Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements
Features
- Provides examples of documented Kaizen improvement from multiple healthcare settings
- Discusses the three levels of Kaizen—daily Kaizen, Kaizen events, and system Kaizen
- Focuses on daily Kaizen methods for staff engagement in the healthcare setting
- Includes a Foreword by Masaaki Imai and an Introduction by Norman Bodek
- Offers templates that are available for download at www.HCkaizen.com
- Winner of a 2013 Shingo Research and Professional Publication Award
Summary
Healthcare Kaizen focuses on the principles and methods of daily continuous improvement, or Kaizen, for healthcare professionals and organizations. Kaizen is a Japanese word that means "change for the better," as popularized by Masaaki Imai in his 1986 book Kaizen: The Key to Japan’s Competitive Success and through the books of Norman Bodek, both of whom contributed introductory material for this book.
Winner of a 2013 Shingo Research and Professional Publication Award!
In 1989, Dr. Donald M. Berwick, founder of the Institute for Healthcare Improvement and former administrator of the Centers for Medicare & Medicaid Services, endorsed the principles of Kaizen in the New England Journal of Medicine, describing it as "the continuous search for opportunities for all processes to get better." This book shows how to make this goal a reality.
Healthcare Kaizen shares some of the methods used by numerous hospitals around the world, including Franciscan St. Francis Health, where co-author Joe Swartz has led these efforts. Most importantly, the book covers the management mindsets and philosophies required to make Kaizen work effectively in a hospital department or as an organization-wide program.All of the examples in the book were shared by leading healthcare organizations, with over 200 full-color pictures and visual illustrations of Kaizen-based improvements that were initiated by nurses, physicians, housekeepers, senior executives and other staff members at all levels.
Healthcare Kaizen will be helpful for organizations that have embraced weeklong improvement events, but now want to follow the lead of ThedaCare, Virginia Mason Medical Center, and others who have moved beyond just doing events into a more complete management system based on Lean or the Toyota Production System.It’s often said, without much reflection, that people hate change. The experiences shared in this book prove that people actually love change when they are fully engaged in the process, get to make improvements that improve patient care and make their day less frustrating, and when they don’t fear being laid off as a result of their improvements.
Mark Graban explains why his new book Healthcare Kaizen is a great resource for healthcare organizations looking to make improvements on the frontlines.(www.youtube.com/watch?v=l4JdaH03Dbo&feature=youtu.be) Check out a recent entry about this book on the Virginia Mason Medical Center Blog, Could this new book help drive your Lean journey? (http://virginiamasonblog.org/2012/09/05/could-this-new-book-help-drive-your-lean-journey/)Table of Contents
WHAT IS KAIZEN?
Kaizen and Continuous Improvement
Bubbles for Babies
Kaizen: A Powerful Word
Kaizen Is Not Just Change, It Is Improvement
We Often Succeed As the Result of Failing More
Kaizen, PDSA, and the Scientific Method for Improvement
Changing Back Can Be Better For Babies
Kaizen = Continuous Improvement
Kaizen Starts with Small Changes
A Small Kaizen with Great Meaning
Kaizen = Engaging Everybody in Their Own Change
Kaizen Upon Kaizen Upon Kaizen
Kaizen Closes Gaps Between Staff and Leaders
Creativity before Capital
Expensive Mistakes Made without the Kaizen Mindset
Kaizen and Lean: Related and Deeply Interconnected Concepts
People Are the Ultimate Competitive Advantage
High-Level Kaizen Principles—The Kaizen Mindset
Asking
Empowering
Recognizing
Sharing
This Is Not a Suggestion System—It Is an Improvement System
Kaizen Has an Impact on People and Performance
The Roots and Evolution of Kaizen
Early Suggestion Programs
Downsides of Suggestion Box Programs
Recovering from Taylorism
The American Roots of Continuous Improvement—TWI and Deming
Kaizen: One of the Two Pillars of The Toyota Way
Masaaki Imai and the Spread of Kaizen (1986)
Dr. Donald Berwick’s Call for Kaizen (1989)
