"Putting the Continuous Back in Continuous Improvement" In this webinar, Mark Graban, author of the Shingo Award-winning " Lean Hospitals " and the upcoming book "Healthcare Kaizen," talks about kaizen and daily continuous improvement in healthcare. Across many industries, many organizations have come to equate the word kaizen with "kaizen events," or focused weeklong improvement projects. Leading lean healthcare organizations, such as ThedaCare and Virginia Mason Medical Center , have learned that they need both projects and small improvements. Kaizen, as a mode of continuous improvement, is characterized by a large number of small, low-cost, low-risk improvements that are driven by front-line staff, who work in collaboration with their co-workers and leaders. Kaizen follows the scientific method and the PDCA (or PDSA) cycle of iterative improvement, where a hypothesis for improvement is tested against actual results. The webinar will show examples of kaizen improvements from numerous healthcare organizations, as well as the practical mechanics for facilitating and managing kaizen. Graban will also discuss the important role of leaders at all levels.

1. “Putting the Continuous Back in
Continuous Improvement”
Mark Graban
• Chief Improvement Officer, KaiNexus
• President, Constancy, Inc.
• Faculty, Lean Enterprise Institute
Author, Lean Hospitals: Improving Quality,
Patient Safety, and Employee Engagement
(2nd edition, November 2011)
Co-Author, Healthcare Kaizen
(Coming April 2012)
© 2011, Constancy, Inc. & Mark Graban / Joe Swartz

2. Kaizen
Kai = Change
Zen = Good

3. Improvement Focus
Eastern Western
Staff morale &
engagement
“ROI”
(Return on
Investment)
Source: Masaaki Imai, KAIZEN (1986)

4. Dr. Berwick’s
Call for Kaizen (1989)
• ”Continuous Improvement as an Ideal in
Health Care”
– Kaizen = “the continuous search for
opportunities for all processes to get better”
• Dr. Donald Berwick
– Founder, Institute for Healthcare Improvement
– Former Administrator, Medicare and Medicaid (CMS)
Citation: Berwick, DM, “Continuous improvement as an ideal in health care,” New England Journal of
Medicine, 1989 May 25;320(21):1424-5.

5. People Hate Change?
“People don’t resist
change, they resist
being changed.”
– Peter Scholtes (1938-2009)

6. Episodic Improvement Events
• “Kaizen Blitz”
– An effort to fix a specific problem of limited scope
– Characteristics:
Ø Typically a weeklong “Event”
Ø Cross-functional teams
Ø Define and fix the problem NOW (action oriented)
• “Kaizen Event” or “Kaikaku Event”?
– Rapid Improvement Event (RIE)
– Rapid Process Improvement Workshop (RPIW)

7. Backsliding from Events
• “… we were only holding the gains on about 40 percent
of those changes, partially because it is easy to slip
back into old ways of doing things if there is a lack of
accountability and follow through.”
– Christina St. Martin, Virginia Mason Medical Center
• Root cause of this?
Citation: St. Martin, Christina, “Seeking Perfection in Health Care: Applying the Toyota Production System
to Medicine,” Performance and Practices of Successful Medical Groups: 2006 Report Based on 2005 Data,
Medical Group Management Association, 20.

8. Different Levels of Kaizen
Very few
Large issues System
Kaizen
Six
Few Sigma
Medium issues
Lean
Event
Many
Small issues
Daily Kaizen
Adapted from: “The Toyota” Way Fieldbook, Liker and Meier

9. PDCA / PDSA
• Plan
• Do
• Study
• Adjust

10. Do Work Improve Work

11. “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 productivity.
Improvements and suggestions by
team members are the cornerstone of
Toyota's success.”
Citation: Toyota Corporate Website

12. Do Work Improve Work

13. Kaizen ≠ Suggestion Box
Common Dysfunctions
• Common Dysfunctions • Slow / No Response
• Slow • Yes / No
• Yes / No • Not Collaborative
• Not Collaborative • Not Transparent
• Buy instead of Do? • Buy instead of Do?

14. Ideas vs. Suggestions
“ Suggestions are things
I think you should do…
Ideas are things
that I can do.”
- Norman Bodek

15. QnEK Kaizen Report

16. Quick and Easy Kaizen
Find
1. Find
2. Discuss Discuss
3. Implement
Implement
4. Document
5. Share Document
Share

17. “Problem Awareness”
• Being able to admit problems
– Mindset & culture
• Being able to see problems
– Seeing waste, “lean thinking”
– From workarounds to kaizen

18. Start Small
• “There are no big problems, there
are just a lot of little problems.”
– Henry Ford
• Make your job easier
• Save a few seconds
• Improve patient care or service
• Improve safety
• Reduce waiting

19. Learning to See Waste

20. Reducing Podiatrist Walking
Restocking Checklist

21. Quick and Easy Kaizen
Find
1. Find
2. Discuss Discuss
3. Implement
Implement
4. Document
5. Share Document
Share

22. Basic Idea Card
• Standardized Card in Use
– Prompts staff through the problem solving process

23. Visual Idea Board
1 2
3
4

24. Nursing Unit Cards

25. Completed Idea Card

26. Coaching on Idea Cards
Source: Healthcare Kaizen

27. Idea Board Progression
Management must ensure
that ideas are followed up on
and that new ideas are
solicited over time.

28. Toyota Benchmark
Not
Implemented
90% Implemented

29. Quick and Easy Kaizen
Find
1. Find
2. Discuss Discuss
3. Implement
Implement
4. Document
5. Share Document
Share

30. Documenting & Sharing
Improvements
• What was the problem?
• What was changed,
improved, or
implemented?
• What were the benefits?
• Who was involved?

31. Kaizen “Wall of Fame”

32. “Creativity Before Capital”
Source: Healthcare Kaizen

33. Patient Focus (NICU)
Source: Healthcare Kaizen

34. Clinical Improvement
Source: Healthcare Kaizen 34

35. What Can We Do as Leaders?
• Ask for Kaizens
– Help create time
• Lead by example – participate
– Get involved – coach, mentor, lead
– Go to the gemba
– Teach root cause problem solving
– Follow the PDCA / PDSA process
• Recognize and celebrate kaizen

36. Quantifiable Results
• Indiana University Health Goshen Hospital
– CEO Challenged staff to $3.5M savings in 2009
– They delivered double that
– $6.5M again in 2010
– $30M savings since 1998
– Modern Healthcare Best Workplaces
• No layoffs for 17 years

37. Quantifiable Results
• Baptist Health Care (“Bright Ideas”)
– 50,000 ideas since 2000
• 14,000 ideas in 2008
– $50M in cost savings and avoidance
• $10.5M in savings, $5.5M in avoidance
– FORTUNE Magazine 100 Best Places to Work
(7 years)

38. Franciscan Savings Impact
Source: Healthcare Kaizen

39. # of Recorded Kaizens
Source: Healthcare Kaizen

40. Franciscan Participation
% People Participating
60%
50%
40%
30% 53%
20% 36%
10%
0%
2010 Since 2007
Source: Healthcare Kaizen

41. Before / After 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

42. Employee Quote
“This is the best thing
we’ve done in my 20
years. We’re finally
fixing things.”

43. Q&A / Contact Info
• Email: mark@constancy.us
• Blog: www.LeanBlog.org
• Twitter: www.twitter.com/LeanBlog
• KaiNexus: www.KaiNexus.com
• Books:
– www.LeanHospitalsBook.com
– www.HCkaizen.com (pre-launch)