Healthcare Kaizen ─ Engaging Front-Line Staff in Sustainable Continuous Improvements

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.

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 bookshows 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/)

Mark Graban is an author, consultant, and speaker in the field of lean healthcare. He is the author of Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement, Second Edition. Mark has worked as a consultant and coach to healthcare organizations throughout North America and Europe. He was formerly a senior fellow with the Lean Enterprise Institute and continues to serve as a faculty member. Mark is also the Chief Improvement Officer for KaiNexus (http://www.kainexus.com/), a startup software company that helps healthcare organization manage continuous improvement efforts. Mark earned a BS in Industrial Engineering from Northwestern University and an MS in Mechanical Engineering and an MBA from the MIT Sloan Leaders for Global Operations Program. Visit his website at www.MarkGraban.com and his blog at www.LeanBlog.org.
Joseph E. Swartz is the Director of Business Transformation for Franciscan St. Francis Health of Indianapolis, IN. He has been leading continuous improvement efforts for 18 years, including 7 years in healthcare, and has led more than 200 Lean and Six Sigma improvement projects. Joseph is the co-author of Seeing David in the Stone and was previously an instructor at the University of Wisconsin. Joseph earned an MS in Management from Purdue University as a Krannert Scholar for academic excellence.

WHAT IS KAIZEN?
Kaizen and Continuous ImprovementKaizen = Change for the BetterBubbles for BabiesKaizen: A Powerful WordKaizen Is Not Just Change, It Is Improvement We Often Succeed As the Result of Failing MoreKaizen, PDSA, and the Scientific Method for ImprovementChanging Back Can Be Better For BabiesKaizen = Continuous ImprovementKaizen Starts with Small ChangesA Small Kaizen with Great MeaningKaizen = Engaging Everybody in Their Own ChangeKaizen Upon Kaizen Upon KaizenKaizen Closes Gaps Between Staff and LeadersCreativity before CapitalExpensive Mistakes Made without the Kaizen MindsetKaizen and Lean: Related and Deeply Interconnected ConceptsPeople Are the Ultimate Competitive AdvantageHigh-Level Kaizen Principles—The Kaizen Mindset Asking Empowering Recognizing SharingThis Is Not a Suggestion System—It Is an Improvement SystemKaizen Has an Impact on People and PerformanceThe Roots and Evolution of KaizenEarly Suggestion ProgramsDownsides of Suggestion Box ProgramsRecovering from TaylorismThe American Roots of Continuous Improvement—TWI and DemingKaizen: One of the Two Pillars of The Toyota WayMasaaki 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 KaizenConclusionDiscussion QuestionsEndnotes

Types of KaizenThe Continuous Improvement of a Lifesaving InnovationThree 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 DallasEvents 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 EventsNot All Kaizen Organizations Rely on Events Kaizen Leads to Innovation at FranciscanMoving Toward a Kaizen CultureThe Real Goal—Cultural TransformationWhat 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 SuccessesSmall Kaizen Leads to More Big Ideas Bite-Size Chunks Imai’s Three Stages of Kaizen
KAIZEN METHODOLOGIES
Quick and Easy KaizenHow to Do KaizenQuick and Easy KaizenStarting the Franciscan Kaizen JourneyThe 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 KaizensVisual Idea BoardsMaking the Improvement Process VisibleSetting up a Visual Idea Board Boards Should Be Highly Visible in the Workplace Boards in "Public" SettingsCommunication That Should Occur before the Visual Idea Board Is Put Up What Happened to the Suggestion Box? What Employees Can Expect A Communication ExampleFormats for Idea Cards Sticky Notes versus Structured Cards Idea Cards versus Suggestion Cards Modeling the Kaizen and PDSA Process in WritingVisual Idea Cards Problem Suggestion or Idea Date Originated Created By Expected Benefits Input Needed From Implementation Steps Results Verified? New Method Standardized? Completion DateIdea Card Examples Staff and Patient Annoyances Asking for Help Addressing Patient Needs Getting Input from OthersOther Formats of Idea Boards and Cards Park Nicollet’s KEEP Form Akron Children’s Hospital Seattle Children’s Hospital PharmacyVisual Management of the Idea BoardsUsing 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 CardsSharing KaizenDifferent Formats for SharingThe Kaizen Wall of Fame FormatKaizen Sharing Examples Making Things Better for Patients Supplies for Patients Improving Meal Rounds Easier to Get DVDs Little Details for PatientsPreventing 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 SpecimensMaking 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 OnePreventing 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 EndocrinologySaving Space or Cost Creativity over Capital in the Lab Company Medical Clinic Costs An Unnecessary Label Rethinking Freezer UseThe Art of KaizenBarriers to Kaizen Resistance to Change Lack of Time—We’re Too BusyA 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 ResortKaizen and Positive Deviance Rules for Leaders
KAIZEN LESSONS LEARNED
The Role of Leaders in KaizenLeading to Create the Culture 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 CostRole 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 PersonallyRole 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 EvaluationsRole 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 ProgramsGetting Started When Will You See Results? Tying Kaizen to the Organization’s StrategyThe Kaizen Promotion Office Staffing the KPOActivities 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 KaizensSustaining a Kaizen Program—Incentives and Rewards Pros and Cons of Financial IncentivesElectronic 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 VanderbiltLean Methods for KaizenTechnique 1: Add Value The Internal Customer’s Point of View Different Forms of Patient ValueTechnique 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 DiagramsTechnique 3: Visual Workplace Color Coding Home Locations Kitchen Example BordersTechnique 4: 5S—Workplace Organization S1: Sort S2: Set in Order S3: Shine S4: Simplify and Standardize S5: SustainTechnique 5: Workstation DesignTechnique 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 CauseTechnique 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 HomeKaizen Tips from an ActressKaizen Tips from a Behavioral ScientistKaizen at HomeKaizen 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
ConclusionA Minute to Learn, a Lifetime to MasterYour Next StepsBuilding a Kaizen Community
Each chapter includes a Conclusion, Discussion Questions, and Endnotes