Rules & Tools to Solve Problems and Eliminate Waste

"When everything seems to be going against you, remember that the airplane takes off against the wind, not with it." -Henry Ford

The purpose of the previous 7 parts in this series was to move us to an understanding of Lean implementation so that we can develop within our healthcare environments an adaptation of Total Quality Management based on Deming's management principles. The goals is to move beyond 'Lean-ing out' crises with focused projects to creating Lean systems that self-perpetuate. This is after all, a management system we are talking about that enables an effective culture of continuous process improvement to exist as leader supported voluntary and mandated team-based activities at all levels of the organization.

We have therefore reviewed the underlying philosophy that promotes people (part 1), the business case for and methods of change (part 2), organizational structure and teams that promote a culture of continual improvement (part 3), new roles and responsibilities of leaders that empower workers (part 4), the team leader role (part 5), roles of the team member (part 6) and the role of the facilitator (part 7).

The intent has not been to cast a broad net of culture-speak and knowledge of tools over the workforce so that we get something that is an 'inch deep and a mile wide' but rather to focus on developing a structured and functional work culture that is 'narrow' (focused and rolled out in specific work areas or so called model lines) and 'deep', extending from top leaders through middle managers down to the level where the actual work takes place.

This approach to Lean mirrors that of numerous Japanese corporations and for us is a paradigm shift meant to optimize the overall system of work, across usual silos of control, rather than local optimization. Success in Lean therefore is promoted by the management culture that facilitates trained, empowered employees and leaders to work in team structures with defined work rules and applying strategies and 'tools' to reduce 3 forms of work inefficiencies.

I depart here from our convention of describing all things in English and use several Japanese terms in italics because each word is invested with much meaning and this is where these concepts are derived from. Muda describes types of waste identified retrospectively within existing processes, mura relates to work design implementation, scheduling and operations inefficiencies, and muri is derived from poor proactive preparation and planning for the new work design.

Wastes: 3 Forms of Work Inefficiencies

  • Muda, non-value added work(7 types of waste that exist under the present work conditions)
  • Mura, unevenness (lack smoothness) of workflow
  • Muri, overburden of work imposed by management because of poor preparation or planning

The 3 define the opportunities within the system of work that members of the workforce at all levels have a hand in coordinating and continually improving. These wastes are sources of variation and inefficiency that if identified and eliminated will allow the system of work to be more efficient and productive, in effect doing more with less. Lean, then, is not the 'tools', which are workarounds employed by the workers for specific situations, but the continuous focus on these aspects of waste reduction as the work is continuously redesigned to be more efficient by those who do it.

Wastes: 7 Types of Waste in Work

  • Overproduction, in excess of what's required
  • Waiting, downstream process inactivity
  • Transport, material & work-in-progress
  • Extra Processing, due to defects, overproduction or excess inventory
  • Inventory, excess requires additional handling and space
  • Motion, personnel & equipment
  • Defects, don't conform to specification or customer's expectation

We have found that a focus on the 'rules of work' as described by Spear and Bowen, sensitizes the workforce in recognizing gaps they experience in light of the 3 forms of wasteful work inefficiencies- 1) within existing work processes, 2) how processes relate to each other in the flow of connected work and 3) in the subsequent design proposals of new work processes. These 'rules of work' define the expectation and key characteristics that the standardized, redesigned work should have.

Rules: 4 Rules of Work Design

  • Rule 1 - Standard Activities: Specifications document all work processes to include content, sequence, timing, location & expected outcome (how do you do your work)
  • Rule 2 - Standard Connections: Connections with clear YES/NO signals directly link every customer & supplier (requests & responses)
  • Rule 3 - Standard Pathways: Every product & service travels a predefined, single, simple & direct flow path (no looping or forking)
  • Rule 4 - Improvement & worker Empowerment: Workers at level where work is done, guided by a teacher, improve their own work, using data (PDCA)

We have illustrated previously in part 3 the process of improving a process depending on the problem- either applying a rapid fix or developing a PDCA based (A3) intervention targeting the root cause and tested with data. Obviously, the latter approach is meant to move toward eliminating the problem rather than applying a patch to a problem that could recur. This is similar to David Hutchins' description of 2 types of solutions to problems as Reversible and Irreversible in his book Hoshin Kanri. The Strategic Approach to Continuous Improvement.

  • "Reversible means that the problem can return if the situation is not regularly monitored. This can involve a Process Audit."
  • "Irreversible solutions are those where the methods have been changed in some way making it impossible for the problem to return. This is known as Mistake Proofing or in Japan 'Poke-Yoke'."

Seen in this light, any of the strategies and tools listed in the toolkit below can be used by the workforce in their structured teams to solve work problems once the forms and types of waste are recognized, the standard is known and the problems are made visible.

Strategies and Tools: Reduce Waste & Improve Workflow

Structure and management

  • Horizontal management across workstations, divisions
  • Defined workstations with team leaders and teams along path of work Partnerships with internal and external 'customers and suppliers'

Workplace physical redesign

  • U or linear workstations to reduce motion
  • Inventory relocated to workstations
  • Work redesign
  • Standardized activities, connection, pathways
  • Continuous flow and pull
  • Reduction cycle times
  • Front loading work in the paths of workflow
  • Elimination of loops, forks
  • Reduction of steps
  • Work simplification
  • Maintenance of sequence
  • Load leveling across hours and shifts
  • Batch size reduction
  • Mistake-proofing
  • Visual workplace to surface defects
  • Color-coding and visual controls

Kanban just-in-time inventory system

  • Production kanbans to promote pull production & communication
  • Inventory kanbans for JIT, recovery of stock room space

Metrics to monitor and target variation

  • Daily metrics to monitor performance variation
  • Whiteboards to identify in-process defects and outliers

Feedback loops to inform defect repair in real time by empowered teams

If all this seems like a lot to remember, it is, in isolation. Once you learn by doing it will become second nature to think in this way about your work.

"We don't want tradition. We want to live in the present and the only history that is worth a tinker's dam is the history we make today." -Henry Ford


  • Ford H. Today and Tomorrow. New York, NY: Doubleday; 1926
  • Ohno T. Toyota Production System: Beyond Large-Scale Production. Portland, OR: Productivity Press;1988
  • Hutchins, David: Hoshin Kanri. The Strategic Approach to Continuous Improvement. Gower Publishing Co. Burlington, VT, 2008.
  • Spear SJ, Bowen HK. Decoding the DNA of the Toyota Production System. Harvard Bus Rev. September 1, 1999:96-106.

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