Mark Graban - Talk at Masaai Imai Event


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June 14, 2012

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Mark Graban - Talk at Masaai Imai Event

  1. 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. 2
  3. Kaizen Kai = Change Zen = Good
  4. Hospital Kaizen Example
  5. Why Kaizen in Healthcare? • Safety • Quality • Waiting Times • Staff Morale • Cost 5
  6. 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.
  7. Where is the Kaizen Spirit?
  8. “This sounds a lot like common sense. You mean everyone isn’t doing this?” - KOMO FM Radio Host 8
  9. We’ve Made Some Progress ThedaCare, University of Michigan
  10. 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
  11. Principles of Kaizen
  12. Why Kaizen? “… emphasizes morale-boosting benefits and positive employee participation over the economic and financial incentives…” - Masaaki Imai
  13. Why Healthcare Kaizen? • Scientific method for improvement • Simple solutions, big impact • Alternative to cost-cutting and layoffs • Put your mind before your wallet
  14. 14 “I feel like a robot.”
  15. Do Work Improve Work
  16. Do Work Improve Work
  17. “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.”
  18. Suggestion Box = FAIL?
  19. Different Levels of Kaizen Six Sigma Very few Large issues Few Medium issues Many Small issues Adapted from: “The Toyota” Way Fieldbook, Liker and Meier Mgmt Kaizen Lean Event Daily Kaizen
  20. PDCA / PDSA 20 • Plan • Do • Study • Adjust
  21. Daily Kaizen Process 1.Find 2.Discuss 3.Implement 4.Document 5.Share Find Discuss Implement Document Share
  22. Basic Idea Card • Standardized Card in Use – Prompts staff through the problem solving process
  23. Visual Idea Board 1 2 3 4
  24. Nursing Unit Cards
  25. Completed Idea Card
  26. Coaching on Idea Cards Source: Healthcare Kaizen
  27. Toyota Benchmark
  28. The Role of Leaders? 28
  29. What Can We Do as Leaders? • Ask for Kaizens – Help create time
  30. 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
  31. “Kaizen is for Everybody” (Imai) Source: Healthcare Kaizen 32
  32. “From the Janitor to the CEO” Source: Healthcare Kaizen
  33. 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
  34. 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
  35. “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
  36. Why Gemba? 100 80 60 40 20 0 Patient Satisfaction
  37. Patients (Gemba) Walkway over tracks Executive Offices Parking Garage
  38. 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
  39. Documenting & Sharing Improvements • What was the problem? • What was changed, improved, or implemented? • What were the benefits? • Who was involved?
  40. Kaizen “Wall of Fame”
  41. “Creativity Before Capital” Source: Healthcare Kaizen
  42. Patient Focus (NICU) Source: Healthcare Kaizen
  43. Clinical Improvement Source: Healthcare Kaizen
  44. Franciscan Participation 60% 50% 40% 30% 20% 10% 0% % People Participating 46% 56% 2011 Since 2007
  45. # of Recorded Kaizens
  46. Franciscan Savings Impact
  47. 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 3.92 8. I feel free to make suggestions for improvement. 2.84 3.48 10. I feel secure in my job. 2.32 3.42 13. Stress at work is manageable. 2.43 3.23 17. I am satisfied with the lab as a place to 2.51 3.43 work. 18. I would recommend my work area as a good place to work to others. 2.38 3.46 Grand Average 2.96 3.69
  48. A Kaizen Culture:
  49. Q&A / Contact Info • Email: • Blog: • Twitter: • Books: – –