Dr. William C. Thornbury Jr. is a family medicine doctor in Glasgow. Just a short while ago, he was like most family physicians. His waiting room was full, and he had to turn away patients. He needed an increasingly large staff to keep up with all the paperwork, and his practice operated on a paper-thin profit margin.
The solution to his problems didn’t come at a medical conference or through a research study conducted by a big-name hospital. Instead, it came as a result of a course for working professionals at the University of Kentucky called True Lean Certification. Dr. William C. Thornbury Jr. is a family medicine doctor in Glasgow. Just a short while ago, he was like most family physicians. His waiting room was full, and he had to turn away patients. He needed an increasingly large staff to keep up with all the paperwork, and his practice operated on a paper-thin profit margin.
The certification is just one component of the UK Center for Manufacturing Lean Systems Programs.
Derived from the Toyota Motor Corp. manufacturing management process, Lean Systems is an approach to production that emphasizes efficiency by continuously identifying and eliminating waste. Lean systems principles were developed at Toyota between 1948 and 1975 and are known within that company simply as the Toyota Production System or TPS. Today it is well known around the world as well as in Kentucky manufacturing circles and especially among parties that do business with Toyota. As UK’s center turns 20 this year, however, other non-manufacturing business sectors are finding that lean principles work equally well for them.
Thornbury, for example, is now a true believer.
“This certification changed my career, my life, and way I look at healthcare,” he said.
UK is far from the only university to offer programs in lean production management training and education. The difference in the UK program and the reason it is called “True Lean” rather than simply “Lean” is its continuous collaboration with Toyota, something no other lean training program can claim.
The College of Engineering building on UK’s campus in Lexington is only 17.7 miles from Toyota Motor Manufacturing Kentucky’s sprawling operation in Georgetown, the Japanese vehicle maker’s first and largest site in North America. Since production began in 1988, TMMK operations have grown – efficiently – larger than many small commonwealth towns: After total investment of $5.9 billion, about 7,000 state residents work at a facility with 7.5 million s.f. (156 football fields) under roof.
A special relationship with nearby Toyota
UK’s proximity allowed for a relationship whose longevity has created expertise on campus also.
Back in 1993, representatives from the UK College of Engineering began talks with Toyota to explore the possibility of collaboration regarding lean knowledge development and manufacturing research and development. The result was the UK Center for Manufacturing Programs that began on campus in 1994 with three goals: study the Toyota Production System; put TPS into usable applications; and share TPS with other businesses.
Today, Toyota is still very much involved. Most visible is the director of the center’s Lean Systems Program, which currently is Bret Anderson. Like all his predecessors, Anderson is a full-time employee on loan from Toyota. He spent the past five years at Toyota’s regional headquarters in Bangkok, Thailand, as vice president of training and development for that area.
As the company’s executive in residence, Anderson’s job is to characterize what is “lean” from the Toyota perspective and ensure that all the center’s efforts reflect that perspective.
“For clients and students, my job is to help them understand what lean means at Toyota,” Anderson said. “For business clients, we want to help them not only understand lean but how to make the transition to lean systems and implement it in their company.”
This is not as easy as it sounds because what “lean” means at Toyota changes constantly. But this is where close affiliation with Toyota gives UK such an advantage. Administrators and faculty can evolve instruction as Toyota evolves the system. Other programs are not as nimble.
UK’s Center now has two primary clients: business executives and UK students.
The business sector came first.
“We bring people into the university where we have courses designed to teach them about what lean is and how it works,” Anderson said. “We do this through a combination of lecture/discussion and lab experience; we explain a concept, but then go into the lab to simulate it. We want them to do the tests themselves. This is a way of teaching that makes it experiential. They leave with an understanding (of lean production) plus the capability to do it.”
That combination has a definite real-world value to businesses.
“One of things we teach on site is problem solving – identifying and solving issues quickly,” Anderson said. “Often the problems solved that week save the company more than it cost them to bring them in.”
The cost for the three-week lean certification class is $7,000.
The center’s teachers can and do also go into businesses to do an assessment of their operation.
“This involves us looking at their current way of learning and assessing against ‘lean’ principles and ways of working,” Anderson said. “We sit down with leadership and work through it and show them what they might do over the next year to implement ‘lean.’ Then we work with them along the way to implement it. We stick with them as long as they need and as often, weekly or monthly.”
The assessment consulting process cost is anywhere from $15,000 to $50,000.
Lean principles part of engineering curricula
For university students, the center offers classes taught in conjunction with the College of Engineering. In addition, lean principles are integrated into the regular curricula for UK engineering majors.
There also are student certification and internship programs.
“We anticipate that students would be adept and understand lean systems and how they work when they graduate,” Anderson said. “In the higher-level courses, students learn about the culture of ‘lean’ – how to treat people and manage policies. Wherever they go, they could help their company move in that direction. Companies like Toyota who already think ‘lean’ are an ideal place for them to work because they already have the basic knowledge when they walk into the door.”
Kim Sayre, Lean Systems program manager, said UK is currently expanding the internship program.
