‘upstream.’ In his visit Mark explained this to me and this has brought a lot of new energy to us. We will try to further reduce inventory, simplify our system and we will have a very big focus on visualization and standardization in the months to come.

Do you have any advice for people who are wondering if this will work for them?

Dennis: I would use the Nike slogan: Just do it! When you first start to hear about lean, WCM (World Class Manufacturing), one piece flow, kanban etc. it all sounds a bit strange. Start with something really small. Like buy your groceries with a kanban system. That is how I learned it. This is a way of thinking, not a system you implement and then go back to business as usual. When you really get this, it will change all!

To conclude I would like to quote Lao Tze: Show me and I will look. Tell me and I will listen. Let me experience and I will learn.

—-

I would like to offer thanks, again, to Dennis for taking his valuable time both to show me around his plant, and to respond with his own words for the story of his experience. What I appreciate most, I think, is that he is not resting on his accomplishments. Rather, he sees what he has done so far only as a foundation.

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“Creativity” vs “Opportunity for Error”

One of the things I often hear when we start talking about mistake-proofing and standardizing operations is that we are taking away people’s “creativity.”

“Creativity” in this case is usually the challenge of figuring out how to make a broken process function, or figuring out how to make the product work when, as designed, it doesn’t. “Creativity” means knowing what Julie actually keeps a stash of the parts that are always short, and knowing how to interpret vague, contradictory or obsolete drawings and work instructions. Nobody can look me in the eye and honestly say that a workplace like that is fully respectful of people.

Honestly, the very last thing I want to do is take creativity out of the workplace. But on the other hand, how much creativity is totally wasted on things that should be simple and straightforward?

As long as people’s mental energy must be expended to simply get the process to do something useful, there is none left for them to figure out why is doesn’t work and fix it.

The illusion, I think, is that once things are standardized that there will be nothing left to do.

Nothing could be further from the truth. There is plenty of work to do.

First, “standardizing” is simply setting down what we believe is our best shot at what should work. Once reality sets in, there are nearly always things nobody thought of – opportunities to learn. Capturing those moments is impossible if there is no consistent baseline in the first place.

And, just for the sake of argument, let’s say that the process, as designed, works pretty well. The question must then be asked: “Are we able to provide our customers exactly what they need, exactly when they needed it, on demand, one-by-one, perfect quality, in a perfectly safe environment?” If the answer to that question even includes a hesitation, then it there is work to be done.

Respect your people. Simplify the things that should be simple. Let them focus their creativity on something that matters, not on how to get through the way without screwing up.

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How Many Production Decisions?

Whether in service delivery (including health care delivery), manufacturing, or any other production environment, your team members are likely having to make lots of decisions under perceived time pressure. Even with great visual aids, many of these processes are mistake-prone.

One of the reasons I like pre-kitting parts for a specific option configuration is that it separates the process of deciding which parts to pick from the process of installing them.

This might not seem that big a deal.

Fortunately, if you have a copy of Windows Vista, it comes with a great simulation that shows just how this can feel on the line.

Look under “Games” and start the “Purple Place” game. Select the building in the middle of the screen, and you will find yourself in a cake factory.

cakes

The idea is to look at the TV monitor on the left, and produce a cake that matches the picture. You can move the belt forward and back to position the cake under the various applicators. Then you simply select the correct choice. Seems pretty simple.

Go ahead, try it.

This screen shot is from the “Advanced” level, but even the “Beginner” is pretty easy to screw up unless you are focused and paying attention all of the time.

So – if you find yourself saying “All the employees need to do is look at the picture, and follow the directions – why is that so difficult?” then see how well you do on this game. Play it from the start of your regular work shift until the first break, say two hours, and see how many mistakes you make.

Now consider that your production environment is likely orders of magnitude more complex than this game for little kids. And you are expecting people to work all day, every day, without ever making a mistake.wrongcake

If you are in health care delivery – think about the picture of the finished cake as the physician’s instructions, and the production line as the actual process of filling the prescriptions, administering medications, protocols for preventing infections, record keeping procedures, and ask yourself if there aren’t many more opportunities for error – that are far better concealed – than the ones in this little game.

Just a thought for the day. Meanwhile – enjoy finding a work-related reason to have “Games” loaded onto your Vista machine! 🙂

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Follow the Learner – Dr. Sami Bahri, DDS

Let me start out with a confession. I am a lousy dental patient. As I read Dr. Bahri’s book, however, I began to realize why I am a lousy dental patient. The thing I dislike about the process is that, unless everything is 100% perfect during a checkup, I invariably have to make another appointment, sometimes more than one, to get the follow-up work complete. In other words, I am exactly the kind of patient that Dr. Bahri is targeting with his practice.

