Article: :Category:Japanese words and phrases
literally translates "real location, real thing” (meaning "the situation onsite") and it is a key principle of the Toyota Production System. The principle is sometimes referred to as "go and see." It suggests that in order to truly understand a situation one needs to observe what is happening at the site where work actually takes place: the gemba (現場). One definition is that it is "collecting facts and data at the actual site of the work or problem."
Application
Taiichi Ohno, creator of the Toyota Production System is credited, perhaps apocryphally, with taking new graduates to the shop floor and drawing a chalk circle on the floor. The graduate would be told to stand in the circle, observe and note what he saw. When Ohno returned he would check; if the graduate had not seen enough he would be asked to keep observing. Ohno was trying to imprint upon his future engineers that the only way to truly understand what happens on the shop floor was to go there. It was where the value was added and waste could be observed.
Genchi genbutsu is, therefore, a key approach in problem-solving, saying that if the problem exists on the shop floor, then it needs to be understood and solved at the shop floor.
Genchi genbutsu is also called Gemba attitude. Gemba is the Japanese term for "the place" (meaning"the place where it actually happens"). Since real value is created at the shop floor in manufacturing, it espouses the philosophy that this is where managers need to spend their time.
Genchi genbutsu is sometimes referred to as "Getcha boots on" (and go out and see what is happening) in English due to its similar cadence and meaning. It has been compared to Peters and Waterman's idea of "Management By Wandering Around". This concept quickly became so universal that new managers instinctively knew that they had to "walk around" to achieve high effectiveness levels. Whilst these ideas, with their associated lists of how-tos, are probably good ideas they may miss the essential nature of Genchi Genbutsu which is less to "visit" and more to "know" by being there. Toyota has high levels of management presence on the production line whose role is to "know" and to constantly improve.
Implementation
It is nowadays used as a primary tool for investigation in most industries.
See also Gemba Contextual inquiry References
Jeffrey Liker. The Toyota Way: 14 Management Principles From The World's Greatest Manufacturer. McGraw Hill, 2003.
Jeffrey Liker, David Meier. The Toyota Way Fieldbook. McGraw Hill, 2005. |
Source: Tuesday, 25 December 2012
Home | SHARE MARKET | EXCHANGE RATE | TRADING | OTHER PUBLICATIONS | ARCHIVES | dailynews ONLINE News Editorial Business Features Political Security Sport World Letters Obituaries OTHER PUBLICATIONS OTHER LINKS
Toyota way in a state owned hospital
Lal Fonseka
Very recently I conducted a successful surveillance audit of ISO
9001:2008 in the Ampara General Hospital and within a space of another
couple of months, this Hospital has emerged as the overall winner in the
recently concluded National Productivity Award Competition. These two
significant feats of the hospital prompted me to write this article.
According to the information available with them, this is not the
first occasion where they have won an award of this calibre. Previously
in many instances, this particular hospital has been able to achieve a
number of awards locally and internationally. The details of those
awards are listed below. There are altogether 12 awards. Ampara General
Hospital is a state owned hospital and it is the only government
hospital which has been certified for ISO 9001:2008 for its Quality
Management System.
* 5 'S' Taiki Akimoto Merit award 2003
Overall Winner of the National Productivity Awards
* Thaiki Akimoto 5 'S' Award - Winner (Service sector) First runner
up (For all aver the competition) 2004
* Tahiki Akimoto 5 'S' Award 1st runner all over the competition 2004
* National productivity awards service sector 3rd place 2004
* Nagaki Yamamoto special KAIZEN award 2005
* Provincial productivity award winner 2005
* National productivity award winner (Service sector Large Scale)
2005
* National Quality award winner service sector 2006
* National productivity Gold award winner (Service & Manufacturing
service sector) 2006
* International Asia Pacific quality award (Health Care) 2007
* National Productivity Award 2010/2011- Grade A
* National Green Award 2012- Silver
Undoubtedly this is a rare feat achieved by a government hospital and
it is the outcome of the fantastic team-work this hospital has in their
day to day work performance.
What is a hospital?
A hospital is an institution for health care providing patient
treatment by specialized staff and equipment, and often but not always
providing for longer-term patient stays. A hospital today is a centre
for professional health care provided by physicians and nurses. The name
comes from Latin hospes (host), which is also the root for the words
hotel and hospitality.
As usual in any other organisations, even in hospitals unless they
delight their customers who happened to be the patients (In-door or
Out-door), clients of such hospitals will look out for alternative
service providers. At the Ampara Hospital, since they always take every
possible attempt to make their patients delight and happy, it has become
a very popular hospital in the country. As per the hospital
administration, almost every week they have got to entertain outside
parties and organisations who come to see their achievements. Under
these circumstances, winning quality awards of this nature cannot be
treated as a miracle.
As per the well written management protocol of Ampara General
Hospital, when a new patient arrives at the hospital, the triage nursing
Officer will refer the patient either to the Out Patients Department (OPD)
or the Primary Care Unit (PCU) on the condition of the patient. All
admission to the hospital from 8pm to 7am will be done through PCU and
7am to 8pm admissions will only be done through OPD or triage referrals.
