Lean Product Development as a System: A Case Study of Body and Stamping Development at Ford

Abstract:

A systems view of lean product development is presented integrating people, process, and tools. This systems approach was derived from intensive study of Toyota's product development system. Principles and methods based on this systems model of lean product development were applied with great success at Ford Motor Company helping to bring to market a record number of products that helped fuel a rebuilding of the company to financial success and award winning world-class product quality.     

Information technology strategy for a patient-oriented,lean, and agile integration of hospital pharmacy and medical equipment supply chains

Both public and private hospitals are increasingly under pressure to reduce costs while improving patient care across all medical disciplines and departments. Hospitals must become patient-oriented, lean, and agile in order to properly realign and integrate health care processes, helping to reconcile efficiency imperatives with patient needs and hospital mission. One of the highest potential for improvement can be found in supply chain management (SCM) practices for medical supplies, which often represent more than 40% of a hospital’s operating budget. We report on 3 case studies of business process management and reengineering projects, relying on advanced information technology, focused on the supply chains of two major urban hospitals, involving $2 million in minimum stocks for drug inventory. Case study 1 deals with an in-depth analysis of SCM practices around a key medical asset in pharmaceutical supply, i.e. infusion pumps. Case study 2 builds upon the findings of case 1, and proposes an radio-frequency identification solution to support a new hospital-wide asset location process and system, aiming for just-in-time availability of infusion pumps for critical drugs administration. Case study 3 complements cases 1 and 2 by analysing the feasibility of integrating the various components of the hospital pharmacy inventories, which in turn could be integrated to asset location systems. Our 3 case studies lead us to a number of conclusions on how hospitals can develop a patient-oriented, agile, and lean perspectives and practices, as well as ensure the proper integration of patient needs within optimised supply chains.     

Lean-Thinking: Implementation and Measurement in Healthcare Settings

Abstract

Despite positive reports about lean approaches to spearhead quality and patient safety improvement efforts, it is still difficult to determine if healthcare employees have transformed into effective lean thinkers. Lean thinking refers to individuals who operate with thoughtful reflection on organizational issues, are committed to continuous improvement efforts, and demonstrate the willingness to lead change. The objective of this theory building research is to contribute a survey instrument and conceptual model to measure individual transformation to lean thinking. Our learnings from the case study suggest that healthcare a professional’s transition to lean thinking via a complex combination of awareness issues at both the unit and individual levels, and both levels should be considered when moving individuals toward readiness and through a personal transformation to lean thinking.     

The impact of extended-hours home hemodialysis and buttonhole cannulation technique on hospitalization rates for septic events related to dialysis access

Few studies adequately document adverse events in patients receiving long, slow, and overnight hemodialysis (NHD). Concerns about high rates of dialysis access complications have been raised. This is an observational cohort study comparing hospital admission rates for vascular access complications between alternate nightly NHD (n=63) and conventional hemodialysis (n=172) patients established on chronic hemodialysis for at least 3 months. Overall, hospital admission rates and hospital admission rates for cardiac and all infective events are also reported. The NHD cohort was younger and less likely to be female, diabetic, or have ischemic heart disease than the conventional hemodialysis cohort. When NHD and buttonhole cannulation technique were used simultaneously, there was a demonstrated increased risk of septic dialysis access events: incidence rate ratio 3.0 (95% confidence interval 1.04-8.66) (P=0.04). The majority of blood culture isolates in NHD patients were gram-positive organisms, particularly Staphylococcus aureus. Alternate nightly NHD did not significantly change total hospital admissions or hospital admissions for indications other than dialysis access complications, compared with conventional hemodialysis. Our data suggest that buttonhole cannulation technique should be used with caution in patients performing extended-hours hemodialysis as this combination appears to increase the risk of septic access complications. Randomized-controlled trials are needed to confirm these findings.     

Using a unit assessment tool to optimize patient flow and staffing in a community hospital.