This book has three parts, each a small book in itself.

In Part 1, Dr. Bahri tells the story of his experience taking his clinic from yet-another-dentist’s-office to an efficient operation with 30%+ more capacity than similar offices, and single-visit throughput for most of his patients.

His initial insight is captured on page 7 where he tells the story of a patient who was genuinely short on time.

We found that her [college student] daughter needed seven onlays and two composite fillings. Because she was short on time, we had to finish the entire treatment in one visit. It took us from 9:00 am to 1:00pm, a four hour visit!

I wondered: Why couldn’t we do this for all of our patients? Weren’t most of our patients short on time?

And, with the realization that this kind of performance is possible, if wasteful, Dr. Bahri starts down the path of figuring how how to do it without the waste.

Another key mental shift was the realization that the patient has more than clinical and medical needs. The patient is buying a service, just like any other, and providing for the non-medical needs are just as important. This means respecting the patient’s time, and delivering the care in a way that aligns with the way the patient wants it.

It was no longer about optimizing the practice, but about optimizing the patient’s experience. Even if the patient didn’t want or need the treatment in one day (some might prefer it broken up over a number of shorter visits), by developing the capability to do so, Dr. Bahri created a flexible system that can respond to the patient’s wishes, no matter what they are.

A little further on, Dr. Bahri shares another crucial insight:

I would like to say that I had a well-designed master plan to reach one-patient flow, but I didn’t. Instead, the story of our lean transformation felt much more like a long trek through a mountain range. Our learning journey was not a straight line.

Steven Spear is pretty clear on this point. He repeatedly points out that the “perfect process” cannot be designed. Rather, it must be discovered, and this is exactly Dr. Bahri’s experience. His journey of discovery dealt with one problem at a time, as it was encountered, rather than trying to solve all of the problems at once. Flow was his “True North” but there wasn’t a GPS. Rather, he recounts a series of obstacles that revealed themselves only as the previous one had been cleared.

But more than simply describing what he did, Dr. Bahri describes what he learned along the way.

The learning component is what distinguishes Dr. Bahri’s journey from most technical-only implementations. He personally, and more importantly, publically set out to learn how to understand the problems, experiment with countermeasures, and apply them. In doing so, I believe Dr. Bahri exhibited that rare commodity in leadership today – humility. Rather than being the guy with the answers, he was the one with the questions. He taught by being a student.

The second section is only a few pages, but it directly addresses the leadership issues. One of the key points is his shift from directive to supportive leadership.

He describes another crucial insight on page 41:

What brings us together and makes us most efficient is clearly seeing the current problems that stop us from achieving and maintaining one patient flow. Once problems are clearly communicated among staff, the desire to eliminate them incites people to collectively take corrective action.

A key point here is that the exact mechanism for doing this is not so important as making sure there is one. One thing that I see common in every organization that has implemented true continuous improvement is some means of identifying and collectively managing problems as barriers to flow. This is much more than just hoping people will “see waste and work to eliminate it.” The process, like any other collective process, must be led and managed.

In the third section, Dr. Bahri breaks down the principles he discovered along the way, organized around the themes of purpose, process and people. In talking about taking a systems view, he also cites many references that other, more narrow minded people, might believe are contradictory, when in fact, they are not.

In particular, he describes Peter Senge’s reference to “The Beer Game” in The Fifth Discipline, and relates it back to his dental practice.

To improve the decision-making process it becomes critical to eliminate delays in the feedback processes that occur.

How does this apply to dentistry? Simple. If we find a cavity while examining a mouth, we have the information about that tooth fresh in our mind. Therefore, we can treat the tooth with minimal risk of making mistakes. On the contrary, if we delay the treatment for a few months, we might forget some of the details, even after writing good notes in the patient’s chart.

If this happens in a dental office of a dozen people, imagine a large hospital or other complex care delivery environment. Each time a patient’s care is transferred from one stage to another, some information is invariably lost. Other information becomes obsolete. The next stage must either re-acquire this information through redundant tests and examination, or (worse) act without it, sometimes at risk to the patient. Either option introduces delays, expense, and chaos into the system.

