I’m off to Japan and my first trip with Seattle Children’s to study integrated facility design and planning methods from the Toyota Motor Company - one of the world’s experts. We will be focused on bringing back insights and learnings that will help us plan Children’s anticipated hospital expansion and facilities for the future.

Our first stop is Tokyo. We’ll be building on our knowledge of continuous performance improvement methods. I’ll write more in a few days to share insights during our trip!

—-Todd Johnson

Vice President, Facilities

Greetings from Nasu-Shiobara, Japan!

Our Seattle Children’s Hospital team of ten, along with kaizen leaders from Virginia Mason, Park Nicollet Health Systems in Minneapolis, Boeing, and Sun Chemical (EU) arrived on Sunday. We travelled by train and bus to this beautiful resort area 1½ hours northeast of Tokyo that is popular with Japanese seniors and families. It’s an excellent location for learning more CPI tools, because there are few diversions from our studies (except perhaps the acclaimed mineral baths), conducted by three sensei from Shingijutsu Consulting.

Yesterday was dedicated to refreshing old kaizen skills and learning more about 3P, the Production Preparation Process that is a relied-upon planning technique at Toyota and will be used as we at Children’s plan our new hospital addition.

3P was created to generate innovative ideas and new, efficient processes for the design of a new facility. It looks at “hardware” like buildings, machines and equipment, as well as the “software” of standardized work, process flow, built-in quality, and logistics. As with our rapid process improvement events, 3P is based on some established tools and follows a pre-determined order, although idea-generation and innovation are cultivated. The process involves first establishing a complete understanding of the current state by determining essential functions and mapping the flows. The key words, or targets, are sketched, relying on concepts from nature and are then grouped by concepts. Seven ideas for solutions are presented by each team member, then narrowed to a few promising design concepts. Prototypes are created quickly and cheaply, often out of cardboard, and then refined using PDCA cycles. Finally, an implementation plan is developed; it must include the essential “what, by whom, and by when?” information.

During our learning day, the sensei reminded us of the fundamentals of this work. It’s important to remember them as we begin our important facility design work at Seattle Children’s. Some key concepts include:

• Without standard work in place, there is no foundation for improvement. We must know our volumes, our lead times and our cycle times and standardize our work to keep in takt time.

• Everyone must understand and agree upon the need for improvement. We must uncover waste, unevenness, and unreasonableness in our operations.

• We need to identify the problems in our “old house”. We can avoid them as we build our “new house”.

• In our redesigned spaces, flow must be visible. We must design for flexibility, extendibility, and rapid changeover.

To practice our newly acquired skills, we’ll travel tomorrow (Tuesday) to the nearby town of Shirakawa, home of the Yamatake Company division that produces and re-manufactures several types of gas meters. We’ll be divided into three mixed teams (comprised of members of all of the participating American, EU-based, and Japanese companies) and will be led by our sensei, Mr. Iwata, Mr. Koide, and Mr.Shuno.

Each team has been given an assignment and has been asked to complete specific tools (such as the time observation and percent load charts, the spaghetti chart, the fishbone diagram, and the process-at-a-glance form) to give an accurate picture of the current state. Each team has also been given an improvement target.

Team one was asked to remove or relocate impediments to flow and staffing flexibility, like machines or conveyor belts that break up the line. The second group was requested to design an ergonomically-sensitive conveyance system that transports large, heavy meters without workers needing to lift or transfer the product. The third team was asked to redesign a line so that the company could easily flex its staff up and down to meet takt time with wildly varying order volume.

We’ll spend the next three days on the factory floor and will give a formal report on our progress on Friday. We’re excited about the learning opportunities, and are constantly discussing the application of the techniques as we seek to design buildings that take the waste and defects out of our processes. We know that we’ll return home with many ideas to help improve quality, patient satisfaction and staff engagement, delivery, cost, and safety.

We’ll report back as the week progresses.

Hello again from Japan.

It’s Thursday morning and our team is heading into the third and final day of factory work.

We all know quite a bit more about gas meters than we did three days ago when we arrived in this large, modern factory. We’ve been impressed by the cleanliness and orderliness of the facility, and have enjoyed the hospitality of the plant’s staff. There are several of the company’s managers in our workshop and they’ve been very helpful in describing current processes, setting up demonstrations, and getting simulation materials.