BACKGROUND: Hospital environments are too often characterized by delays for patients receiving diagnostic testing and prolonged waiting times to complete needed therapy. Frequently there is confusion in scheduling, related at least in part to the complex interplay of clinical acuity and highly individualized care. Luther Midelfort recently began to change the process of patient flow to improve access to care, optimize outcomes by enabling timely intervention, and decrease the wasting of resources. UNIT ASSESSMENT TOOL: The hospital developed a unit assessment tool based on the traffic light concept, which consisted of an assessment of current capacity and a graded, color-coded "workload tolerance" for each hospital unit. Each unit can instantly update its own status and query those of other work environments in the hospital. EXPERIENCE WITH THE UNIT ASSESSMENT TOOL: For most of the January-July 2001 period, there was generally a progressive decrease in the percentage of time that the units were coded as red (unit closed to new admissions), with concurrent increases in the percentage of time that the units were coded as green (unit open). Use of the tool appears to have contributed to a dramatic increase in staff satisfaction. SUMMARY AND CONCLUSIONS: The key to regulating patient flow has been to adopt a nursing-initiated capping trust policy whereby nurses are given the authority to limit new admissions. Initiatives are now under way to provide different units with novel models of resource sharing, ranging from flexible housekeeping to "flying nurse squads" to assist units that have become red.     

Improving the NPD Process by Applying Lean Principles: A Case Study

Abstract:

This article extends the new product development (NPD) literature by presenting a case study of a lean product development (LPD) transformation framework implemented at a U.S. based manufacturing firm. In a departure from typical LPD methods, in this article the design structure matrix and the cause and effect matrix are integrated into the lean transformation framework, allowing analysis of the underlying complexity of a product development (PD) system, and thus facilitating determination of the root causes of wasteful reworks. Several strategies to transform the current PD process into a lean process are discussed. Besides the two-phase improvement plan, a new organizational structure roadmap and a human resources plan are also suggested to support the recommended changes in the NPD process. The results of the first phase show a 32% reduction in PD cycle time due to the proposed NPD process. The article concludes with lessons learned and implications for engineering managers based on the case study.     

Simulation Study: Improvement for Non-Urgent Patient Processes in the Emergency Department

Abstract

This case research was designed to determine if non-urgent patient processes could be improved using a fast-track process in the emergency department of a medical center. The existing fast-track process served 40% of overall walk-in patients at the emergency department. We proposed a series of potential enhancements to patient flow. The proposed smart-track process highlights three features: (1) balancing workload, (2) a flexible re-visit option, and (3) renovation of a portion of the fast-track area into a consulting area. Simulation study results revealed that the enhanced smart-track process has the potential to reduce the average wait time of patients by 73.2% while reducing the burnout of medical staff. This study provides an example of how simulation can be used by engineering managers to make improvements to operations in the healthcare industry.     

Collaborative and lean new product development approach: a case study in the automotive product design

Collaboration between buyer and the supplier has been widely studied in the contemporary research to enhance the efficiency of the product development process. Early involvement of stakeholders in development leads to reduced development time and cost and enhanced quality. The current study presents an approach termed as ‘collaborative and lean’ (C&L) approach to new product development (NPD). It involves application of lean principles in a collaborative environment between an automotive component supplier and the original equipment manufacturer (OEM). The study compares the deployment of two methodologies of development – generic process and the C&L process for developing the same part by a supplier for two different OEMs. Development with one OEM was done using generic process and the other using the C&L process. The study uses value stream mapping of the various phases of the development and attempts to understand the application of the proposed approach in the automotive domain. It highlights the potential of a combined C&L approach in reducing non-value-adding activities, cycle time and effort during NPD. The study attempts to enhance the understanding of NPD in a collaborative environment and explores the possible merits of the proposed approach.     

Criteria for a lean organisation: development of a lean assessment tool

Lean principles have long been recognised as a competitive advantage. Although there are several measures for various aspects of lean production in the literature, there is no comprehensive measure for overall lean implementation in business firms. An appropriate measurement tool is needed to assess the effectiveness and efficiency of the lean implementation throughout the entire organisation. Based on lean research, a comprehensive tool called the leanness assessment tool (LAT) is developed, using both quantitative (directly measurable and objective) and qualitative (perceptions of individuals) approaches to assess lean implementation. The LAT measures leanness using eight quantitative performance dimensions: time effectiveness, quality, process, cost, human resources, delivery, customer and inventory. The LAT also uses five qualitative performance dimensions: quality, process, customer, human resources and delivery, with 51 evaluation items. The fuzzy method allows managers to identify improvement needs in lean implementation, and the use of radar charts allows an immediate, comprehensive view of strong areas and those needing improvement. Practical uses of the LAT are discussed in the conclusion, along with possible limitations.     