So – Perhaps deliberately, perhaps by happenstance, the result of all of this was that Dr. Bahri created a learning organization – one in which people continuously test and challenge their assumptions, and actively seek out more understanding of the system itself.

There are two things I really like about this book.

First, Dr. Bahri’s story begins with the customer – his patients – and he challenges himself, and his staff, to deliver all of the required procedures, planned or discovered, during a single visit. This idea turns the whole concept of tightly scheduling appointments centered on the care providers on its ear, and focuses instead on the care receivers. In short, he wants to deliver continuous flow of care to the patient, without interruption, until it is complete.

From that simple decision – to deliver a continuous flow of care to the patient, rather than an hour here and an hour there, with days of waiting in between – grows an organizational culture focused on driving toward this ideal condition.

The second is that he emphasizes the role of the leader as change agent. While it is theoretically possible to “outsource” or delegate the role of change agent in your organization, if that is going to work, the change agent has to be seen as a a true agent, acting explicitly on behalf of the leader. Few managers are willing to back up their so-called “change agents” to that degree. This leaves the organization in an ambiguous state where “change agent” is expected to convince the people (and the leader) that the proposed changes are “good.” When the leader is the change agent, this ambiguity is removed, and things move forward.

Over the years, I have seen a few spectacular successes. The one thing they all have in common is a leader who is personally dedicated to his or her own learning, and is willing to learn publically – rather than being afraid of appearing ignorant. Dr. Sami Bahri, DDS is one of those leaders, and this book goes far beyond dentistry or medical topics.

In the end – is this book perfect? No, I would prefer increased emphasis and a bit sharper contrast in some areas. But any serious practitioner, in any field would do well to read this story. As the title suggests, it is much less about implementing in a medical or dental practice than it is about leadership in any change effort.

Ironically, some in manufacturing are likely to dismiss it as only being appropriate for a service delivery environment.

Follow-up: Mark Graban has a video podcast interview of Dr Bahri on his site.

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The Purpose of a BHAG

In his book Built to Last, Jim Collins explores the characteristics of companies with sustained performance, and introduced the term “BHAG” for “Big, Hairy, Audacious Goal.” (or something close to that 😉  ).

Last week I had the honor and pleasure to spend a day at the Verbeeten Institute, a radiation oncology clinic in Tilburg, The Netherlands. It was clear they have been working very hard on improvement, built on coaching from Blom Consultancy, who were my hosts there.

Every Tuesday, the medical staff gathers for lunch and host a presentation on a topic of interest. Last week, that was me.

Though I had a fair idea where I wanted to go, I didn’t have a structured, prepared speech. I wanted to get started, and then see where the audience led things.

I started off with a somewhat tailored version of my “Project Apollo story” to emphasize the difference between Kennedy’s BHAG challenge and the higher level objective of “world leader in space exploration.”

Then I asked a question – what would be a BHAG for Verbeeten that they could use to drive themselves toward their goal of “World Class Care.” One of the audience members, from the very back, said “First treatment in one day.”

This was pretty radical. The current process of initial consultation, CT scan, preparing a detailed treatment plan, and getting the patient in for his first treatment can take 20+ days today, though the actual patient involvement in the process is only a few hours, actually less if you start sharpening your value-added pencil.

As we started to get general agreement that this might be a good thing, one of the doctors asked a really interesting question.

Why?

In most cases, there isn’t any compelling clinical reason to try to accelerate this process, and in some cases there are pretty good reasons not to. So Why? was a pretty damned good question to ask – why go to all of the trouble. Why does it matter?

Setting aside, for a minute, the logical arguments of an improved patient experience, let’s explore that a bit.

What it comes down to is, not so much the goal itself, but what you have to do to accomplish it.

It makes the organization push itself through thinking, innovation, and into territory that, as things are right now, is unachievable.

In other words, you have to get really good. You have to become intently focused on everything that is distracting from the core purpose of the organization. You have to excel at execution.

The only way to get there is to learn to define what results you want (a “defect free outcome”), what steps are required to achieve it, carry them out, respond immediately when something unprogrammed or unexpected happens, and seek to understand – at a detail level – what wasn’t understood before.

Napoleon Hill is quoted as saying “A goal is a dream with a deadline.” So long as the goal aligns with a sense of higher purpose, and people can emotionally get behind it, they are a great help in simplifying the message and keeping everyone focused. Deming famously walked about “consistency of purpose.” This is one way to show it.

