Henry Ford a Change Freak?

I love old books. Just the smell, the texture, the excitement that comes from holding a book in your hands that is generations old can be amazing. I love reading primary history, history written by those who have lived what they are writing. History in many ways is corrupted when seen and summarized through the eyes of those who didn't live the events they write about. What becomes quickly apparent when reading old books is the reality that there is very little that is "new under the sun." Wisdom that creates best sellers today are often based on wisdom that is decades, if not centuries, old. A great example of this can be found in Henry Ford's "Today and Tomorrow," published in 1926.

Last week I shared the following quote from Ford's book with a Definity University Lean Certification class:

"Our own attitude is that we are charged with discoverinng the best way of doing everything, and that we must regard every process employed...as purely experimental. If we reach a stage...which seems remarkable as compared with what has gone before, then that is just a stage...and nothing more. It is not and cannot be anything more than that. We know from the changes that have already been brought about that far greater changes are to come, and that therefore we are not performinng a single operation as well as it ought to be performed."

It certainly appears that Henry Ford may have been a charter member of the Change Freaks! His approach to continuous improvement was certainly ahead of its time, an approach to continuous improvement that is still transforming organizations today. Here are a few thoughts on the wisdom we can find in the short excerpt above:

1. "Our own attitude..." Transformational change begins with attitude. It is not a program, an initiative, or a corporate goal. Real change leadership seeks to bring about an organizational culture that embraces change as the only way to move forward and thrive.

2. "...discoverinng the best way of doing everything" Every organization is on a journey of discovery. Be suspicious of any leader or organization that has a "program" to fix all the issues of an organization. As a change agent, don't slip into believing that all of today's problems can be solved with the same tools and methods you used in the past. This is expecially prevalent today with "programs" like lean, Six Sigma, ISO, etc. All of these are valuable, but they aren't silver bullets. Take the time to discover the new ways. Build on what you've learned, but don't limit yourself by making everything fit into your paradigms and previous experience.

3. "...every process...as purely experimental" Observe the current condition. Make plans to improve. Execute on those plans with the required challenges. Measure and study the impact. Adjust your approach where needed based on what you have learned. And then start the process all over again. Nothing but the laws of God and nature are fixed. Everything else is an experiment!

4. "...far greater changes are to come" Changes that are successful simply point the way to greater changes that are to come. Don't get comfortable or the world (and your competition) will pass you by. Henry Ford was also famous for saying "You can have a car in any color you want, as long as it is black." Unfortunately, in some ways, he failed to act on his own wisdom!

5. "...we are not performinng a single operation as well as it ought to be performed." As shared in a previous post, real change begins with a hatred for the current state. Hatred. Not dissatisfaction-many people live their entire lives dissatisfied with the way things are but do nothing to change. Hate the inefficiencies you see in your organizations. Hate the shortcomings you see in your own life. Resolve to stay on the journey of continuous improvement. Nothing is as good as it can be this side of heaven, so resolve to do all you can to make it better.

Ford Motor Company is the only major US car manufacturer that hasn't been in line for government bail outs and subsidies. They are the only US automobile manufacturer not contemplating bankruptcy. I won't venture to claim to know all the reasons why, but I have to believe at least one factor is that they have a legacy of finding a better way to do business, of never being satisfied with how things are today. What legacy will you and your organization leave? What you do TODAY will impact TOMORROW in ways you cannot possibly imagine!

What Gets Measured Gets Changed

Virginia felt powerless. She was one of the first women to ever be admitted to the surgical residency at Columbia University in 1933. Always a trail blazer, she didn't quit when told by the chairman at the end of her residency that, as a female, she had little chance of attracting patients and having a successful career. He persuaded her instead to join the college hospital staff as an anesthesiologist. She dedicated herself to the job and became only the second woman in the United States to become board certified in anesthesiology. She was often quoted as saying "Do what is right and do it now!" In spite of all this success, she felt helpless to change a situation that almost daily broke her heart.



As an anaesthesiologist, she was bedside for hundreds of births and was appalled by the the care that many newborns received. In the 1930s, delivering a child was the single most dangerous event in a woman's life: one in 150 pregnancies ended in the death of the mother. As shocking as these statistics are today, the odds were even worse for newborns: one in thirty died at childbirth, scarcely better than a century before. Virginia saw babies born blue and left unattended to die. Babies who were malformed, small, or not breathing were listed as stillborn and simply allowed to die with no attempts to revive them. She knew in her heart that many of them could be helped, but as an attending anesthesiologist she had no authority to help them or change medical practice. She wasn't an obstetrician, and she was a female in a male dominated world.



