Healthcare Kaizen Webinar Mark Graban Gemba Academy Dec 2011


Published on

"Putting the Continuous Back in Continuous Improvement"

In this webinar, Mark Graban, author of the Shingo Award-winning " Lean Hospitals " and the upcoming book "Healthcare Kaizen," talks about kaizen and daily continuous improvement in healthcare. Across many industries, many organizations have come to equate the word kaizen with "kaizen events," or focused weeklong improvement projects. Leading lean healthcare organizations, such as ThedaCare and Virginia Mason Medical Center , have learned that they need both projects and small improvements.

Kaizen, as a mode of continuous improvement, is characterized by a large number of small, low-cost, low-risk improvements that are driven by front-line staff, who work in collaboration with their co-workers and leaders. Kaizen follows the scientific method and the PDCA (or PDSA) cycle of iterative improvement, where a hypothesis for improvement is tested against actual results.

The webinar will show examples of kaizen improvements from numerous healthcare organizations, as well as the practical mechanics for facilitating and managing kaizen. Graban will also discuss the important role of leaders at all levels.

Published in: Business, Health & Medicine

Healthcare Kaizen Webinar Mark Graban Gemba Academy Dec 2011

  1. “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
  2. Kaizen Kai = Change Zen = Good
  3. Improvement Focus Eastern Western Staff morale & engagement “ROI” (Return on Investment)Source: Masaaki Imai, KAIZEN (1986)
  4. 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.
  5. People Hate Change?“People don’t resistchange, they resistbeing changed.” –  Peter Scholtes (1938-2009)
  6. 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)
  7. 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.
  8. Different Levels of KaizenVery fewLarge issues System Kaizen SixFew SigmaMedium issues Lean EventManySmall issues Daily KaizenAdapted from: “The Toyota” Way Fieldbook, Liker and Meier
  9. PDCA / PDSA • Plan • Do • Study • Adjust
  10. Do Work Improve Work
  11. “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
  12. Do Work Improve Work
  13. 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?
  14. Ideas vs. Suggestions“ Suggestions are things I think you should do… Ideas are things that I can do.” - Norman Bodek
  15. QnEK Kaizen Report
  16. Quick and Easy Kaizen Find1. Find2. Discuss Discuss3. Implement Implement4. Document5. Share Document Share
  17. “Problem Awareness”•  Being able to admit problems –  Mindset & culture•  Being able to see problems –  Seeing waste, “lean thinking” –  From workarounds to kaizen
  18. 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
  19. Learning to See Waste
  20. Reducing Podiatrist Walking Restocking Checklist
  21. Quick and Easy Kaizen Find1. Find2. Discuss Discuss3. Implement Implement4. Document5. Share Document Share
  22. Basic Idea Card•  Standardized Card in Use –  Prompts staff through the problem solving process
  23. Visual Idea Board1 2 3 4
  24. Nursing Unit Cards
  25. Completed Idea Card
  26. Coaching on Idea CardsSource: Healthcare Kaizen
  27. Idea Board Progression Management must ensurethat ideas are followed up on and that new ideas are solicited over time.
  28. Toyota Benchmark Not Implemented90% Implemented
  29. Quick and Easy Kaizen Find1. Find2. Discuss Discuss3. Implement Implement4. Document5. Share Document Share
  30. Documenting & Sharing Improvements •  What was the problem? •  What was changed, improved, or implemented? •  What were the benefits? •  Who was involved?
  31. Kaizen “Wall of Fame”
  32. “Creativity Before Capital”Source: Healthcare Kaizen
  33. Patient Focus (NICU)Source: Healthcare Kaizen
  34. Clinical ImprovementSource: Healthcare Kaizen 34
  35. 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
  36. 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
  37. 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)
  38. Franciscan Savings ImpactSource: Healthcare Kaizen
  39. # of Recorded KaizensSource: Healthcare Kaizen
  40. Franciscan Participation % People Participating 60% 50% 40% 30% 53% 20% 36% 10% 0% 2010 Since 2007Source: Healthcare Kaizen
  41. 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
  42. Employee Quote“This is the best thing we’ve done in my 20 years. We’re finally fixing things.”
  43. Q&A / Contact Info•  Email:•  Blog:•  Twitter:•  KaiNexus:•  Books: – – (pre-launch)