Today we have another guest post from fellow blogger Mark Graban of LeanBlog.org, one of the top-read blogs about Lean today. Mark is a Lean consultant in healthcare and frequent keynote speaker at conferences, but many of his blog posts also cover Lean topics in sports. He has even created an ebook of his posts about sports. I have contributed a handful of articles to his blog, and he and I collaborated on his LeanBlog podcast in April about Lean in sports. He contributed a guest post last month about Bryce Harper and warning tracks. He was instrumental in my start as a Lean blogger and I’m extremely grateful for his support. Follow Mark on Twitter at @MarkGraban.
Gronk’s Surgery and What You Should Know about Post-Op Infections
By Mark Graban
Rob Gronkowski (it’s more efficient to call him “Gronk”) is, of course, an All-Pro tight end for the New England Patriots. He’s also a notorious shirtless dancer and surgery undergoer. Tuesday, he underwent back surgery, his seventh surgery since 2009, including four procedures on his forearm over the past year.
The first two Gronk arm surgeries were required to address fractures that occurred in NFL games (an occupational hazard, to say the least). His third surgery, in February, was necessary to clear out an infection that set in after the second procedure.
Why is this worth pointing out? A post-op infection isn’t just a necessary risk from surgery. It’s increasingly seen as something that shouldn’t happen if everybody involved in the surgical team, including the patient, does everything right the first time.
Pats quarterback Tom Brady was slowed down by a staph infection (click at your own risk) in 2008, after knee surgery. As reported, Brady required three additional surgeries to clear out the infection. Infections like this can lengthen the players’ recovery time, creating a huge risk or financial loss for NFL teams as a player misses more games or even has their career jeopardized.
How common are knee surgical infections?
Infections are unusual in knee surgeries in any case, [Dr. Riley Williams] said. He led a study in the 1990s that found an infection rate at the Hospital for Special Surgery of 0.3%, which had not changed much since. “I know it’s less than 1%,” he said.
The general risk for surgical-site infections is approximately 1 to 3% (2 to 5%, by some studies). An estimated 40 to 60% are preventable, if not more. These infections lead to higher cost ($3-10 billion annually in the U.S.), longer hospital stays, and higher mortality (3% of patients die from their surgical-site infections).
Beyond the uncertainty caused for fantasy football rosters, why should we care about surgical infections? Because they can happen to any of us.
Joint replacement, such as a knee or hip, is increasingly common with modern technology and an aging population (not just retired athletes). The Wall Street Journal reports infection rates can be “as high as 1.6% for knees and 2.4% for hips, or as many as 20,000 surgical infections per year.”
Surgical site infections (and other hospital-acquired infections) are increasingly seen as preventable, rather than being inevitable. As reported in the WSJ, there are a number of basic process steps that are shown to reduce infection rates, including:
- Giving antibiotics before surgery (at the right time)
- Removing hair with clippers instead of shaving (which avoid small cuts that could let bacteria from your skin enter your bloodstream)
- Prepping skin with alcohol-based antiseptic
- Showering or bathing with an antiseptic soap in the days leading up to surgery
See also the CDC’s guide to what you should know before surgery.
It’s a basic Lean principle that having a better process leads to better results. If we can make it more likely for people to do things right the first time, we’ll get better results, including fewer infections.
[Chad's note: the term used for preventing processes from doing things improperly is known as error-proofing or "poka yoke." A perfectly error-proofed process means that a bad output or result is impossible to create. An example of this would be a USB plug - you cannot put the plug in incorrectly, it only goes in one way. To reiterate what Mark stated, by error-proofing the pre-op, procedural, and post-op care for surgeries we can minimize the likelihood of infections...and in the cases of Brady and Gronk, a lower likelihood of multiple surgeries that would potentially keep them from helping the Pats win on the field.]
Now, do any of those steps sound like any sort of fancy or expensive medical technology? Not at all. But these steps are not followed 100% of the time. It’s impossible to speculate about whether the Gronk or Brady infections occurred even after all of the proper precautions being followed. But if you’re a patient, you can ask your surgeon what their process is for guaranteeing that these precautions will be taken and if they are aware of best practices.
The hospital can likely do more to make sure clippers are always readily available, otherwise a surgical team might be rushed and decide to use a razor to save time. The hospital might also need to hold surgeons accountable if they regularly refuse to give antibiotics to their patients (except, of course, when allergies or other factors are involved).
Another challenge for patients is that it can be very difficult to get data about infection rates for different surgeons or different hospitals. The state of Washington has a website that shows comparative data, but many hospitals show “no data available.” But this sort of data can’t be found in all states or countries.
98% might sound like a pretty good level of quality, but two “defects” out of 100 increases the chances that an infection will occur. I don’t think I’d like to be that one patient out of 50 who isn’t given the best standard of care… I don’t want that risk, if it can be avoided (and it can).
I had a chance to visit the South West London Elective Orthopaedic Centre (SWLEOC) back in 2009. This hospital performs total joint replacements – knees and hips. Through the use of the Lean methodology to improve processes, SWLEOC ensures that the best care is provided to each patient, making sure key steps and preventative measures always happen. As they explained to me, they have “better, more standardized processes” and more consistent surgical teams who work together more frequently.
As documented in their 2009 annual report, SWLEOC went an ENTIRE YEAR without a postoperative infection (see pages 36 and 37) – and that was with performing about 250 procedures a month.
If the typical infection rate is about 2%, we could have expected to see 60 infections… but SWLEOC had zero. Their 2010 report talks about the Lean process that has led to better care:
EOC managers and clinicians have been working effectively at increasing efficiency and reducing waste through adopting a lean philosophy in order to meet the demanding productivity and quality improvements that the Unit needs to deliver. The EOC staff have embraced the need for continuous quality improvements that refine The EOC’s pathways, reduce costs and increase throughput through its state of art surgical facility.
They had another year without an infection, as the data shows from their report:
The best in healthcare, via Lean, shows what’s possible, even if some hospitals and surgeons still think zero post-op infections is an impossible goal.
As coach Vince Lombardi once said, “Perfection is not attainable, but if we chase perfection we can catch excellence.”
Maybe we’ll see a day where our favorite players and best players don’t get post-surgical infections… and neither will we, the fans.
Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen. Learn more about Mark’s on-site and public workshops. He is also the Chief Improvement Officer for KaiNexus. He blogs regularly at http://www.LeanBlog.org.