"Medicine’s Need for Kaizen" (1990)
Norman Bodek and American Kaizen
Conclusion
Discussion Questions
Endnotes
Types of Kaizen
Three Levels of Kaizen
Imai’s Three Levels of Kaizen
Complementary Nature of the Levels of Kaizen
Three Types of Kaizen at Children’s Medical Center Dallas
Events Alone Will Not Make You Lean
The Origins of Kaizen Events
Basic Structure and Format of an Improvement Event
Impressive Results from Kaizen in Healthcare
Virginia Mason Medical Center
ThedaCare
Criticisms of Weeklong Events
Not All Kaizen Organizations Rely on Events
Kaizen Leads to Innovation at Franciscan
Moving Toward a Kaizen Culture
The Real Goal—Cultural Transformation
What a Kaizen Culture Feels Like
Everyone Is Engaged
Drivers of Engagement
Everyone Is Relentlessly Searching for Opportunities to Improve
The Two Parents of Transformation: Pain and Possibility
Pain
Possibilities
You Have Control over Your Workplace
Patients and Families Are Happy
Staff and Physicians Are Happy
Work and Patient Care Flow Like Clockwork
The Workspace Is Clean, Orderly, and Safe
Everyone Works Together
Everything Gets Questioned
Small Successes Lead to Bigger Successes
Small Kaizen Leads to More Big Ideas
Bite-Size Chunks
Imai’s Three Stages of Kaizen
KAIZEN METHODOLOGIES
Quick and Easy Kaizen
Quick and Easy Kaizen
Starting the Franciscan Kaizen Journey
The Quick and Easy Kaizen Process
Step 1—Find
Start Small
Start With You
Make Your Work Easier
Make Your Work Safer
Make Your Work More Interesting
Build Your Skills, Your Capabilities, and Your Knowledge
See an Opportunity or a Problem
Step 2—Discuss
Discuss with your Direct Supervisor
Discuss with Your Team Members
Quantify the Idea
Step 3—Implement
Enrolling Others to Help
Implement the Improvement Idea
Seven Days Grace
Step 4—Document
Finalize the Kaizen report
Submit Report For Approval
Step 5—Share
Leveraging Improvement Ideas from Others
Sharing Kaizens
Visual Idea Boards
Making the Improvement Process Visible
Setting up a Visual Idea Board
Boards Should Be Highly Visible in the Workplace
Boards in "Public" Settings
Communication That Should Occur before the Visual Idea Board Is Put Up
What Happened to the Suggestion Box?
What Employees Can Expect
A Communication Example
Formats for Idea Cards
Sticky Notes versus Structured Cards
Idea Cards versus Suggestion Cards
Modeling the Kaizen and PDSA Process in Writing
Visual Idea Cards
Problem
Suggestion or Idea
Date Originated
Created By
Expected Benefits
Input Needed From
Implementation Steps
Results Verified?
New Method Standardized?
Completion Date
Idea Card Examples
Staff and Patient Annoyances
Asking for Help
Addressing Patient Needs
Getting Input from Others
Other Formats of Idea Boards and Cards
Park Nicollet’s KEEP Form
Akron Children’s Hospital
Seattle Children’s Hospital Pharmacy
Visual Management of the Idea Boards
Using Idea Cards to Coach People on Kaizen
The Suggestion to "Be More Careful"
Something’s Not Happening—So Don’t Forget
Easier for Us, but Not Best for the Whole System?
Tracking Completed Cards
Sharing Kaizen
Different Formats for Sharing
The Kaizen Wall of Fame Format
Kaizen Sharing Examples
Making Things Better for Patients
Supplies for Patients
Improving Meal Rounds
Easier to Get DVDs
Little Details for Patients
Preventing Mistakes or Harm
Ensuring Proper Bed Cleaning
Preventing Pressure Ulcers
More Accurate Lab Results Through Standardized Work
Proper X-Ray Ordering
Ensuring Equipment is Ready
Eye Protection for Lab Staff
Preventing Aerosolized Specimens
Making Work Easier for Staff
Easier to Plug In Carts
Improved Ergonomics and Specimen Quality
Saving Sore Feet
Better Phone Ergonomics and Productivity
Combining Two Forms Into One
Preventing Delays
Faster Code STEMI Heart Attack Care
Meds for Discharged Patients
Getting Patients to Rooms with Less Delay
More Timely Test Results for Rounding
Fewer Supply Chain Delays
Better Access to Endocrinology
Saving Space or Cost
Creativity over Capital in the Lab
Company Medical Clinic Costs
An Unnecessary Label
Rethinking Freezer Use
The Art of Kaizen
Barriers to Kaizen
Resistance to Change
Lack of Time—We’re Too Busy
A Model for Mobilizing Support
Tenet 1: Respect Others
Tenet 2: Create a Vision That Matters
Tenet 3: Convey the Why
Tenet 4: Connect to the Mission
Is This About Me or Is This About the Mission?
