Healthcare Kaizen Webinar Mark Graban Gemba Academy Dec 2011

“Putting the Continuous Back in Continuous Improvement” Mark Graban •  Chief Improvement Officer, KaiNexus •  President, Constancy, Inc. •  Faculty, Lean Enterprise Institute Author, Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement (2nd edition, November 2011) Co-Author, Healthcare Kaizen (Coming April 2012)© 2011, Constancy, Inc. & Mark Graban / Joe Swartz

Kaizen Kai = Change Zen = Good

Improvement Focus Eastern Western Staff morale & engagement “ROI” (Return on Investment)Source: Masaaki Imai, KAIZEN (1986)

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 Berwick –  Founder, 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.

People Hate Change?“People don’t resistchange, they resistbeing changed.” –  Peter Scholtes (1938-2009)

Episodic Improvement Events•  “Kaizen Blitz” –  An effort to fix a specific problem of limited scope –  Characteristics: Ø Typically a weeklong “Event” Ø Cross-functional teams Ø Define and fix the problem NOW (action oriented)•  “Kaizen Event” or “Kaikaku Event”? –  Rapid Improvement Event (RIE) –  Rapid Process Improvement Workshop (RPIW)

Backsliding from Events •  “… we were only holding the gains on about 40 percent of those changes, partially because it is easy to slip back into old ways of doing things if there is a lack of accountability and follow through.” –  Christina St. Martin, Virginia Mason Medical Center •  Root cause of this?Citation: St. Martin, Christina, “Seeking Perfection in Health Care: Applying the Toyota Production Systemto Medicine,” Performance and Practices of Successful Medical Groups: 2006 Report Based on 2005 Data, Medical Group Management Association, 20.

Different Levels of KaizenVery fewLarge issues System Kaizen SixFew SigmaMedium issues Lean EventManySmall issues Daily KaizenAdapted from: “The Toyota” Way Fieldbook, Liker and Meier

PDCA / PDSA • Plan • Do • Study • Adjust

Do Work Improve Work

“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 Toyotas success.”Citation: Toyota Corporate Website

Do Work Improve Work

Kaizen ≠ Suggestion Box Common Dysfunctions•  Common Dysfunctions •  Slow / No Response•  Slow •  Yes / No•  Yes / No •  Not Collaborative•  Not Collaborative •  Not Transparent•  Buy instead of Do? •  Buy instead of Do?

Ideas vs. Suggestions“ Suggestions are things I think you should do… Ideas are things that I can do.” - Norman Bodek

QnEK Kaizen Report

Quick and Easy Kaizen Find1. Find2. Discuss Discuss3. Implement Implement4. Document5. Share Document Share

“Problem Awareness”•  Being able to admit problems –  Mindset & culture•  Being able to see problems –  Seeing waste, “lean thinking” –  From workarounds to kaizen

Start Small•  “There are no big problems, there are just a lot of little problems.” –  Henry Ford•  Make your job easier•  Save a few seconds•  Improve patient care or service•  Improve safety•  Reduce waiting

Learning to See Waste

Reducing Podiatrist Walking Restocking Checklist

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 CardsSource: Healthcare Kaizen

Idea Board Progression Management must ensurethat ideas are followed up on and that new ideas are solicited over time.

Toyota Benchmark Not Implemented90% Implemented

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 ImprovementSource: Healthcare Kaizen 34

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

Quantifiable Results•  Indiana University Health Goshen Hospital –  CEO Challenged staff to $3.5M savings in 2009 –  They delivered double that –  $6.5M again in 2010 –  $30M savings since 1998 –  Modern Healthcare Best Workplaces •  No layoffs for 17 years

Quantifiable Results•  Baptist Health Care (“Bright Ideas”) –  50,000 ideas since 2000 •  14,000 ideas in 2008 –  $50M in cost savings and avoidance •  $10.5M in savings, $5.5M in avoidance –  FORTUNE Magazine 100 Best Places to Work (7 years)

Franciscan Savings ImpactSource: Healthcare Kaizen

# of Recorded KaizensSource: Healthcare Kaizen

Franciscan Participation % People Participating 60% 50% 40% 30% 53% 20% 36% 10% 0% 2010 Since 2007Source: Healthcare Kaizen

Before / After Data from CMC Lab Before Lean 12 Months After Starting Lean3. I have the opportunity to do what I dobest every day. 3.11 3.928. I feel free to make suggestions forimprovement. 2.84 3.4810. 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 placeto work. 2.51 3.4318. I would recommend my work area asa good place to work to others. 2.38 3.46Grand Average 2.96 3.69

Employee Quote“This is the best thing we’ve done in my 20 years. We’re finally fixing things.”

Q&A / Contact Info•  Email: mark@constancy.us•  Blog: www.LeanBlog.org•  Twitter: www.twitter.com/LeanBlog•  KaiNexus: www.KaiNexus.com•  Books: – www.LeanHospitalsBook.com – www.HCkaizen.com (pre-launch)

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Healthcare Kaizen Webinar Mark Graban Gemba Academy Dec 2011

by Mark Graban on Dec 06, 2011

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Healthcare Kaizen Webinar Mark Graban Gemba Academy Dec 2011 — Presentation Transcript