Last week the Pirates’ #1 pitching prospect Gerrit Cole made his MLB debut, and for a franchise that has been mired in mediocrity longer than this year’s crop of incoming college freshman have been alive (at least the Cubs have made the playoffs this century) his appearance could signal the turning point for the organization. His performance did not disappoint – he carried a shutout into the seventh inning and the Pirates won the game.
But what DID disappoint? The Pirates heightened their security protocols for entering the ballpark on this day, which caused some delays. From John Perrotto of Pittsburgh’s Times Online (text courtesy of Rob Neyer because the Times Online is subscription-requiring):
The Pirates decided to implement new security measures Tuesday night, primarily wanding each fan before going through the turnstiles. It turned out to be a disaster.
The lines stretched for blocks and a significant number of the 30,614 in attendance missed Cole striking out Giants left fielder Gregor Blanco on three pitches to open the game. It’s one of those moments you never get back as a fan.
According to some of those who got caught in line, security was understaffed and extremely slow in the wanding procedures.
In Pittsburgh’s defense, they don’t have huge attendance figures and the game was on a Tuesday night, when attendance is lower than average relative to the weekend. They probably thought they could implement higher security screening as an experiment, but because of the larger-than-normal crowd to see the potential future Pittsburgh ace the team was unprepared.
I’m not going to get into a big subjective or political debate about heightened security measures being a further loss of freedoms or liberties, what with all this Edward Snowden and NSA discussion currently abounding, but as Rob Neyer points out (objectively):
…considering that not a single human life has been lost in a terrorist attack in an American professional sports stadium, ever — we’re talking about hundreds of millions of people since 9/11…
Rob goes on to suggest that the data tells us that attending a baseball game is essentially safer than flying in a 75-year-old airplane (you’d have to click and read his article to get his reference).
What does this have to do with Lean? Well, two things.
One, teams are investing resources – time, money, people – into preventing an occurrence of a bad situation that could be devastatingly bloody and is hard to predict, but has never happened. Just like we all have to take our shoes off at the airport because one guy one time had a bomb in his shoe (okay, extreme example). It’s one thing to invest resources in things that help augment and improve the customer experience, but based on this comment in Rob’s blog post:
As it happens, I went to the park Tuesday night to see Cole make his major league debut. I am sure the Pirates chose a Tuesday to start their new security procedures because that’s a low crowd night, and they could work out the kinks. Then, Cole was scheduled and they had a big walk-up sale and a near-capacity crowd. Oops. But, instead of punting, the bumbling Bucco brass (Perotto [sic] is spot-on here) sallied forth. The result is my friend and I missed the top of the first inning, when Cole threw his first major league pitches.
…I’d say Pittsburgh could have thought this through a little better.
Second, let’s say wanding is here to stay and will wand patrons every game going forward. Had the Pirates and the outsourced security personnel properly done time studies on the time it takes to wand a single patron and based on estimated walk-up crowd couldn’t the team/security company called in for reinforcements because of the larger demand?
If no, could the Pirates have flexed their own staffing to provide a few extra bodies to wave extra wands (and let trained security staffers make bigger decisions on how to handle patrons not passing the wand test)? I’m guessing a little preparation and value stream mapping could have helped the situation here.
Instead of being better prepared, a magical night for long-lasting Pirates fans was a little less magical.
During a summer in my younger years I was a tag-along for a company that would install home theater systems. We would install big screen televisions on walls, stereos and speakers, satellite television systems, projectors, lighting systems, and so forth.
Our day would consist of multiple scheduled installation trips to homes and businesses – we would come to the shop to pick up supplies of wires, harnesses, connectors, work requests, components, customer specifications, and information on the electronics companies that subcontracted the installation work out to us. As needed, we would go out to job sites and based on the work we were projected to do we’d select necessary components from the van or make trips back to the shop or local electronics store if there were components we were missing. The van would generally be very cluttered with leftover components from previous jobs or scrap materials from cutting components and walls to size.
Our types of jobs would vary greatly – some jobs were simple installations, some just required technical assistance, and others required busting out some heavy tools and machinery to drill through structures. Thusly, the components required would vary greatly and the time commitment would too. We were paid by the job (not every job paid the same), so the more jobs we completed the more financially lucrative it was for us. The jobs were scheduled as they came into the shop, with first-come-first-serve as the scheduling process. In addition, we would sometimes get calls about emergency jobs that would alter our schedule.
We found that we spent a lot of time driving around unnecessarily back to the shop or the electronics store for missing components. We were also ending up with way too many of certain types of cables or components in the van that simply would not get consumed fast enough to necessitate their presence, thereby creating additional clutter. The clutter extended our installation time because we had to dig through it all.
My installation partner/supervisor/driver and I put together an organizational plan with the intent of reducing the amount of time we spent driving/searching unnecessarily so we could do more installations and make more money. With the cooperation of the schedulers, purchasing department, and shop owner, we went about changing how we operate.
- We made a rough sketch of data on the most common types of installations we were doing and the attributes of each of those installations (estimated times for each install, tools required, components required) in the form of a very rudimentary Pareto chart.
For example, let’s say 25% of our installations were for satellite television service. This typically required the satellite provider system components (dish, receiver box w/remote) and coaxial cable with hardware. On a typical day where we might do 4-5 installations, it was a fair bet that we’re doing at least one satellite television service installation. With this knowledge, we were able to plan accordingly with pre-stocked components.
We also asked the schedulers to identify installation attributes that might add to the complexity of our work. For example, if hardware already existed in the walls of the installation location or the material the walls were made from (drywall, brick, concrete, etc). Anything that would help us better plan for upcoming installations and time investments would keep us from having big scheduling fluctuations because of unknown circumstances.
- We identified frequently-used components with estimated rates of consumption and developed a small cabinet system or cable rack that could easily be replenished as needed.
To save space in the van for important and frequently-used materials we put together a component replenishment process to refill drawers on a daily or as-needed basis. We set quantities for each component that we might consume in 2-3 days but were commonly used and included infrequently-used but minimal-space-consuming parts as well. This way we had the most common pieces ready to go but also minimized the frequency by which we had to make emergency trips for less-common components simply because we did not know we’d need them ahead of time.
The cabinet system was easy to manage, reduced clutter, and made finding materials easy.
