Lean For Everyone

Lean Healthcare - My wife burned herself and that is considered a pre-existing condition.

We just recently got new insurance via Blue Cross Blue Shield of Michigan and discovered that anything that happens to me, my wife K. or daughter D. is considered a pre-existing condition for the next 6 months.

Back Story-

My wife accidentally knelt down on a lighter that had just been used to light the birthday candles on my daughters cake. 

She got a burn that was about the size of my thumb and quickly formed a blister.  The following day it was much redder around the area so we thought we might have to go see the doctor.

We had just changed insurance and were not certain how the new coverage worked.  This prompted a phone call to Blue Cross Blue Shield of Michigan which led to some startling information.

Everything is considered a pre-existing condition until proven otherwise.

"NOTE: All benefits, except preventive services, are subject to a 180-day waiting
period for pre-existing conditions. " 

This is what the top of the brochure says for the health plan.  What isn't mentioned is that anything that happens to you for the first 180 days is automatically considered a pre-existing condition until proven otherwise.  Be careful...if you or your spouse are decapitated you may need to prove that this wasn't a prior issue.

 

You are responsible for paying the doctor's bill and have to wait to get paid back by the insurance company.

Your provider will need to submit paperwork to prove that whatever happened to you is not pre-existing.

Paperwork will need to be filled out by the provider of the service (doctor or hospital) and submitted to Blue Cross Blue Shield for review.  Download BCBS Forms

A trained reviewer will examine the information to determine if this was indeed a valid claim and not a pre-existing condition.  If the claim is approved then you will get paid back.

Time frame for having your claim processed and getting paid back...UNKNOWN.

 

This is so confusing BCBS people are well versed on the subject.

I spoke to a very pleasant woman at BCBS about this at length.  She said that they went through a lot of training about this because it is one of the most confusing and common questions they get.  It seems like they are treating the symptom and not the root cause.  Maybe a less confusing plan would be better or allowing the hospital some discretion about what to consider a pre-existing condition.

In the end we didn't go to the doctor.  By the time we had figured out the insurance,  the wound had begun to heal from the bandage + Neosporin we were using.  I asked the nice BCBS person to e-mail me the forms for future use however they don't have external e-mail.  She had to "snail mail" them to me instead.

Messy Freezers: How to wrangle your R&D people in biotech

You know them by their actions:   Nothing in the -80 C is labeled. There are 12 racks in the 4 C and each one has only 4 samples and those are labeled with bad handwriting that say 1, 2, 3 and 4.  Every time a freezer alarm sounds it's R&D looking for something that they can't locate right away.

An R&D labs disarray is directly proportional to the amount of space it is allowed to occupy. 

In simple terms, it will spread like "Manifest Destiny" through the lab occupying as much space as allowed.  Then it will ask for more.

 

The Story

The R&D department told me that they needed another shelf in the freezer because they ran out of space. 

I went with the Director of R&D to the freezer and looked inside at the mostly empty racks and did a 5 Whys.

What we discovered was that much of the contents of the shelf were so old that nobody knew what they were or who did the original experiments. 

They were still there because of the "fear" of throwing something valuable away because nothing was labeled.

 

What occurred next was a 5-S of the freezer.

After many of the items were cleaned out  and tossed we then gave accountability of keeping the freezer clean to one individual of the R&D team. 

This accountability rotated each week to a new member so everyone felt the difficulty in keeping the shelf organized. 

Within 2 months the R&D team started working together to keep the shelf organized.

Other benefits that were quickly realized were:

• Freezer alarms were no longer going off all the time
• Several members started voicing the opinion that they always hated the disorganization
• Everyone was happier to be able to get back to the science and away from the "searching"
• Projects were closed faster and items discarded quickly to make room for new ideas

 

I want to thank Mike for bringing this question up to me at my last talk.  I also want to emphasize that this is not just prevalent in the R&D department of commercial companies but also in most of academia as well.  It's hard to "wrangle cats" but not impossible.

Why you need to use WIIFM when implementing Lean culture

"WIIFM" or "What's In It For Me" is the basis for much of what people do both consciously and subconsciously.  As lean trainers we need to use this to our advantage when trying to transform a company.

People are not generally selfish however they often gravitate their thoughts to "Is this going to make MY life easier?".  "How is this going to impact ME?" 

I do this all the time...it's called being human.  So why not use this emotional aspect when changing the current culture in a company.

WIIFM exists in every company, it just takes on many different forms.

Several of the companies I worked with in the past operated under the C.Y.A. system.  This "Cover Your Ass" culture caused an inventory of additional e-mails and counter signatures.

Teamwork was thought of as never having to take the blame alone and possibly being able to shift the blame to another "team member".

