"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.
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.
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 System
to Medicine,” Performance and Practices of Successful Medical Groups: 2006 Report Based on 2005 Data,
Medical Group Management Association, 20.
8. Different Levels of Kaizen
Very few
Large issues System
Kaizen
Six
Few Sigma
Medium issues
Lean
Event
Many
Small issues
Daily Kaizen
Adapted from: “The Toyota” Way Fieldbook, Liker and Meier
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
Toyota's success.”
Citation: Toyota Corporate Website
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
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
30. Documenting & Sharing
Improvements
• What was the problem?
• What was changed,
improved, or
implemented?
• What were the benefits?
• Who was involved?
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)
41. Before / After 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
42. Employee Quote
“This is the best thing
we’ve done in my 20
years. We’re finally
fixing things.”