All Critically ill patients are admitted through the PCU and on the
findings of this unit; decisions are taken whether to give treatments
in-ward or out-door to the patients. Ampara is a general hospital, which
is set up to deal with any types of diseases and injuries, and typically
has an emergency ward (PCU) to deal with immediate threats to health and
the capacity to dispatch emergency medical services. A general hospital
is typically the major health care facility in its region, with large
numbers of beds for intensive care and long-term care, facilities for
surgery and childbirth, bio assay laboratories, and so forth. Larger
cities may have many different hospitals of varying sizes and
facilities. But this is a wonderful hospital and it is worthwhile making
a special trip to Ampara to see its ambiance and the quality service.
For decades, it has been a common belief that success in the
marketplace was dependent upon organisations' ability to create
satisfied customers. This was revealed in researches done by (Arnold et
al., 2005; Parasuraman et al., 1985; Reichheld and Sasser, 1990; Rust
and Zahorik, 1992, 1993). In fact, early scholars argued that the
creation of a satisfied customer was the fundamental core of businesses
or service centres (Drucker, 1973). Consistent with this argument is the
fact that one of the central themes of the marketing concept is
delivering products and services that satisfy customer needs. In return,
satisfied customers are expected to exhibit behaviours that are
favourable to the organisations, such as future patronage and making
recommendations to others.
Because of the recognized importance of customer satisfaction, it has
been a topic that has generated substantial attention among
academicians.
Emphasis on customer satisfaction often stems from the thought that
keeping current customers is much less expensive than attempting to
attract new customers. Similarly in a hospital customers are the
patients.
But another significant point that was noticed in Ampara Hospital is
that they do not call these customers as patients. Instead, they call
them as clients.
They are the people who come to the hospital seeking some redress or
relief.
During my audit as was mentioned at the very beginning of this
article, it was also observed that Ampara has adopted the world famous
Toyota Production System successfully in carrying out their day to day
functions. According to my knowledge, it is the only hospital in Sri
Lanka which has adopted the Toyota Production System in a highly
effective manner.
The Toyota Way is a set of principles and behaviors that underlie the
Toyota Motor Corporation's managerial approach and production system.
Toyota first summed up its philosophy, values and manufacturing ideals
in 2001, calling it "The Toyota Way 2001." It consists of principles in
two key areas: continuous improvement, and respect for people. As was
told before, Ampara Hospital successfully applied the Toyota way in its
hospital. The number of awards won by the hospital will be
self-explanatory for implementation of Toyota way in the hospital.
The two focal points of the Toyota principles are continuous
improvement and respect for people. The principles for a continuous
improvement include establishing a long-term vision, working on
challenges, continual innovation, and going to the source of the issue
or problem. The principles relating to respect for people include ways
of building respect and teamwork.
Research findings
In 2004, Dr. Jeffrey Liker, a professor of industrial engineering,
published "The Toyota Way." In his book Liker calls the Toyota Way, "a
system designed to provide the tools for people to continually improve
their work." The system can be summarized in 14 principles.
According to Liker, the 14 principles of The Toyota Way are organized
in four sections: (1) long-term philosophy, (2) the right process will
produce the right results, (3) add value to the organization by
developing your people, and (4) continuously solving root problems
drives organizational learning. Long-term philosophy
The first principle involves managing with a long-view rather than
for short-term gain. It reflects a belief that people need purpose to
find motivation and establish goals. In this aspect, Ampara Hospital
administration has managed the hospital with a long-view especially on
the followings.
1. The external environment: This includes such factors as
performance monitoring and management; and the availability of
cost-effective treatments and technologies including the beautiful
surroundings.
2. Hospital management: This covers such factors as leadership and
the use of effective management practices; cooperation between director
and clinicians; and the speed at which new and cost-effective treatments
and technologies are adopted
3. Hospital operational processes: These include the control of
labour costs; the use of Nursing skill-mix by giving them adequate
training; shortening length of stay in the hospital by patients; and
measures intended to reduce errors and increase quality.
Right process will produce right results
The next seven principles are focused on process with an eye towards
quality outcome. Following these principles, work processes are
redesigned to eliminate waste (Muda- Japanese word for waste) through
the process of continuous improvement - Kaizen. The seven types of muda
are (1) overproduction/service; (2) waiting, time on hand; (3)
unnecessary transport or conveyance; (4) over processing or incorrect
processing; (5) excess inventory; (6) motion; and (7) defects.
The principles in this section empower employees in spite of the
bureaucratic processes of State Sector, as any employee in the hospital
system to take corrective and preventive action to extend an effective
quality service emphasizing that quality takes precedence which is known
as Jidoka in the Toyota Production system. Jidoka means in brief is
automation with human touch. In another way we could describe it as
autonomation which prevents the defective services, eliminates
overprovision of services and focuses attention on understanding the
problem and ensuring that it never recurs. It is a quality control
process that applies the following four principles.
1. Detect the abnormality.
2. Stop doing excessive work
3. Fix or correct the immediate condition.
4. Investigate the root cause and install a countermeasure.
The way the Toyota bureaucratic system is implemented to allow for
continuous improvement (kaizen) from the people affected by that system
so that any employee may aid in the growth and improvement of the
company.