The cables were a little more cumbersome since we couldn’t really stock pieces – they came in spools. However, we knew the lengths of cable (be it coax or stereo wire or ethernet cable or whatever) on each spool and could easily determine how much length of cable was available on the spool rack we put in place. We ordered spools large enough to get us through a couple of days of work but small enough to pick up an extra spool at the shop to hold in the truck when the spool on the rack ran out – we could quickly replace it as needed.
- We separated the commonly-used and basic tools from the special case, infrequently used tools.
This allowed us to tote a smaller batch of tools more frequently and not have to drag every tool we have into each installation location, saving us wear and tear. We kept the special tools in the truck and would pick them up as needed. We designated cabinet drawers to those tools but kept the common tools in a small tool kit that wasn’t very heavy. We didn’t go so far as to label drawers or put down 5S foam pads to keep tools separated, but we knew where everything was and where tools were supposed to go once we were done.
So what were the results overall?
When we got used to the new system of organization and planning, we saved enough time to add an additional installation to our regular schedule. In the same amount of time during the day we got more done and it was more lucrative for us.
Our consumption of materials was more predictable, and we had less loss of components due to breakage or damage (getting crushed by heavy equipment or falling out of the van). The company was tying up less money in inventory because ordering was easier to forecast. This made the purchasing agents happier.
Scheduling our jobs was easier and more predictable as we had less variation in installation times. This made for happier schedulers. More predictable schedules also meant customers had installations done sooner and were not subject to wild swings in daily schedules (“Oh, we’ll be at the house between 9 and 4 but don’t know when for sure”). Customers were happier.
Because customer satisfaction went up, our reliability went up in the eyes of the companies subcontracting us, our component loss figures went down, and our profitability went up…the owner was happier. He was so happy, in fact, that he instituted our ideas into the other installers and their vans – a sharing of a best practice.
The overall investment in improvement was minimal – just some time to sketch out the plan and the money to create/install racks and cabinets. However, the payoff was impressive overall and made a big difference in the company’s overall performance.
Pat Forde of Yahoo! Sports lays out the dire situation in the NCAA enforcement division.
The NCAA enforcement division – the most scrutinized, controversial and perhaps vital part of the entire organization – is in crisis mode. It is short-handed. It is suffering from an alarming brain drain and morale deficit. It has been beaten into a corner by the backfired Miami football investigation and subsequent fallout.
The overarching purpose of the NCAA’s existence is to facilitate a collective set of rules and standards for schools and athletic teams to compete intercollegiately. It goes beyond simple rules, though. The NCAA is the governing body for intercollegiate athletics in determining championships in sports, and it does this by standardizing athletic seasons and schedules and facilitating championship structures.
However, if your school wants to play and compete for those coveted championships, it has to follow specific guidelines in the interest of equality and fairness. This means no skirting the rules to get a leg up, no breaking of rules, no cheating. Basic baselines for student-athletes like qualifications to attend college and maintaining baseline GPA in college classes. Baselines for schools and teams such as restrictions on practices, scholarships, roster sizes, schedules, outside contact with boosters and financiers.
There are a lot of schools – 120 just in the Football Bowl Subdivision (FBS) – under the NCAA umbrella. So what are some of the problems?
It has lost its leader in (former NCAA Vice President of Enforcement Julie Roe) Lach, who was hand-picked by (NCAA President Mark) Emmert to succeed David Price and continue leading the NCAA into a new era of enforcement.
Eight veterans lost in less than two years, most of them boots-on-the-ground investigators. And everyone expects more to come, as morale plummets and a siege mentality takes hold in Indianapolis.
Tuesday, it announced that enforcement was seeking to make five hires – a significant number of openings in a department that normally has a staffing of 60.
High turnover with already low staffing numbers to cover oodles of schools. The temptation for schools to cheat is higher than ever, because the money being chased is higher than ever and the available enforcement eyes are starting to dwindle.
In organizations that properly apply Lean thinking as an operational philosophy, there is a difference between basic auditing and rule enforcement. Processes and results should be audited for adherence to best practices (and questions should be asked when best practices are not followed, which isn’t always a bad thing), but basic employment and participation rules (especially those relevant to safety and conduct) should be governed via audit and enforced.
Processes can be nebulous, because improvement is nebulous. Rules should be relatively binary – if you violate this rule, this is the penalty (save for special circumstances, I suppose).
However, the NCAA’s set of rules and standards is being shown to be not binary, behind in the times/not keeping up with technology, and underenforced because the enforcers are underequipped to handle the workload.
Organizations demonstrate an issue’s importance by providing adequate resources and attention to it. The NCAA and Mark Emmert are doing neither to suggest that adherence to the NCAA’s guidelines is a priority.
Manufacturing and traditional business settings have understood the importance of objective, meaningful metrics for many, many years.
Metrics aren’t necessarily used as quotas or objectives (as Dr. Deming fights against in his 14 points) but as reasonable indicators of “Are we doing a good job?” or “Are we on our way to accomplishing our planned outcomes?” or “Are we properly meeting the needs of our current customers with the plan to serve even more customers down the line?”
For a sport that is so addicted to statistics, it’s surprising that there has been such a large disconnect in baseball between on-field success and proper metrics. Only now are baseball teams more open to considering more meaningful data that are better indicators of top team performance, but it took books written by Bill James, SABR, and Michael Lewis (Moneyball – more here and here) to generate the momentum for the metrics push.
Baseball still largely focuses on metrics that are not directly linked to winning – batting average (hits per time at-bat), runs batted in, home runs – but at least there are some that are identifying the proper direct metrics and letting them be the primary guide for improvements. From Rob Neyer of Baseball Nation:
As I’m sure you know, there’s a strong relationship between runs scored, runs allowed, and winning percentage. We’ve known this for quite some time and … well, I suppose it’s always been obvious that if you score more runs than your opponents you’ll probably win more games than you lose, and that if you score a lot more runs than you allow, you’ll probably win a lot more games than you lose. But Bill James actually quantified this relationship with something he called “the Pythagorean method,” and of course that method’s been refined a bit over the years.
A baseball team’s primary objective: win the baseball game.
- What dictates the difference between winning and losing? Run differential – you score more runs than the other team, you win.
- How do you control run differential? Score more runs, allow fewer runs.
Identifying the direct metrics (such as run differential) is not rocket science. Getting to the next level, the indirect metrics, adds complexity. Let’s take a gander.
