I Feel For Toyota

During my fifty-three year career in manufacturing, I developed a flair for solving a problem. It is not easy.  In order to find the root cause you have to continue to ask why until people think you are nuts.  My last job was manufacturing a product that we made in the billions. The item is relatively simple in appearance, but it is highly functional. The product is a cable tie. The original purpose of the cable tie was to hold wires together.  Over the years, people have learned to find many applications for this unique item.

My team designed the product, designed and made the molds that produced the product, and set the quality requirements of the manufacturing process. Often we received a complaint. Usually, a customer told us the ties were breaking. He wanted us to fix the problem. Our sales staff immediately replaced his defective product. Most of the time, it was a single package.  My engineers always asked for samples of the failures and any unused samples from the package that the failure ties came from. The failed tie often contained clues to why it failed.  The unused samples gave us some product to test in our lab. If we were very lucky, the Quality Control number was still on the package. That number allowed us to trace the manufacturing process variables.

Usually, I received a handful of broken ties from the complaint. With those samples, it became my job to determine what caused the failure.  I will not bore you with the details of how I proceeded, but if I could not duplicate the problem in the lab, I was looking for a needle in a haystack. Many times, we shut down our highest producing mold until there was an answer.  Talk about pressure to do something.  I can only imagine what is going on within Toyota right now, but I have a good feeling for what it is. I feel for the engineers whose job it is to solve the problem.

Currently, I drive a 2005 Toyota Avalon. I have rehearsed my reaction to a runaway acceleration many times. I only hope that if it happens that I have enough time to react appropriately before I kill myself or someone else. I have dubbed my car the Death Star. At this writing, I am listening to the Senate questioning of the CEO of Toyota. The man, Akio Toyoda from Toyota, said their fix might not be the answer to the acceleration problem. That is a nice way of saying they still do not have a clue about what is causing the problem.

I also studied the quality process taught by US guru Joe Duran, and utilized by the Japanese car companies. In this program, Duran taught that it is cost effective to shut a line down when you find a problem, and leave it down until you fix the problem.  That is a hard concept to swallow. Most manufacturing companies do not buy into it. Mine often did, but the justification for shutting down a mold had to be great. In Toyota’s move to stop selling cars, and to shut down their factories until they fix the quality problem, they practice what they preach. They will come out as winners in the long term.

In the meantime, I bet there are at least a thousand engineers running like chickens with their heads cut off trying to duplicate the problem. As they analyze every aspect of the design, they will come up with ideas that are very probably the answer, and they will implement solutions. They may even stumble upon the root cause and re-create the problem. That is when I will believe they have solved the problem, and until then I drive the Death Star.

Why Is Health Care So Expensive?

High Cost DocumentationDuring the last couple of weeks, I got a first hand reminder of what  it is like in a health care system.  My late Auntie Marie was hospitalized for a few days before she died. Of course, Peggy and I visited often during those days. There was one thing that stuck out as I walked the halls of a well known suburban hospital. No matter which floor we were on,  or which nurse’s station we were near, people were diligently entering data or writing on charts.
I began to wonder what that was all about. Very few of these people were tending to patients, yet all of them were very busy. These people are all very expensive. Health care workers don’t come cheap. What is so important to require so much documentation? I quizzed my daughter, who is a nurse, to explain. We had a very nice father daughter discussion on the matter. She cleared up some of my mis-conceptions.
In summary here is why they document:
1. If it ain’t documented the insurance company, Medicare, etc. doesn’t pay. Of course the hospital is a business, and requires money to run. Patients never like to pay for their own health care,  therefore they pay for insurance to pay the bill for them. The insurance companies are also in business to make a profit. They sell us policies with fine print defining just what they will cover. Medicare does the same thing. Their rules are just as stringent as any insurance company’s. Therefore, hospitals document in order to charge.
Insurance companies take a bad rap when they cite the fine print in a policy, and refuse to pay. We should all be more careful when we buy policies. We tend to go for the lowest cost. Of course we do, why pay more? Except we don’t read the details, or the details don’t matter when we sign the contract. There is a famous insurance company commercial, running now, that touts the ability to tailor make a policy to fit your budget. Guess what? They do it by limiting your benefits. We go for price, they go for the sell, and we are happy until we get into a health crisis and the bill comes to us. 
2. Doctors need information from the nurses in order to make your health care decisions. They work by reading test reports, and the charts documenting vital signs such as temperature, blood pressure, heart rate, and  repsonses to medications.  Doctors also write instructions to the nurses for your treatment. Then, as a CYA they document their treatment plan and diagnosis. Again, if it ain’t documented they don’t get paid. A doctor  might spend ten minutes per patient reading a chart, and two minutes talking to him. If you have a serious problem, the doc may take three minutes to explain the prognosis.  Nurses document your vital signs, and dispense drugs. Certified Nursing Assistants do all the other dirty work of keeping patients comfortable. In the good old days, the nurse did it all. My wife Barbara tended to a surgical ward at West Side VA hospital back in 1959. She took care of, and documented up to thirty patients at a time. Life was simpler back then.
3. Hospitals have quality control programs. They are crappy compared to the ones  industry has  put into place to make all the products, and drugs they use, but they have systems.  These systems require documentation. In my business, we said that if we could measure something, we could improve it. Therefore, any quality system requires data documenting metrics that can show management if they are doing well. Most hospitals require you to complete a satisfaction questionnaire when you leave. This is an example of their input.
4. Lastly, health professionals document to CYA (cover your ass). All doctors and hospitals are so afraid a patient will sue them that they over document in order to cover themselves in the event that one of them makes an error. Or, if the patient and his family perceive a screw up.
The bottom line is that I saw dollars with wings and heard a cash register ringing as I walked the corridors of that hospital.
Obama’s solution to this problem is to invent a totally new health care system to compete with the one in place. If the actual health care industry doesn’t know how to fix their problem, what makes us think a group of Congressman and Senators can  invent  a new system to fix it all?
Bend over America, the government wants to give you an enema.
In a future post, I will present a plan for realistic reform. Stay tuned.
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