Presented by Mark Graban to a healthcare conference gathering in Turkey in April 2018. Mark Graban is the author of the book "Lean Hospitals" and co-author of "Healthcare Kaizen," the books that are essentially source material for this talk.

1. @MarkGraban
Mark@MarkGraban.com
Respect for People and
Continuous Improvement
for Healthcare

2. Lean is a set of concepts,
principles and tools (thinking)
used to create and deliver
the most value from the
customer’s perspective while
consuming the fewest
resources , and by engaging
people in continuous
problem solving.
Text and image © Lean Enterprise Institute, used with permission

3. What is Lean Healthcare?
• Lean is built on three bedrock concepts:
1. respect for people
2. scientific method to seek perfection
3. clear purpose: to align systems, strategy, and
performance to yield customer value as the result.
Source: John Toussaint, MD

4. “Equally Important Pillars”

5. • Ensure people have what they need to do the work
• Don’t put people in a broken process
• Doesn’t drive cost cutting through layoffs
• Don’t overburden people
• Have proper staffing levels
• Work to your level of licensure
• Give help and support when needed
• Allow people to do meaningful work
• Not blaming people for systemic errors
• Listen and engaging people in improvement
Lean Respects & Supports Staff

7. What is TPS
Philosophy?
• Customer first
– Provide customers with what they want, when they
want it, and in the amount they want it
• People are the most valuable resource
– Deeply respect, engage, and develop people
• Continuous improvement (kaizen)
– Engage everyone each and every day
• Shop floor (gemba) focus
– Go to where the work is done to find & solve problems

8. What is Meant by Respect?
• Doesn't mean being nice... it means showing respect
• Respecting each individual and their contribution regardless of education or job title
• Challenging people to do better because we believe in them, but then providing support as
needed
• Respect means helping, but not doing things for them. Don't rob them of ability to learn and
improve on their own.
• Respect for humanity or respect for human nature - we're all imperfect and prone to error,
which is why we error proof, make sure we have the right staffing levels, etc.
• In healthcare, it means being respectful of patients and their family members
• Means not blaming individuals for systemic problems or medical errors
– Doctor who forgot to order an aspirin when patient had chest pain example
• Respect means not asking people to do too much
• Respect means creating a system and an environment in which people can be successful.
Doesn't mean perfect...
• Respect means actively engaging everybody in improvement

9. Kaizen
Kai = Change
Zen = Good

10. “everybody
improving,
everywhere,
and every day”

11. Four Goals of Kaizen
In this order:
1. Make things easier
2. Make things work better
3. Make things work faster
4. Make things cheaper
(without hurting quality)

12. “The culture here is staff input into everything.
They want staff figuring out how to fix things.
What can we do to make our job easier?
They allow us to implement things to see if it will work.”
See videos at www.leanblog.org/franciscanvideos

13. Woman’s
& Children’s
3P
EMR
Implementation
Six
Sigma
Projects
Large
Kaizen
Medium
Kaizen
Small
Kaizen
New Indy
Bed Tower
Lean
Events
Daily Kaizen
3 Levels of Kaizen
Bubble size is meant to roughly represent relative size of effort
Complexity
COG
Group
Best
Practices
PACE

14. PDCA / PDSA

15. 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”
• Criticized leaders who look for “bad apples”
• Leaders cannot be “a mere observer of problems”
• Described Deming-like culture shift

17. Find
Discuss
Implement
(Test)
Document
Share
The Kaizen Process

18. 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

19. Q&A / Contact Info
• Email: mark@MarkGraban.com
• Website: www.MarkGraban.com
• Blog: www.LeanBlog.org
• Twitter: www.twitter.com/MarkGraban