Mark Graban - Talk at Masaai Imai Event

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June 14, 2012

June 14, 2012

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  • 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: mark@LeanBlog.org • Blog: www.LeanBlog.org • Twitter: www.twitter.com/MarkGraban • Books: – www.LeanHospitalsBook.com – www.HCkaizen.com