sexta-feira, 25 de novembro de 2011

Dicas Lean de casamento de uma recém-casada

Uma mulher que trabalha com Lean nos Estados Unidos escreveu umas dicas de como alguns conceitos podem ajudar no casamento. Achei legal compartilhar com todos...

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Have you ever thought that certain Lean Six Sigma practices might be beneficial for your marriage? Although I’m just a newlywed, I’ve had success with these Lean relationship tips in my brief time as a wife. 



WIP, JIT, and Poka Yoke’s Take the ‘Honey-Do’ List to a Whole New Level

I’ve been told by my husband that long to-do lists stress him out and overwhelm him so much that he loses his focus and can’t complete any of the tasks on the list. Well, I’m a list-maker and multi-tasker by nature (with no sympathy), so you can quickly see where that conversation went.

I started to think about our situation and dissect it in terms of Lean thinking. My list of 88 things to do (I’m really not joking) isn’t Lean. If the unfinished tasks on my list are my work-in-process (WIP), or the unfinished items in a production process, then I’m in big trouble. Optimal production management aims to minimize WIP, and in my case, I keep adding things to my list even if I haven’t yet completed prior tasks. Talk about frustrating!

I can’t seem to get ahead, but it’s no wonder because my WIP is much too high. But how can we solve our problem? While I keep my backlog of “things to do” long, I’ve decided to task out each day into more manageable daily tasks for both of us. Utilizing a mix of poka yoke mechanisms and just-in-time (JIT) lean production methodology, it’s now much easier to complete three or four daily tasks. If either of us finish daily tasks and has time to spare, it’s easy to use the now-empty daily task list as a kanban for signaling that there’s still a backlog with more tasks that can be completed.

Sticky-note poka yoke reminders can also be used to enforce the importance of household chores and bills that need to be paid by a certain date. My husband appreciates sticky notes with only one especially important task. He knows that he needs to get that one thing done before even thinking about anything else on the backlog.

I’m convinced that Lean Six Sigma thinking can help in all areas of my life. After all, these techniques helped me to plan the wedding, and now they’re really coming in handy as my husband and I navigate married life together.

Lean Marriage Tips II: Using 5-Why Analysis and Fishbone Diagrams for Problem- Solving

I’m lucky to be in a marriage where arguing is an unlikely occurrence, but I've found that common Lean Six Sigma tactics, such as 5-Why Analysis and Fishbone diagrams, can come in handy when I’m trying to solve minor disagreements with my husband.

A 5-Why Analysis was developed by Toyota to solve defects in their vehicle process lines. The technique can help you diagnose the root cause of really any problem by prompting you to ask questions that explore the cause and effect relationships behind that problem.

Generally, asking five “why” questions about your initial problem will quickly reveal the main
cause(s), without any in-depth statistical analysis. You may even find that you need less than the suggested five why questions to get to the root of your issue.
 
However, there also might be times when you’ll find yourself asking more than five questions.

Let’s use a 5-Why Analysis to solve a problem a married couple is likely to face:

Problem: My wife or husband is unhappy with my cleanliness around the house.

-Why is your wife or husband unhappy with your cleanliness around the house?
I leave my wet towels on the bedroom floor instead of hanging them up to dry in the bathroom after I shower in the morning.

-Why do you leave your wet towels on the bedroom floor?
It’s convenient to set my towels on the bedroom floor while I change into my clothes.

-Why is it convenient for you to set your towels on the bedroom floor?
I’m in a hurry in the morning, and it’s faster to set my towels on the floor in the bedroom while I change than walk back into the bathroom and hang them up.

-Why are you in a hurry in the morning?
I’m still very tired when my alarm goes off, so I hit the snooze button several times before actually getting out of bed to start my day.

-Why are you so tired when your alarm goes off in the morning?
I go to bed too late.

Aha! After asking five “why’s,” it looks like the root cause is that after over-sleeping in the morning your spouse is too rushed to hang up towels. Of course, you could have kept going with questions to figure out why your spouse is getting to bed so late, but sometimes it’s not necessary to delve deep into the analysis when there is already a glaring solution.