- How do you score more runs? Produce outs at a lower rate and get on base at a higher rate, and don’t run into outs when you’re on the bases (caught stealing or baserunning blunders – TOOTBLAN).
This is why on-base percentage is such a critical statistic to Moneyball. It doesn’t matter how you reach base, whether it’s a walk or hit or being hit by a pitch, because the only way to score runs is by getting players on base. (Yes, hitting home runs counts as getting on base.)
- How do you allow fewer runs? Minimize how often opposing players reach base.
- How do you minimize how often opposing players reach base? Employ pitchers who effectively generate more outs and defensive players who generate more outs.
Relative to the current level of analysis on offensive production of baseball players and teams, proper pitching and defensive metrics are tricky and statistical experts still don’t have the metrics perfected. There are a LOT of variables between pitching and defense that require deeper analysis. However, the experts are getting better and the metrics are becoming more reliable.
I’m essentially clueless about physical training. There’s a lot I need to change about my overall physical fitness. I’m a semi-healthy eater when I’m at home, but when it comes to working out I need a lot of help. I had mulled over joining a gym and dragged my heels about actually making it happen until about a month or so ago.
Some criteria I had for the gym I select would be:
- proximity to my house (can’t use “far drive” as an excuse to not go)
- availability of trainers (someone with more knowledge needs to help me)
- variety of machines and classes (I don’t want to limit myself)
- long hours of access (my schedule is crazy and I need early mornings and late nights at the gym)
- minimal red tape (those fees and cancellation costs are ridiculous)
After requesting some referrals from friends that are members of different area gyms I joined the Gold’s Gym in North Augusta, SC as it met all of my criteria. It also helps that they have a network of gyms across the country that I can visit while I’m on the road (I took advantage of this while I was in Indianapolis for the ASQ World Conference).
In addition to the gym membership I also inquired about personal trainers. For a fee I would work with this trainer once a month on monitoring my fitness goals, designing workouts that if properly followed would help me achieve my goals while also keeping some basic physical ailments in mind (I’ve been having some lower back issues), and some assistance with meal planning/food intake. Based on what the program offers and the rate the gym charges, I signed up.
My basic expectations/outputs for the training program are:
- Weekly specifically-designed workout routines that focus on different areas of my body (core, arms, legs, etc.) that I carry with me or keep at the gym (because I won’t see the trainer every day)
- Use of the online calorie burn/food consumption monitoring program
- Monthly checks on measurements
I expect the value of the program to be very apparent. Simple expectations, right? I’m given a path to follow (work instructions) and the proper monitoring tools (monthly checks = strategic metrics, monitoring program = routine tactical metrics) I should see results.
Early last month I had my initial assessment with a trainer named Darrell. He would set me up with the full program once I had fully signed up for (and paid for) the next session, which I scheduled for late last week. Unfortunately between that initial assessment and my first full training session (last Thursday) Darrell left the company and I was assigned a new trainer.
No worries. I did have to do some initial assessment stuff over (somehow my paperwork upon starting the program got misplaced) but we went through one phase of a workout and the trainer said I’d have my monthly workout plan saved for me at the gym and I could come get it anytime I needed. I expect to be at the gym 4-6 days a week so I’d need to start using my workout plan right away.
Cut to Saturday when things go awry.
I’m ready to use my workout plan. I go to the back filing cabinet where my monthly workout plan should be kept. It’s not there. Nothing is prepared. In fact, on a table near the filing cabinet:
Not only is my workout plan not done, nothing appears to be done and the trainer just left my initial assessment/goals/data out in the open for anyone to come and grab.
I go to the front desk to get assistance. I ask what the story is with my workout plan, I show them the filing cabinet and my paperwork out on the table, and I simply look for answers. The fellow I talk to says “I’m just a sales guy, I can’t speak for any of the trainers and what they do because they’re part of a different company and they don’t work on weekends…”
(Unfortunately, this gentleman is misinformed – the trainers are now part of Gold’s Gym and not a separate company.)
Basically this “sales guy” was pretty ill-informed about what he was selling overall. After he couldn’t answer my questions (and really didn’t want to answer them, as he was trying to walk away from me as fast as possible) he said “Well just go work on some cardio.”
No, sales guy. I’m not paying you to create my workout. I’ve paid to work with a physical trainer on a workout plan, and I have not yet received that value.
Last week I asked the question “What is quality?” My short answer to that question was:
the rate by which customer expectations are met, where customer expectations are “what the customer wants, the quantity the customer wants, when the customer wants it, where the customer wants it, and in what condition the customer wants it.”
Because my experience with the Gold’s Gym personal training staff has fallen short of fulfilling my basic customer expectations – no workout plan, no access granted to the online calorie burn/food monitor yet, failure to protect private information, but I’m still billed on a monthly basis – this was a low quality transaction.
There’s more to operating a business that sells physical fitness than just a bunch of machines. It’s good that Gold’s Gym offers personal trainers but their process of maintaining customer relationships needs a serious examination.
In a similar story on quality, with a failure to meet basic customer expectations, here’s fellow ASQ Influential Voices blogger Nicole Radziwill with her very iffy experience with a European rental car transaction.
Because there are quite a few new readers of the Lean Blitz Blog (after the Masters pin flag giveaway and ASQ Influential Voices program participation both boosted viewership and subscribers) I feel it’s a good idea to revisit some of the basic concepts of continuous improvement. In the not-too-distant future I will roll out a new (but basic) continuous improvement framework that demonstrates the importance of customer/partnership expectations.
Today I’m asking a very simple question with various answers: what is quality?
The ASQ glossary defines “quality” as:
A subjective term for which each person or sector has its own definition. In technical usage, quality can have two meanings: 1. the characteristics of a product or service that bear on its ability to satisfy stated or implied needs; 2. a product or service free of deficiencies. According to Joseph Juran, quality means “fitness for use;” according to Philip Crosby, it means “conformance to requirements.”
Another definition, from the Business Dictionary:
In manufacturing, a measure of excellence or a state of being free from defects, deficiencies and significant variations. It is brought about by strict and consistent commitment to certain standards that achieve uniformity of a product in order to satisfy specific customer or user requirements. ISO 8402-1986 standard defines quality as “the totality of features and characteristics of a product or servicethat bears its ability to satisfy stated or implied needs.”
