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Sunday, 8 May 2011

Toyota's production system - even the doctors are using it

Having tried more than once, I can attest that it's difficult to persuade smart professionals, like lawyers, that they have something to learn from the production systems that companies such as Toyota have developed for manufacturing cars. After all, what could possibly be the connection between making cars and giving legal advice? 

A few of the people reading this post will be old enough to remember when cars were routinely unreliable, before the Japanese car industry's greatest gift to the world's motorists - reliability as standard. Nowadays, we take it for granted that our cars, whoever makes them, will start every morning and run without breaking down. But that wasn't always the case. The car industry is one of the biggest in the world and it succeeded in making a major transformation in quality. It's worth stopping to ask if there's anything we can learn.


You can read plenty of articles on the topic of "legal process engineering", but this post isn't about LPO or cost reduction. It's about something much more important than that. Instead, I want to ask what the mentality behind the Toyota Production System (TPS) could do to increase the quality of what we do as lawyers. 
Rather than dive into details about manufacturing, which will turn a lot of readers off, I think the best way to unlock this topic is by looking at healthcare. 

In 2005, Steven J Spears published an article in the Harvard Business Review entitled "Fixing Healthcare from the Inside, Today". You can find it at this link: http://bit.ly/miB9l7. HBR has a paywall, so it will be worth me summarizing the core idea:


"Every year, 98,000 people die in U.S. hospitals as a result of errors. And as many as 65 out of every 1,000 suffer injury or illness as a consequence of treatment. In the nation that leads the world in medical science, what explains these alarming statistics? It’s not that health care professionals lack intelligence, training, or compassion. Rather, operating under ambiguous, complex conditions, they work around problems to meet patients’ needs.


Problems’ root causes go unexamined. Result? The same problems crop up repeatedly—sometimes with tragic consequences. How can health care professionals radically improve patient care quality? Abandon work-arounds. Instead, apply the same operations-design principles that drive the renowned Toyota Production System (TPS): use small, rapid experiments to uncover and solve problems as they occur. Clarify who’s responsible for doing which procedures—and when and how. Foster a culture of continuous improvement by helping colleagues apply the experimental method to their own challenges. By improving their work while they’re actually doing it, health care practitioners can deliver extraordinary savings—in lives and dollars."


There are some really striking examples in this article. One of them concerns reducing infections when patients have a central line inserted. In several hospitals in Pittsburgh, doctors reduced deaths during a given period from these types of infections from 19 to 1. They achieved this by making small, almost trivial, improvements, such as replacing opaque wound dressings with transparent ones. The transparent dressing allows nurses to see at once if an infection is developing. 

Another example concerns moving the gloves inside the sterile surgery kit from the middle to the top of the pile intended for the doctor to use during a surgical procedure. Previously, after scrubbing up, the doctor would have to touch several items in the pile in order to remove and put on the sterile gloves. After the change, the gloves were always on the top of the pile, so the doctor could put them on before touching any other items.


These tiny changes saved people's lives. If they were made widely, thousands of people who currently die during treatment would live. Frightening, isn't it. Every single one of us has a vested interest in making sure this happens. Many people go through their lives without needing legal services, but the healthcare system has a near 100% capture rate, because all of us get sick at some point and, sorry to put it so bluntly, we're all going to die. Let's just hope that isn't because of an avoidable infection in a hospital.


One of the important points that comes through in the Spears article is that doctors are smart people, who care about their patients and try hard to do their jobs well. That description would apply equally to many lawyers. One key 
insight from the TPS is that, instead of relying on smart people to work around problems, you should remove the problems by analyzing what causes them and fixing them by making changes in what's "normal". The only thing that matters is the quality of the output to the customer and you analyze everything accordingly.

I don't think it's a sensible use of space in this blog to go into a lot of detail of the methodologies used in the TPS. If you're interested to read more, I'd recommend John Shook's book about value stream maps: http://amzn.to/lfoCei. The principles are easy to understand and you can start "trystorming" almost at once. Embedding the mentality more deeply is where the challenge lies. 
I've personally used the methodologies from the TPS to improve the quality of legal services delivered by teams I've managed. I don't think it's a panacea, but it is a powerful tool for some kinds of problems.

If doctors can make these kinds of improvements in the delivery of professional services by applying this kind of thinking, surely there must be something there for lawyers? I believe there is and I think it's about something more fundamental than the cost of our services. It's about the quality of them.

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Since this was published, Simon Lewis posted such a useful comment, that I am adding it to the main text:

Anthony Kearns' compelling article "What Law Firms Can Learn from Airlines and Hospitals: Risky Business" The AmLaw Daily July 6 2010 also explore some of the issues raised here. It concludes that "the adoption of these principles presents significant challenges given the way lawyers are trained and law firms are structured and managed." (http://bit.ly/8YvTwB)


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Next time, I am going to turn to cost. I'll describe an online procurement process we recently used for a multi-jurisdiction project and ask how can we answer the challenge in this week's Economist magazine about reducing the cost of legal services. http://www.economist.com/node/18651114

3 comments:

  1. Tom this is an excellent post. AON recently sent round an extremely long and detailed questionnaire to law firms it insures that’s designed to reduce risks. That means having systems in place so you can ensure you deliver a standardised service with appropriate checks and balances in place. There is no doubt that firms who can say 'yes' to all AON’s detailed questions will get cost effective PI quotes this autumn, and we worked extremely hard to be able to say yes. Their form acted as an impetus for us to re-examine our systems and procedures and ways of working. I had been using the Lexcel guides to put in place sound structures, and we already had many policies and procedures in place. Nevertheless it is a real challenge as a law firm to ensure that satisfied clients who return for further services have a similar user experience. It must be so difficult when you have different lawyers across the firm delivering different types of services. We are still examining our workflows and processes to put in place effective systems for different types of work we do, so I shall order John Shook's book immediately as it sounds v. useful.

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  2. Anthony Kearns' compelling article "What Law Firms Can Learn from Airlines and Hospitals: Risky Business" The AmLaw Daily July 6 2010 also explore some of the issues raised here. It concludes that "the adoption of these principles presents significant challenges given the way lawyers are trained and law firms are structured and managed." (http://bit.ly/8YvTwB)

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  3. Here is a blog on continuous improvement and "lean" in law offices, written by a lawyer:

    http://leanlaw.net/

    ReplyDelete