In this case, your spouse should aim to get to bed earlier, so it’s easier to get up in the morning—which will allow for a less-hurried morning routine. (I know, easier said than done!)

While it’s up for debate whether or not a 5-Why Analysis will actually help you solve major disputes with your spouse, the tool can be a light-hearted solution for minor disagreements. I think it can be a good problem-solving method for use both at work and even at home. But then again, what do I know? I'm only a newlywed.

5S in My Kitchen

Every so often I think of a quality improvement technique that might help me when I’m home cleaning and organizing, or doing some of my other wifely duties. The kitchen is truly a woman’s version of the “man cave,” and I like to keep my kitchen work space organized for efficiency.
 
A 5S audit is a quality improvement technique developed to standardize a workplace for effectiveness by tracking the results of the following 5 phases: sort, set in order, shine, standardize, and sustain. It’s really the perfect tool for keeping an organized kitchen. And believe me—I’m no Top Chef, but 5S helps me keep my kitchen in order!

Sort—Ask yourself: Are all the items involved really necessary? Here’s your chance to get rid of that broken hand blender and throw away the three extra discolored spatulas you have hanging around. Do you rarely use that wine chiller that’s taking up precious counter space? Put all kitchen gadgets you use only occasionally in a pantry closet, reserving counter space for the kitchen appliances you use most.

Set in Order—Ask yourself: Is each kitchen tool close to where it will be used? Are items clearly labeled? To prevent the salt-instead-of-sugar problem when making a umpkin pie, clearly label ingredients if you have them kept in countertop canisters. I realized I was keeping dishwashing detergent in the hallway pantry, rather than in the cabinet right next to the dishwasher. Keep your flow path simplified to optimize the time you spend preparing foods by finding all the ingredients you need for a recipe before you begin. This can also help you prevent those last-minute trips to the grocery store.

Shine (Keeping your kitchen clean)—After cooking, it can be tempting to leave the pile of dishes in the sink and wash them later. It’s important to tackle these messes as you cook. If you have downtime waiting for something to finish cooking, load the dishwasher or wipe off a messy countertop. This will drastically decrease your clean up time after cooking. Leaving your kitchen untidy for several days could increase your chances for foodborne illnesses! And in the case of a factory, a messy workspace can hide signs that equipment or process steps are malfunctioning.

Standardize—Is everyone in your family aware of standard kitchen procedures? My husband will love this one: Does everyone know the optimal way to load a dishwasher so that the most dishes can be loaded and cleaned correctly? And in the case of manufacturing, keeping procedures correctly documented and work stations identical will help keep duties standardized.

Sustain—Can these standards be maintained? Are your kitchen tools being stored in their correct places? Are you always thinking of new and better ways of completing a process or using a new tool? While these questions can help you eliminate wasteful behavior in your kitchen, they were originally developed to help you improve processes within your job and your company. Taking note of these considerations (on paper and discussing in meetings) can help you get organized and improve productivity.

Quality Companion offers a 5S audit form that makes it easy to evaluate process conditions relative to best practices, while tracking your ongoing implementation of 5S improvement and controls. Companion rolls up your 5S data into a bar chart that shows how well your process is scoring in specific categories—so you know what areas of your process are running fine, and which ones might need some work.

quarta-feira, 9 de novembro de 2011

Mais uma tragédia em um hospital

Hoje foi divulgada uma notícia muito triste, uma tragédia: um bebê de 12 dias morreu em função de um erro hospitalar. A tragédia foi na Zona Oeste de SP.

http://ultimosegundo.ig.com.br/brasil/sp/bebe-de-12-dias-morre-apos-receber-leite-materno-na-veia/n1597360616232.html

Essa questão de excelência no atendimento em hospitais é um fator crítico. Qualquer descuido torna-se fatal e uma tragédia pra família das vítimas. Imagino a dor dos pais desse bebê.