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10 Days in The Netherlands

Over the weekend I returned from a 10 day visit to The Netherlands as a guest of Blom Consultancy.

I am still compiling my experiences, and will be sharing them with you as I do so. (You already have one of them in the previous post.)

However the purpose of this post is specifically to give a big “Dank je wel” to the people at Blom and several of their clients who made my stay something I will never forget.

A special thanks goes to Corrie and Margareth for making this trip happen, and to Corrie, Margareth and Anton for hosting me in your homes and allowing me to get to know you and your families that much better.

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Get Specific

A couple of days ago I had an interesting session with an improvement team in a fairly large company. They have been working on this for almost 10 years, and believe that while they have made some spot progress, they are clear that they have spent a lot of money but not yet established what they call a “lean culture.” Their implied question was “How do we get there?”

My question was “When you say ‘a lean culture,’ exactly what are you thinking about?”

What do people do? How do they behave?

“People find and eliminate waste every day.”

OK, so if they were doing that, what would you see if you watched?

There was a bit of a struggle to articulate an answer.

I see this all of the time. We rely on the jargon or general statements to define the objective, without really digging down the next couple of layers and getting clear with ourselves about what the jargon means to us. This is especially the case when we are talking about the people side of the system.

But the people are the system. They are the ones who are in there every single day making it all happen. It is people who do all of the thinking.

Consider these steps:

  • Define Value.
  • Map your value streams.
  • Establish flow.
  • Pull the value through the value stream.
  • Seek perfection.

This is the implementation sequence from Lean Thinking by Womack, Jones and Roos, that has been the guideline for a generation+ of practitioners.

Learning to See taught that generation (and is teaching this one) to establish a current-state map of the value stream, and then a design the future state to implement as flow is established. The follow-on workbooks focused on establishing flow and pull, and did it very well.

While not the only way to go about this, it does work for most processes to establish flow in materials and information.

But what do people do every day to drive continuous improvement, and how are those efforts organized, harnessed, and captured to put the results where they can truly benefit customers and the business?

Here are some things to think about.

What exactly is the target condition for your organization? Can you describe what it will look like? Can you describe it in terms of what people experience, and do, every day?

When your people go home to their families and share what they did at work today, what will they talk about? And I don’t just mean the engineers and managers. What will the front-line value-creating people remember from the workday?

How will they talk about problems?

If your target future state now includes changes in how people work, ask yourself more questions.

When, exactly, are they going to do these things you described? By “when” I mean what time, starting when, ending when.

What, exactly, do they do when they encounter a problem during production?

How, exactly, do you expect the organization to respond to that problem? Who, exactly, is responsible to work through the issue and get things back on track? How long do they have to do it? If the problem is outside their scope, what is supposed to happen? How, exactly, does additional support get involved?

If these new activities involve new skills, when and how, exactly, are people supposed to learn them and practice them to get better at it? Who is supposed to teach them, when, where, and how? How will you verify that the new skills are being used, and are having the effect you intend?

“If we do this, what will happen?”

And then what? And then what?

Think it through.

The “people” future state is far more important than future state of the material and information flow.

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Cool Email Mistake Proofing

My main desktop computer runs Ubuntu Linux. The default email client is called Evolution. A recent upgrade introduced a very cool feature. When I hit “Send” it looks for language in the email that might indicate I meant to include an attachment. If there is no attachment, it pops up this handy reminder:

screenshot-attachment-reminder

Maybe Microsoft Outlook does this too, I haven’t used the latest version, so I don’t know. But in any case, this is a great example of catching a likely error before it escapes the current process. I can’t count the number of times I have hit “Send” only to get an email reply “You didn’t include the attachment.” Obviously I was about to do it again, or I wouldn’t be writing this. 😉 Since I am sending out things like resumes right now, that is something I would really like to avoid.

When talking about mistake proofing, or poka-yoke, there are really three levels.

The first level prevents the error from happening in the first place. It forces correct execution of the correct steps in the correct order, the correct way. While ideal, it is sometimes easier said than done.

The next level detects an error as it is being made and immediately stops the process (and alerts the operator) before a defect is actually produced. That is the case here.

The third level detects a defect after it has occured, and stops the process so that the situation can be corrected before any more can be made.

Each has its place, and in a thorough implementation, it is common to find all of them in combination.

Related to this are process controls.

