Another group of excited Children’s team members has gone to Japan!

They left on May 29 for two weeks of intense learning about continuous performance improvement methods and work. The group will visit many companies that use Toyota’s lean methods and look for ways to apply these techniques back at home.

The group is a broad representation of the hospital, including staff from the Emergency Department, Radiology Department, Operative Services, CPI Department, Marketing Communications and more.

Watch for posts on this site from each of the teams. Team members include:

Emergency Department Team

• Tony Woodward
• Dawn Cotter
• Russ Migita
• Amanda Mogg
• Kendra Powell
• Cara Bailey
• Connie Whillock
• Mark Del Beccaro

Radiology Team

• Ed Weinberger
• Chuck Fritz
• Ray Ramoso
• Randy Otto
• Lisa Brandenburg
• Barb Bouche
• Emily Camm
• David Perry

Operative Services Team

• Cheryl Tada
• Jeremy Geiduschek
• Tony Avellino
• Pat Hagan
• Judy Dougherty
• Sean Flack
• Ti Refvem
• Loan Lam

Wishing them safe travels. Check back here for real-time reports from across the planet.

The ED team completed a great first day in Nagoya, Japan. After a perfect flight from Seattle to Tokyo, a connector flight to Nagoya and an informational bus ride to Nagoya Central, the team settled in and prepared for a visit to Nagoya castle, which was built in the 1600s.

The visit was designed to enable individuals on each team to look at an unfamiliar area and process, collate their observations with each other and the other groups (OR and radiology), and relate those observations to our work environment and opportunities. This process was aided by sketching what we saw.

It was amazing to perceive the same area and structures in different and unique ways. While some focused on macro-structure, others saw the intricate design elements as their primary observations. Others saw the surrounding environment, while several individuals concentrated on the people involved. It reminded us of how we look at things through eyes and minds with diverse training and backgrounds, and often see different aspects of the same process, or the same picture in different ways.

A few of the major take home points for us included the following. Some noted that the visible structure is built and predicated on the infrastructure, which is intricate, but clearly thoughtfully planned and implemented. The solid structure of the castle walls reminded us that although the load bearing walls might be solid and uniform, the structure of the remainder of the walls was variable and unique, not unlike the multidisciplinary and unique individuals who make our institution function on a daily basis.

As we intently looked and sketched our areas, we were also reminded that first looks are indeed just that. We missed several key observations on those short assessments, reminding us of the need to go to the source often to experience the environment and learn, rather than look once and assume.

It was also obvious to us that although the surroundings were extensive and beautiful, they were somewhat overwhelming to us, even as tourists. We projected that feeling to how our patients and families might feel in our large and expansive facility. Although it is comforting to us as employees to work in a superb institution, it can be overwhelming and stressful for our patients and families, who not only have to contend with a new environment, but also manage the actualities of the illness, injury or other issue that has brought them to us.

It is our people who make the facility what it is and we are the ones who can make the building friendly and patient/family centric, as well as manage the medical concerns in a consistent, standard and quality fashion. As we viewed a facsimile model of several workers, connected by a rope and working in unison, who were tasked with moving a huge square building rock, it reminded us that the impossible and the unbelievable can be accomplished by teams that work together to provide safety, design a process and monitor results.

Together, working on the small as well as the large opportunities, we too can accomplish what might be thought of as impossible. Results might include service on demand with no waiting for care or interventions regardless of the time or day and medical processes without waste.

This has been a great first day of lean immersion and we are excited to continue our journey as CPI students and teachers. We look forward to sharing more information with you as we continue in Japan and upon our return.

May 31, 2008

The ED Team,
Dawn Cotter, Russ Migita, Kendra Powell, Amanda Mogg, Mark Del Beccaro, Cara Bailey, Connie Whillock and Tony Woodward

…striving to stay ahead of the times.” This was the core philosophy of Sakichi Toyoda, founder of what is today’s Toyota Motor Corporation. While in Nagoya, our first stop during the Japan CPI trip, the Radiology team had the opportunity to tour Toyota’s Commemorative Museum of Industry and Technology. This unique museum successfully takes you through Toyota’s early days of textile looms (late 1800s) to future focused human design. It was truly a rewarding experience for the Radiology team. We have included a photo showing six of our team members with their sketching pads at the ready.

