Today, you are about as safe in a U.S. hospital as you would be parachuting off a bridge or a building. But it doesn't have to be that way. Right now, some hospitals are making enormous short-term improvements, with no legislation or market reconfiguration and little or no capital investment. Instead of waiting for sweeping changes in market mechanisms, these institutions are taking an operations approach to patient care. In case after detailed case, this article describes how doctors, nurses, technicians, and managers are radically increasing the effectiveness of patient care and dramatically lowering its cost by applying the same capabilities in operations design and improvement that drive the famous Toyota Production System. They are removing ambiguity in the output, responsibilities, connections, and methods of their work processes. These changes--which can be done in the course of an ordinary workday, sometimes in a matter of hours--are designed to make the following crystal clear: Which patient gets which procedure (output)? Who does which aspect of the job (responsibility)? Exactly which signals are used to indicate that the work should begin (connection)? And, precisely how is each step carried out (method)? Equally important, managers are being transformed from rescuers who arrive with ready-made solutions into problem solvers who help colleagues learn the experimental method. Thus, these hospitals are breaking free of the work-around culture that routinely obscures the root causes of so many problems, creates so much waste, and leads to so many unnecessary deaths.
All complex systems have four distinct hierarchical design levels: system objectives, architecture, interfaces, and components. Each level has a distinct design question associated with it. Distinguishing among these levels and understanding the questions associated with each offers insight into the evolution of products and markets as well as the principles by which organizations should be structured to accomplish each task. The first section of the note contains examples that illustrate the four levels of complex-product design and how each level cascades naturally to the next. The second section discusses the implications of the hierarchy in terms of project management, product evolution, and market evolution. The third section introduces the idea that a similar framework of hierarchical design levels can be used when thinking about the design of complex processes.
Many companies have tried to copy Toyota's famous production system--but without success. Part of the reason why, says the author, is that imitators fail to recognize the underlying principles of the Toyota Production System (TPS), focusing instead on specific tools and practices. This article tells the other part of the story. Building on a previous HBR article, "Decoding the DNA of the Toyota Production System," Spear explains how Toyota inculcates managers with TPS principles. He describes the training of a star recruit--a talented young American destined for a high-level position at one of Toyota's U.S. plants. Rich in detail, the story offers four basic lessons for any company wishing to train its managers to apply Toyota's system--rather than go through the cursory walk-throughs, orientations, and introductions of most companies. First, there's no substitute for direct observation. Toyota employees are encouraged to observe failures as they occur--for example, by sitting next to a machine on the assembly line and waiting and watching for any problems. Second, proposed changes should always be structured as experiments. Employees embed explicit and testable assumptions in the analysis of their work. That allows them to examine the gaps between predicted and actual results. Third, workers and managers should experiment as frequently as possible. The company teaches employees at all levels to achieve continuous improvement through quick, simple experiments rather than through lengthy, complex ones. Finally, managers should coach, not fix. Toyota managers act as enablers, directing employees but not telling them where to find opportunities for improvements.
Jack Smith had a stellar career at Chrysler managing major design teams and manufacturing plants before deciding to join industry leader and benchmark Toyota. It is his first day on the job; what will his orientation entail? Cursory walkthroughs and introductions before assignment to a job commensurate with his experience and accomplishments or something else to acclimate him to Toyota's unique management approach?
Jack Smith had a stellar career at Chrysler managing major design teams and manufacturing plants before deciding to join industry leader and benchmark Toyota. It is his first day on the job; what will his orientation entail? Cursory walkthroughs and introductions before assignment to a job commensurate with his experience and accomplishments or something else to acclimate him to Toyota's unique management approach?
Jack Smith had a stellar career at Chrysler managing major design teams and manufacturing plants before deciding to join industry leader and benchmark Toyota. It is his first day on the job; what will his orientation entail? Cursory walkthroughs and introductions before assignment to a job commensurate with his experience and accomplishments or something else to help him acclimate to Toyota's unique management approach?
Martin Stein, a recent business school graduate, is the new owner of Quality Imaging Products (QIP), a $10-million-a-year remanufacturer of printer and copier ink cartridges. Within weeks of buying the company, QIP's vp for finance, gives an ultimatum: a raise or he walks, leaving Stein with the burden of straightening out a nonfunctional financial system while customers, suppliers, product managers, and production staff compete for his attention. Presents Stein as an example of a small-company manager who must juggle a far broader range of issues in greater depth than his big-company counterparts to meet the needs of customers profitably.
For nearly three months, John Carter, a vascular surgeon by training, had been studying a variety of clinical processes at Deaconess-Glover Hospital in Needham, Mass. Carter was looking for an opportunity to test the applicability of Toyota Production System "Rules-in-Use" in the health care context. After several weeks of increasing focus, he had found a particular process--medication administration--to test his ideas. He had just suggested to John Dalton and Julie Bonenfant, the hospital's president and vice president, that they create a learning unit or model line within one of the nursing wards to begin conducting experiments. Dalton and Bonenfant received his modest proposal negatively. They complained that his proposal seemed remarkably unambitious, yet, paradoxically, they complained that creating a dedicated learning unit within the larger nursing ward would be infeasible. Carter struggled to explain how they could react simultaneously with such seemingly contradictory sentiments.
