By Mark Graban Soapbox Mark-Graban Healthcare Kaizen

?Health care professionals have plenty of ideas for improvement that they would like to contribute and implement, as they have incredible intrinsic motivation and passion for providing the best patient care. This is true in roles that provide direct patient care, and it is true in ancillary and support departments throughout our hospitals. Everybody wins when leaders at all levels create an environment where improvement happens every day. The safety of our patients and the financial health of our organizations (and our nation’s health system) depend on it!

Lean and Kaizen Alternatives

Toyota’s management approach is the basis for what is known as “Lean”—as applied around the world in manufacturing, health care, retailing, software startups, and other service industries. As a general quality improvement and management system, Lean is based on a few mental models that might not be present in every health system, including:
1) Problems are treasures—openly acknowledging problems without looking to blame individuals.
2) The people doing the work are the experts in designing and improving work.
The dual pillars of “The Toyota Way” are “equally important” and mutually beneficial, especially in health care settings. These pillars are:
Continuous Improvement (or “kaizen”)
“Respect for People”

Because we respect our patients and our staff, we are obligated to have a continuous improvement process that improves care and reduces frustrations in the workplace. Higher staff engagement correlates with (or leads to) better clinical outcomes and patient satisfaction, as many studies have suggested. The main difference with Lean is that improvement comes from everybody—not just specialists or designated experts. It is often said at Toyota that everybody has two jobs:
1) Do your work.
2) Improve your work.

The kaizen methodology gives health care organizations a way to turn a goal of continuous improvement into a reality.

The Kaizen Model

When the idea of kaizen is introduced, people often respond by saying, “Yeah, we do that. We have a suggestion box.” Kaizen is very different from a suggestion box model in a number of ways. First, suggestions tend to be focused on what somebody else (often the manager) should do, while kaizen focuses on what people can fix in their own area. Second, suggestion boxes are opaque (and often locked), while kaizen systems are transparent. Third, suggestions are typically pulled from the box and reviewed (by a far-off committee) on a monthly or quarterly basis, while kaizen ideas should be responded to (and often implemented) within a day or two.

At a high level, kaizen follows the scientific method, in the form of the “Deming Cycle”:
Plan: Initiating a change by understanding the current situation and root cause of problems; developing a change, and stating a hypothesis about what will occur with the change.
Do: Carrying out a small-scale test, or pilot, of the change.
Study: Testing the change and its hypothesis: gathering data, observing the changes and outcomes.
Act: Based on those results, deciding to accept, adopt, and spread the change, or making adjustments (or trying something different).

As team members identify problems or opportunities for improvement, their supervisor and colleagues work with them to implement an idea. Managers work in a collaborative mode, rather than just saying yes or no to ideas, as in an older-style suggestion box system.

Kaizen-style improvements are documented in simple “before and after” documents, as shown below. These documents give recognition to employees when they are posted on bulletin boards or in a Web-based system. The documents also allow good ideas to be shared throughout the organization.

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Biomedical departments can use the kaizen process to identify and implement improvements within their own departments. How can you make your own work easier and less frustrating? How can you work with hospital units to make the interactions and handoffs go more smoothly? If you engage the people who do the work as the improvement experts, great things will happen—quickly.

The Value of Kaizen

An increasing number of health care organizations are learning that Lean is about more than a handful of tools or week-long events. Organizations like the Franciscan St Francis Health System in Indianapolis (employer of my Healthcare Kaizen co-author, Joe Swartz) are embracing kaizen as a model for daily continuous improvement.

In 2011, its staff members implemented more than 4,000 kaizen improvements, or about two per person. While it does not insist on a formal return on investment calculation for each improvement, the health system very conservatively estimates it is saving about $2 million a year with kaizen. And, that is in addition to improvements to staff morale, quality, patient satisfaction, and more. The kaizen mind-sets and methodologies work, given the right leadership. We need more of it in health care, in the United States, and around the world. 24×7 Soapbox column, January 2013

Mark Graban ( is the author of the Shingo Award-winning book Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement, and the newly released book Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements. For more information, contact [email protected].