Applying Kaizen to the Complaint Review ProcessThe Minnesota Board of Nursing Experience

Kaizen – What is it?

Kaizen

Minnesota – Land of 10,000 Lakes

The Challenge

Average case processing times had significantly increased with a potential for risk to the public

MN Board of Nursing Kaizen

• Goals– Improve efficiency in the complaint

review process– Reduce length of time to resolve a

complaint

Continuous Improvement• Continuous Improvement (CI) is an

ongoing effort to improve products, services or processes– Six Sigma– Business Process Management (BPM)– Total Quality Management (TQM)– Lean• Kaizen

Kaizen History

• Implemented in several Japanese businesses after WWII

• Influenced by American business and quality management teachers who visited the country

Kaizen Event

• A facilitated, rapid improvement event that engages the creativity of employees to remove waste from the product or process

Kaizen Event (cont.)• Focused on an area to achieve

rapid improvement• Augments, but does not replace

current process• Achieves as many improvements

as possible during a typical 3 – 5 day event

When should a Kaizen Event take place?

• Need for solution is urgent• Impact is big• Prolonged disruption cannot be

tolerated

Key Features

• Small change improvements• Workers generate the ideas• Minimal capital outlay• Seek continued improvement

Underlying Principle

• Continuous improvement is the responsibility of every worker, not just a selected few.

Is Kaizen the right approach for you?

• Is the process consistent with Lean?• Is the opportunity high impact?• Is it a management or personnel

issue?• Is the current state understood and

are valid countermeasures known?

Is Kaizen the right tool? (cont.)

• Is the effort/cost to implement small?• Is the team-based approach able to

be completed in 5 days or less?

Scope the Process

• State the business issue:– Draft a statement about the effect

current process is having on the agency/customers/stakeholders

– Why is it important to address the process now?

Alignment

• Is the process to be addressed important to the overall success of the agency?

• Is it a core business process?

Need

• Is the current process clearly not working as well as is should? Consider complaints, rework, defects, unhappy employees.

• Is it a core business process that affects other processes or programs?

Impact

• Is it a process that affects a large number of stakeholders/customers?

• Does the process consume a lot of resources?

• Is it a highly visible process to stakeholders and customers?

Willingness

• Management has an interest in supporting and making needed changes.

• Workers are open to change, willing and interested in participating in an improvement event.

Preparation

Process Steps• Define the business

issue• Determine the scope

of process for the improvement

• Establish goals• Assemble the team

MN Process• Increasing case

resolution times • Complaint intake to

resolution• Resolve non-

jurisdictional complaints w/in 10 days; jurisdictional w/in 150 days

Scope

• Describe what is to be included in the scope of the event.

Goals

• The Sponsor and Team Leader establish the event goals.

Goals (cont.)

• Consider the following when setting goals:– Goals should be measurable– Goals should set the bar high– Goals should be clear and easily

articulated– Goals need to be set or ratified by the

Sponsor to support change

Assemble the Team

• Organizational Sponsor• Team Leader• Team Members• Neutral Facilitator

Sponsor

• Create and ratify scope and goals• Select the Team Leader• Selects Team Members in

consultation with the Team Leader• Kicks off the event with words of

support

Sponsor (cont.)

• Checks in with Team Leader throughout the week

• Attends the final presentation• Ensures improvements are

implemented and sustained

Team Leader

• Creates scope and goals with Sponsor

• Identifies team members with Sponsor

• Gathers pre-work• Schedules and participates in pre-

event meeting

Team Leader (cont.)

• Helps to facilitate Kaizen member involvement

• Works with Sponsor to ensure action items are completed and results are sustained

Team Members

• Supply information• Technical support• May include an outside set of eyes

Facilitator

• Assists Sponsor in setting scope; preps for Kaizen event

• Trains Team Members in the elements of Lean for the event

• Facilitates and captures the results of the event

Prior to the Kaizen Event

• Sponsor/Team Leader generate enthusiasm and support for the event

• Demonstrate commitment for the event

• Publicize the event both before and after

Event Logistics

• Location, tools, food• Work hours• Interruptions• Organization support• Breaks

Kaizen Event Sequence

• Training and kick-off• Analysis of current state• Select areas of focus• Create possible solutions• Select solutions

Kaizen Event Sequence (cont.)

• Establish metrics for success• Plan, implement and repeat• Standardize and sustain• Report results• Celebrate

Analyze Current State

Look for wastes:• Too many process steps• Excessive time in process• Ineffective scheduling• Excessive handling/inventory

Analyze Process (cont.)

• Bottlenecks/defects• Poor organization of physical space

(5 S’s)• Batching• Inefficient or lack of work flow• Opportunities to apply technology to

increase efficiency

Swim Lane Map

• A technique to analyze a process from beginning to end

• A structured way to gather information, organize and present data about the existing process

Swim Lane illustration

Future State

• Be open to new possibilities• Don’t be bound by how it’s done

today• Don’t be discouraged by previous

failures

Future State (cont.)

• What would be the ideal?• What would it look like if all the

waste was eliminated?– The target is elevated when the ideal

and total elimination of waste is considered

Current and Future State

Solutions

• Quick Wins• Recommendations

Prioritization of Recommendations

Our Outcomes

Pre-Kaizen:198 days – All complaints65 days – Non-jurisdictional complaints

Post-Kaizen:129 days – All complaints

• 35% reduction25 days – Non-jurisdictional complaints

• 60% reduction

Sustaining the Improvements

• Requires the support of the entire team and Board

• Requires time away from day-to-day duties to implement action plan

• Requires fiscal/IT resources• Must be a priority

Next steps

• Development of a new database– Planning with Kaizen recommendations

in mind– Online complaint submission– Expanded use of electronic documents– Increased reporting capabilities– Incorporate “plain language” into

standard documents

Lessons Learned

• There is value in systematically reviewing a process with the intent to improve

• Isolating time and making a commitment is important

• Valuable relationships were formed between staff and board members

Lessons Learned (cont.)

• We all learned more about the work that each of us does

• Developed “Kaizen mindset”• Solidified the commitment to the

Board’s mission and values

Resources

• http://mn.gov/admin/lean/• http://leanproduction.com/kaizen.html• Creating a Kaizen Culture: Align the

Organization, Achieve Breakthrough Results, and Sustain the Gains by Jon Miller, Mike Wroblewski, Jaime Villafuerte

Speaker Contact Information

Rene Cronquist, RN, J.D.Director of Practice and PolicyMinnesota Board of Nursing2829 University Avenue SE Suite 200Minneapolis, MN 55414612.317.3027Rene.Cronquist@state.mn.us

Barbara Damchik-Dykes, J.D.Discipline CoordinatorMinnesota Board of Nursing2829 University Avenue SE Suite 200Minneapolis, MN 55414612.317.3022Barbara.Damchik-Dykes@state.mn.us