Quality is a much more complicated term than it appears. Dictionary definitions are usually inadequate in helping a quality professional understand the concept. It seems that every quality expert defines quality is a somewhat different way. There are a variety of perspectives that can be taken in defining quality (e.g. customer’s perspective, specification-based perspective). Are there commonalities among these definitions? Is any one definition “more correct” than the others? Is one quality expert “right” and the others “wrong”? Quality professionals constantly debate this question. The editors of Quality Digest say that defining the word “quality” is “no simple endeavor.” They asked, in their December 1999 issue, for readers to send them their definitions of quality to be gathered and posted on Quality Digest Online.
A modern definition of quality derives from Juran’s “fitness for intended use.” This definition basically says that quality is “meeting or exceeding customer expectations.” Deming states that the customer’s definition of quality is the only one that matters.
By virtue of the fact that every process has a customer and a set of expectations for outputs of that process, quality has to be defined by the customer.
So I define quality as the rate by which customer expectations are met, where customer expectations are “what the customer wants, the quantity the customer wants, when the customer wants it, where the customer wants it, and in what condition the customer wants it.”
It’s not a simple definition to come by, but think about it as a customer. What makes for bad quality?
- Not receiving exactly what you want
- Defective products or services
- Receiving too little or too much of what you request
- Untimely delivery of what you want
- Non-preferred location of the delivery of what you want
Let’s take “a quality watch” as an example. What might make a Rolex a “quality timepiece” to you?
- Provides the time accurately
- Has a fancy, elegant design
- A well-known and well-regarded logo front-and-center that implies elegance
- Upon purchase of the timepiece, the timepiece is actually available
- Not only timely availability but also timely delivery
- Upon delivery, the timepiece actually functions as expected and isn’t broken
If any of those elements are missing, would your interpretation of the quality suffer accordingly?
As a customer it is imperative that you define what a quality transaction is for you. When you define quality, you also define value. Value is what establishes what you are willing to pay/compensate for said transaction.
If any of those elements are missing, would the amount you are willing to pay drop? If the watch is broken or the logo is gone or the design is flawed or the delivery is late, wouldn’t you look at this as being a lower-quality transaction than expected because you paid for something you didn’t receive?
Lean and Six Sigma are both quality methodologies. Both focus on trying to provide what the customer wants, when they want it, and how they want it. Everything derives from the customer expectations though.
I first started blogging about Lean and quality in late 2011. As I dug into multiple topics – values, activities, tools, applications – I began referencing content and insights from other writers I was following like Mark Graban, Tim McMahon, Nicole Radziwill, and John Priebe.
What I soon realized was that these bloggers would sometimes provide posts in support of this network of writers through the American Society for Quality called the ASQ Influential Voices. From the “blogroll” of the Influential Voices page:
ASQ’s Influential Voices are quality professionals and online influencers who raise the voice of quality on their personal blogs. Based around the world, the Influential Voices are passionate about improvement and other key issues in the quality community. They represent countries such as India, Ecuador, China, Malaysia, Australia, and the United States, and comprise a wide range of industries.
The Influential Voices include ASQ CEO Paul Borawski, who generates discussion on quality topics and trends on his blog, A View from the Q. Paul looks to the global quality community to add to the conversation.
When I was introduced to the other bloggers and read up on the content and topics they cover, I thought it would be great to one day join this group of writers as another voice covering a different industry and with a new viewpoint. (Call it a long-term goal of mine, only with no specific plan of achieving it other than “keep on writing unique content folks want to read.”)
However, after returning from the ASQ World Conference in Indianapolis earlier this month, I was invited by ASQ to join the Influential Voices!
It’s a major honor to partner with these writers who have large followings and have been quality professionals for longer than I have. We all will generate content related to specifically-identified quality topics on a monthly basis, typically in response to the topics initially developed by Paul Borawski. Any of the ASQ Influential Voices responses I provide will generally be tagged with the logo shown above.
I will get started with ASQ Influential Voices content next month, but I may submit my responses to previous topics in other posts as well.
In other news, Memorial Day is a special holiday for me as it provides a special focus on my two grandfathers who were both military veterans. I don’t know much about their specific service as it was not generally a topic we spent time discussing but while I was very fortunate to have met my grandfathers after they survived and completed their service obligations there are many other families who are not as fortunate to have their service members return home.
Simply saying “Thank you for your service” to all service men and women does not begin to cover my sincere gratitude for their sacrifices over the last two centuries. They’ve put their lives on the line like I’ve never had to, and no words I say can make up for that. My hat is off to all of you.
The Indianapolis 500, which runs every Sunday of Memorial Day weekend, is nicknamed “the greatest spectacle in racing” but it can also be considered the proving ground for many breakthrough innovations in vehicle technology, safety, and strategy.
Uni Watch contributor Rob Caplette has a great historical recap of the Indianapolis 500 and the big changes for cars and their teams over the years. From the article:
When we look at the modern single seater rockets that IndyCars have become, it is hard to imagine that in the beginning the cars were 2-seaters, a driver to look forward and a mechanic to look back. The rearview mirror in your car is an invention that was pioneered at Indy.
What about cycle times and safety for the non-drivers?
Every aspect of Indycars and IndyCar racing has undergone changes from the original days. Pit stops literally fell from several minutes down to the seconds they take today. As the speeds of the cars grew, the safety measures for the crew grew as well. The guys going over the wall used to be in khakis and other clothing that could easily catch fire. Now, like the drivers, the crews wear fire retardant suits and helmets.
Without that desire to win, many technological innovations we see in our cars today would not have been possible. The Kaizen mindset of the racing teams and car designers with the focus on knocking mere seconds off of lap times meant that no piece of the car would be left unquestioned. Some ideas tested at the track worked well, others didn’t. However, that desire to be the best meant that some implemented ideas would be unusual but that doesn’t mean they wouldn’t be effective.
The whole article is a great read – heck, Uni Watch is always a great read.
Finally. I can finally announce the winners of the Masters Pin Flag Giveaway, six weeks after the Masters. It took a little while because I had to confirm mailing addresses, but here we go!
