Having spent the last week in a healthcare Rapid Improvement Event (i.e. Kaizen), I continue to marvel at the power and resourcefulness of a dedicated team of people. Our topic was “Patient Access” – in other words, how to get patients into beds more rapidly in a hospital that is typically at (or beyond) stated capacity. The large team of 20 stakeholders and first-line associates was lead by two of my partners in crime – experienced Black Belts who facilitated the team discussions, kept the group on track, and ensured that we met our deliverable targets. My role was “helper Black Belt” – leading subgroups, assisting with forms and procedure designs, and generally being the utility outfielder. [Using three Black Belts for a Kaizen??? I’ll address this in my next post.]

Those of you familiar with Kaizen events know that Monday is the problem definition and waste identification day. Wow, did we ever come up with problems and wastes! So many, in fact, that the group was a little discouraged. “We’ll never be able to do anything about all this!”

Tuesday, being solution day, was even tougher. The groupat first shied away from tackling “the elephant in the room” – physician behaviors and even some nursing or otherassociatebehaviors. One of our Black Belts quickly got the group back on track – challenging the team to work on the real issues wherever they might fall. We developed a list of physician issues to discuss with our Vice President of Medical Affairs (VPMA) and he met with us to review the perceptionsand barriers relating to physician rounding, writing discharge orders, and other issues. For the process issues, the team broke up into two groups to work on “scheduled” admissions (OR, Cardiac Cath Lab, Chemo patients) and “unplanned” admissions (ER, Direct Admits). We also worked on decreasing nursing dissatisfiers – primarily improving communication paths anddecreasing delays in bed assignments. The team said, “This is too complicated – too many people affected – this will never work!”

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On Wednesday we implemented our solutions – improved communications, an emailed “bed snapshot” report, and streamlined bed request pathways. Almost immediately we started getting positive feedback – fewer phone calls, an easier process, more of a feeling that the process was controllable (as opposed to the former crisis mode). The team said, “I can’t believe it, it’s working!”

By Thursday the process data was looking pretty good – a few tweaks were needed here and there. The team said, “Wow! What happened?”

The Friday Report-Out was very positive and enthusiastic. The team said, “We never thought we could do this! This is great! When can we do another?”

The leadership who came to the Report-Out said, “We don’t understand how you got from Monday’s day of confusion to Friday’s success! This Rapid Improvement Stuff is great!” So, we’ll be inviting them to participate in future events so that each leader can understand how we go from confusion to efficiency – it’s not by saying “Shazam!” and out of the blue a magic lightning bolt of Lean efficiency strikes the hospital – but by the intensive and structured work of the Rapid Improvement Event team.

Comments 6

  1. Sue Kozlowski

    Thanks for your comments, Ram. I’ll respond to your email address to take this conversation off line.

    For those of you looking for more information on the Lean Rapid Improvement Event (or Kaizen) methodology, there are many great books and web sites out there in addition to the blog links at the left of this page. I hesitate to list any sources because of endorsement-phobia.

    One of my learnings is that there is no "cookbook" way to lead a Kaizen. It’s more a matter of being familiar with the concepts and the tools, and being able to springboard from what the team comes up with for process steps and wastes, to come to a good solution for that unique event.

    As a matter of fact, I’ve been involved in discussions about how to "teach" lean, and we always end up saying – you have to DO it to learn it. Book learning and PowerPoint presentations are not the key!

    Having said that, I wish you luck on your Lean journey.

  2. Ram


    I would like to see all your experiences well put together so that if somebody has to do another rapid improvement process can use all your experirnces and preparations as a stepping stone and proceed further.

    For someone like me it is a little difficult to lead a kaizen event as I am completely inexperienced.

    Since your event was successful especially with the Elephant (medical Staff) I would think it would be great example or a trianing material for beginners like me.

    It would be nice if you could include how long it takes to prepare for a Kaizen event, did you do any background study before starting the event related to that entire process.

    Did you train the team on LEAN 101 or were they already trained. Were 5 days in your Kaizen event solely dealing with problem or did you introduce tools like VSM to the team and did a hands on training kind of?

    I would really approciate if you could explain your first hand Kaizen experience so peple like me can learn from it and use it further events when we have address any such events in the future.



  3. Ram

    Thanks Sue,

    I am looking forward to hearing from you.


    [email protected].

  4. Sue Kozlowski

    Ram, please contact me via email – your email address is undeliverable on my system. Thanks,
    –Sue K.
    [email protected]

  5. Jim

    Isn’t it “utility infielder”?

    The company I work for (Ktech Corp) does a lot of support work for Sandia National Laboratories; SNL is using Lean Six Sigma methods over there now, as well as some ISO 9000.

  6. Sue Kozlowski

    Thanks Jim, just goes to show that I know more about Captain Marvel than I do baseball. I appreciate your sharing your current experience.

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