In late 1999, Madison Avenue was experiencing phenomenal growth in sales, clients, employees, and services provided. The stress and strain on the firm's employees was considerable and threatened to jeopardize the high-quality, active-ad management for which the firm was developing a positive reputation. From late 1999 through July 2000, the firm embarked on a number of initiatives to improve its internal processes so that it could scale successfully, meet the needs of its customers, maintain the quality of the services it provided, and improve efficiency enough to generate operating profits. The case describes the many efforts made within Madison Avenue to improve its processes.
By July 2000, Madison Avenue had experienced extraordinary growth in sales, employees, clients, and service offerings. From late 1999 to July 2000, the company had taken several initiatives to redesign its internal processes so that the firm could continue to grow, while maintaining the quality of its service offering and increasing efficiency enough to show profitability. Matt Garvin, the company's chief strategy officer, was considering a host of new service offerings to complement its core service--active management of online advertising. The question to Garvin was twofold: What opportunities made strategic sense for the company? What strategic opportunities matched well with the company's operational capabilities? How reliable, robust, and responsive are they? Can they handle the growth, scale, and scope that Garvin is contemplating. Can be taught alone as a strategy case or in conjunction with the (B) case to emphasize the product-process matching problem. If taught together, one case can be assigned to half the students, the other case to the other half to simulate more fully the organizational challenge of communicating across functional specialties--i.e., the service equivalent of product development, production, marketing, and sales.
When Jack Sindler founded Spir-it, Inc. in 1934, he was the company's sole employee. By 1999, Sindler's firm more than survived its first 55 years. Employment was up to nearly 200, with facilities in two states and work done in three shifts. The product line--which had grown to 20,000 items grouped into 800 distinct product families--supported annual sales of $12.4 million. Richard Oedel, Spir-it's manager and then its owner in the 1980s and the 1990s, faced a number of challenges. These challenges extended beyond managing a product line that had grown increasingly varied, a customer base that had become increasingly diverse and dispersed, and a technological base that had grown to include a greater number of manufacturing processes. Spir-it's workforce had become increasingly international. Most employees spoke English as a second language, so supervisors had to be multilingual to be successful. Orders between the two locations were sometimes garbled, vacation policies were different, and health care and other benefit plans were subject to three different state laws, as were workers compensation and other state-specific programs. Oedel had to develop a human resources policy that effectively met the particular needs of his workforce and also effectively addressed the idiosyncratic situations that arose unexpectedly each day.
Managers are often confronted with the challenge of improving critical business processes so that their efforts are not merely ad hoc. This note provides a template by which improvement efforts are converted from unstructured efforts to bona fide, hypothesis-testing experiments that lead not only to process improvement but to the creation of broader and deeper understanding of how the process works. This is a tool for system improvement, learning, and creation of learning systems.
Assistant Professor Sam Benson was about to end the class session portion of his course with only student projects remaining. Then, he received a phone call from a student, George McHenry, who had missed 11 of 20 sessions. McHenry wanted to know what he needed to do to salvage his standing in the section so that he would be given a category-III grade and not a category-IV grade and avoid review by the Academic Performance Committee (perhaps jeopardizing his chances for graduation). In his first year of teaching, Benson didn't know how to handle the situation and received conflicting advice from senior faculty colleagues. Teaching purpose: Presents an actual situation and challenges the reader to arrive at an appropriate solution. The reader will have to consider short-term and long-term consequences of the decision that is chosen, with careful consideration concerning the reader's own philosophy about the division of responsibility in the learning process and the role of punitive measures to motivate and punish.
Requires participation in a team research project. Each team should have three to four members. The goal of the project is to acquire first-hand knowledge of how a particular business process is managed at a small company.
Chronicles the initial efforts to teach a health care organization to manage itself according to the principles of the Toyota Production System (TPS). Describes the decision and dilemmas that arose from the implementation experiment. Builds on Bowen and Spear's earlier research in industrial settings. They found that TPS is an integrated approach to designing, doing, and improving the work of individual people and of groups of people working collaboratively to produce and deliver goods, services, and information. The Deaconess-Glover Hospital project tested the efficacy of the TPS in a nonindustrial setting (i.e., health care) and also offered insight into how to convert an organization, managed by its existing management system to one managed by TPS principles. This case provides background on Deaconess-Glover Hospital and on the TPS teacher, John Kenagy. Describes how Kenagy observed the work at the hospital to understand the system. Given how Kenagy gathered data and based on what he directly observed, what should he recommend to managers about their next step?
Introduces a "new-economy" company, Madison Avenue, facing challenges of mega-success. In the two years since its founding, the company's revenues have grown from zero to nearly $30 million, head count has swollen from the start-up handful to more than 200, and the client base has gone from one to dozens. In the company's short life, Madison Avenue's managers have already tried four organizational forms to more efficiently and reliably meet the needs of its customers. Despite the intense, ongoing efforts to find an appropriate organizational form, employees struggle to keep pace with ever-increasing demands. Ted Samson, an implementation engineer at Madison Avenue and a reservist in the Marine Corps, expresses a collective frustration in an e-mail to his boss. The case contains a history of Madison Avenue, starting with its serendipitous creation as an outgrowth of a family business's efforts to advertise on the Web and the collateral development of an expertise in Web advertising and the evolution of the company's business model. Gives a detailed explanation of the internal processes by which Madison Avenue creates, implements, and optimizes online advertising campaigns for its clients. The case asks students to analyze how Madison Avenue currently does its work and then to design a "target condition"--based upon analysis of the company's "current condition"--of how Madison Avenue's internal processes might be redesigned in order to produce higher quality ad campaigns, at less cost, with shorter lead-times, and with greater flexibility in responding to customer needs.