Healthcare Kaizen

© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.

Healthcare Kaizen: The Suggestion Box is Dead

Guest Presenter: Mark Graban

August 21, 2012


§  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


•  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

www.leanblog.org

Mark Graban


The Sugges1on Box is Dead! Mark Graban President, Constancy, Inc.

Chief Improvement Officer, KaiNexus Faculty, Lean Enterprise Ins1tute

August 21, 2012




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


Kaizen = Change for the BeRer

•  ‘Kai’ means “change.”

•  ‘zen’ means “good.”


Kaizen is Not Just Events

Six Sigma Project

Adapted from: “The Toyota” Way Fieldbook, Liker and Meier

Very few Large issues

Few Medium issues

Many Small issues

System Kaizen

Lean Event

Daily Kaizen


“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.”


Kaizen is for Everyone! “… emphasizes morale-‐boos1ng benefits and posi1ve employee par1cipa1on over the economic and financial incen1ves…”

-‐ Masaaki Imai


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.


Barriers to Kaizen?

Source: Healthcare Kaizen

© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved. Found posted in a hospital lab (during ini9al Lean assessment) Source unknown

Fear of Layoffs


“No Layoffs Due to Lean”


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


People Hate Change?

“People don’t resist change, they resist being changed.”

–  Peter Scholtes (1938-‐2009)


Why Not Best Prac1ces?

“People support what they create.” -‐ Margaret J. Wheatley

See YouTube: hgp://bit.ly/Support-‐Create


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


A Proposed Formula


Completed Kaizen Example


“Quick and Easy” Kaizen

1. Find 2. Discuss 3.  Implement

4. Document

5. Share

Find

Discuss

Implement

Document

Share


Why Kaizen?

1.  Make your work easier 2.  Make your work more

interesting 3.  Develop your skills &

capabilities

Norman Bodek


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


Itera1ve PDSA Improvements

One improvement olen leads to another


Ideas

Improvements


Improvements for NICU Moms (1)









Kaizen: Real, Daily, Visual (Visual Idea Board)

Children’s Medical Center Dallas (Lab)


Kaizen: Real, Daily, Visual (Electronic -‐ KaiNexus)


Completed “Idea Card”


Kaizen on Her FIRST Day



Kaizen “Wall of Fame”

Children’s Medical Center Dallas (Lab)


EHART Blood Pressure Cuffs

Before After

Taking time digging through the bucket on top of the crash cart to try to find the correct size blood pressure cuffs. This can be problematic during an EHART® when you want to get a blood pressure (BP) in a hurry so that you can get medications in the patients.

Place a small strip of Velcro® brand hook and loop fasteners on the wall with different sizes of BP cuffs. Staff is able to quickly visualize the different sized cuff and get the proper size for the patient, and the blood pressure can be obtained quicker.

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

Innova1on & Kaizen



“Just Do Its” & Problem Solving


Problems & Opportuni1es


What Can We Do as Leaders?




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


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?


Coaching on Idea Cards



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


KaiNexus Data / Charts

Whitepaper: hgp://bit.ly/KaiNexus


Franciscan Par1cipa1on

0%

10%

20%

30%

40%

50%

60%

2011 Since 2007

46% 56%

% People Par1cipa1ng



# of Recorded Kaizens



Franciscan Savings Impact



Ideas vs. Sugges1ons

“ SuggesEons are things I think you should do… Ideas are things that I can do.”

-‐ Norman Bodek


Q&A / Contact Info •  Email: [email protected] •  Blog: www.LeanBlog.org •  Startup: www.KaiNexus.com •  TwiRer: www.twiger.com/MarkGraban •  Books:

– www.LeanHospitalsBook.com – www.HCkaizen.com

• www.Hckaizen.com/kaizenpreview


Upcoming Webinars Date Topic

Thu Aug 23 Value Stream Mapping: Think Strategy Before TacEcs

Thu Sep 13 Rapid Improvement: How to Change Behaviors and Get Stuff 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

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