Eu escrevi o post "Hospitais sem sofrimentos", contextualizando a quantidade de perdas que temos em alguns processos dentro de hospitais. No post "A causa-raíz é a enfermeira?", pudemos ver como processos que não são robustos podem gerar tragédias. E novamente me deparo com uma notícia triste como essa. Até quando a Secretaria de Segurança Pública e a Secretaria de Saúde vão esperar para tomar ações que efetivamente resolvam os problemas de processos que dependam de pessoas pra funcionar e, consequentemente, não são robustos?

No final da notícia li que a enfermeira foi demitida. Olha aí, novamente, a causa-raíz é a enfermeira então? É claro que existe uma parcela de culpa dos enfermeiros e que devem ser investigadas e tratadas, visto que o número de casos como esses vem crescendo muito (vide dados abaixo do Globo.com*), mas o fato é que só culpar enfermeiros não vai resolver o problema.

É preciso avaliar constantemente os processos, o modus operandi dos enfermeiros. Deveriam existir rotinas de verificação dos processos ANTES de problemas ocorrerem, de modo a sempre melhorarem os mesmos que apresentem problemas. Assim é feito em manufaturas e funciona muito bem! Com isso, poderiam explorar mais os detalhes do processo de tratamento dos pacientes, minimizando a possibilidade de falhas e as consequentes tragédias. Existem tantos conceitos e ferramentas conhecidos e divulgados (FMEA, Poka-Yoke, 5S, etc) que deveriam ser de obrigatório em hospitais.

Para o caso acima, como é a organização da sala de tratamento? Os medicamentos estão devidamente organizados para evitar falhas? Foi feita uma análise de possíveis falhas que podem ocorrer? Existem dispositivos à prova de falhas instalados no hospital para evitar que erros como esse ocorram?

No final da reportagem também informam que vão instalar inquérito administrativo para investigar o caso.... agora??? Agora infelizmente é tarde e, mais infelizmente ainda, o inquérito é pra ver de quem foi a culpa, não pra atacar a causa-raíz do problema.

Em outro post, "Hand-off pode ser um grande problema", cito casos como o ocorrido e sua grande possibilidade de acontecer. Pensando em hand-off... Como será que foi feita a passagem de turno? Será que existe um processo robusto para evitar que informações vitais fiquem anotadas em pedaços de papel guardados nos bolsos dos enfermeiros? Será que existe uma rotina de Genba Walk (caminhar pelo processo) para garantir uma efetiva troca de turno e de informações?

Esses conceitos estão ilustrados no livro Lean Hospitals, de Mark Grabam, além de vários outros conceitos de gestão empresarial, usando como modelo o Lean System, que podem ser aplicados tranquilamente em hospitais. Podem não, DEVERIAM ser aplicados!

*Erros acima da média

O resultado são os erros, que se multiplicam. Nos últimos 12 meses, o Coren paulista recebeu 356 denúncias contra enfermeiros, técnicos e auxiliares, o triplo da média dos anos anteriores.

O "Fantástico" teve acesso a um relatório com os principais casos investigados pelo conselho em 2010. Entre eles, está o caso de um auxiliar que diluiu, por engano, um medicamento em cloreto de potássio, que é uma das substâncias da injeção letal usada para executar presos onde vigora a pena de morte e causa parada cardíaca.

Em Votuporanga, a 521 km de São Paulo, uma mulher de 83 anos morreu ao receber na veia penicilina benzatina, um antibiótico muito forte. “Ela só virou o olho e acabou”, lembra Lurdes de Oliveira, filha dela. A técnica de enfermagem deveria ter aplicado a injeção no músculo.

Em outro episódio, desta vez envolvendo um auxiliar, um recém-nascido recebeu uma injeção na artéria da mão, quando o certo seria na veia. O bebê teve quatro dedos amputados.

Na Grande São Paulo, mais um erro absurdo. Uma auxiliar de enfermagem conectou, sem querer, uma mangueira de inalação no braço de Mariana, de 1 ano e 8 meses. “O bracinho da menininha inchou rapidinho, inchou que nem um balão. Ela suspirou e morreu”, conta Rosilene de Souza, mãe de Mariana. O diagnóstico: embolia provocada pelo ar no sangue.

Em todos os casos citados até agora, os responsáveis foram afastados e aguardam o julgamento do conselho.