iSixSigma

Sustainability of Kaizens in Healthcare

Ok, I have to pose a question for the general “Lean Thinkers” out there who are aware of how conservative healthcare is. I have been reading so many articles that highlight the success of Kaizen events in healthcare settings. However, I have to ask myself, do they really work? Do the changes really sustain? Is it possible to make dramatic changes to a setting within a healthcare facility in five days? The team of implementers at my organization have never done what is defined as a “kaizen event,” and we’re not sure we want to try.

The biggest concern for me is that there will be no staff buy-in as a result of a five day implementation. Because healthcare is filled with skilled autonomous workers, change seems very difficult to overcome. It’s quite ironic in an industry that constantly changes with new regulations and technology, but replacing complex thinking with common sense is overwhelming to healthcare workers. Also, when you do have a group of the willing, there isn’t enough of them with enough time to devote to such a fundamental revolution.

Secondly, can you pull the resources needed in less than five days? Can you have members from the IT department, facilities department, etc. on-board and able to assist the whole time? Obviously, these people would have to be on hand working side-by-side with the implementers in order to achieve the results. It’s almost like that home makeover show: everyone is working side-by-side to have a house built in a week. It may work for them, but it has been my reality that these people aren’t always available at a great length of time.

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Finally, are the champions, stakeholders, executives ready and willing to commit to such drastic policy changes in such a short period of time? It seems, from the case studies I’ve read, policy changes happen on the fly and with little executive involvement. How can these changes sustain?

Of course, the optimist in me says that making such drastic changes in such a short period of time eliminates the opportunity for the “what if…” flag to be flown in my face. Drawing out a plan and strategically implementing it over time has committed me to a life of “firefighting.” It seems I am perpetually stuck in a “one step forward, two steps back” routine. So I can see how a dramatic overhaul would not allow enough time mull over the natural resistance to change.

Can anyone describe a typical Kaizen event in a healthcare setting, and how it was able to be successful in an industry that is bound and determined to maintain its conservative roots in an industry experienced in change?

Comments 10

  1. Andrew Downard

    Andrew,

    I don’t speak Japanese, but from what I understand of the meaning of "Kaizen", the term "Kaizen Event" is an oxymoron. In my opinion you are wise to be wary. Continuous Improvement can’t be an event. I realize this goes against standard dogma; allow me to impolitely suggest that Kaizen events are beloved by consultants for reasons often un-related to the long-term continous improvement of client businesses. Don’t worry about all the articles. Worry about understanding how your organization behaves and responds, and develop an approach to continuous improvement that makes sense in that environment. No one can do that better than an intelligent and perceptive insider…like you.

    Just my $0.02.

    Andrew Downard.

  2. Andrew Downard

    Well said, Mr. Meyers.

    Events definitely have their place, but only in the context of a much broader continuous improvement approach. They need to be the tip of a very large iceberg. Too often I see deployments which have Kaizen events at the front end in an attempt to create "quick wins". It’s a nice thought, but I’ve never seen it work in a sustainable way.

    Again, well said.

  3. Matt Meyers

    I agree with Mr. Downard, for the most part. I work for a fairly conservative company with a very ingrained culture of autonomy and organizational "silos". As we implement our lean six sigma program, I have watched and learned a lot from the healthcare industry, because it is so similar in that respect. So I can only tell you what I have seen.

    The ONLY successful efforts I have seen in healthcare come after a very careful and deliberate introduction and sales job that addresses the professional and political issues in the hopsital environment. Many of the participants will not be on board, and it is the leader’s (management engineer) job to delicately dispel the misconceptions about the problems and the root causes of the problems. This effort will take a lot of time and work to sweat the details. An "event" will have to occur, by which I mean a couple of days where everyone is in the same room working on the problem. This is what is usually called a Kaizen event, but is a misnomer because so much work has been happening for months in advance. As I’m sure you know, it is invaluable to have the process personnel and the decision makers in the same room at the same time, but is *is not* a 5-day event, by any stretch of the imagination.

    Finally, I don’t think there is a "typical Kaizen event in a healthcare setting", because the differences among private and county hospitals, as well as physician offices and outpatient clinics, are monumental.

  4. Kubilay

    I have no experince in Healthcare but I believe :

    What is most important in a Kaizen Workshop is preparation : Not only physical but also psychological..

    A good Kaizen Leader should prepare the gang for changes beforehand and do all the required changes during Kaizen week with agreement (even written)..

    then create a ’Sustainability Plan’..

    Kaizen is not going there and saying ’hi guys, this week we will improve your process..’ :-)

    Kubilay

  5. Pondhe

    JUst my 2 cents here!

    kaizen events got that total saying of to be done in "5 days" because that suits the consultant’s scedules very well : start on Monday and get it done by friday and go for a next project.
    So I would think especially in healthcare it needs a lot more gound work than 5 days. If you are condutcting a Kaizen as a leader of the group then educating the entire group on most of the basics and the terminology and selling the entire concept and trying to make them understand and coach them on thinking itself is a big challenge. If you are an internal Kaizen leader you would want to nurture a leader from with in the project participants, so that they can take over from there on is a big challenge. Once a decision is made to conduct a Kaizen we already have the results of that pre-decided so its all in acheiving those said results at a faster pace and sustaining them is a Kaizen challenge. So I think not only sucessfull kaizen event but also a successfl education to the team is quite necessary to keep up those results of that even.

