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Healthcare Kaizen



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Recorded webinar:


Karen’s Books:

This webinar was held with guest presenter, Mark Graban of

Suggestion box programs, while well intended, usually fail to engage employees in any improvement, yet alone continuous improvement. As one healthcare professional said, referring to their old suggestion box, “That’s where good ideas go to die!”

In comparison, the "kaizen" model for improvement, from Lean and Toyota Production System, however, is alive and thriving in many organizations. This webinar will focus on key differences between suggestion box programs and the kaizen model, giving specific tips and ideas that your organization can adopt to make continuous improvement a daily reality.

Guest Mark Graban shared practical methods and strategies from his new book, co-authored with Joe Swartz, Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements, that will help you engage employees in meaningful, lasting improvement.

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Healthcare Kaizen

  1. Healthcare Kaizen: The Suggestion Box is Dead Guest Presenter: Mark Graban August  21,  2012   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  2. §   Founder,  Karen  MarEn  &  Associates,  LLC   (1993).     §   Lead  Lean  transformaEons  &  develop  people  in   office,  service  and  knowledge  environments.     §   Teach  at  University  of  California,  San  Diego’s   Lean  Enterprise  program.     §   Author:   Karen  Mar1n,   Principal   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  3. Mark  Graban   •  Currently:   •  President,  Constancy,  Inc.   •  Faculty  member,  Lean  Enterprise  InsEtute   •  Chief  Improvement  Officer,  KaiNexus   •  Author  of  Lean  Hospitals  (2008,  2011)   •  Shingo  Research  and  Professional  PublicaEon   Prize,  2009   •  Co-­‐Author  of  Healthcare  Kaizen  (2012)   •  With  Joseph  E.  Swartz                 •  BS  Industrial  Engineering,  Northwestern  University   •  MS  Mechanical  Engineering  &  MBA,  MIT   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  4. The  Sugges1on  Box  is  Dead!   Mark  Graban   President,  Constancy,  Inc.   Chief  Improvement  Officer,  KaiNexus   Faculty,  Lean  Enterprise  Ins1tute     August  21,  2012   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  5. ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  6. ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  7. Dysfunc1ons  of  Sugges1on  Systems   •  Slow  /  No  Response   •  Yes  /  No  Answers   •  Not  CollaboraEve   •  Not  Transparent   •  Buy  Instead  of  Do?   •  Complaints  Against  Others   •  IncenEves  à  FighEng   •  Quotas  à  Gaming   Builds  on  the  book  Ideas  are  Free!  by  Robinson  &  Schroeder   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  8. Kaizen  =  Change  for  the  BeRer     •  ‘Kai’  means  “change.”   •  ‘zen’  means  “good.”     ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  9. Kaizen is Not Just Events   Very few Large issues System Kaizen Six Sigma Few Project Medium issues Lean Event Many Small issues Daily Kaizen Adapted from: “The Toyota” Way Fieldbook, Liker and Meier ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  10.        “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   produc1vity.    Improvements  and   sugges1ons  by  team  members  are   the  cornerstone  of  Toyota's  success.”   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  11. Kaizen  is  for  Everyone!   “…  emphasizes  morale-­‐ boos1ng  benefits  and   posi1ve  employee   par1cipa1on  over  the   economic  and  financial   incen1ves…”     -­‐  Masaaki  Imai   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  12. Dr.  Berwick’s     Call  for  Kaizen  (1989)     •  Kaizen  =  “the  conEnuous  search  for   opportuniEes  for  all  processes  to  get  beger”       •  Dr.  Donald  Berwick   –  Founder,  InsEtute  for  Healthcare  Improvement   –  Former  Administrator,  Medicare  and  Medicaid  (CMS)   CitaEon:  Berwick,  DM,  “ConEnuous  improvement  as  an  ideal  in  health  care,”  New  England   Journal  of  Medicine,  1989  May  25;320(21):1424-­‐5.     ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  13. Barriers  to  Kaizen?   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  14. Fear  of  Layoffs   Found  posted  in  a  hospital  lab  (during  ini9al  Lean  assessment)   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source  unknown  
  15. “No  Layoffs  Due  to  Lean”   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  16. We  Don’t  Have  Time?   “Mikki  Gremp,  RN,  lel  one   hospital  because  a  number   of  policies,  including  its   pracEce  of  'flexing  down,'   lel  her  feeling  that  nurses   weren't  valued.”   AJN Report: The Other Side of Mandatory Overtime Roxanne Nelson BSN, RN Maureen Shawn Kennedy MA, RN, editorial director AJN, American Journal of Nursing April 2008, Volume 108 Number 4, Pages 23 - 24 ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  17. People  Hate  Change?   “People  don’t   resist  change,   they  resist  being   changed.”     –  Peter  Scholtes   (1938-­‐2009)   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  18. Why  Not  Best  Prac1ces?   “People   support  what   they  create.”    -­‐  Margaret  J.  Wheatley   See  YouTube:  hgp://­‐Create   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  19. Joint  Commission  Now  Says…   “it  may  be  Eme  for  hospitals   to  move  away  from  best   prac1ces  and  develop   comprehensive  process   improvement  tools  —  which   can  include  Lean,  Six  Sigma   or  other  emerging   methodologies  —  that  allow   for  deeper,  more  specific   analyses  of  their  pa1ent   safety  needs.”    -­‐  Mark  Chassin,  MD,  President     ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  20. A  Proposed  Formula   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  21. Completed  Kaizen  Example   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  22. “Quick  and  Easy”  Kaizen   Find   1.  Find   2.  Discuss   Discuss   3.  Implement   Implement   4.  Document   5.  Share   Document   Share   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  23. Why  Kaizen?   Norman Bodek 1.  Make your work easier 2.  Make your work more interesting 3.  Develop your skills & capabilities ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  24. Start  Small   •  “There  are  no  big  problems,  there   are  just  a  lot  of  ligle  problems.”     –  Henry  Ford     •  Make  your  job  easier   •  Save  a  few  seconds   •  Improve  paEent  care  or  service   •  Improve  safety   •  Reduce  waiEng   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  25. Itera1ve  PDSA  Improvements   Improvements Ideas One  improvement  olen  leads  to  another   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  26. Improvements  for  NICU  Moms  (1)   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  27. Improvements  for  NICU  Moms  (2)   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  28. Improvements  for  NICU  Moms  (3)   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  29. Kaizen:  Real,  Daily,  Visual   (Visual  Idea  Board)   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Children’s  Medical  Center  Dallas  (Lab)  
  30. Kaizen:  Real,  Daily,  Visual   (Electronic  -­‐  KaiNexus)   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  31. Completed  “Idea  Card”   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  32. Kaizen  on  Her  FIRST  Day   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  33. Kaizen  “Wall  of  Fame”   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Children’s  Medical  Center  Dallas  (Lab)  
  34. Innova1on  &  Kaizen                        EHART  Blood  Pressure  Cuffs   Before After Taking time digging through the bucket on top Place a small strip of Velcro® brand hook and loop fasteners on the of the crash cart to try to find the correct size wall with different sizes of BP cuffs. Staff is able to quickly visualize blood pressure cuffs. This can be problematic the different sized cuff and get the proper size for the patient, and the during an EHART® when you want to get a blood pressure can be obtained quicker. blood pressure (BP) in a hurry so that you can get medications in the patients. The Effect Improved quality of care and faster response to the needs of the patient in an acute setting. Name Supervisor Date Savings Elizabeth Black Diana Brown, Manager 12-10-2008 Quality ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  35. “Just  Do  Its”  &  Problem  Solving   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  36. Problems  &  Opportuni1es   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  37. What  Can  We  Do  as  Leaders?   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  38. ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  39. ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  40. What  Can  We  Do  as  Leaders?   •  Ask  for  Kaizen   –  Help  create  Eme   –  Don’t  stop  asking   •  Lead  by  example  –  parEcipate   –  Get  involved  –  coach,  mentor,  lead   –  Go  to  the  gemba   –  Teach  root  cause  problem  solving   –  Follow  the  PDSA  process   •  Recognize  and  celebrate  Kaizen   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  41. Asking  Every  Day   •  Are  there  any  problems   interfering  with  your   work?   •  With  paEent  care?   •  Have  you  had  any  ideas   for  improvement  lately?   •  Do  you  have  what  you   need  to  do  your  job?   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  42. Coaching  on  Idea  Cards   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  43. Before  /  Amer  Data  from  CMC  Lab   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 work. 2.51 3.43 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 ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  44. KaiNexus  Data  /  Charts   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Whitepaper:  hgp://    
  45. Franciscan  Par1cipa1on   %  People  Par1cipa1ng   60%   50%   40%   30%   56%   46%   20%   10%   0%   2011   Since  2007   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  46. #  of  Recorded  Kaizens   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  47. Franciscan  Savings  Impact   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  48. Ideas  vs.  Sugges1ons   “  SuggesEons  are  things     I  think  you  should  do…            Ideas  are  things          that  I  can  do.”     -­‐  Norman  Bodek   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  49. Q&A  /  Contact  Info   •  Email:   •  Blog:     •  Startup:   •  TwiRer:   •  Books:   –   –   •   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  50. Upcoming Webinars Date   Topic   Thu  Aug  23   Value  Stream  Mapping:  Think  Strategy  Before  TacEcs   Rapid  Improvement:  How  to  Change  Behaviors  and  Get  Stuff   Thu  Sep  13   Done  FAST   Thu  Oct  4   Put  an  End  to  OrganizaEonal  ADD:  Create  Your  2012  Strategic   Improvement  Plan   Thu  Nov  1   We’ve  Had  it  All  Wrong:  Manage  Processes,  Not  People       858.677.6799   TwiRer:  @karenmar1nopex   Blog  &  newsleRer:     ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     50