Each process has conditions which must exist for it to succeed. Having some way to verify those conditions exist prior to starting is a form of mistake-proofing. Let’s say, for example, that your torque guns rely on having a minimum air pressure to work correctly. Putting a sensor on the air line that shuts off the gun if the pressure drops below the threshold would be a form of stopping the process before a defect is actually produced.

A less robust version would sound an alarm, and leave it to the operator to correctly interpret the signal and stop the process himself. Your car does this if you start the engine without having the seatbelt fastened. (back around 1974-75 the engine would not start (see above), but too many people (i.e. Members of Congress) found this annoying so the regulation was repealed.)

Consider the question “Do I have all of the parts and tools I need?” What is the commonly applied method to ensure, at a glance, that the answer to this question is “Yes?”

If you answered “5S” then Ding! You’re right. That is one purpose of 5S.

A common question is how mistake-proofing relates to jidoka.

My answer is that they are intertwined. Jidoka calls for stopping the process and responding to a problem. Inherent in this is a mechanism to detect the problem in the first place.

The “respond” part includes two discrete steps:

  • Fixing or correcting the immediate issue.
  • Investigating, finding the root cause, and preventing recurrance.

Thus, the line stop can be initiated by a mistake-proofing mechanism (or by a person who was alerted by one), and mistake-proofing can be part of the countermeasure.

But it is not necessary to have mistake proofing to apply jidoka. It is only necessary for people to understand that they must initiate the problem correction and solving process (escalate the problem) whenever something unprogrammed happens. But mistake-proofing makes this a lot easier. First, people don’t have to be vigilant and catch everything themselves. But perhaps more importantly, they don’t have to take the (perceived) psychological risk of calling out a “problem.” The mechanics do that for them. It is safer for them to say “the machine stopped” than to say “I stopped the machine.”

Back to my email…

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GM’s Singularity

I am going to break my self-imposed rule against further comment on the automotive industry in general, even though it is more commentary about current events than it has to do with the Toyota Production System.

In physics, a black hole is a singularity – a point where time and space are collapsed to a zero-dimensional point. Any singularity in space has, at some distance, an “event horizon.” This is a point of no return. Once anything crosses the event horizon, it cannot escape. Not even light. Everything will end up being sucked into the singularity… eventually. Thus, no information about what is inside the event horizon can ever be known outside it. Because of this information blackout, the term “singularity” has a meaning in general language to define a point in time through which the past cannot be extrapolated to a prediction of the future. Such is Monday, June 1, 2009 for General Motors.

I don’t think there was any doubt to anyone some months ago (except, perhaps, Rick Wagoner and the board of directors) that Monday’s events were inevitable – the “event horizon” had been crossed.

The question is: When was the point when there is nothing they could have done?

I am asking because I look at Jim Collins’ model of collapse, and it is clear to me that GM followed the model, but it took decades, not just a few years.

This article in Business Week Online, How Rick Wagoner Lost GM is pretty damming of several CEOs, back to Roger Smith, and perhaps further. But Rick Wagoner is particularly called out. In the end:

Wagoner continually went before the American public and Congress unprepared and angry, demanding taxpayer support without ever being able to articulate why he wanted $25 billion, how the company would use the money, and what GM’s vision was for a future viable enterprise.

But the last few months’ theatrics aside, up to what point could they have pulled it out?

While our “lean” community has been busy comparing GM to Toyota, I want to suggest a different, more comparable, model: Ford.

Both companies dealt with exactly the same political landscape, the same union issues, the same cost structures. Their range of products was comparable, and by and large, over the years, they made many of the same mistakes.

But right now, Ford continues. Sure, they are hurting, but they don’t seem to be mortally wounded.  When did Ford say “Hey! This isn’t working anymore” or more precisely “Hey! If this continues, we are going to be out of business!” In other words, when did Ford get off the Denial track? And more importantly, are they beginning to develop a fact-based learning culture? It’s too early to tell, to be sure, how all of this is going to play out.

However, I predict that it will be no easier for Barak Obama to get-in-get-it-done-and-get-out of GM than it was for George W. Bush to do so in Iraq. Both jumped based on rationalized emotional justifications, with inadequate resources and no clear exit strategy . (And there, to be sure, the parallels end.)

The political quagmire is only just beginning. Whether anyone likes it or not, because “the people” are majority shareholders, the U.S. Congress is the de-facto board of directors. No matter what the President wishes about maintaining “hands off” management, that isn’t going to happen once the corporate constituents realize they can use all of their lobbying tools to influence corporate decisions. I hope I’m wrong about all of that.