JIT manufacturing
Power& tradition holding back progress Contents Overcome reactionaries

JIT manufacturing

This presentation reviews just-in-time manufacturing with analysis based on complex adaptive system (CAS) theory. 
Have you ever wondered why Just in time (JIT) applied to manufacturing has improved quality and reduced costs while the approach failed in health care?  This presentation:
  • Describes how problems in manufacturing were overcome by the application of Just in time(p.3) methods
  • Outlines the core techniques(p.4) of Just in time including its leverage of total engagement of personnel
  • Highlights the aspects of manufacturing(p.6) that enables these improvements, aspects which are missing in health care

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Power& tradition holding back progress Contents Overcome reactionaries
Introduction to Just in time (JIT) manufacturing methodology
  • JIT was developed to improve flexibility, quality, and reduce waste in manufacturing
  • Removed errors, reduced transportation, stock and waiting times
  • Involved and empowered all employees
  • Encouraged iterative design
  • Cross functional participation helped enrich the perceptions applied in design for manufacture
  • Views manufacturing operation as a network of process and operational flows
    • Operations add value by transforming inputs into desired outputs - non JIT manufacturing focused on operations aiming to
      • Reduce labor costs
      • Automate
    • Processes link the operations together and add no value so JIT aims to minimize them - JIT studies process flows and aims to
      • Restructure to maximize effectiveness of linked operations
      • Reduce the costs of the processes

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Power& tradition holding back progress Contents Overcome reactionaries
JIT core techniques
To improve flexibility and quality JIT:
  • Involves all personnel (agents), aligns goals, trains them and then benefits from and responds to insights
  • Encourages a focus on a limited set of outputs
  • Continuously reduces processes
  • Designs iteratively for manufacture and demand
  • Prefers 'small machines' - low capital, little risk if specialize to key flows
  • Prophylactically fix processes
  • Reduce setup
  • Align product mix with layout and flows

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Power& tradition holding back progress Contents Overcome reactionaries
JIT core techniques
To reduce waste JIT:
  • Iteratively improves visibility
  • Reduces inventory
  • Keep operations steadily moving
    • Negative feedback sustains steady flows
    • Redundant capacity is accepted as essential to sustain flows
  • Improves processes
  • Improves scheduling with demand push and final assembly pull (Kanban)
    • Reduce batch sizes
    • Associate flow step with transaction (Kanban card)
    • Operator detected issues stop the flow
      • No detected error is moved on
    • Cells in final assembly can allow a general operation/supplies to specialize late
  • Integrate suppliers

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Power& tradition holding back progress Contents Overcome reactionaries
JIT use in manufacturing compared with health care
Manufacturing and health care systems differ (although Geisinger shows they can be aligned):
  • JIT excels in the end-to-end architected systems available to product manufacturers while its methodology is undermined in chaotic and complex adaptive (CAS) systems found in health care
  • Manufacturing businesses have aligned goals while health care includes multiple organizations with conflicting goals: nurses, doctors, administrators, drug and medical equipment companies, scientists and teachers
  • JIT drives the outputs of manufacturing to be limited while health care aims to restore health to the patient, but this can require time consuming observation of the interdependent aspects of the patient
  • Manufacturing benefits from continuously reducing processes while health care is constrained by the patients' needs and features
  • Manufacturing can optimize around specialized small machines while health care business models conflict - where ever chaotic systems or CAS prevail high capital investment can align with collected expertise to outperform specialized processes with optimized small machines 
  • Manufacturing can identify where redundancy is necessary to maintain flows but health care requires time and trained staff to assess complex interdependencies and implement varied treatment plans - redundancies which are easily optimized away in administrative efficiency exercises
  • Scheduling can be optimized by integrating the supply chain and manufacturing designs while patient and problem variability and interdependencies introduce large unpredictable delays into health care flows
  • Manufactured product is designed to a specification while the patient in health care has evolved to be unique
  • High volume manufacturing can afford to define the end-to-end process while health care processes must cope with variation, ambiguity and interdependence
  • Successful JIT manufacturing flows are laid out to match the operational activities while health care must
    • Respond to vastly different emergency situations including time critical trauma cases and long term chronic problems
    • Cope with adverse interdependent reactions to procedures required to sustain life
  • Manufacturing flows can be paced so that end-to-end the rates are stable and sustained while health care input rates are uncontrollable, buffer capacity is costly and ownership is fragmented
  • Market oriented manufacturing has demonstrated improved competitiveness from reduced waste and better quality from integrating suppliers while health care's patients have little ability to make a market and so suppliers and partners benefit from and encourage over supply, opaque processes and regulatory protection. 

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Power& tradition holding back progress Contents Overcome reactionaries
Backup slides follow

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Power& tradition holding back progress Contents Overcome reactionaries
Shewhart cycles: Walter Shewhart advocated the use of iterative cycles of: Planning, Doing, Checking and Acting to fix issues (PDCA)
  PDCA cycle emerges naturally in complex adaptive systems
  • Examples include the cell cycle, cell death programme, cell growth programme, Just-In-Time manufacturing
  • Plans in an adaptive system are schematic structures
    • Associated with current environmental state indirectly through modeling
    • Models generate predictions of results of performing each strategy
  • Performing, or 'do'ing, a highly valued strategy will result in some change of state of the agent and its environment
  • Agent can compare (check) the result against the models prediction
    • Human agents evolved strategies often avoid checking so a required process supports the formation of the habit
  • If reality differs from the prediction the valuation of the strategy can be adjusted

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