The team sketched extensively throughout our time in the museum (see photo of Ray Ramoso hard at work). During our team debrief (an exercise every team participates in at the end of each day) we identified 3 key learnings from our museum visit: 1) The 3 Is of success - incremental, iterative improvement; 2) The power of the 7 design principles which include “flexibility in use” and “simple and intuitive”; and 3) start small with reliable methods - in other words don’t hesitate too long before you jump in and begin a cpi project or pilot. Speaking of reliable methods, this is one of the implications for the Radiology team at Children’s. We agreed that we need, as a pilot project, to pick a specific area in Radiology to begin focusing on reliable methods and to get on the road of incremental, iterative improvement. In addition, we resolved that we need to understand our current processes better by collecting and analyzing data and via first hand observation.

During our bus ride back from the museum our discussion always led us back to the core reason for Toyota’s great achievements - an unwavering belief that they could be successful. This was clearly demonstrated by Sackichi Toyoda’s son, Kiichiro, who in 1934 moved the company into car production when many said it could not be done by a Japanese company. What you realize when you go to Gemba and see Kaizen (continuous improvement) principles in action is that it requires a strong, long term commitment to continuous learning and improvement.

We look forward to learning about more ways to improve our Radiology value stream as our trip continues and sharing some of these learnings with you in our next blog entry.

The Radiology Team

Greetings from the Operative Services team here in Japan. After two days in Nagoya, we traveled south, arriving in Fukuoka late Sunday evening, where the rain greeted us again. We spent all day Monday in classes learning about Kaizen from our four senseis. We studied just in time, standardized work, kanban systems and flow of materials and information.

“Although we have been working on many of these concepts already, we are learning that we have just scratched the surface of our leanings and the importance of constantly building “iterations” on the work we have already started,” says Cheryl Tada.

Monday ended with a traditional Japanese dinner where some of us were found to be more adventuresome than others.

“The culture and people have made us feel very comfortable. We are learning the Japanese way and trying not to disturb the “wa” (harmony),” says Eli White.

Even with limited Japanese language skills, we have been able to find our way (mostly), order food and understand the flow of work in the factories. The use of visual cues is everywhere along with a service culture that is unmatched. We have seen airline workers and immigration officials running in the airport terminals to assist passengers. Hard to believe for those accustomed to air travel these day perhaps, but true!

Another example of service excellence was provided on our last night in Fukuoka when a group of us set out to find the famed street-side food stalls located downtown. We must have looked a little lost as we were spontaneously adopted by a local businessman who took time to detour from his trip home and escort us to our destination.

The past two days we spent going to “Gemba” at Showa Manufacturing. They specialize in various heating and air conditioning equipment and have been practicing Kaizen (lean) for over 20 years. Judy Dougherty “saw standard work in action that clearly allowed the worker time to be creative and to continually improve the process. Furthermore, intuitive layouts supported the training of new workers.”

Sean Flack was “surprised by the craftsmanship and variety of custom work evident in a factory setting.” Clearly, manufacturing environments have more in common with our workplace than we might intuitively expect.

As Ti Refvem commented “many ideas can be taken from the factory floor and used in our setting. The factory workers use a combination of manual techniques and high-tech machinery to service our customer. We also do this in health care”.

Today we traveled an hour by bus to two car manufacturing plants. We first visited the Nissan plant in Kyushu where we were left speechless by the extensive use of robots to perform many tasks. Who would have thought that we would be reminded of ballets and waltzes while watching these machines perform their work?

Then we were privileged to travel into the hills outside town to the Toyota plant where Lexus and Highlander models are made. Again, we were awed by the synchronous work of man and machine. As Jeremy Guideschek observed, “it’s all about the flow”. Unlike Nissan however, Toyota has clearly chosen to rely less on robots, and with careful thought provides a safe and supportive environment that promotes worker excellence.

Thanks for reading our blog and we look forward to reporting to you all in person on our return to Seattle.

The Operative Services Team