“An internship is typically a one-time commitment, generally during the summer with no university credit,” Sayre said. “We now have faculty available to oversee internships, and we are planning to offer a three-semester co-op (program with professional work experience): The student would attend classes for three months, then work full time for three months with faculty oversight. This would give them a richer experience.”
The teachers for these courses also set the UK program apart: All the instructors are retired from Toyota.
“Our instructors didn’t just study ‘lean’ programs; they lived it and worked it,” Sayre said. “They are all capable and accomplished a lot at Toyota. Most of them have a lot of experience, often 20 years or more at Toyota.
Culture is what makes it work
Although ‘lean’ is about ferreting out waste and eliminating it, lean is also just as much about people, according to Glen Uminger. Now a consultant, Uminger retired from Toyota after 27 years and was director of the UK Lean Systems Program from January 2012 until early 2014.
“ ‘Lean’ is so much about culture and the environment, about engaging everyone,” Uminger said. “Everyone should learn and improve every day. Everyone should be a problem solver. Everyone should own and improve their work.
“The process starts with leadership. You want to encourage people to ‘surface’ problems and then enable them to solve them. It has to be continuous. That is the foundation of True Lean.”
It takes more than an understanding of what the goal is, though.
“The culture side is what so many companies miss. It’s hard to bottle and implement,” he said. “Consultants can sell short-term benefits, but they usually don’t get a change that is lasting. I have seen many companies try over a period of years and can’t figure out why it hasn’t worked. They haven’t changed the culture” of their business.”
During his tenure, Uminger led UK Centers efforts to help enterprises as diverse as banks, a railroad, healthcare companies, manufacturing, leadership, nonproduction, human resources – he describes the ‘lean’ application targets as “everything.”
“This is critical,” Uminger said. “People think ‘lean’ is manufacturing. It’s really a whole way of thinking.”
Uminger cited the center’s work with a Cincinnati food bank.
“If you think about a food bank, their inputs are donated food or money. Every day is a different pool of resources,” he said. “The goal is to use those resources to make the most meals possible. If you are not good at it there is leftover food, and there is nothing you can do with it; it is wasted.
“They learned (via ‘lean’) to take active inventory and create recipes guaranteed to consume all ingredients. Their yield has gone up 15 percent – with the same resource, the number of meals they could offer increased 15 percent.”
Cutting up-front costs … can be costly
The center also helped a major credit card company, according to Uminger.
“They looked at what happened when a customer called customer service and had to be transferred, sometimes twice, to resolve their issue. They had an 85 percent first-time satisfaction rate and wanted to increase that. Fifteen percent went to level two, a third of those to level three,” he said.
“They laid out their process flow and identified what points in the process caused them to have to send the customer to level two – what drove people to level three. Then they took it one (process) ‘bucket’ at a time,” Uminger said.
“One of the reasons the customer had to be sent to level two was that the employee didn’t have enough information, for example. They solved that problem and tracked the result, and so on,” he recounted. “The first-time satisfaction rate went from 85 to 94 percent. The company was able to reduce staff for the second and third levels. They may be able to centralize call centers. The first-time satisfaction rate is still climbing as they keep following the same process.”
Contrary to the culture at most companies, Uminger said, the credit card company didn’t “stress for dollars; they stressed for process.” And it improved its financial performance.
“If you put dollars out front, you start chasing dollars and do things to get more dollars,” he said. “You pressure people to take more calls per hour, but customers may not be happy and cancel their cards. You may save pennies up front and cost yourself dollars. If you work the process, you work on the impact on the customer and the measure of activity. When customers are satisfied, cost savings will follow. Dollars get saved.”
Glasgow doc’s app handles simple cases
After learning the principals of True Lean Systems, Medical Associates of Southern Kentucky, the family practice of Dr. Thornbury in Glasgow, developed a mobile phone app that he believes very well might revolutionize healthcare not just at his clinic in southcentral Kentucky but throughout the country.
Called Me-Visit, the app takes advantage of smartphone technology to allow doctor and patient to connect regardless of where they are located at the time. If someone has a minor medical issue – perhaps a rash, fever, pain or bad cold – they can call a number with their smartphone. Their doctor returns the call shortly when he or she has a few minutes, but in the meantime the Me-Visit system gathers pertinent patient information. When the doctor calls, the patient then efficiently receives the proper medical feedback, information and a prescription if needed without the disruption of having to schedule a visit, travel to and wait in the doctor’s office.
Patients who truly need a one-on-one visit with the doctor do still come in.
“This is not for every case,” Thornbury said. “We need to get the simple cases out of the office and get the ones who need a visit in there. This method uses less time and fewer resources with the same outcome.”
Me-Visit has lowered the per capita cost of care in his clinic by 30 percent, Thornbury said. He partnered with UK to study outcomes, and university found similar results. “Me-Visit is 200 percent more efficient than any model out there,” he said, citing the study.
The app will be available this winter in 12 Southeastern states, including Kentucky.
“All of this came from attending that Lean Systems Certification class four years ago,” Thornbury said. “I had no idea how much it would change my life.”
Debra Gibson Isaacs is a correspondent for The Lane Report. She can be reached at [email protected]