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© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Healthcare Kaizen: The Suggestion Box is Dead
Guest Presenter: Mark Graban
August 21, 2012
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
§ Founder, Karen MarEn & Associates, LLC (1993).
§ Lead Lean transformaEons & develop people in office, service and knowledge environments.
§ Teach at University of California, San Diego’s Lean Enterprise program.
§ Author:
Karen Mar1n, Principal
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
• Currently: • President, Constancy, Inc. • Faculty member, Lean Enterprise InsEtute • Chief Improvement Officer, KaiNexus
• Author of Lean Hospitals (2008, 2011) • Shingo Research and Professional PublicaEon
Prize, 2009 • Co-‐Author of Healthcare Kaizen (2012)
• With Joseph E. Swartz
• BS Industrial Engineering, Northwestern University • MS Mechanical Engineering & MBA, MIT
www.leanblog.org
Mark Graban
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
The Sugges1on Box is Dead! Mark Graban President, Constancy, Inc.
Chief Improvement Officer, KaiNexus Faculty, Lean Enterprise Ins1tute
August 21, 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.
Dysfunc1ons of Sugges1on Systems
• Slow / No Response • Yes / No Answers • Not CollaboraEve • Not Transparent • Buy Instead of Do? • Complaints Against Others • IncenEves à FighEng • 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 BeRer
• ‘Kai’ means “change.”
• ‘zen’ means “good.”
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Kaizen is Not Just Events
Six Sigma Project
Adapted from: “The Toyota” Way Fieldbook, Liker and Meier
Very few Large issues
Few Medium issues
Many Small issues
System Kaizen
Lean Event
Daily Kaizen
© 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 produc1vity. Improvements and sugges1ons 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-‐boos1ng benefits and posi1ve employee par1cipa1on over the economic and financial incen1ves…”
-‐ Masaaki Imai
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Dr. Berwick’s Call for Kaizen (1989)
• Kaizen = “the conEnuous search for opportuniEes for all processes to get beger”
• Dr. Donald Berwick
– Founder, InsEtute for Healthcare Improvement – Former Administrator, Medicare and Medicaid (CMS)
CitaEon: Berwick, DM, “ConEnuous 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?
Source: Healthcare Kaizen
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved. Found posted in a hospital lab (during ini9al Lean assessment) Source unknown
Fear of Layoffs
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
“No Layoffs Due to Lean”
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
We Don’t Have Time?
“Mikki Gremp, RN, lel one hospital because a number of policies, including its pracEce of 'flexing down,' lel 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 Prac1ces?
“People support what they create.” -‐ Margaret J. Wheatley
See YouTube: hgp://bit.ly/Support-‐Create
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Joint Commission Now Says… “it may be Eme for hospitals to move away from best prac1ces 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 pa1ent 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?
1. Make your work easier 2. Make your work more
interesting 3. Develop your skills &
capabilities
Norman Bodek
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Start Small
• “There are no big problems, there are just a lot of ligle problems.” – Henry Ford
• Make your job easier • Save a few seconds • Improve paEent care or service • Improve safety • Reduce waiEng
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Itera1ve PDSA Improvements
One improvement olen leads to another
Source: Healthcare Kaizen
Ideas
Improvements
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Improvements for NICU Moms (1)
Source: Healthcare Kaizen
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Improvements for NICU Moms (2)
Source: Healthcare Kaizen
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Improvements for NICU Moms (3)
Source: Healthcare Kaizen
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Kaizen: Real, Daily, Visual (Visual Idea Board)
Children’s Medical Center Dallas (Lab)
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Kaizen: Real, Daily, Visual (Electronic -‐ KaiNexus)
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Completed “Idea Card”
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Kaizen on Her FIRST Day
Source: Healthcare Kaizen
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Kaizen “Wall of Fame”
Children’s Medical Center Dallas (Lab)
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
EHART Blood Pressure Cuffs
Before After
Taking time digging through the bucket on top of the crash cart to try to find the correct size blood pressure cuffs. This can be problematic during an EHART® when you want to get a blood pressure (BP) in a hurry so that you can get medications in the patients.
Place a small strip of Velcro® brand hook and loop fasteners on the wall with different sizes of BP cuffs. Staff is able to quickly visualize the different sized cuff and get the proper size for the patient, and the blood pressure can be obtained quicker.
The Effect Improved quality of care and faster response to the needs of the patient in an acute setting.
Name Supervisor Date Savings
Elizabeth Black Diana Brown, Manager 12-10-2008 Quality
Innova1on & Kaizen
Source: Healthcare Kaizen
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
“Just Do Its” & Problem Solving
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Problems & Opportuni1es
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
What Can We Do as Leaders?
© 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.
What Can We Do as Leaders? • Ask for Kaizen
– Help create Eme – Don’t stop asking
• Lead by example – parEcipate – Get involved – coach, mentor, lead – Go to the gemba – Teach root cause problem solving – Follow the PDSA process
• Recognize and celebrate Kaizen
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Asking Every Day • Are there any problems
interfering with your work?
• With paEent care? • Have you had any ideas
for improvement lately? • Do you have what you
need to do your job?
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Coaching on Idea Cards
Source: Healthcare Kaizen
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Before / Amer 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
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
KaiNexus Data / Charts
Whitepaper: hgp://bit.ly/KaiNexus
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Franciscan Par1cipa1on
0%
10%
20%
30%
40%
50%
60%
2011 Since 2007
46% 56%
% People Par1cipa1ng
Source: Healthcare Kaizen
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
# of Recorded Kaizens
Source: Healthcare Kaizen
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Franciscan Savings Impact
Source: Healthcare Kaizen
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Ideas vs. Sugges1ons
“ SuggesEons are things I think you should do… Ideas are things that I can do.”
-‐ Norman Bodek
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Q&A / Contact Info • Email: [email protected] • Blog: www.LeanBlog.org • Startup: www.KaiNexus.com • TwiRer: www.twiger.com/MarkGraban • Books:
– www.LeanHospitalsBook.com – www.HCkaizen.com
• www.Hckaizen.com/kaizenpreview
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Upcoming Webinars Date Topic
Thu Aug 23 Value Stream Mapping: Think Strategy Before TacEcs
Thu Sep 13 Rapid Improvement: How to Change Behaviors and Get Stuff Done FAST
Thu Oct 4 Put an End to OrganizaEonal ADD: Create Your 2012 Strategic Improvement Plan
Thu Nov 1 We’ve Had it All Wrong: Manage Processes, Not People
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