Pin Flag Winners:
Mike Jeffers, Coyote Bat Company
Dave Murphey, Miami Dolphins
Jeff Vervlied, Aspen International Group
Swag Bags (er, Boxes):
Steven Gold, Nashville Sounds Baseball Club
Jon Pruis, Roche Diagnostics
Deana French, Kenworth Trucks
Eric Blagg, Greenville Drive Baseball Club
Jim Miesle, Eli Lilly and Editor at One Foot Down, SBNation’s Notre Dame Football blog
Tom Laurent, Discover Financial Services
Michael Heneghan, Driehaus Capital Management
Back to regular blogging soon – there are a couple of topics like anchored putter bans and protective pitcher headgear that need attention, and a big announcement I need to make about a group affiliation.
Earlier this year I wrote a post about how the New York Mets were changing their AAA affiliate from the Buffalo Bisons to the Las Vegas 51s and that they now have the longest distance between a AAA team and a parent MLB club.
I was interviewed for an article in The Toronto Star about how the Toronto Blue Jays, who became the parent club of the Buffalo Bisons, would reap the benefits of having their next-level minor league affiliate in such close proximity. From the article:
But a nearby affiliate means that when injuries arise the Jays no longer have to summon reinforcements from a destination that is three time zones and 3,150 kilometres away. Reducing time spent waiting for call-ups reduces the games played short-handed over the course of a 162-game season.
Check it out and have a great weekend!
Today we have another guest post, this time from fellow blogger Mark Graban of LeanBlog.org, one of the top-read blogs about Lean today. Mark is a Lean consultant in healthcare and frequent keynote speaker at conferences, but many of his blog posts also cover Lean topics in sports. He has even created an ebook of his posts about sports. I have contributed a handful of articles to his blog, and he and I collaborated on his LeanBlog podcast last month about Lean in sports. He was instrumental in my start as a Lean blogger and I’m extremely grateful for his support. Follow Mark on Twitter at @MarkGraban.
By Mark Graban, www.leanblog.org
Although he might call this a “clown post, bro” I am writing about Washington Nationals outfielder Bryce Harper and how he plowed full speed and face first into the outfield wall at Chavez Ravine on Monday night (article and video via Deadspin).
Harper is no longer a rookie, but you’d think he would know how to find the outfield wall… it’s called a warning track. As Deadspin said, “It’s called a warning track for a reason.” The warning was not heeded by Harper. Maybe he thought this was a rickety minor-league wall that he could run right through, as seen in this classic clip from the early 1990′s:
The now familiar warning track was first utilized in Old Yankee Stadium, where a running track probably just happened to be convenient for that purpose. The warning track was officially mandated by Major League Baseball in 1949 after earlier using sloped inclines to warn outfielders.
The standard warning track today is brown (or sometimes orange) dirt (or a polymer blend) that provides both a color contrast and tactile contrast from the outfield grass. As an outfielder speeds or lumbers toward the wall, peripheral vision and the feeling under foot tells the outfielder “warning: wall approaching.” The polymer blend also claims to give an audible “crunch” sound for the outfielder.
The international standards organization ASTM actually has a published standard for baseball warning tracks: “ASTM F2270 – 12 Standard Guide for Construction and Maintenance of Warning Track Areas on Athletic Fields” (how anal-retentive does that sound?).
It states, in part:
In order to provide for an effective warning track surface, the warning track must be constructed and maintained in such a manner so that the player can sense the change in texture from the regular playing surface and the warning track without having to look. This feature is very important in that the player is often visually focused on the ball during play and would not be looking at the ground as he/she is running toward the warning track. The warning track must also be constructed and maintained in such a manner that the warning track itself, or the surface transition, does not pose a hazard to the players.
Does not pose a hazard? That’s not always the case, apparently. New York Yankee Mark Teixiera blamed their stadium’s warning track for an injury to then-teammate Lance Berkman in 2010:
“That warning track around our stadium is very dangerous,” Mark Teixeira said Thursday of the synthetic surface. “It’s hard, it’s basically concrete with sand on top. It needs to be fixed.”
Berkman didn’t disagree with Teixeira, but he wasn’t as blunt. “It’s slick, it’s hard,” Berkman said. “I don’t have much experience with it, but most warning tracks are not that way.”
The warning track is supposed to be about 10 to 15 feet wide (or three full running strides), but there’s no exact standard for that, per MLB rules or the ASTM.
Earlier this year, the Texas Rangers and San Diego Padres played two exhibition games on a field crammed into the Alamodome’s football footprint. The stadium featured an incredibly short-porch right field of just 285 feet (with an non monster-like 16 foot wall).
When I was there for one game, I noticed how the “warning track” around the field was really just brown artificial turf. This clearly violates the ASTM standard, as it couldn’t possibly have a different texture than the outfield “grass.” I don’t think this caused any injuries, but it was just two meaningless games (although some have criticized Harper for playing too aggressively with a 6-0 lead… just play it off the wall, bro).
The ASTM standard, by the way, says you CAN have a turf warning track IF it surrounds a “skinned” (or dirt) area, such as the infield for software. Not the case at the Alamodome.
So what’s the takeaway that’s relevant to those using the Lean methodology? The lesson is that warning signs don’t always work in any workplace. I’ve collected a number of signs on one of my blogs, “Be More Careful!”
There’s one sports-related sign, one that I found sitting in the center field bleachers at Wrigley Field – if you wander up and sit behind/under the famous manually-operated scoreboard. Sitting there, if there were an exciting play (not likely, considering the Cubs), a fan would easily jump up (forgetting the sign) and bump their head.
I once saw a glass wall/window at a hospital that had a warning, as if the employees and visitors were birds – “Don’t walk into me… please!” Could be helpful on outfield walls perhaps.
This warning sign on a piece of pharmacy automation warned workers against putting their hands inside the machine when it was running. A truly Lean environment (and your average non-Lean factory) would be sure to have equipment that could NOT be opened while running. We’d call this “mistake proofing” (or “poka yoke” in Japanese).
It’s better to have a process where it’s impossible to make a mistake rather than relying on people to be careful. We are more likely to have perfect processes than perfect people. The Toyota Production System produces better products because they build in quality rather than trying to inspect it in at the end of the line. They don’t have more warning signs or more inspectors – they have better process. There’s quite a history of this at Toyota, going back to the days before they made cars, even.
In the case of serious surgical errors, it’s apparent how warning signs would probably not be effective. If they were, we could just post a bunch of signs everywhere, including one that says, “Warning! Don’t operate on the wrong side of the patient’s brain” – as errors like this occur all too often.
