Healthcare kaizen The Sugges)on Box is Dead… But Staff Improvement Ideas Live On

The
 Sugges)on
 Box
 is
 Dead…
 
But
 Staff
 Improvement
 Ideas
 
Live
 On
 

 
Mark
 Graban
 

President,
 Constancy,
 Inc.
 
Chief
 Improvement
 Officer,
 KaiNexus
 
Faculty,
 Lean

 Enterprise
 Ins)tute
 


 
August
 23,
 2012
 
©
 2012
 Mark
 Graban
 and/or
 Joseph
 E.
 Swartz.
 All
 Rights
 Reserved.
 
 


©
 2012
 Mark
 Graban
 and/or

 Joseph
 E.
 Swartz.
 All
 Rights
 Reserved.
 
 


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


Dysfunc)ons
 of
 Sugges)on
 Systems
 

• 
• 
• 
• 
• 
• 
• 
• 

Slow
 /
 No
 Response
 
Yes
 /
 No
 Answers
 
Not
 CollaboraDve
 
Not
 Transparent
 
Buy
 Instead
 of
 Do?
 

Complaints
 Against
 Others
 
IncenDves
 à
 FighDng
 
Quotas
 à
 Gaming
 
Builds
 on
 the
 book
 Ideas
 are
 Free!
 by
 Robinson
 &
 Schroeder
 

©
 2012
 Mark
 Graban
 and/or

 Joseph
 E.
 Swartz.
 All
 Rights
 Reserved.
 
 


Kaizen
 =
 Change
 for
 the
 BeTer
 
 
•  ‘Kai’
 means
 “change.”
 

•  ‘zen’
 means
 “good.”
 
 

©

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


Kaizen is Not Just Events
 
Very few
Large issues

Few
Medium issues

System
Kaizen
Six
Sigma
Project

Lean
Event

Many
Small issues
Daily Kaizen
Adapted from: “The Toyota” Way Fieldbook, Liker and Meier
©
 2012
 Mark
 Graban
 and/or
 Joseph
 E.
 Swartz.
 All
 Rights
 Reserved.
 
 



 
 
 
 “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
 
produc)vity.
 

 Improvements
 and
 
sugges)ons
 by
 team
 members
 are
 
the
 cornerstone
 of
 Toyota's
 success.”
 
©
 2012
 Mark
 Graban
 and/or
 Joseph
 E.
 Swartz.
 All
 Rights
 Reserved.
 
 

Kaizen
 is
 for
 Everyone!
 
“…
 emphasizes
 morale-­‐
boos)ng
 benefits
 and
 
posi)ve
 employee
 
par)cipa)on
 over
 the
 
economic
 and
 financial
 
incen)ves…”
 
 
-­‐
 Masaaki
 Imai
 

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


Dr.
 Berwick’s
 
 
Call
 for
 Kaizen
 (1989)
 

 

•  Kaizen
 =

 “the
 conDnuous
 search
 for
 
opportuniDes
 for
 all
 processes
 to
 get
 beYer”
 

 

 
Dr.
 Donald
 Berwick
 

• 

– 

Founder,
 InsDtute
 for
 Healthcare

 Improvement
 

– 

Former
 Administrator,
 Medicare
 and
 Medicaid
 (CMS)
 

CitaDon:
 Berwick,
 DM,
 “ConDnuous
 improvement
 as
 an
 ideal
 in
 health
 care,”
 New
 England
 
Journal
 of
 Medicine,

 1989
 May
 25;320(21):1424-­‐5.
 


 

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


Barriers
 to
 Kaizen?
 

©
 2012

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

Source:
 Healthcare
 Kaizen
 
 


Fear
 of
 Layoffs
 

©
 2012
 Mark
 Graban
 and/or
 Joseph

 E.
 Swartz.
 All
 Rights
 Reserved.
 
 

Found
 posted
 in
 a
 hospital
 lab
 (during
 ini9al
 Lean
 assessment)
 
Source
 unknown
 


“No
 Layoffs
 Due
 to
 Lean”
 

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


We
 Don’t
 Have
 Time?
 
“Mikki
 Gremp,
 RN,
 lef
 one
 
hospital
 because
 a

 number
 
of
 policies,
 including
 its
 
pracDce
 of
 'flexing
 down,'
 
lef
 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

©
 2012
 Mark

 Graban
 and/or
 Joseph
 E.
 Swartz.
 All
 Rights
 Reserved.
 
 


People
 Hate
 Change?
 
“People
 don’t
 
resist
 change,
 
they
 resist
 being
 
changed.”
 
 
–  Peter

 Scholtes
 
(1938-­‐2009)
 

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


Why
 Not
 Best
 Prac)ces?
 

“People
 
support
 what

 
they
 create.”
 

 -­‐
 Margaret
 J.
 Wheatley
 

See
 YouTube:
 hYp://bit.ly/Support-­‐Create
 
©
 2012
 Mark
 Graban
 and/or
 Joseph
 E.
 Swartz.
 All
 Rights
 Reserved.
 
 

Joint
 Commission
 Now
 Says…
 
“it
 may
 be
 Dme
 for
 hospitals
 
to
 move
 away
 from
 best
 
prac)ces
 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
 pa)ent
 
safety
 needs.”
 

 -­‐

 Mark
 Chassin,
 MD,
 President
 


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


A
 Proposed
 Formula
 

©
 2012

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


Completed
 Kaizen
 Example
 

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

 


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

Find
 

Discuss
 

Implement
 

Document
 

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


Why
 Kaizen?
 
Norman Bodek
1.  Make your work easier
2.  Make your work more
interesting
3.  Develop your skills &
capabilities

©
 2012

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


Start
 Small
 
•  “There
 are
 no
 big
 problems,
 there
 
are
 just
 a
 lot
 of
 liYle
 problems.”

 
 
–  Henry
 Ford
 
 
• 
• 
• 
• 
• 

Make
 your
 job
 easier
 
Save
 a
 few
 seconds
 
Improve
 paDent
 care
 or
 service
 
Improve
 safety

 
Reduce
 waiDng
 

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


Itera)ve
 PDSA
 Improvements
 

Improvements

Ideas

One

 improvement
 ofen
 leads
 to
 another
 
©
 2012
 Mark
 Graban
 and/or
 Joseph
 E.
 Swartz.
 All
 Rights
 Reserved.
 
 

Source:
 Healthcare
 Kaizen
 
 


Improvements
 for
 NICU

 Moms
 (1)
 

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

Source:
 Healthcare
 Kaizen
 
 


Improvements
 for
 NICU
 Moms
 (2)

 

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

Source:
 Healthcare
 Kaizen
 
 


Improvements
 for
 NICU
 Moms
 (3)
 

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

Source:
 Healthcare
 Kaizen