医院放射科病人就诊精益价值流研究

试图讨论如何消除或减少放射科病人就诊的无价值服务流程及流程时间。精益价值流程图（Value Stream Mapping,VSM）是精益制造（Learn Manufacturing）框架下的一种用来描述物流和信息流的可视化工具,在传统制造业已经广泛应用。以精益价值流理论和方法为基础,借助仿真建模方法分析华西医院医技放射科病人就诊服务流程和流程时间,找出主要瓶颈流程。针对主要瓶颈流程进一步分析其瓶颈资源约束,发现其医师班均匀分配病人、诊断病例信息、撰写诊断报告的管理问题,从而得出改善方案和策略。精益管理的资源粗能力匹配机制是改善病人就诊服务流程的一种有效方法。     

People Pillars: Re‐structuring the Toyota Production System (TPS) House Based on Inadequacies Revealed During the Automotive Recall Crisis

Toyota has long been recognized as a leader in lean manufacturing and production quality through a dedicated practice of continuous process improvements and waste elimination techniques hallmarked within their Toyota Production System (TPS) and the ‘Toyota Way’ principles. Toyota's long list of successes and quality achievements has inspired companies within all industry sectors, not just automotive, to seek application of the coveted TPS into their process models in hopes of achieving the rewards that lean production promises. However, a recent series of automotive recall announcements associated with Toyota quality control have led many industry experts and students to reflect on possible inadequacies of the TPS House model. This article seeks to identify potential structural shortcomings and possible deficiencies of the TPS House in light of the root causes of recall crisis and suggest potential re‐structuring to better achieve continuous improvement. Copyright © 2016 John Wiley & Sons, Ltd.     

A Multilevel Framework for Lean Product Development System Design

Abstract:

Organizations today face intense and growing pressure to reduce cost, decrease time to market, and maximize stakeholder value in product development (PD). Many organizations have adopted lean product development (LPD) methods in an attempt to improve their PD systems; however, despite two decades of research, there is still much less understanding of the characteristics of effective LPD systems than of effective lean manufacturing systems. LPD systems are complex systems involving multiple organizational levels; however, most LPD research to date has focused only on a single level. There is currently a lack of understanding of the interactions between levels and effective means for managing these interactions. In this article, we propose a multilevel framework designed to capture key LPD system principles at the functional, project, and portfolio levels; tools and practices for implementing principles at each level; and approaches for managing the interactions between levels. A longitudinal case study is used to expand and refine a conceptual framework developed through literature review. Future research should focus on further validating the framework and applying the framework to improve LPD system design.     

Relationships between lean product development enablers and problems

The lean product development (LPD) approach uses lean principles and enablers (tools, techniques and practices) to reduce waste and continuously improve the product development processes (PDP). Other than reducing product development lead time, LPD also aims at improving quality by reducing problems that might occur during the process. Several LPD enablers are proposed in the existing literature; however, there is limited knowledge on how these enablers may effectively counteract the occurrence of problems in the PDP. We empirically tested the association between 4 groups of LPD enablers and 11 groups of LPD problems in a sample of 64 companies that are undergoing lean implementation in the shop floor and administrative areas. There are two major contributions here. First, we propose an empirically validated instrument for assessing the adoption of LPD enablers and the incidence of LPD problems in companies filling an existing gap in the literature. Second, we provide understanding on how LPD enablers can mitigate the incidence of LPD problems, allowing companies undergoing lean implementation to better manage their PDP. Moreover, some results demonstrate that the association between enablers and problems may not be as suggested in the existing literature.     

Exploring the applicability of the LICON methodology for a 1%CrMoV steel

Abstract

The results of a series of creep crack incubation (CCI) tests have been used to examine the effectiveness of the LICON methodology for predicting long duration uniaxial rupture properties of a 1%CrMoV steel at 550°C. It has been demonstrated that good predictions can be made using this approach but that, for this to be possible, a knowledge of additional information is also required including uniaxial creep strain data, uniaxial and multi-axial rupture time properties and the results of finite element analysis.

In order to apply the creep damage enhancement approach to the low alloy creep resistant steel, it has been necessary to establish the steady-state creep stress state in the compact tension testpiece geometry used in the investigation. The new evidence is described.     

Energy-Aware Production Scheduling in Flow Shop and Job Shop Environments Using a Multi-Objective Genetic Algorithm

Abstract

The energy-aware scheduling problem is a multi-objective optimization problem where the main goal is to achieve energy savings without affecting productivity in a manufacturing system. In this work, we present an approach for energy-aware flow shop scheduling problem and energy-aware job shop scheduling problem considering the process speed as the main energy-related decision variable. This approach allows one to set the appropriate process speed for every considered operation in the corresponding machine. When the speed is high, the processing time is short but the energy demand increases, and vice versa. Therefore, two objectives are worked together: a production objective, paired with an energy efficiency objective. A generic elitist multi-objective genetic algorithm was implemented to solve both problems. Results from a simple comparative design of experiments and a nonparametric test show that it is possible to smooth the energy demand profile and obtain reductions that average 19.8% in energy consumption. This helps to reduce peak loads and drops on applied energy sources demand, stabilizing the conversion units operational efficiency across the entire operational time with a minimum effect on the production maximum completion time (makespan).     