Hospitals don’t post warning signs that say, “Caution: Don’t give the babies the wrong medication” or “Warning! Don’t mix up the laboratory specimens.” I’m glad they don’t have signs like this because they wouldn’t be effective.
Warning signs are pretty useless. ESPN even wrote that “warning tracks are useless.” At best, warning signs are a last resort – to be used only if you can’t find any way to error proof the problem. Warning tracks seem to fit into that category. It might not be 100% effective, but it’s better than not having a track.
Bryce Harper KNEW the wall was there (he can’t be that dumb, bro). He just forgot in the moment. That’s often how errors occur, whether it’s a medical error or forgetting to set the flaps on a plane before takeoff or hitting a Boston overpass with your bus, even though there was a warning sign (a lesson in error proofing that had fallen into disrepair).
We’re all exceptionally human. We make mistakes. I just don’t know how you truly error proof against running into the outfield wall.
I guess a Lean countermeasure would be making sure the wall had enough padding (Harper hit a section of scoreboard in the Dodger Stadium wall). I’m sure there is an ASTM standard on the thickness and softness of wall padding? Maybe to be explored in a future blog post…
Let’s be careful out there.
As reported in March, the ice maintenance system at James Brown Arena in Augusta broke down and forced the Augusta RiverHawks minor league hockey team to relocate their games to another Augusta-based hockey rink for the remainder of their season. There was also a good chance the repairs would be so costly that the arena would choose not to implement the repair and force the RiverHawks to leave town or cease operations all together.
Yesterday it was announced that the RiverHawks would follow the latter. A statement from owner Bob Kerzner:
The Augusta RiverHawks organization regrets to announce that we will not be playing in Augusta next season.
After waiting over two and a half months, the League deadline to commit to play next year is at hand and a decision needed to be made. We, as an organization, have not received any positive information concerning the replacement of the ice system at the James Brown Arena. A May 12th deadline was communicated to the building manager back at the end of March or the beginning of April. We also have not received any information concerning monetary compensation for the loss of the Arena for the eight games that were to be played in the James Brown Arena in March of this year.
We are taking a leave from League play with the approval from the League’s governors for one season. Hopefully, something can be done in the greater CSRA to bring hockey back the following year. We will retain our franchise.
To recap the situation, the system of pumps, tanks, and pipes below the ice at James Brown Arena has allegedly outlived its stated useful life and in the middle of the season the system broke down (pipes in the ice broke, and apparently more breakage elsewhere in the system). The team was forced to play the remainder of their home games in another arena with significantly lower fan capacity, so attendance was limited to season ticket holders and sponsors. The cost of the repair/replacement system will be north of $1M and since the team was leasing the space at James Brown Arena the costs don’t all fall back on the team itself.
A last ditch attempt to see how the costs could be covered:
Kerzner said he was told insurance would not cover the cost of the system, meaning another process will be needed to determine whether it will be fixed.
It’s just a bad situation overall, but it also goes to show you how poor quality can be the nail in the coffin for any organization, whether it’s sports or traditional business.
Proper maintenance of the ice system (and by “proper” maintenance I mean fixing all the problems right when they occur, applying preventative maintenance to the system as well as scheduled maintenance, use of the Total Productive Maintenance philosophies) could have potentially extended the life of the system. Proper problem identification, immediate and correct repair to problems, and adequate attention to ways to improve the system is the difference between a car being in service for 20-30 years and having to replace a car every 10 years or so.
By not applying proper maintenance (which might run, I don’t know, $50-75K per year?) the situation became so much more costly (replacement north of $1M), but it also meant loss of ticket sales (move to lower-capacity arena, and the attendees are those who already had tickets purchased) and a team no longer using your arena.
I don’t see the RiverHawks ever coming back to Augusta, even after the upcoming season. If a new ice system is implemented at JBA, it doesn’t look like it will happen anytime soon. Penny wise, dollar foolish.
The ASQ World Conference on Quality and Improvement closed last Wednesday and now that I’m finally back I’m going to cover some of the things I saw and experienced.
My primary responsibility for the conference was as a judge for the International Team Excellence Awards. The ITEA is a competition on improvement and project management that follows criteria very similar to the Malcolm Baldrige process excellence criteria. Teams from companies and organizations all over the world submit and provide presentations on a project where they have been successful in applying the project management principles. Teams are judged less on their final results and more on following the criteria and specifying the who/how/what/why of seamless integration of their projects.
I have been a judge in the preliminary rounds in Jacksonville, Boulder, and Charlotte the last three years and this was my first opportunity to attend the Finals held at the WCQI every year. We as judges digest a lot of information from the presentations and ask a lot of questions, but then rate the presentations according to how well they met or exceeded each item in the criteria (which is lengthy). Teams with top scores win prizes and recognition on the ASQ website – here are some of the winning presentations from the past.
This is a really neat process, and it would be great for more teams to enter the competition. If nothing else, the project management framework and criteria are phenomenal and are applicable to any improvement project. Even if teams didn’t enter the competition the framework should be a tool kept readily available for other internal projects.
I had the pleasure of grabbing drinks with Lean consultant/author and ASQ WCQI keynote speaker Karen Martin on Monday evening at Shula’s Restaurant downtown. She is the author of The Outstanding Organization and would be heading to Utah early Tuesday morning to accept the Shingo Research and Professional Publication Award for her book. (In Lean circles, this is the equivalent of winning the home run title.) She and I have been “Twitter buddies” for a while and this was the first time we had the chance to meet in person.
We talked for a couple hours about how TOO has made a difference for her readers and for her as she’s won the Shingo Award, but we also talked about some other projects she has on the horizon which include additional books. She also gave some fantastic advice on how to approach the activities of consulting as a whole and talked about the podcasts we’ve both recorded with Mark Graban (hers is here, mine is here). We are also looking at doing a blog co-post on our experiences as owners of Audi automobiles – we both have some interesting things to share.
Swag giveaways at conferences can be great or run-of-the-mill – conference trade show booth operators and marketing gurus, take note. This year at the conference we had the standard giveaways of company pens/fliers/business cards and Post-It Notes, maybe some 30-day trials of software here and there. We even had booths giving away cash prizes and iPads to one lucky winner. I’m part of the Lean Enterprise Division of ASQ and “my” booth was giving away t-shirts…to attendees who were already members of the division. Not much of a recruitment tool.