Working with Others Based on Their Willingness to Invest
Strategy 1: Cocreate with Those Eager for Opportunity
Seek Their Ideas
Play Kaizen Catch Ball
Reigniting Everyone’s Creativity
Strategy 2: Sell Opportunity to Those That Are Cautious
Encourage
Seven Days Grace
Measure Progress
Strategy 3: Find Common Meaning with and Negotiate with Opposers
Include Opposing Viewpoints
Find Common Meaning
Negotiate
Use Demands as a Last Resort
Kaizen and Positive Deviance
Rules for Leaders
KAIZEN LESSONS LEARNED
The Role of Leaders in Kaizen
Key Actions for Leaders at All Levels
Key Action 1: Believe In the Power of Kaizen
Key Action 2: Participate in Kaizen
Key Action 3: Just Ask
Ask, Don’t Tell
Key Action 4: Use Kaizen to Develop People
Key Action 5: Ensure Staff Members Are Recognized and Rewarded
Key Action 6: Share and Spread Ideas
Key Action 7: Sell the Benefits
It Is Not Always about Cost
Role of Top-Level Managers
Leadership and Kaizen Participation Starts at the Top
Dr. John Toussaint’s Participation
Going to the Gemba
Kaizen Reports Are for Everybody
Key Actions for Top-Level Managers
Key Action 1: Communicate Expectations and Prioritize
Key Action 2: Resource Adequately
Key Action 3: Sponsor a Recognition and Incentives Program
Key Action 4: Share Notable Kaizens
Key Action 5: Thank People Personally
Role of Middle-level Managers
Paula’s Baby Steps Lead the Way
The "Great Big Pile of Problems"
Leaders Drive Kaizen Success
The Kaizen Difference
Key Actions for Middle-level Managers
Key Action 1: Be the Departmental Owner and Develop Co-Owners or Coordinators
Key Action 2: Use Departmental Meetings
Key Action 3: Encourage Staff to Participate by Asking for Their Ideas
Key Action 4: Create a Departmental Recognition System
Key Action 5: Put a Tracking System in Place, If One Does Not Exist
Key Action 6: Tie to Performance Evaluations
Role of First-Level Managers
A First-Level Manager Is a Coach
Key Actions for First-Level Managers
Key Action 1: Coach
Key Action 2: Empower Staff—Do Not Do the Kaizen for Them
Key Action 3: Use Rounding to Coach
Key Action 4: Help Set Expectations
Key Action 5: Review and Approve Kaizen Reports
Key Action 6: Help Document Benefits
Key Action 7: Make Kaizen Fun
Key Action 8: Recognize and Reward
Key Action 9: Share and Spread Ideas
Key Action 10: Be a Cheerleader
Organization-Wide Kaizen Programs
Getting Started
When Will You See Results?