IE在医院就诊流程优化中的应用:案例研究

在所研究的医院中,病人花了大量时间在排队,因此很有怨气.使用流程分析方法,对就诊流程进行了再设计.在此基础上用Flexsim进行建模和仿真,结果显示,在设计的系统病人的平均等待时间降低了31%.     

Nightly home hemodialysis: Five and one-half years of experience in Lynchburg, Virginia

Background: Lynchburg Nephrology Dialysis Incorporated initiated a nightly home hemodialysis (NHHD) program in September 1997. As of April 30, 2003, 40 patients had completed training; 28 patients were at home and 2 patients were in training. The average age of the patients at the initiation of the home‐based therapy was 50 years, with a range of 23 to 81 years. There have been 24,239 treatments at home with a total of 84.86 patient‐years on NHHD, the longest patient for 66.7 months and the shortest for 1 month. Methods: Patients dialyzed using the Fresenius 2008H machine, 6 to 10 hr, 5 to 6 nights per week. Treatment parameters included a blood flow rate of 200 to 250 mL/min; a dialysis flow rate of 200 to 300 mL/min; and a standard dialysis solution with 2.0 mEq/L potassium, 3.0 to 3.5 mEq/L calcium concentrations, 35 mEq/L HCO₃, and 140 mEq/L sodium. The longitudinal data of each patient in the program for 1, 2, 3, 4, and 5 years were compared to the same patient's pre‐NHHD data. There were 25 patients in the program for 1 year, 19 patients for 2 years, 14 patients for 3 years, 6 patients for 4 years, and 4 patients for 5 years. Results: Statistically significant improvement occurred in all five groups' need for antihypertensive medications and phosphate binders, SF36 scores, calcium/phosphorus product, blood pressure, number of hospital admissions, and number of days of stay in the hospital. The mortality rate was 2.4% deaths per patient‐year with a 95% confidence interval of 0.9% to 9.4%. Conclusions: In a longitudinal study, NHHD showed significant improvements in patient secondary outcomes. The improvement in these secondary outcomes was associated with an improvement in mortality rate.     

Analytical models to determine room requirements in outpatient clinics

Outpatient clinics traditionally organize processes such that the doctor remains in a consultation room while patients visit for consultation, we call this the Patient-to-Doctor policy (PtD-policy). A different approach is the Doctor-to-Patient policy (DtP-policy), whereby the doctor travels between multiple consultation rooms, in which patients prepare for their consultation. In the latter approach, the doctor saves time by consulting fully prepared patients. We use a queueing theoretic and a discrete-event simulation approach to provide generic models that enable performance evaluations of the two policies for different parameter settings. These models can be used by managers of outpatient clinics to compare the two policies and choose a particular policy when redesigning the patient process. We use the models to analytically show that the DtP-policy is superior to the PtD-policy under the condition that the doctor’s travel time between rooms is lower than the patient’s preparation time. In addition, to calculate the required number of consultation rooms in the DtP-policy, we provide an expression for the fraction of consultations that are in immediate succession; or, in other words, the fraction of time the next patient is prepared and ready, immediately after a doctor finishes a consultation. We apply our methods for a range of distributions and parameters and to a case study in a medium-sized general hospital that inspired this research.     

Challenges in the transformation to lean production from different manufacturing-process choices: a path-dependent perspective

The implementation of lean production remains popular among industrial companies, and the requirement for individualised steps in its implementation is widely accepted; however, research has not yet considered the different process choices available to the companies. The conclusions drawn from the automotive industry's mass production environment may be misleading, given the different conditions of many other industries. We therefore compare case data from a craft producer with the rich, case-study based literature of mass producer companies that highlight the transformation from mass to lean production. We derive a list of specific challenges a craft producer must approach using a different strategy than a mass producer. This study adds to the lean production theory by demonstrating how different manufacturing process choices influence the lean transformation process and its successful implementation. It provides specific propositions concerning the transformation to lean by considering the different processes of craft and mass production companies. Furthermore, the case study gives an in-depth understanding of the challenges a craft-oriented company faces when becoming lean.