After a brief familiarization on Tuesday morning, we headed for the factory floor to observe the operators, measure cycle times (which varied from a few seconds on one line to hours on another), and develop ideas for improvement. Each team member produced at least seven ideas, basing them on concepts from nature. For example, in an operation that involved removing paint from a casing, the team referred to sandstorms and the grinding movement of a glacier. With idea forms grouped conceptually, a ranking took placed based on established criteria such as cost, quality, improvements in safety, and capital required to implement the improvement measures. Then off we went to simulate.

The teams used prodigious amounts of cardboard, duct tape, used soft drink bottles, and a few items found in the factory to create a vision of new equipment and production methods. Standard work sheets were developed for the revised processes, which we will test tomorrow (Thursday) morning. Some of our colleagues from the plant stayed late last night producing prototypical carts and other equipment to assist us in this testing. After observing several cycles of the proposed new processes in the redesigned space, we’ll prepare implementation plans for each of the three lines. Our hosts tell us that they want to develop many of the good concepts that have come out of our work here.

Our 1-½ hour bus rides back to our hotel gave the Children’s team some time to reflect on what we’ve seen and how the concepts can be applied to creating a new facility that supports our mission to become the best children’s hospital. We applied some standard tools to the debriefing sessions and recorded some key observations, including:

• Having accurate data about our current processes is essential to improving them.

• Our work begins with process improvement. We can’t build a new facility based on bad processes.

• Even in standardized processes we find variation. We must go to the site of care and observe to get a deep understanding of the work.

• Time is the shadow of motion. Every movement adds time to a process; if it does not add value it should be reduced or eliminated.

• Sometimes simple tools are the best. It’s easy to leap to an IT solution or to buy an expensive piece of equipment but sometimes neither is necessary.

• Simulation, based on the real process, is very powerful in helping avoid problems with the future-state design.

• Building flexibility into the facility is essential because demand and process will change over time.

Tomorrow, our teams will formally present a summary of our work to our sensei and the factory managers. After celebratory lunch and ceremony, we’ll head back to Tokyo where the team from Seattle Children’s will draw together more of our learning and continue translating them to guide our improvement work and phase one project design. We’ll make one more blog entry before we head back to our families and Seattle Children’s on Sunday.

—Todd Johnson

Hello!

It’s Saturday night in Japan and we’re in Tokyo, looking back on a very intense week of training, hands-on practice and reflection on the tools of the Toyota Production System.

Yesterday our three teams presented the results of our improvement workshops at the Yamatake meter plant to our sensei, the company’s CEO, and some of its work unit managers. They told us that they were extremely impressed by the hard work, professionalism and insight demonstrated by each of our teams. They benefited from an outside look (and very cool new equipment mock-ups) at their own operation, and we reinforced and added to our CPI skills.

This morning, after a 5:30 a.m. visit to the enormous and unbelievably bustling Tokyo fish market, our nine-member group from Seattle Children’s gathered to summarize and discuss the key learnings from the trip, to identify the implications for our own hospital operations, and to talk about the next steps for our integrated design process.

We grouped our observations into three important categories: leadership characteristics, CPI tools, and process planning guidelines. These were translated into the beginnings of a high-level plan for the process that we’ll use to design our Phase I hospital expansion. When we get back to Seattle, we’ll engage others to help us complete the data gathering and standard work for our first integrated design workshop, which will take place in February 2009. At least three other related events will be spread throughout the year.

In Japan, we’ve worked side-by-side with people from at least seven counties and have, at times, been challenged by the cultural differences represented in the workshop. We’ve noted how much the experience was strengthened by being away from what we know well, but have also observed how much of our CPI knowledge transcends borders and industries. We also can’t help but see how our host country, a densely-populated, natural-resource scarce, highly-industrialized island nation, functions so well using anthropological standard work, visual cues, and shared goals. We can’t wait to get home and continue planning a facility that will enable Seattle Children’s to advance its vision to be the best children’s hospital anywhere.

—Todd Johnson
Vice President, Facilities