Healthcare Kaizen

Mark Graban• President, Constancy, Inc.

• Chief Improvement Officer, KaiNexus

• Faculty, Lean Enterprise Institute

Author: Lean Hospitals

(2nd edition, November 2011)

Healthcare Kaizen(Released June 27, 2012)

© 2012, Constancy, Inc. & Mark Graban/Joe Swartz

2

Kaizen

Kai = Change

Zen = Good

Hospital Kaizen Example

Why Kaizen in Healthcare?

• Safety• Quality•Waiting Times• Staff Morale• Cost

5

Dr. Berwick’s Call for Kaizen (1989)

• ”Continuous

Improvement as an Ideal in Health Care” – Kaizen = “the continuous

search for opportunities for all processes to get better”

Dr. Donald BerwickFounder, Institute for Healthcare Improvement

Former Administrator, Medicare and Medicaid (CMS)

Citation: Berwick, DM, “Continuous improvement as an ideal in health care,” New England Journal of Medicine, 1989 May 25;320(21):1424-5.

Where is the Kaizen Spirit?

“This sounds a lot like common sense. You mean everyone isn’t doing this?”

- KOMO FM Radio Host

8

We’ve Made Some Progress

ThedaCare, University of Michigan

Greg Jacobson, MD

“Imai's book KAIZEN opened me up to a new world to me.  My medical training had taught me about medicine: how to take a history, how to work up a patient, and how to treat disease.  Healthcare is more than that… we are here to care for patients and to address all of their needs.  That requires understanding that problems exists with the overall system. Kaizen offers a systematic and complete approach for doing meaningful improvement work in which everyone can be involved.”

Emergency Medicine Physician

CEO, KaiNexus

Principles of Kaizen

Why Kaizen?

“… emphasizes morale-boosting benefits and positive employee participation over the economic and financial incentives…”

- Masaaki Imai

Why Healthcare Kaizen?

• Scientific method for improvement• Simple solutions, big impact• Alternative to cost-cutting and

layoffs• Put your mind before your wallet

14

“I feel like a robot.”

Do Work Improve WorkTwo Jobs at

Toyota

Do Work

Improve Work

Do Work Improve WorkTwo Jobs in a Hospital

Do Wor

k

Improve Work(You know if there’s nothing else to do

and if we don’t send you home)

“What Sets Us Apart?”

“Every Toyota team member is empowered with the ability to improve their work environment. This includes everything from quality and safety to the environment and productivity. Improvements and suggestions by team members are the cornerstone of Toyota's success.”

Suggestion Box = FAIL?

Six Sigma

Adapted from: “The Toyota” Way Fieldbook, Liker and Meier

Very fewLarge issues

FewMedium issues

ManySmall issues

MgmtKaizen

LeanEvent

Daily Kaizen

Different Levels of Kaizen

PDCA / PDSA

20

•Plan•Do •Study•Adjust

Daily Kaizen Process

1.Find

2.Discuss

3.Implement

4.Document

5.Share

Find

Discuss

Implement

Document

Share

Basic Idea Card• Standardized Card in Use

– Prompts staff through the problem solving process

Visual Idea Board1 2 3 4

Nursing Unit Cards

Completed Idea Card

Coaching on Idea Cards

Source: Healthcare Kaizen

Toyota Benchmark

90%

The Role of Leaders?

28

What Can We Do as Leaders?

• Ask for Kaizens–Help create time

What Can We Do as Leaders?

• Ask for Kaizens–Help create time

• Lead by example – participate–Get involved – coach, mentor, lead–Teach root cause problem solving–Follow the PDCA / PDSA process–Go to the gemba

“Kaizen is for Everybody” (Imai)

32Source: Healthcare Kaizen

“From the Janitor to the CEO”

Source: Healthcare Kaizen

What Can We Do as Leaders?

• Ask for Kaizens–Help create time

• Lead by example – participate–Get involved – coach, mentor, lead–Teach root cause problem solving–Follow the PDCA / PDSA process–Go to the gemba

Go to the Gemba

“Toyota managers should be sufficiently engaged on the factory floor that they have to wash their hands at least three times a day.”

- Taiichi Ohno

“Gemba is for Everyone”

“…Kaplan tours the hospital daily looking for problems and solutions. Everyone is encouraged to look for changes to make work more efficient.” - Virginia Mason CEO Gary Kaplan

Why Gemba?

Januar

y

Febru

ary

Mar

chApril

May

June

July

August

Septe

mber

Octob

er

Novem

ber

Decem

ber

Januar

y0

40

80

Patient Satisfaction

Patients (Gemba)

Walkway over tracks

ExecutiveOffices

Parking Garage

What Can We Do as Leaders?

• Ask for Kaizens–Help create time

• Lead by example – participate–Get involved – coach, mentor, lead–Go to the gemba–Teach root cause problem solving–Follow the PDCA / PDSA process

• Recognize and celebrate kaizen

Documenting & Sharing Improvements

• What was the problem?

• What was changed, improved, or implemented?

• What were the benefits?

• Who was involved?

Kaizen “Wall of Fame”

“Creativity Before Capital”

Source: Healthcare Kaizen

Patient Focus (NICU)

Source: Healthcare Kaizen

Clinical Improvement

Source: Healthcare Kaizen

Franciscan Participation

2011 Since 20070%

10%

20%

30%

40%

50%

60%

46%56%

% People Participating

# of Recorded Kaizens

Franciscan Savings Impact

Before / After Data from Children’s Medical Center Dallas Lab

Scores out of 5 (5 being highest) Before Lean

12 Months After Starting Lean

3. I have the opportunity to do what I do best every day.

3.11 3.928. I feel free to make suggestions for improvement.

2.84 3.48

10. I feel secure in my job. 2.32 3.4213. Stress at work is manageable. 2.43 3.2317. I am satisfied with the lab as a place to work.

2.51 3.4318. I would recommend my work area as a good place to work to others.

2.38 3.46

Grand Average 2.96 3.69

A Kaizen Culture:

Q&A / Contact Info

• Email: mark@LeanBlog.org• Blog: www.LeanBlog.org • Twitter:

www.twitter.com/MarkGraban • Books:–www.LeanHospitalsBook.com–www.HCkaizen.com