Tying Kaizen to the Organization’s Strategy
The Kaizen Promotion Office
Staffing the KPO
Activities of the Kaizen Promotion Office
Activity 1: Facilitates the Practice of Kaizen
Activity 2: Reports Kaizen Metrics
Activity 3: Coordinates Rewards and Recognition
Activity 4: Facilitates Kaizen Sharing across the Organization
Activity 5: Develops Kaizen Standardized Work
Activity 6: Develops and Delivers Staff Education
Activity 7: Facilitates the Documentation and Tracking of Kaizens
Sustaining a Kaizen Program—Incentives and Rewards
Pros and Cons of Financial Incentives
Electronic Kaizen Systems
Advantages of an Electronic Online Database
Quick Entry
Automatic Routing and Electronic Approval
Ideas to Hold for Later
Quick Search and Retrieval
Electronic Kaizen within Intermountain Healthcare
Electronic Kaizen at Park Nicollet
Electronic Kaizen at Vanderbilt
Lean Methods for Kaizen
Technique 1: Add Value
The Internal Customer’s Point of View
Different Forms of Patient Value
Technique 2: Eliminate Waste
Waste 1: Transportation
Waste 2: Overproduction
Waste 3: Motion
Waste 4: Defects (Errors and Rework)
Waste 5: Waiting
Waste 6: Inventory
Waste 7: Overprocessing
Waste 8: Lost Human Potential, Creativity, and Opportunities
Seeing Waste Through Process Observation
"Go See"
Spaghetti Diagrams
Technique 3: Visual Workplace
Color Coding
Home Locations
Kitchen Example
Borders
Technique 4: 5S—Workplace Organization
S1: Sort
S2: Set in Order
S3: Shine
S4: Simplify and Standardize
S5: Sustain
Technique 5: Workstation Design
Technique 6: Problem Solving
A3 Problem-Solving Technique
Example Problem-Solving A3
Problem-Solving Methods Used with A3
Find the Point of the Cause
Identify the Root Cause
Technique 7: Error Proofing
Fatal and Preventable Healthcare Errors
Four Elements of a Zero Defect Quality System
Element 1: Self-Check and Successive Check
Element 2: Immediate Feedback and Corrective Action
Element 3: Source Inspection
Element 4: 100% Inspection
Kaizen At Home
Kaizen Tips from a Behavioral Scientist
Kaizen at Home
Kaizen before Work
Kaizen for Breakfast
Kaizen to Get Ready for Work
Kaizen with Your Coffee
Kaizen to Get Dressed
Kaizening Cup Clutter
Kaizen on the Way to Work
Kaizen in the Home Office
Kaizen on the Computer
Kaizen on the Physical Desktop
Kaizen after Work
Kaizen for Dinner
Kaizen in the Backyard
Improvements
Kaizen Home Repair
Kaizen for the Earth
Kaizen in the Bathroom
Kaizen and Your Kids
A Vacation from Kaizen?
Kaizen for Repetitive Tasks
Kaizen for the Kaizen Process
Conclusion
A Minute to Learn, a Lifetime to Master
Your Next Steps
Building a Kaizen Community
Each chapter includes a Conclusion, Discussion Questions, and Endnotes
Author Bio(s)
Editorial Reviews
Mark Graban is one of the most respected voices in the Lean world. He is the founder and driving force behind Lean Blog, (http://www.leanblog.org/blog/) a vibrant site he continuously updates with compelling information and analysis about lean in health care. Mark’s new book, Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements (co-authored with Joseph E. Swartz), is a must read for anyone on a Lean journey. At Virginia Mason, the concept of kaizen, which Mark and Joe write about so well in the new book, is ingrained in the organization’s cultural DNA. … The real goal of Lean in health care, they write, is cultural transformation. This is an essential insight. At Virginia Mason, the work of adapting the Toyota Production System to health care in the form of the Virginia Mason Production System has cultural transformation at its core. This sort of change is anything but easy. Culture, as the saying goes, tends to eat strategy for lunch. But cultural change is transformative.. … Mark and Joe understand the patience required to do this work well. They recognize the power of the sort of continuous incremental improvement at the heart of the Toyota Production System. … The book is highly detailed and includes helpful discussion questions at the end of each chapter.
—Virginia Mason Medical Center Blog, Could this new book help drive your Lean journey?
Read the full review at: http://virginiamasonblog.org/2012/09/05/could-this-new-book-help-drive-your-lean-journey/
I hope you will discover, as we have, the incredible creativity that can be derived by engaging and supporting each and every employee in improvements that they themselves lead.
—Robert (Bob) J. Brody, CEO, Franciscan St. Francis Health
Front line staff must know, understand, embrace and drive Kaizen and its tools to achieve incremental and continuous improvements. This book will help health care organizations around the world begin and advance their journey.
—Gary Kaplan, MD, FACP, FACMPE, FACPE, Chairman and CEO, Virginia Mason Medical Center, and Chairman of the Board, Institute for Healthcare Improvement
Healthcare leaders need to read this book to understand that their management role must radically change to one of supporting daily kaizen if quality safety and cost are to improve in healthcare.
The healthcare industry is in the midst of truly fundamental change, and those organizations that engage their front line staff … will be well positioned to thrive in a post-reform environment.
Healthcare Kaizen is a practical guide for healthcare leaders aspiring to engage frontline staff in true continuous improvement. Graban and Swartz skillfully illustrate how to foster and support daily continuous improvement in health care settings.
