I love hearing about how LEAN strategies can do more important things than just help companies make more money.  Watch this video (or read the transcript) of Bill Moyers Journal for 9/11/09 where he interviews Dr. Jim Yong Kim, a public health expert and the new president of Dartmouth College.   Without mentioning LEAN by name, Dr. Kim  explains how LEAN thinking can improve healthcare, and how it (along with other strategies normally associated with industrial efficiency) should be implemented in U.S. Hospitals.

While there are many articles and posts out there discussing LEAN in healthcare, I just like the way this explains it.

Some quotes from the transcripts, with my comments interspersed [in italics and in square brackets].

BILL MOYERS: Why are we talking about the American health care system as a crisis? What’s wrong with our health care system?

DR. JIM YONG KIM: My own particular take on it is that I think for many, many years, we’ve been working under the fantasy that if we come up with new drugs and new treatments, we’re done.

The rest of the system will take care of itself. In my view, the rocket science in health and health care is how we deliver it. And unfortunately, there’s not a single medical school that I know of that actually teaches the delivery of health care as one of the essential sciences [sic]

[in other words, Dr. Kim is saying that high-tech innovation alone is not enough to make us excellent. The same can be said for many manufacturing facilities.]

DR. JIM YONG KIM: Well, just think about a single patient. So a patient comes into the hospital. There’s a judgment made the minute that patient walks into the emergency room about how sick that person is. And then there are relays of information from the triage nurse to the physician, from the physician to the other physician, who comes on the shift.

From them to the ward team, that takes over that patient. There’s so many just transfers of information. You know, we haven’t looked at that transfer of information the way that, for example, Southwest Airlines has. Apparently they do it better than any other company in the world.

[The same way we gain efficiencies by LEANING the flow of materials and of information in our facility.]

DR. JIM YONG KIM: It means how do you evaluate clinical outcomes? How do you understand variation in doctors’ practices, for example? And ultimately, how do you fix the problems? So the group at Dartmouth Institute does all of that. We look at variation. You know, why is a Medicare reimbursement rate, you know, almost a third in the Mayo Clinic area, as opposed to Miami?

[Measure results.  Analyze variation. Improve procedure.]

DR. JIM YONG KIM: Well, I’ve noticed over the years that when it comes to our most cherished social goals, not only do we tolerate poor execution, sometimes we celebrate poor execution. Sometimes it’s part of the culture. You know, these folks are trying to solve this terrible problem. They can’t keep their books straight.

They really don’t know what they’re getting. They don’t measure anything. But they’re on the right side, so that’s okay. I think we’re in a different time.

[Tolerating waste as a cultural problem.]

Lots of China-based bloggers are talking about Nicholas Kristof ’s latest Op-Ed in the New York Times, so I thought I’d attack it from my angle.

Basically, Kristof’s argument is that Western intolerance to sweatshops lead to joblessness and misery in poor countries.  After all, a sweatshop job is better than abject poverty.

He writes:

When I defend sweatshops, people always ask me: But would you want to work in a sweatshop? No, of course not. But I would want even less to pull a rickshaw. In the hierarchy of jobs in poor countries, sweltering at a sewing machine isn’t the bottom.

My views on sweatshops are shaped by years living in East Asia, watching as living standards soared — including those in my wife’s ancestral village in southern China — because of sweatshop jobs.

Well, MY views on sweatshops are shaped by  a decade of experience running factories in Southern China and by doing business in the greater China for over two decades.

My comments:

1. If labor standards are constraining the rise of manufacturing in poor countries, and eliminating those standards would help alleviate poverty, why not take it further; why not eliminate safety  and quality standards (UL, CE, et al)  and environmental standards (RoHS, WEEE) at the same time?

2. I’ve seen a number of ugly facilities in China which I would classify as sweatshops, and have found that these factories tend to  waste big bucks through mismanagement of labor and inventory, and then try to draw it back by skimping on workers’ compensation, housing, and benefits.  Simply allowing these factories to run on as sweatshops puts no pressure on them to improve their management.  (Yes, I’m saying here that even in “low cost countries” such strategies as LEAN and JIT can work to improve results for workers, shareholders and customers alike).

Here’s the mantra;

Keep it Lean, Keep it Simple, Keep it Real, Keep it Going

Here’s what I mean:

• Keep it lean
  Generally, dysfunctional or under-performing factories are operating
  inefficiently, and lots of low-hanging fruit can be gathered and hauled
  away by utilizing lean principals.
• Keep it simple
  Identify concrete problems and propose limited but effective solutions.
  If you are responsible for leading a turn-around, the complexities of
  perfectionism are simply not part of your world! Go for a quick fix for
  80% of the problem and go snag the remaining 20% later after you’ve
  become a hero.

• Keep it real
  Make sure you accurately measure progress (inventory reduction,
  operating cost reduction, on-time delivery, production cycle time,
  etc.) against accurate baseline data. If a performance indicator is
  really difficult to measure, it may need to be changed to one which can be measured easily.  (e.g., SMART KPI)
• Keep it going!
  Ensure that your performance is repeatable by establishing
  transformational best practices as written procedures, on which all
  relevant personnel are trained.