Recognition of the value of employees is also part of the principle
of measured production rate which is termed as Heijunka. On a production
line, as in any process, fluctuations in performance increase waste.
This is because equipment, workers, inventory and all other elements
required for production must always be prepared for peak production.
This is a cost of flexibility. Even in Ampara Hospital, fluctuations in
performance is controlled through implementing decease preventive
programs such as Combatting Malaria, Dengue and also having an isolated
ward for infectious deceases such as TB and Chicken Fox etc.; this is
known as demand amplification
These principles are also designed to ensure that only essential
materials are employed (to avoid over services), that the work
environment is maintained efficiently (5SProgram) to help people share
work stations and to reduce time looking for needed tools, and that the
technology used is reliable and thoroughly tested.
Value to organization
Human development is the focus of principles 9 through 11 in Toyota
Way. Principle 9 emphasizes the need to ensure that leaders embrace and
promote the corporate philosophy. This reflects, according to Liker, a
belief that the principles have to be ingrained in employees to survive.
Same thing applies in Ampara Hospital which is the very reason employees
including the clinicians attached to the hospital wish to stay back in
the hospital for longer periods. The present director has been working
in the same hospital for last 10 years while the senior matron's service
is more than 10 years.
I am told that even certain consultants do think twice before
accepting the transfer orders. The 10th principle of Toyota way
emphasizes the need of individuals and work teams to embrace the
company's philosophy, with teams of 4-5 people who are judged in success
by their team achievements, rather than their individual efforts.
In the Hospital, team-work is eminent very clearly through which
hospital's philosophy is embraced by the various teams and departments
of the hospital. Principle 11 looks to business partners, who are
treated by Toyota much like they treat their employees. Toyota
challenges them to do better and helps them to achieve it, providing
cross functional teams to help suppliers discover and fix problems so
that they can become a stronger, better supplier. This is another area
Ampara Hospital is heavily concentrating and they too always try their
level best to achieve the expectations of Ministry of Health and the
Society and also to treat their suppliers to their maximum satisfaction.
Solving root problems drives organisational learning
The final principles embrace a philosophy of problem solving that
emphasizes through understanding, consensus based solutions swiftly
implemented and continual reflection and improvement. Consensus
decision-making is a group decision making process that seeks the
consent of all participants. Consensus may be defined professionally as
an acceptable resolution, one that can be supported, even if not the
"favorite" of each individual. Here again in this hospital, Cross
Functional Teams' meetings are frequently held and the Internal Quality
Audits are being conducted at least once in every 6 months. Management
Review Meetings are also held once in every six months and consensus
based decisions are taken and implemented. This is a highly effective
tool which the hospital does always use for their continual improvement.
The 12th principle sets out the expectation that managers will
personally evaluate operations so that they have a firsthand
understanding of situations and problems. This is sometimes referred to
as "Get your boots on" and go out and see what is happening due to its
similar cadence and meaning. It has also been compared to Peters and
Waterman's idea of "Management by Wandering Around". This concept
quickly became so universal that new managers instinctively knew that
they had to "walk around" in order to achieve high effectiveness levels.
Whilst these ideas, with their associated lists of how-tos, are probably
good ideas they may miss the essential nature of Genchi Genbutsu which
is less to 'visit' and more to 'know' by being there. Toyota has high
levels of management presence on the production line whose role is to
'know' and to constantly improve. Similarly even in Ampara Hospital, all
heads of the departments including the Director have a habit of making
frequent visits in the entire hospital just to see what happens in the
key areas such as Clinical Wards and Surgical Theaters. During these
visits, actions where it is necessary are taken on the spot.
Principle 13 like in the Toyota Production System encourages thorough
consideration of possible solutions through a consensus process, with
rapid implementation of decisions once reached at Ampara Hospital. This
is known as Nemawashi in Japanese Language. It means an informal process
of quietly laying the foundation for some proposed change or project, by
talking to the people concerned, gathering support and feedback, and so
forth. It is considered an important element in any major change, before
any formal steps are taken, and successful nemawashi enables changes to
be carried out with the consent of all sides.
The final principle requires that Toyota be a "learning
organization", continually reflecting on its practices and striving for
improvement. According to Liker, the process of becoming a learning
organization involves criticizing every aspect of what one does. There
is no doubt about this principle as far as the Ampara Hospital is
concerned as it is a learning organization. By looking at the awards
they have won since year 2003 onwards, how can anyone say anything
against it?
However, one of the strongest findings observed in Ampara Hospital
was that good leadership, and effective general and clinical management
which are both crucial for making productivity gains. I do now believe
that after reading this article, you are now tempted to make a visit to
the hospital as to see how they have successfully adopted the Toyota way
in their operations. EMAIL | PRINTABLE VIEW | FEEDBACK | | News | Editorial | Business | Features | Political | Security | Sport | World | Letters | Obituaries |
Produced by Lake House Copyright © 2012 The Associated Newspapers of Ceylon Ltd.
Comments and suggestions to :
Web Editor |