—John E. Billi, MD, Associate Vice President for Medical Affairs, University of Michigan
I hope everyone reads this book and recommits to the fundamentals of Lean, particularly the involvement of frontline staff in process redesign.
Kaizen has marvelously engaged so many of our staff and enabled them to improve the world around them to the benefit of staff, patients and community.
Mark Graban and Joseph Swartz present a clear pathway for successful Lean practice in
Healthcare Kaizen. This should be on every healthcare systems reading list.—David Munch, MD, Senior Vice President and Chief Clinical Officer, Healthcare Performance Partners
Mark and Joe provide real-life examples of how those who do the work provide ideas for small changes that add up to BIG results. Healthcare Kaizen is a must for leaders whose focus is the patient and how to effectively and efficiently deliver quality and safety with improved outcomes.
—Betty Brown, MBA MSN RN CPHQ FNAHQ, President, National Association for Healthcare Quality
Using examples from Franciscan Health and other forward-thinking medical groups, the book contains valuable strategies for organization-wide cultural transformation to create an more efficient, patient-centered healthcare system dedicated to continuous quality improvement.
This inspirational book is packed with examples and is informed by the authors’ years of experience on the ‘front-lines’ themselves, helping leading healthcare organizations around the world to build successful kaizen programs.
—Alan G. Robinson, PhD, Professor, Isenberg School of Management, University of Massachusetts; and Author of Ideas Are Free: How the Idea Revolution Is Liberating People and Transforming Organizations
At Beth Israel Deaconess Medical Center, everybody improving every day is a critical aspect of our Lean and quality improvement efforts. Healthcare Kaizen, is full of relatable examples as well as practical ideas that will inspire staff, clinicians and leaders at all levels.
—Alice Lee, Vice President, Business Transformation, Beth Israel Deaconess Medical Center
In
Healthcare Kaizen, Mark and Joe remind us of the great power of daily problem solving. The story of Franciscan St. Francis Health is compelling, where leaders created the opportunity for great people at the frontline making great improvements for patient care.—Michel Tétreault, MD, President and CEO, Bruce Roe, MD, Chief Medical Officer, St. Boniface Hospital, Winnipeg, Canada
I have learned that respect for the people who work for you is key to any transformation. Mark Graban and Joseph Swartz do a great job of capturing this truth in their book… This book is a long needed addition to my growing lean healthcare library.
The vision of a world in which our healthcare institutions operate with a universal discipline of relentless, patient-centered improvement remains a vitally important yet distant dream. In
Healthcare Kaizen, Mark Graban and Joseph Swartz illustrate just how to make that dream a reality.—Matthew E. May, Author of The Elegant Solution and The Laws of Subtraction
The philosophy, tools and techniques discussed in the book work, and work well, in any environment. We in healthcare must improve – we owe it to our patients and communities – and Mark and Joe are helping to show us the way.
—Dean Bliss, Lean Improvement Advisor, Iowa Healthcare Collaborative
What Mark Graban and Joseph Swartz have done in
Healthcare Kaizen is to bring hope and light to a part of our society that is facing increasing challenges. Healthcare Kaizen will be a reference on the subject for many years to come.—Jon Miller, CEO, Kaizen Institute
Hopefully this book will become a blueprint for healthcare organizations everywhere that truly want to be great!
Fixing health care may be our generation’s great test. We’ll need to engage all the good people who currently work in broken systems. Mark and Joe have helped to show us how.
Graban and Swartz present the kaizen philosophy in the most accessible way I’ve seen yet. THIS is the missing link in healthcare reform.
—Karen Martin, Author of The Outstanding Organization and The Kaizen Event Planner
In this new book, Graban and Swartz offer a new and innovative approach towards improving the healthcare delivery system. Unlike previous attempts by too many others, the book introduces the reader to the concept of “Kaizen”, often described as the source of Toyota’s transformation into an auto giant, acclaimed worldwide for its quality and service. The timing for the publication could not be better. … Focusing on ‘Kaizen Theory’, the book is illustratively rich in theory and applications. … The reader is introduced to concepts, tools, and exercises that foster creativity and innovation. Graban and Swartz present vivid examples to illustrate visibility, participation and accountability. … Every reader will find great value in this publication. In closing, we look forward to their next book … .
—Miguel Burbano and Whitney Churchill, writing on www.neenan.com