However, the biggest buzz and attention were around the unique giveaways. My favorites were the stress ball bulldozers from the ASQ Design & Construction Division.
I get that ASQ trade show booth operators don’t really lend themselves to marketing buzz and excitement – it’s hard to find “fun” in food/cosmetics/pharmaceuticals that don’t involve illegal activities or actionable passion in auditing – but this is where investment in outside marketing might make a significant impression.
Besides, how else am I going to collect great swag to give away to subscribers next year? (Yes, I’m giving away some squeezy bulldozers next time around.)
ASQ has started a subgroup for young members called Young Quality Professionals. I had the chance to meet with a handful of YQP’s organizers Monday evening for a drink and discussion.
There is a BIG talent and membership vacuum with ASQ right now – less than 10% of the ASQ membership is younger than 30 years old (so I’ve been told) while membership demographics are heavily skewed toward those who are approaching retirement age. Once those aging members leave the organization, ASQ membership will drop significantly. Because the skew exists today, very little attention is being paid to the new quality professionals and a tiny percentage of ASQ activities are designed to actively engage the younger segments.
If ASQ continues to operate as it does today, the membership bottom will fall out in the next 5-10 years and great conferences like this will not have as much clout. Most importantly, a collective global focus and critical mass will dissipate, and ASQ will struggle.
It’s a good thing that ASQ recognizes this upcoming problem and is making strides to fix this by creating YQP, but what is clear is that YQP doesn’t have a strategy. We youngsters (I’m 33 but including myself anyway) are not much different from generations older than us, we just receive information differently. Technology has changed how we communicate and operate. That being said, YQP can’t consist of one guy writing blog posts into a vacuum of no audience, and simply creating a social media presence. YQP requires a strategy that takes into account the needs/desires of the younger demographic AND connects them with the resources that satisfy those needs.
I have been asked to help ASQ and YQP on developing this strategy so that the mission and results of YQP are clearly defined and can be used as a recruiting tool.
This is a critical time for ASQ’s future – the drive and desire are there to make differences, but the know-how and organization is missing. I’m confident our efforts will be successful, but we must act quickly.
I was only able to see one full keynote presentation while I was in Indianapolis. It was the final speaker, Sally Hogshead, but her event was great.
The purpose of her talk was to understand how the world sees all of us – how we are able to fascinate our network based on our personality types. She had participants complete a personality survey before her talk and identify the archetype and triggers of our personality – passion, power, trust, mystique, prestige, alarm, and rebellion.
She showed the data of the ASQ conference attendees (how many of us fall into which archetype) versus the rest of the population who has taken her survey and we as a whole were significantly skewed toward trust, passion and prestige. I, on the other hand, lean toward mystique and rebellion. That sounds about right – I have intense focus on showing others how to change for the better, but I also don’t give away all my secrets.
Before attending Sally’s talk I had the chance to record an interview with the ASQ Quality for Life group. They share videos of individuals who tell their stories of how quality has been useful in their professional and personal lives. I, of course, talked about how Lean and continuous improvement can be applied in sports. I will share that video when it goes live in the coming months.
Next year’s WCQI will be held in Dallas – I hope I’m able to attend again!
Happy Mother’s Day to all the mothers out in the world – if it wasn’t for your mother, you wouldn’t be here to read this.
It’s an understatement that my mom is the glue that holds the family together. In my years she’s certainly been a jack-of-all-trades – fixing, coaching, teaching, preparing, managing, disciplining, facilitating, transporting, listening, everything.
While I hadn’t really thought of her in the past as a “Lean thinker” maybe I should reconsider. What can my mom possibly teach me about Lean?
- Strategic thinking
Early on in our development, she was thinking about how short-term decisions could impact the long-term results for me and my siblings – schools to attend, classes to choose, activities, after-school supervision, and so on.
- Cross-training and versatility
As previously mentioned, she certainly continues to operate as a jack-of-all-trades and seeks to solve problems by any means necessary. She might not have known about root cause analysis or the fishbone diagram, but her reasoning was always solid.
- Use the right tool for the job
She is not particularly mechanically inclined but she is a stickler for following the instructions, which means using the proper tool and not improvising. I don’t recall a project she ever left unfinished, especially as a result of not having the right tool to begin with.
- Activity and task balancing
She had to manage her schedule as it fit the family’s needs and duties – dropping off and picking up from our many activities like basketball practice or rehearsals or marching band competitions, shopping for food and clothing, cooking meals, cleaning everything, yet still having the time to spend with us directly.
- The importance of cleanliness and organization
No matter how much 5S training I’ve had or provided, no one (me included) can keep a house clean and organized (yet also warm and functional) like my mom. Maybe it should be her providing the 5S training…
- Early development and support, and teaching by example
While I don’t remember these activities specifically, our mom worked with us at a very early age on basic learning activities like hand-eye coordination, phonics, communication, mathematics, and interpersonal relations (er, sharing our toys with one another). The earlier those teachings are accepted and adopted by the learners, the faster the benefits from doing so are reaped (reading early, faster comprehension, accelerated absorption of facts).
- Visual management
Mom would measure our heights in a door frame and draw pencil lines with names/dates to measure our growth over time.
- Rewarding good behavior
It wasn’t particularly often that she had to punish bad behavior, but when we did well (good grades on report cards, finishing chores, and the like) we were rewarded with candy or allowances.
- People aren’t interchangeable parts
None of us were ever treated just like the other siblings. Rewards were different, as were punishments. Our chosen activities were different. Clearly our personalities were different. In order to achieve the expected end results we all had to be handled in different manners.
- Doing what’s right versus what’s most popular
Believe it or not, we weren’t ever particularly big fans of the studio portrait sittings. However, we needed photos to send to family so despite our protests (read: crying) we complied (eventually). Now we can look back and laugh.
Also, it’s cliche, but she was a stickler for not letting us ruin our dinner by splurging on after-school treats.
- Time studies
When our mom would drive us to school we could watch the clock and based on elapsed time displayed by the time we passed certain landmarks on our trips we could tell if we were ahead or behind schedule and if we would be late or on time.
- Safety first
Mom would always show us the proper and safe way to do things, and reacted with excellent quality first aid when we didn’t follow her lead.
This list could go on and on…but in the end, she’s a Lean thinker and she might not even know it.
Happy Mother’s Day!