Interview with Dr. Steven Spear – Part 1 Toyota, a community of scientists

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Outline of Highlights…..Please listen to the podcast for details

Today we are fortunate to have as our guest Dr. Steven Spear

Dr Spear is a Senior Lecturer at Mass. Institute of Technology, where he teaches an introduction to Lean Manufacturing and Six Sigma for students in the Leaders for Manufacturing and System Design and Management Programs.

Steven also teaches in Harvard Medical School and School of Public Health Programs.

And is a senior fellow at the Institute for Healthcare Improvements

Steven played an integral role in developing the Alcoa Business System and the “Perfecting Patient Care program of the Pittsburg Regional Healthcare Initiative.

Steven has authored or co-authored:

Publications
_Learning from the Masters: By adopting complex processes from Toyota and Alcoa,
hospitals can improve performance,_ Cerner Quarterly, (2006).

_Fixing Healthcare from the Inside: Teaching Residents to Heal Broken Delivery Processes As They Heal Sick Patients, _ Research and Innovation in Medical Education Invited Address, American Association of Medical Colleges Annual conference. Academic Medicine. 81(10) Suppl:S144-S149, (2006).

_Using Real-Time Problem Solving to Eliminate Central Line Infections,_ with Richard Shannon and other co-authors. Joint Commission Journal on Quality and Patient Safety. 32:479-487, (2006).

_Operational Failures and Interruptions in Hospital Nursing Work,_ with Anita Tucker,
Health Services Research, (2006).

_The Health Factory,_ New York Times [op ed], (2005).

(#) (*) _Fixing Healthcare from the Inside, Today,_ Harvard Business Review (2005).

_Ambiguity and Workarounds as Contributors to Medical Error,_ with Mark Schmidhofer,
Annals of Internal Medicine (2005).

_Medical Education as a Process Management Problem,_ with Elizabeth Armstrong and Marie Mackey, Academic Medicine (2004).

DB  Welcome to this Competing Podcasts Steve.
In Decoding the DNA of TPS the seminal paper you co-authored with H. Kent Bowen you state that the TPS creates a “community of scientists, could you elaborate?

SS  * Community of Scientist is what separates Toyota from everyone else in the world and the automotive industry.
*Article written in 1999, since then we continue to plug away and understand Toyota.
* In a highly competitive, sometimes cutthroat, limited profitability and leadership that’s hard to sustain. If you look at the auto industry that’s true for everyone but Toyota
* Toyota solves problem that effects most large organizations
* Complex processes create problems
* 300 engineering years to redesign a Camry
* No one in the room understands the entire design or how to get there
* That same scale exists elsewhere and is overwhelming and failure is easy
* Toyota found that you can’t design something great, greatness is discovered
DB – Please discuss Toyota’s “four rules”

SS

* We found the “Four (unwritten) Rules of the TPS to be:
1. All work shall be highly specific as to content, sequence, timing and outcome
2. All customer-supplier connections must be direct
3. The pathways of every product and service must be simple and direct
4. Any improvement must be made in accordance with the scientific method

The Scientific Method Establish a prediction declare ahead of time
Experiment
Measure outcomes
* Got what predicted – that confirms our thinking
* Contrary Of that is something I didn’t understand and need to invest more time to investigate to deepen knowledge further

DB Rigid yet flexible
Scientific yet simplified……?

You state Toyota is a learning institution and that workers learn by applying four questions to any process…..could you elaborate?

SS
From 1999 until 2005 our understanding has evolved.
All work is a process, has a start and finish, inputs and outputs
All processes have various levels at which they need to be designed
You have to be very clear as to the output you wish to achieve
Work back from a successful outcome
Develop the necessary steps and sequence and have a person responsible for each step
Pathways, flow, sequence and who owns them
Connections how do we indicate demand, what is the format
What specific process, sequence, timing, location and output for each step to achieve perfect quality leaving that step and then received by the subsequent step How do we know our expectations are correct or incorrect?
We establish built in tests to establish when things are going wrong
Common to all levels:
Is it specified and is there a built in system that tells you whether it is working or not.

Links to selected articles by Dr. Spear:

Decoding the DNA of the Toyota Production System, Harvard Business Review, September 1999
http://harvardbusinessonline.hbsp.harvard.edu/b02/en/common/item_detail.jhtml;jsessionid=DHJJYTO5KZJ30AKRGWDR5VQBKE0YIIPS?id=99509

Learning to Lead at Toyota, Harvard Business Review, May 2004
http://harvardbusinessonline.hbsp.harvard.edu/b02/en/common/item_detail.jhtml?id=R0405E&referral=1043

Fixing Healthcare from the Inside, Today, Harvard Business Review, September 2005
http://harvardbusinessonline.hbsp.harvard.edu/b02/en/common/item_detail.jhtml?id=1738

Using Real-Time Problem Solving to Eliminate Central Line Infections
Joint Commission Journal on Quality and Patient Safety
Volume 32, Number 9, September 2006 , pp. 479-487(9)
http://www.ingentaconnect.com/content/jcaho/jcjqs/2006/00000032/00000009/art00001

Ambiguity and Workarounds as Contributors to Medical Error Annals of Internal Medicine (free download)
2005; 142: 627-630
http://www.annals.org/cgi/content/full/142/8/627?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=spear%2C+steve&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

The essence of just-in-time: embedding diagnostic tests in work-systems to achieve operational excellence
Production Planning and Control, Volume 13, Number 8, December 2002 , pp. 754-767(14)
http://www.ingentaconnect.com/content/tandf/tppc/2002/00000013/00000008/art00008

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