Then she had an idea, an incredibly simple idea that changed the course of medical history. She developed a measure for nurses to rate the condition of babies at birth on a scale of zero to ten. An infant got two points if it was pink all over, two for crying, two for taking good, vigorous breaths, two for moving all four limbs, and two it its heart rate was over a hundred. Published in 1953 the score turned an ambiguous and intangible concept (the condition of an infant at child birth) into data that could be collected and analyzed. Nurses and doctors had to pay more attention to the condition of an infant to rate its score, and during this time many babies improved quickly with simple care. The measurement started being applied virtually world-wide one minute after birth and again five minutes after birth. If for no other reason than the competitive nature of attending physicians, scores began to improve and thousands of lives saved. Neo-natal units and hundreds of other transformational changes to infant care such as ultrasounds, fetal heart monitors, and spinal and epidural anaesthesia were developed over the years to improve scores.



And the results? Today a full term baby dies in just one childbirth out of five hundred, and a mother dies in less than one in ten thousand. To put this into perspective, relative to the statistics of the 1930s over 27,000 mothers and 160,000 infants lives have been saved. And it all started with a frustrated and heart broken doctor who decided to measure what had never been measured before. Virginia Apgar changed the course of medical history and saved thousands of lives with her simple but ingenious measurement, which became know world-wide as the "Apgar Score."



One cannot improve what one cannot (or chooses not) to measure. Often organizations put measures in place to gauge the effect of their improvement efforts. But many overlook the power of the measurement itself. Simply giving timely and accurate feedback to those who can affect change can transform organizations. Perhaps the health care crisis in which we find ourselves today could have been averted if similar measurements had been put in place for all surgical procedures and hospital administrators. Who knows, what we choose to measure today may change the world tomorrow...

Hand Washing in Hospitals (Part 3)

As Paul Harvey always liked to say, "Now for the rest of the story..."

Not to be deterred from her mission, our infectious disease specialist Deborah Yokoe turned to a new product as a potential answer to the hand washing dilemma: alcohol rinses and gels. These items had actually been used in Europe for almost two decades, but had only recently caught on in the United States. These gels have the same potency as hand washing but can be applied and air dry in 15 seconds. Yet even this solution was met with resistance and took over a year to be adopted in the hospital. The staff feared the product would produce noxious odors. Next came fears that it would be irritating to the skin. Then rumors surfaced that the alcohol gel would reduce fertility. All of these rumors were false, but it took months to dispel each through communication and training. With the eventual adoption of the alcohol gels, compliance increased from 40 to over 70 percent. But surprisingly hospital infection rates didn't drop at all! Apparently the 30 percent non-compliance rate still allowed plenty of opportunity for the transmission of infections.

Not to be deterred by the failures of the industrial engineering efforts and alcohol gel adoption, surgeon Jon Lloyd continued to struggle with finding a way to reduce infection rates. Interestingly he received inspiration from reading an article about a Save the Children program to reduce malnutrition in Vietnam. After years of trying to bring outside solutions into Vietnamese villages only to be met with resistance, missionaries instead chose to find solutions from village insiders. They studied villagers who had the best nourished children and discovered that these mothers were breaking with locally accepted practices in many ways. They were feeding their children even when they had diarrhea, giving several small feedings a day, mixing greens in with their food, and other revolutionary practices. Aid workers shared these practices with other villagers and posted results for all the villagers to see. The ideas began to take hold and malnutrition dropped by 65-85% within two years in every village where this approach was taken.

Lloyd was struck by this idea and evaluated how it could be adopted by his hospital to reduce infection rates. With the help of the infectious disease specialists thirty minute small group sessions were held with health care workers at every level from food service workers to surgeons to nurses to janitors. They simply started the sessions by saying "We have a serious problem with the spread of infectious diseases in this hospital and we are here to learn your ideas on how to solve it." Many said it was the first time anyone had ever asked them what they would do about the problem, and ideas came pouring out. As a result of these sessions, norms began to change. When new gel dispensers were received staff members took charge of where to place them. Nurses began to confront doctors who were bypassing good hygiene practices. Therapists who didn't like to wear gloves during procedures were convinced by peers that it was no big deal. Ideas and small victories were publicized throughout the hospital and recognition given.

The result: One year into the effort MRSA wound infection rates dropped to zero. The Robert Wood Johnson Foundation recently launched a multi-million dollar initiative to adopt this approach in ten more hospitals across the country and study the results.

So what is there to learn for your organization in this case study? I would be interested to hear what you think, so please feel free to comment on lessons learned!