    I’m new to these events and healthcare but it is quite challenging at the same interesting to be part of it.

  6. Ashish Ranjan

    Well, I have practiced kaizen events for more than 3 years and that too with Shingijutsu Consultants.

    Many big, hospitals in US have already adopted Kaizen philosophy successfully.

    My Observations:

    1) Kaizens are rarely 100% sustained, but generally improvements are 75% sustained and we build upon them in successive events.

    2) Most important achievement in any Kaizen even is establishing flow and standardizing processes. This would ultimately help in mistake-proofing and better communication amongst the autonomous workers/experts in health care.

    Initially any Kaizen implementation looks difficult, because it actually changing the entire work philosophy and mindsets. Naturally the path is difficult to tread, but then results are fabulous.

    For any other exchange of insights please write to me at [email protected].

    ashish

  7. Scott Ward

    As a Nurse and Black Belt currently working in a hospital setting, everyone’s comments prior to post ring true.

    We have successfully completed a Kaizen "flavored" event: process improvement ideas, implementation on the fly, and control plan within a 5 day window.

    Learning’s from our event:
    -we accessed a variety of tools such as CAP/Workout (GE), Lean, DMAIC, Crew Resource Management (Life Wings)
    -ONE PERSON CAN NOT DO THIS ALONE in my opinion
    -the problem must be narrow focused
    -voice of the customer, process map, and CAP prior to the event
    -strong sponsor support including front-line manager buy-in
    -and the most important point: ensure that employees in the area all know what is planned and that they might be asked to complete a task in multiple methods within a short time-frame

    Something for you to ponder, a typical DMAIC project in our institution takes approximately 32-48 hours of team meeting time over a 4-6 month period. We completed our project in 38hrs over a 5 day period.

    Would we do this again?
    The answer is yes, but only if the problem is well scoped/narrow and preparation time is available.

  8. si

    Kaizen is an approach to solve a specific problem and implement the changes in a short time frame. It is not a change management strategy and will not make up for poor sponsorship (as the posts above indicated).

    You still need to prepare, engage the players and define what you want to do in advance (not the solution but the problem to be addressed – scope).

    The overall project (i.e. value stream) needs to be already supported and well understood. The individuals should know their roles and responsibilities.

    All of the above sound familiar? It’s the exact setup for almost every change.

    What Kaizen does is cut the fat (time/effort) from M/A/I and sometimes C.

    Everyone needs to commit that the change is important enough to dedicate 2/3/5 days of their best people’s time. Scheduling problems is only an indication of prioritization issues.

    Ensuring stability over time is tough. Sponsorship has more to do with this than the approach used (i.e. kaizen or ….).

    Last point: kaizen means change for the better. It doesn’t necessarily have to be quick but why not if you can. The one thing that needs to be explained about kaizen – the result is never the perfect solution (which solution ever is!!). Make sure people are aware that 80% improvement is fantastic. Not all problems will be solved but that is ok.

  9. C Harlan

    Kaizen is a tool for stimulating communication between the direct enablers in an organization and the "process experts". Much of the time solutions to efficiency or cost savings or whatever is being looked at lies in the depths of your organization. The Kaizen should be short, 3-5 days in order to avoid monotany and keep the ideas flowing.
    My experience with Kaizen is in the manufacturing environment. We provide a product just as a heathcare facility would. Nine times out of ten communication between the customer and the supplier in the process is the problem. Next would be contacting the right person to enact change. Finally, without support and sustainability from leadership, the change will fail. This is why a Kaizen must be planned, sourced and facilitated well. With these elements in place, the power of the Kaizen is great. It is an investment like any other.

  10. Andrew M. Hillig

    The difference between healthcare and manufacturing is that devoting staff for a 5 day intense breakout of the Lean Principles is nearly impossible. An early comment spoke of a lack of prioritization. In a sense you are correct, we work in an industry of increasing cost with decreasing reimbursement. In addition to that, areas in healthcare, such as nursing, pharmacy, and laboratory are experiencing extreme staffing shortages – making available labor a precious commodity.

    Break that down, and the priority becomes the patient, not the continuous process improvement initiative.

    Sure, the behind the scenes planning is great, and is what I do. However, as we all know, a best laid plan never goes as anticipated. In my experience, even if I wanted to break something out in 5 days, it would be impossible from a staffing standpoint.

    I can see some value in using Kaizen at the very tip of the iceburg once the scope has been narrowed and immediate improvement opportunities have been identified. However, for Kaizen to work in Healthcare, the industry needs to stop biting off more than they can chew. It’s a commen occurrence that makes healthcare what it is. We often put the cart in front of the horse, get ourselves too excited, and then the project blows up in our faces. We cannot say we’re going to completely re-invent the wheel in our Emergency Department and expect those changes to last, or even get their wheels off the ground.

    Great feedback…Keep it coming

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