My personal favorite was the  printing of documents and storing them in a "safe place"....you know...just in case you need to CYA.  The WIIFM here was making sure you didn't get fired,  but it didn't lead to any gains for the worker or the company.

More work was generated to CYA then to actually move value to the customer.

So why not use WIIFM to facilitate the growth of a Lean culture-

• A spot bonus for implementing a change that saves the company money over a period of time
• Performance based pay due to stable processing metrics.
• Promotions and granting of projects based on learning and utilizing lean philosophy
• How you can use lean in your home life to make it easier and save time-PERSONAL GAIN

As lean practitioners I think we need to focus on the WIIFM factor and use it help facilitate change.  If we try to rename it to WIIF - "Everyone" or WIIF - "The Company", we will be trying to change human nature and that is a tall order.

I would love a place where people were dedicated to making their company and the world a better place for everyone.  As for today, I'm willing to settle for just some incremental improvement.

The simplest playscape I've ever assembled...but there's still room for improvement.

The construction is solid and the parts are very well numbered however the documentation to assemble the product could use some improvement.

This is a Kid's Creations Circus 3 Wood Swing Set and it is very well built.

The wood is very solid and the design is good.  The assembly instructions did give us a problem which made us wary during the first several hours of installation.

You do need a ladder to assemble the product.

Kid's Creations doesn't list a ladder as a necessary tool, however the wood slat roof is not pre-assembled and needs to be nailed directly on the top.  Only Chris Angel could put that on without a ladder.

The instructions also state that you need a 3/4" inch socket.  The part that is omitted is that you need a "Deep Well" socket otherwise you won't be able to tighten it down all the way.  We did have to go back to the store (re-work) and purchase these 2 items.

We were unimpressed as to how the set was delivered.  However after doing inventory, everything was accounted for...or so we thought.  There were supposed to be 2 packs of screws - 2" and 2 1/2".  We were accidentally given 2 packs of 2 1/2" screws.  We found this out when the sharp points started sticking out on the other side of the boards.  We had to stop and make another trip back to the store (re-work again).

 

Because the parts were well numbered inventory went very quickly as did locating the parts during assembly.

 

Other issues that caused delays:

• On the third step, the instruction images had the bolts going in backwards. This was confirmed after a phone call to a company rep. and sending a few images to [email protected]
• The instructions for the walls referenced bolt holes "facing the ground".  This meant after it was upright and not during the assembly while laying down. It took us 1.5 hrs to figure that one out.  We were a little hot and tired by this point.
• We had to assemble parts of the roof three times because it was unclear where to install four of the braces.  However, this became obvious only at a much later step when we had to connect something else to it.
• Nowhere do the directions tell you to use the washers with the lag bolts.
• The instructions stop after you construct the wood portions of the set.  The rope ladder, plastic wheel and telescopes have no instructions for installation or placement suggestions. (We used the picture on the website as a guide)
• The images used to show each wood assembly show extra holes that are not on the boards so orientation of the boards may be confusing.
• We had a lot of extra bolts at the end that went unused which made us second guess some of the installation.  As a result, we went through and rechecked everything again.

Overall all this is a solid product.  It is a clear example of how a great product can quickly be considered mediocre because the overall experience had a few issues.  We could have shaved off almost 4 hours out of the 12 hours it took us to put this up.  The assembly confusion and several trips to the store really detracted from the experience and piled on the time.

This is still the easiest one I've ever assembled and the kids were playing on it minutes after we finished.  This was of course after we rechecked everything again! *smile*

I've learned how standard work helps me with my 2 yr old

My daughter is just starting to potty train and we are using visual controls to help us.  However, what happens when Daddy doesn't wash hands the same way Mommy does?

 

Routine and standard work are very important when training.  

Kids are young, creative, inventive and also ignorant of how to perform what we consider to be a basic task.  For them to learn there needs to be a set way of doing something.  After this is learned they can then add their "creative" twist on finding a "new" way to do it.

My wife K. and I were teaching her differently causing confusion.

K. and I hadn't communicated the standard way to wash hands so by doing things 2 different ways she was getting frustrated and unhappy.  This of course caused me to be frustrated as well.

Communication and training for EVERYONE is important.

I know how to wash my hands several different ways however I had to be informed of how "We" as a team were going to help teach our daughter.  Now that we all do it the same way and expectations are understood, the frustration is gone.

In many companies the managers and directors are often NOT on the same page causing confusion as well.

• How projects are assigned
• Promotions and pay raises
• Running meetings and general expectations

After the standard work is defined and taught then improvements can begin.

Already my daughter is checking to see if throwing the water in the air and splashing it around the sink will improve the cleanliness of her hands.  I find it doubtful however I'm willing to allow some open experimentation and kaizen since now we are all a little happier with the process.